Medicine-related problems resulting in emergency department visits.
OBJECTIVE
Our aim was to estimate the prevalence of medicine-related problems, understood as negative clinical outcomes, that result in hospital emergency department (ED) visits and to establish relationships among risk factors and the appearance of pharmacotherapy negative outcomes.


METHODS
Methods A stratified two-stage probabilistic sampling approach was used which consisted of stratified random sampling of patients visiting the ED followed up by interviews. A systematic appraisal tool was used to identify pharmacotherapy negative outcomes within the framework of the information gathered. Bivariate and multivariate analyses were carried out. Cost per process was estimated.


RESULTS
The prevalence of pharmacotherapy negative outcomes producing ED visits was 33.17% (95%CI: 31.09-35.25). These negative outcomes could be divided into three categories: ineffectiveness (19.76%; 95%CI: 17.92-21.60), necessity/use (10.52%; 95%CI: 9.48-11.56), and lack of safety (2.89%). About 73% (95%IC: 70.03-76.23) of the negative outcomes were considered to be preventable. Average cost per negative outcome was 329.5 euros (95%CI: 185.4-473.5). Factors associated with the appearance of negative outcomes were age, number of medicines taken, and the combined effect of both of these factors. Compared with those participants younger than 18 years, patients between 45 and 64 years of age presented an odds ratio (OR) of 2.52 (95%CI: 1.1-5.78), while those older than 65 years had an OR of 3.63 (95%CI: 1.27-10.35). Compared with people not using medicine(s), patients using one to two different medicines presented with an OR = 19.91 (95%CI: 8.28-47.87), and those using more than three medicines had an OR = 22.71 (95%CI: 3.05-69.26). Finally, compared with patients younger than 18 years and not using medicines, patients aged 45-64 years taking three or more different medicines presented with an OR = 64.07, while those older than 65 years taking three or more medicines presented with an OR = 31.50.


CONCLUSIONS
The prevalence of negative clinical outcomes was 33%, of which more than 73% of these were preventable. Factors associated with their appearance were age, number of medicines, and their combined effect.
Baena
M Isabel
MI
Pharmaceutical Care Research Group, University of Granada, Granada, Spain. f_llimos@medynet.com
Faus
M Jose
MJ
Fajardo
Paloma C
PC
Luque
Francisco M
FM
Sierra
Francisco
F
Martinez-Olmos
Jose
J
Cabrera
Andres
A
Fernandez-Llimos
Fernando
F
Martinez-Martinez
Fernando
F
Jiménez
José
J
Zarzuelo
Antonio
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004347:Drug Interactions; D004358:Drug Therapy / Q000191:economics*; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008508:Medication Errors; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D019338:Polypharmacy; D013030:Spain; D016896:Treatment Outcome