1. Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial
- Author
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Séverine Henrard, Denis O'Mahony, Lorène Zerah, Wilma Knol, Anne Spinewine, Ingeborg Wilting, Olivia Dalleur, Stefanie Thevelin, Martin Feller, Erin K. Crowley, Carla Meyer-Massetti, Pharmacoépidémiologie et évaluation des soins [iPLesp] (PEPITES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université Catholique de Louvain = Catholic University of Louvain (UCL), Centre de Gériatrie [CHU Pitié Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), University of Bern, University Medical Center [Utrecht], University College Cork (UCC), ZERAH, Lorène, UCL - SSS/LDRI - Louvain Drug Research Institute, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (MGD) Département de pharmacie, and UCL - (SLuc) Département de pharmacie
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Drug ,Aging ,medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,media_common.quotation_subject ,Pharmacist ,trigger tool ,older people ,medicine ,Humans ,610 Medicine & health ,media_common ,Aged ,Retrospective Studies ,Polypharmacy ,drug-related hospital admissions ,[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,business.industry ,[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,Retrospective cohort study ,General Medicine ,[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences ,medicine.disease ,Hospitals ,Hospitalization ,[SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences ,Trigger tool ,Pharmaceutical Preparations ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Hospital admission ,Emergency medicine ,adverse drug events ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Geriatrics and Gerontology ,business ,Older people ,Adverse drug reaction ,360 Social problems & social services - Abstract
Background identifying drug-related hospital admissions (DRAs) in older people is difficult. A standardised chart review procedure has recently been developed. It includes an adjudication team (physician and pharmacist) screening using 26 triggers and then performing causality assessment to determine whether an adverse drug event (ADE) occurred (secondary to an adverse drug reaction, overuse, misuse or underuse) and whether the ADE contributed to hospital admission (DRA). Objective to assess the performance of those triggers in detecting DRA. Design retrospective study using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) trial. Settings four European medical centres. Subjects multimorbid (≥ 3 chronic medical conditions) older (≥ 70 years) inpatients with polypharmacy (≥ 5 chronic medications) were enrolled in the OPERAM trial (N = 2,008) and followed for 12 months. We included patients with ≥1 adjudicated hospitalisation during the follow-up. Methods the positive predictive value (PPV; number of DRAs identified by trigger/number of triggers) was calculated for each trigger and for the tool as a whole. Results of 1,235 hospitalisations adjudicated for 832 patients, 716 (58%) had at least one trigger; an ADE was identified in 673 (54%) and 518 (42%) were adjudicated as DRAs. The overall PPV of the trigger tool for detecting DRAs was 0.66 [0.62–0.69]. Conclusions this tool performs well for identifying DRAs in older people. Based on our results, a revised version of the tool was proposed but will require external validation before it can be incorporated into research and clinical practice.
- Published
- 2022
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