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      Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward

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          Abstract

          Background

          Knowledge of risk factors for drug-related hospitalizations (DRHs) is limited.

          Aim

          To examine the prevalence of DRHs and the relationships between DRHs and various variables in multimorbid patients admitted to an internal medicine ward.

          Methods

          Multimorbid patients ≥ 18 years, using minimum of four regular drugs from minimum two therapeutic classes, were included from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016. Clinical pharmacists prospectively conducted medicines reconciliations and reviews to reveal drug-related problems (DRPs). Blinded for identified DRPs, an interdisciplinary group retrospectively made comprehensive, clinical assessments of each patient case to classify hospitalizations as drug-related (DRH) or non-drug-related (non-DRH). Age, sex distribution, Charlson Comorbidity Index (CCI), renal function, aberrant genotype frequencies, body-mass index, number of drugs, proportion of patients which received assistance for drug administration from the home care service, and/or through multidose-dispensed drugs, and occurrence of specific DRP subgroups, were compared separately between patients with DRHs versus non-DRHs, followed by multiple logistic regression analysis.

          Results

          Hospitalizations were classified as drug-related in 155 of the 404 included patients (38%). Factors significantly associated with DRHs were occurrence of adverse effect DRPs (adjusted odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4–8.0), adherence issues (OR 2.9, 1.1–7.2), home care (OR 1.9, 1.1–3.5), drug monitoring DRPs (OR 1.9, 1.2–3.0), and CCI score ≥6 (OR 0.33, 0.14–0.77). Frequencies of aberrant genotypes did not differ between the patient groups, but in 41 patients with DRHs (26.5%), gene-drug interactions influenced the assessments of DRHs.

          Conclusion

          DRHs are prevalent in multimorbid patients with adverse effect DRPs and adherence issues as the most important risk factors.

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          Most cited references37

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          Prediction of Creatinine Clearance from Serum Creatinine

          A formula has been developed to predict creatinine clearance (C cr ) from serum creatinine (S cr ) in adult males: Ccr = (140 – age) (wt kg)/72 × S cr (mg/100ml) (15% less in females). Derivation included the relationship found between age and 24-hour creatinine excretion/kg in 249 patients aged 18–92. Values for C cr were predicted by this formula and four other methods and the results compared with the means of two 24-hour C cr’s measured in 236 patients. The above formula gave a correlation coefficient between predicted and mean measured Ccr·s of 0.83; on average, the difference between predicted and mean measured values was no greater than that between paired clearances. Factors for age and body weight must be included for reasonable prediction.
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            The epidemiology of multimorbidity in primary care: a retrospective cohort study

            Background Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available. Aim To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation. Design and setting Retrospective cohort study, undertaken in England. Method The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified. Results In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions. Conclusion Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.
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              Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis.

              It is currently admitted that adverse drug reactions (ADRs) account for a great burden of disease. Of particular concern are ADR-induced hospital admissions, particularly in the elderly; they receive most of the medications and they are the most prone to develop ADRs. Therefore, our aim was to carry out a study of ADR-induced hospital admissions focused on the elderly population.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 July 2019
                2019
                : 14
                : 7
                : e0220071
                Affiliations
                [1 ] Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
                [2 ] General Internal Medicine Ward, the Medical Clinic, Oslo University Hospital, Oslo, Norway
                [3 ] Faculty of Medicine, University of Oslo, Oslo, Norway
                [4 ] Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
                [5 ] Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
                [6 ] Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
                [7 ] Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
                Newcastle University, UNITED KINGDOM
                Author notes

                Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Author ML received PhD funding from the South-Eastern Norway Regional Health Authority (grant number 12/00718). The other authors declare that they have no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0001-8583-911X
                http://orcid.org/0000-0002-2997-6141
                Article
                PONE-D-19-05128
                10.1371/journal.pone.0220071
                6645516
                31329634
                cf63fad1-431e-4907-a46d-c843429d2e96
                © 2019 Lea et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 February 2019
                : 8 July 2019
                Page count
                Figures: 1, Tables: 3, Pages: 15
                Funding
                Funded by: Helse Sør-Øst RHF (NO)
                Award ID: 12/00718
                Award Recipient :
                The study was funded by South-Eastern Norway Regional Health Authority (PhD grant number 12/00718 to author ML, https://www.helse-sorost.no/south-eastern-norway-regional-health-authority), Hospital Pharmacies Enterprise, South Eastern Norway ( https://sykehusapotekene.no/), Oslo University Hospital ( https://oslo-universitetssykehus.no/oslo-university-hospital) and Diakonhjemmet Hospital ( http://diakonhjemmetsykehus.no/#!/diakon/forside/om-sykehuset/brief-information-in-english). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Pharmacists
                Medicine and Health Sciences
                Pharmacology
                Adverse Reactions
                Medicine and Health Sciences
                Pharmacology
                Drug Adherence
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Drug Administration
                Medicine and Health Sciences
                Pharmacology
                Drug Interactions
                Drug-Drug Interactions
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Research and Analysis Methods
                Research Design
                Clinical Research Design
                Adverse Events
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Hospitals
                Hospitalizations
                Custom metadata
                The data that supports the findings of this study are available upon request from Oslo University Hospital due to ethical restrictions involving patient-sensitive information imposed by the Regional Committee for Medical and Health Research Ethics in Norway (REC) and the Privacy Ombudsman at Oslo University Hospital. Data are available from the authors and REC upon reasonable request and with permission of Oslo University Hospital. Interested researchers can contact REC via email at rek-sorost@ 123456medisin.uio.no or the corresponding author.

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