DataSheet1_Drug-Related Hospital Admissions via the Department of Emergency Medicine: A Cross-Sectional Study From the Czech Republic.docx

Background: Drug-related hospital admissions (DRAs) represent a significant problem affecting all countries worldwide. This study aimed to determine the prevalence and preventability of DRAs, identify the most common medications involved in DRAs, the most common clinical manifestations of DRAs and describe the preventability aspects of DRAs.Methods: This cross-sectional study examined unplanned hospital admissions to the University Hospital Hradec Králové via the department of emergency medicine in August–November 2018. Data were obtained from electronic medical records. The methodology of DRA identification was adapted from the OPERAM DRA adjudication guide.Results: Out of 1252 hospital admissions, 195 DRAs have been identified (145 related to treatment safety, 50 related to treatment effectiveness). The prevalence of DRAs was 15.6% (95% CI 13.6–17.6). The most common medication classes involved in DRAs related to treatment safety were Antithrombotic agents, Antineoplastic agents, Diuretics, Corticosteroids for systemic use, and Beta blocking agents. The most common medication classes involved in DRAs related to treatment effectiveness included Diuretics, Antithrombotic agents, Drugs used in diabetes, Agents acting on the renin-angiotensin system, and Lipid modifying agents. Gastrointestinal disorders were the leading causes of DRAs related to treatment safety, while Cardiac disorders were the leading causes of DRAs related to treatment effectiveness. The potential preventability of DRAs was 51%. The highest share of potential preventability in medication classes repeatedly involved in DRAs related to treatment safety was observed for Anti-inflammatory and antirheumatic products, Psycholeptics, and Drugs used in diabetes. Potentially preventable DRAs related to treatment safety were most commonly associated with inappropriate drug selection, inappropriate monitoring, inappropriate dose selection, and inappropriate lifestyle measures. On the contrary, DRAs related to treatment effectiveness were more commonly associated with medication nonadherence.Conclusion: It should be emphasized that in most DRAs, medications were only a contributory reason of hospital admissions and that benefits and risks have to be carefully balanced. It is highlighted by the finding that the same medication classes (Antithrombotic agents and Diuretics) were among the most common medication classes involved in DRAs related to treatment safety and simultaneously in DRAs related to treatment effectiveness. The study highlighted that apart from problems related to prescribing, problems related to monitoring and patient-related problems represent significant preventability aspects.

背景：药物相关住院（DRAs）是全球各国普遍面临的重大问题。本研究旨在确定DRAs的患病率和可预防性，识别DRAs中最常见的药物，DRAs最常见的临床表现，并描述DRAs的可预防性方面。方法：本研究为一项横断面研究，于2018年8月至11月期间，通过布拉格克朗洛夫大学医院的急诊科，考察了非计划性住院。数据来源于电子病历。DRAs识别的方法借鉴了OPERAM DRA裁决指南。结果：在1252例住院病例中，共识别出195例DRAs（其中145例与治疗安全性相关，50例与治疗有效性相关）。DRAs的患病率为15.6%（95%置信区间为13.6-17.6）。与治疗安全性相关的DRAs中，最常见的药物类别为抗凝血剂、抗肿瘤药物、利尿剂、全身用皮质类固醇和β受体阻滞剂。与治疗有效性相关的DRAs中，最常见的药物类别包括利尿剂、抗凝血剂、用于糖尿病的药物、作用于肾素-血管紧张素系统的药物和降脂药物。与治疗安全性相关的DRAs的主要原因是胃肠道疾病，而与治疗有效性相关的主要原因是心脏疾病。DRAs的可预防性潜力为51%。在DRAs中反复涉及的药物类别中，潜在可预防性最高的比例见于抗炎和抗风湿产品、镇静催眠药和用于糖尿病的药物。与治疗安全性相关的潜在可预防性DRAs最常见的是与药物选择不当、监测不当、剂量选择不当和生活方式措施不当有关。相反，与治疗有效性相关的DRAs更常见的是与药物非依从性有关。结论：应强调，在大多数DRAs中，药物只是住院的辅助原因，必须谨慎权衡其利弊。研究发现，相同的药物类别（抗凝血剂和利尿剂）同时出现在与治疗安全性相关的DRAs和与治疗有效性相关的DRAs中最常见的药物类别中。该研究指出，除了处方问题外，监测问题和患者相关的问题也是重要的可预防性方面。