Re: Death by medicine

British Journal of Clinical Pharmacology
Volume 63 Issue 2 Page 136-147, February 2007

Which drugs cause preventable admissions to hospital? A systematic
review

R. L. Howard , A. J. Avery,1Nottingham Primary Care Research
Partnership, Broxtowe & Hucknall PCT, Hucknall Health Centre and S.
Slavenburg,22Radboud University, Nijmegen, the Netherlands, S. Royal,
33Primary Care, University of Nottingham at Derby Graduate Entry
Medical School, Derby and G. Pipe,11Division of Primary Care,
University of Nottingham, Nottingham, UK, P. Lucassen22Radboud
University, Nijmegen, the Netherlands, & M. Pirmohamed44Clinical
Pharmacology and Consultant Physician, University of Liverpool,
Liverpool, UK Nottingham Primary Care Research Partnership, Broxtowe &
Hucknall PCT, Hucknall Health Centre and 1Division of Primary Care,
University of Nottingham, Nottingham, UK, 2Radboud University,
Nijmegen, the Netherlands, 3Primary Care, University of Nottingham at
Derby Graduate Entry Medical School, Derby and 4Clinical Pharmacology
and Consultant Physician, University of Liverpool, Liverpool, UK
Mrs Rachel Howard, Nottingham Primary Care Research Partnership,
Broxtowe & Hucknall PCT, Hucknall Health Centre, Nottingham NG8 1HT,
UK. Tel: +44(0)115 8590770 Fax: +44(0)115 8590772 E-mail:
rachel.howard@xxxxxxxxxxxxxxxxxxxxxxxxxxx

Abstract
Aims
Previous systematic reviews have found that drug-related morbidity
accounts for 4.3% of preventable hospital admissions. None, however,
has identified the drugs most commonly responsible for preventable
hospital admissions. The aims of this study were to estimate the
percentage of preventable drug-related hospital admissions, the most
common drug causes of preventable hospital admissions and the most
common underlying causes of preventable drug-related admissions.

Methods
Bibliographic databases and reference lists from eligible articles and
study authors were the sources for data. Seventeen prospective
observational studies reporting the proportion of preventable drug-
related hospital admissions, causative drugs and/or the underlying
causes of hospital admissions were selected. Included studies used
multiple reviewers and/or explicit criteria to assess causality and
preventability of hospital admissions. Two investigators abstracted
data from all included studies using a purpose-made data extraction
form.

Results
From 13 papers the median percentage of preventable drug-related
admissions to hospital was 3.7% (range 1.4-15.4). From nine papers the
majority (51%) of preventable drug-related admissions involved either
antiplatelets (16%), diuretics (16%), nonsteroidal anti-inflammatory
drugs (11%) or anticoagulants (8%). From five studies the median
proportion of preventable drug-related admissions associated with
prescribing problems was 30.6% (range 11.1-41.8), with adherence
problems 33.3% (range 20.9-41.7) and with monitoring problems 22.2%
(range 0-31.3).

Conclusions
Four groups of drugs account for more than 50% of the drug groups
associated with preventable drug-related hospital admissions.
Concentrating interventions on these drug groups could reduce
appreciably the number of preventable drug-related admissions to
hospital from primary care.

* * *
It's interesting that diuretics are causing these kind of problems,
given that the results of HYVET will probably cause increased use in
the elderly.

Marilyn

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