Research Activities, August 2013
Most hospitalizations of older veterans for therapeutic failures or adverse drug withdrawal events are potentially preventable
Patient Safety and Quality
Ninety percent of hospital admissions of older veterans for therapeutic failures (TFs) and adverse drug withdrawal events (ADWEs) are potentially preventable, reveals a new study. It also found that black veterans were significantly more likely to have a TF-related hospitalization than white veterans. A therapeutic failure is defined as "a failure to accomplish the goals of treatment, resulting from inadequate or inappropriate drug therapy and not related to the natural progression of disease." An ADWE is defined as "a clinical set of symptoms or signs that are related to the removal of a drug."
The researchers randomly selected 678 unplanned hospitalizations of veterans 65 years of age and older. Medication chart review and a Therapeutic Failure Questionnaire were used to determine if the hospitalization was caused by a TF. An algorithm was also applied to determine if an ADWE was the cause. Of the veterans studied, 75.5 percent were white and 12.8 percent were black. Forty veterans had unplanned hospitalizations due to 34 TFs and 8 ADWEs involving 54 drugs. More than half (58.8 percent) of all TF-related admissions involved the cardiovascular system.
The most common specific condition was heart failure and the most common medication class involved was beta-blockers. Of the 34 TFs, 32 were deemed preventable if medication nonadherence and suboptimal prescribing had been corrected. In the case of ADWEs, symptoms most commonly involved the cardiovascular system and the most common drug class was diuretics. Six of the eight ADWEs were preventable, with half resulting from medication nonadherence. Race was found to be the only significant factor associated with a TF-related hospitalization. Blacks and other non-white groups had an increased risk compared to whites. The study was supported in part by AHRQ (HS17695 and HS18721).
See "Prevalence of potentially preventable unplanned hospitalizations caused by therapeutic failures and adverse drug withdrawal events among older veterans," by Zachary A. Marcum, Pharm.D., M.S., Mary Jo V. Pugh, Ph.D., R.N., Megan E. Amuan, B.S., M.P.H., and others in the Journal of Gerontology Series A Biological Sciences and Medical Sciences 67(8), pp. 867-874, 2012.