The Pharmacy Read List: May 11th Edition

We’re back from a grueling exam month and we’re extremely proud to present another month of the UBC PSSJ Pharmacy Read List! The Read List is a biweekly update on pharmaceutical literature. Every two weeks we handpick one of the most relevant and interesting pharmacy-related publications and summarize it for your convenience. At the end of every month, a quiz on that month’s content will be released. Simply take the quiz and answer correctly to be automatically entered into a draw for a gift card prize.

This week we have an summary of a study laying out the prevalence of and impact on individuals by medication-related pediatric visits to emergency departments. Turns out, there’s a lot to be done to stop completely preventable medical events. Have a read below.

Instructions to access: Copy and paste the article title into UBC Summon to read the full article, or access the EZProxy link below.

Medication-Related Emergency Department Visits in Pediatrics: a Prospective Observational Study

Medication-related visits (MRVs) to the emergency department (ED) is an established source of financial burden in health care, and an area where the pharmacists can help to decrease the very burden by identifying the medication-related issues to help the patients. However, such studies have been done primarily in the adult population and not in pediatric population, where many studies were limited by their designs. This study, which involved several health care workers and researchers including Dr. Peter Zed as the pharmacist, was a 12-month prospective observational study in pediatric population aimed to examine the types of MRVs  to ED and identify frequency, severity, as well as preventability of the visits while also identifying various factors associated with the MRVs. Out of 2028 that were enrolled, it was found that 163 (8%) patients had MRV during the study, as identified by clinical pharmacist as well as ED physician. Of this, about 65% were considered preventable MRVs; an MRV was considered preventable if a drug treatment or lack of treatment was different from “current best practice” in a variety of ways including but not limited to inappropriate drug, dose, regimen, mismatch to patient profiles (known allergy, pharmacokinetic parameters, adherence, etc), lack of monitoring, etc. With respect to drugs, 83.4% of all MRVs involved 1 drug implication (that is, single drug was the major cause of MRV) while 9.8% involved 2 drugs and 6.8% involved 3 drugs. Of all MRVs, the three most common classes of drugs resulting in MRV were anti-infectives (27.4%; e.g. beta-lactam agents), respiratory agents (22.4%; e.g. inhaled corticosteroids), and central nervous system agents (20.4%; e.g. antidepressants), while the three most common events leading to MRV where adverse drug reactions (26.4%), subtherapeutic dose (19.0%), and nonadherence to the medications (17.2%). The incidence of MRVs was also related to higher incidences of hospitalization or longer hospitalization. Based on the incidence of MRV, significant preventability, identification of most common causes of MRVs, as well as its implications on the duration of hospital stay, the authors suggest that strategies could be implemented in high-risk situations (e.g. high risk medications). While some limitations of the study do exist (e.g. recall bias from family, bias in the determination of MRV across the pharmacist, ED physician, or the adjudicators if there is disagreement, observer effect of ED physicians), there appears to be little doubt that drug-related causes have profound effect in ED visits and appropriate interventions can significant decrease the impact of MRVs on the pediatric populations.

– Yohan Choi
B.Sc. (Pharm) Candidate 2016

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