Abstract
Background/Aims: The emergency department (ED) is a high-risk care setting. Risk of adverse drug events (ADE) associated with ED care is insufficiently explored, particularly among older patients. We examined prescribing to individuals aged 60 years or older during an ED visit. The aims were to (1) ascertain drugs newly initiated in conjunction with an ED visit, (2) determine the proportion of newly initiated drugs that are considered high-risk, (3) determine the proportion of patients with discharge diagnoses associated with increased ADE risk, and (4) describe repeat ED visits among these patients.
Methods: Patients must have had health plan membership for 6 months prior to the ED visit and remained members (or die) within 6 months after the visit. Data to identify the cohort, determine prescribing, and establish ED visits were extracted from electronic medical records and administrative claims. Drugs were defined as newly initiated if no drug within that therapeutic class was dispensed to that patient within the previous 180 days and if the drug was dispensed within 72 hours of ED discharge or before the next outpatient visit (if sooner). Drugs were classified as high-risk based on literature associating the drugs with ADE (i.e., drug-drug or drug-disease interactions, drug-laboratory monitoring recommendations, drugs to avoid in the elderly). Discharge diagnoses were classified as increased risk of ADE based on published evidence. A repeat ED visit was defined as an ED visit within 180 days of the first ED visit.
Results: At Kaiser Permanente Colorado in 2006, 6868 older patients were discharged to home after an ED visit, with 1338 patients newly initiated on 1883 drugs. Ten classes accounted for 80% of newly initiated drugs; all are high-risk for ADE among older patients: narcotics (27%), antibiotics (25%), corticosteroids (6%), antihistamine/cold remedies (5%), antispasmodics (4%), anti-anxiety agents (4%), anti-asthmatics (3%), anticoagulants (2%), gastrointestinal drugs (2%), and muscle relaxants (2%). A primary discharge diagnoses was listed in 25% of visits; diagnoses included cardiovascular, respiratory, gastrointestinal, neurologic, metabolic, end-stage renal disease, hypoglycemia, hemorrhage, rash, and syncope. 48% of patients had a repeat ED visit.
Conclusions: Among older patients, high-risk drugs are often initiated in conjunction with an ED visit. Work is needed to determine the extent to which drugs initiated during ED visits result in ADE.
- Received September 11, 2008.
