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Risk factors for drug-related problems in a general hospital: A large prospective cohort

OBJECTIVE: To identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients. METHODOLOGY: Prospective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by da...

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Autores principales: Saldanha, Valdjane, de Araújo, Ivonete Batista, Lima, Sara Iasmin Vieira Cunha, Martins, Rand Randall, Oliveira, Antonio Gouveia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199929/
https://www.ncbi.nlm.nih.gov/pubmed/32369489
http://dx.doi.org/10.1371/journal.pone.0230215
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author Saldanha, Valdjane
de Araújo, Ivonete Batista
Lima, Sara Iasmin Vieira Cunha
Martins, Rand Randall
Oliveira, Antonio Gouveia
author_facet Saldanha, Valdjane
de Araújo, Ivonete Batista
Lima, Sara Iasmin Vieira Cunha
Martins, Rand Randall
Oliveira, Antonio Gouveia
author_sort Saldanha, Valdjane
collection PubMed
description OBJECTIVE: To identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients. METHODOLOGY: Prospective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample. RESULTS: The study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%. CONCLUSION: This study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice.
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spelling pubmed-71999292020-05-12 Risk factors for drug-related problems in a general hospital: A large prospective cohort Saldanha, Valdjane de Araújo, Ivonete Batista Lima, Sara Iasmin Vieira Cunha Martins, Rand Randall Oliveira, Antonio Gouveia PLoS One Research Article OBJECTIVE: To identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients. METHODOLOGY: Prospective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample. RESULTS: The study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%. CONCLUSION: This study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice. Public Library of Science 2020-05-05 /pmc/articles/PMC7199929/ /pubmed/32369489 http://dx.doi.org/10.1371/journal.pone.0230215 Text en © 2020 Saldanha et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Saldanha, Valdjane
de Araújo, Ivonete Batista
Lima, Sara Iasmin Vieira Cunha
Martins, Rand Randall
Oliveira, Antonio Gouveia
Risk factors for drug-related problems in a general hospital: A large prospective cohort
title Risk factors for drug-related problems in a general hospital: A large prospective cohort
title_full Risk factors for drug-related problems in a general hospital: A large prospective cohort
title_fullStr Risk factors for drug-related problems in a general hospital: A large prospective cohort
title_full_unstemmed Risk factors for drug-related problems in a general hospital: A large prospective cohort
title_short Risk factors for drug-related problems in a general hospital: A large prospective cohort
title_sort risk factors for drug-related problems in a general hospital: a large prospective cohort
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199929/
https://www.ncbi.nlm.nih.gov/pubmed/32369489
http://dx.doi.org/10.1371/journal.pone.0230215
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