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Which drugs cause preventable admissions to hospital? A systematic review

  1. R. L. Howard1,
  2. A. J. Avery1,
  3. S. Slavenburg3,
  4. S. Royal4,
  5. G. Pipe2,
  6. P. Lucassen3,
  7. M. Pirmohamed5

Article first published online: 26 JUN 2006

DOI: 10.1111/j.1365-2125.2006.02698.x

Issue

British Journal of Clinical Pharmacology

British Journal of Clinical Pharmacology

Volume 63, Issue 2, pages 136–147, February 2007

Additional Information

How to Cite

Howard, R. L., Avery, A. J., Slavenburg, S., Royal, S., Pipe, G., Lucassen, P. and Pirmohamed, M. (2007), Which drugs cause preventable admissions to hospital? A systematic review. British Journal of Clinical Pharmacology, 63: 136–147. doi: 10.1111/j.1365-2125.2006.02698.x

Author Information

  1. 1

    Nottingham Primary Care Research Partnership, Broxtowe & Hucknall PCT, Hucknall Health Centre and

  2. 2

    Division of Primary Care, University of Nottingham, Nottingham, UK,

  3. 3

    Radboud University, Nijmegen, the Netherlands,

  4. 4

    Primary Care, University of Nottingham at Derby Graduate Entry Medical School, Derby and

  5. 5

    Clinical 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@broxtowehucknall-pct.nhs.uk

Publication History

  1. Issue published online: 26 JUN 2006
  2. Article first published online: 26 JUN 2006
  3. Received 30 January 2006Accepted12 April 2006Published OnlineEarly26 June 2006

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Keywords:

  • adverse effects;
  • drug safety;
  • drug therapy;
  • drug toxicity;
  • medication errors;
  • systematic review

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.

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