Adverse drug reactions and associated patient characteristics in older community-dwelling adults: a 6-year prospective cohort study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Ann S Doherty¹  Fiona Boland²  Frank Moriarty³  Tom Fahey¹  Emma Wallace⁴ 

[1] Health Research Board ,(HRB) Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland ,(RCSI) University of Medicine and Health Sciences;HRB Centre for Primary Care Research, Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland, Data Science Centre, RCSI University of Medicine and Health Sciences;School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences;HRB Centre for Primary Care Research, Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Department of General Practice, University College Cork

关键词: adverse drug reaction;    drug-related side effects and adverse reactions;    electronic health records;    general practice;    older adults;    polypharmacy;   

DOI  :  10.3399/BJGP.2022.0181

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background To date, research on adverse drug reactions (ADRs) has focused on secondary care, and there is a paucity of studies that have prospectively examined ADRs affecting older adults in general practice.Aim To examine the cumulative incidence and severity of ADRs and associated patient characteristics in a sample of community-dwelling older adults.Design and setting Prospective cohort study of older adults (aged ≥70 years, N = 592) recruited from 15 general practices in the Republic of Ireland.Method Manual review of the participant’s general practice electronic medical record, linked to the national dispensed prescription medicine database, and a detailed, self-reported patient postal questionnaire. The primary outcomes were ADR occurrence and severity over a 6-year period (2010–2016). Unadjusted and adjusted logistic regression models examined potential associations between patient characteristics and ADR occurrence.Results A total of 211 ADRs were recorded for 159 participants, resulting in a cumulative incidence of 26.9% over 6 years. The majority of ADRs detected were mild (89.1%), with the remainder classified as moderate (10.9%). Eight moderate ADRs, representing 34.8% of moderate ADRs and 3.8% of all ADRs, required an emergency hospital admission. ADRs were independently associated with female sex (adjusted odds ratio [OR] 1.83, 95% confidence interval [CI] = 1.17 to 2.85; P = 0.008), polypharmacy (5–9 drug classes) (adjusted OR 1.81, 95% CI = 1.17 to 2.82; P = 0.008), and major polypharmacy (≥10 drug classes) (adjusted OR = 3.33, 95% CI = 1.62 to 6.85; P = 0.001).Conclusion This prospective cohort study of ADRs in general practice shows that over one-quarter of older adults experienced an ADR over a 6-year period. Polypharmacy is independently associated with ADR risk in general practice and older adults on ≥10 drug classes should be prioritised for regular medication review.

【 授权许可】

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