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Drug-related problems in a clinical setting: a literature review and cross-sectional study evaluating factors to identify patients at risk
  1. Carli Michèle Wilmer1,2,
  2. Victor Johan Bernard Huiskes3,
  3. Stephanie Natsch2,
  4. Alexander Johannes Maria Rennings4,5,
  5. Bartholomeus Johannnes Frederikus van den Bemt2,3,
  6. Jacqueline Maria Bos6
  1. 1Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
  2. 2Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
  3. 3Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
  4. 4Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  5. 5Department of Anaesthesiologie, Center of Orthopaedics, Sint Maartenskliniek Nijmegen, Nijmegen, The Netherlands
  6. 6Department of Clinical Pharmacy A16, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
  1. Correspondence to Dr Jacqueline Maria Bos, Department of Clinical Pharmacy A16, Canisius-Wilhelmina Hospital, Postbus 9015, Nijmegen 6500 GS, The Netherlands; jm.bos{at}cwz.nl

Abstract

Objectives This study aims to summarise existing evidence on risk factors for drug-related problems (DRPs) in hospitals as well as ambulatory care or nursing homes and adds additional empirical evidence on risk factors for DRPs in non-elective hospitalised patients.

Methods A comprehensive literature review was performed to compose an overview of demographic, clinical and pharmacological risk factors associated with DRPs in different settings (ambulatory care, nursing homes and hospitals). A cross-sectional study on rehabilitation, cardiology and pulmonology wards of three hospitals in Nijmegen, the Netherlands, was performed to assess possible risk factors for DRPs in a clinical setting.

Results The comprehensive review identified 21 papers discussing risk factors for drug-related hospital admissions, use of potential inappropriate drugs, adverse drug reactions and other types of DRPs. The majority of these studies had been carried out in ambulatory care (11 papers; 52%). Polypharmacy, comorbidity and the use of specific drugs (antithrombotics, antidiabetics) were most often positively associated with the occurrence of DRPs. Our cross-sectional study demonstrated that admission to the rehabilitation ward, admission at the intensive care unit and comorbidity were associated with the occurrence of potential DRPs in a clinical setting.

Conclusions Although risk factors associated with DRPs differ greatly among published papers, comorbidity, polypharmacy and the use of specific drugs (antithrombotics, antidiabetics) were frequently associated with DRPs. Although several guidelines advise to use prespecified risk factors (like age, polypharmacy and renal impairment), one should be aware that most of these risk factors are insufficiently grounded on empirical evidence.

  • Comorbidity
  • Drug Utilization
  • Drug-Related Side Effects and Adverse Reactions
  • Hospitalization
  • Medication Errors

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