Drug-Related Emergency Department Visits in an Elderly Veteran Population

• Published in: The Annals of pharmacotherapy 2005-12, Vol.39 (12), p.1990-1995
• Main Authors: Yee, Jennie L, Hasson, Noelle K, Schreiber, Donald H
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory Care; Biological and medical sciences; Costs and Cost Analysis; Drug Overdose; Drug Prescriptions - economics; Drug Prescriptions - statistics & numerical data; Drug-Related Side Effects and Adverse Reactions; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Female; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Male; Medical sciences; Middle Aged; Patient Compliance; Pharmaceutical Preparations - economics; Pharmacology. Drug treatments; Retrospective Studies; Substance-Related Disorders; Treatment Failure; Veterans - statistics & numerical data
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1E541

BACKGROUND Given that adverse drug events result in extensive costs and healthcare resource utilization, the goal is to better understand drug-related emergency department (ED) visits so that programs can be implemented to improve the quality of health care. OBJECTIVE To (1) determine the incidence of drug-related ED visits at a large, tertiary care, Veterans Affairs hospital; (2) identify causes of these drug-related ED visits; (3) determine patient outcomes, healthcare resource utilization, and costs associated with these visits; and (4) determine the proportion of adverse drug reaction (ADR)–related ED visits that were spontaneously reported to the hospital's ADR reporting program. METHODS We conducted a retrospective electronic chart review of all patients who visited the ED during the second week of each month in 2003. Causes for drug-related visits were identified. ADRs in this study included side effects, drug allergies, and drug–drug interactions (DDIs) and were assessed using the Naranjo probability scale. RESULTS A total of 2169 patients were included in the study. Drug-related visits accounted for 12.6% of all ED visits. The main causes of drug-related visits were ADRs and nonadherence, which accounted for 33% and 19% of drug-related visits, respectively. Only 11% of these ADRs were spontaneously reported to the hospital's ADR reporting program. Thirty-five percent of drug-related visits led to hospitalizations, which resulted in an average length of stay of 9.3 days. The institution's total cost of drug-related visits was approximately $1.5 million over 12 weeks. CONCLUSIONS Many ED visits are drug related and often result in hospitalization and increased healthcare resource utilization. Only a minimal number of the ADRs resulting in ED visits are spontaneously reported to hospital ADR reporting programs.