Medication-related problems occurring in people with diabetes during an admission to an adult teaching hospital: A retrospective cohort study

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Abstract

Aims

To examine the characteristics of medication-related problems occurring in people with diabetes admitted to hospital and to identify risk factors for medication-related problems.

Methods

A retrospective cohort study of medication-related problems occurring in patients admitted to an adult, inner-city Australian teaching hospital was conducted over two-years. The risk factors associated with medication-related problems were identified using random effect logistic regression.

Results

There were 9530 admissions of people with diabetes involving 5205 individuals over a two-year period. Medication-related problems were associated with 686 (7.2%) admissions involving 571 individuals (11.0%). The most common medication-related problems were medication errors (64.1%) associated with hypoglycaemia and unintentional overdose. Five factors were significantly associated with medication-related problems: female gender [odds ratio (OR) 1.30, 95% confidence intervals (CI) 1.11–1.52], age of 18–50 years (OR 2.32, CI 1.85–2.91), single marital status (OR 1.46, CI 1.24–1.74), mental and behavioural problems (OR 1.74, 1.43–2.11), and a comorbidity index score of at least one (OR 1.35–1.67).

Conclusions

Five significant risk factors were associated with medication-related problems in people with diabetes admitted to hospital. These risks need to be considered when developing care plans and interventions to prevent medication-related problems for individuals with diabetes.

Introduction

Medication-related problems are a significant public health issue due to the widespread use of medicines and the associated morbidity, mortality, and economic costs [1]. Medication-related problems can occur due to over-use, under-use, or inappropriate use of medicines [2] and the majority of problems are often preventable [1]. These problems can arise due to misuse of medicines caused by the healthcare provider, the carer, or the individual [2]. Each year in Australia, medication-related problems account for an estimated 140,000 admissions to hospital annually, which represents between 2.4% and 3.6% of all hospital admissions [1], [3] and an estimated annual economic burden of $380 million [1], [4]. In the United States (US), the prevalence of medication-related problems ranges between 1.6% and 6.5% [5], and is as high as 11.7% in the United Kingdom (UK) [6]. However, it is often difficult to make accurate comparisons among studies and countries because different methods are used to describe and determine the prevalence of medication-related problems. The frequency of medication-related problems remains persistently high in clinical practice, and, although many medication-related problems cause little or no risk to the individual, some have serious consequences including hospital admission, prolonged hospital stay, additional utilization of resources, and loss of productivity for the individual, disability and death.

One effective strategy to prevent medication-related problems is to identify the factors that increase the risk. If an individual is deemed to be ‘high risk,’ resources can be targeted towards preventing problems from occurring. Many researchers have estimated the frequency of medication-related problems and the factors associated with them [3], [7], [8], [9]. These studies show that people who are older than 65 years, who have a chronic disease, who are prescribed a large number of medications, or who come from non-English speaking backgrounds (NESBs) are at high risk of medication-related problems [10], [11].

Likewise, although many researchers have explored the risk factors associated with medication-related problems, there is a paucity of research examining diabetes-specific risk factors occurring in people with diabetes from NESBs. The prevalence of diabetes is increasing worldwide; in particular, the prevalence of diabetes is higher among ethnic minority groups from NESB compared to citizens born in western countries. In Australia, the prevalence of diabetes among Australian-born citizens is 3.0% compared to 5.0% of people born in Southern and Eastern Europe, 6.0% of people born in South East Asia, and 7.0% of people born in North Africa and the Middle East [12].

In the UK, similar diabetes patterns are reported with the prevalence of diabetes among the UK born population is 3% compared to 20% of people born in South Asia and 17% people born in Africa and the Caribbean [13]. However, the US is one of three countries with the highest prevalence of diabetes, along with India and China [14]. In the US, the prevalence of diabetes is 7.1% for non-Hispanic born Americans compared to 8.4% of Asian born Americans, 11.8% Hispanics and Latinos, and 12.6% of non-Hispanic blacks [15].

The aims of the current study were to examine the prevalence and characteristics of medication-related problems occurring in people with diabetes admitted to a teaching hospital and identify the risk factors associated with medication-related problems.

Section snippets

Subjects

People with diabetes admitted to hospital were identified using the Australian modification of the International Classification of Disease (ICD-10-AM) [16] primary and secondary codes for diabetes (E10, E11, E13, and E14). Participants included all people with type 1, type 2, or unspecified diabetes who were admitted to a public teaching hospital in Melbourne, Australia and aged 18 years and over during the study period (January 1, 2005–December 31, 2006). An admission to hospital was defined

Method

Medication-related problems occurring in hospital admissions over a two-year period were identified in a retrospective cohort of people with diabetes by extracted data from the Health Information Service (HIS) database. The HIS database includes demographic, admission, discharge, and diagnostic information using the ICD-10-AM [16] code set. Using the primary and secondary ICD-10-AM codes for diabetes (E10, E11, E13, and E14) people with diabetes who were admitted to hospital were identified.

In

Descriptive statistics

Descriptive statistics of the 5205 individuals with diabetes admitted to hospital are shown in Table 1. There were slightly more men (55.7%) than women in the sample. Ages ranged between 18 and 106 years (M = 68.47, SD = 13.63) and three-quarters (75.0%) of people were older than 61 years. There were similar numbers of people from both an ESB (n = 2743, 52.7%) and a NESB (n = 2462, 47.3%), the majority of people from a NESB were born in Italy (n = 754, 30.6%), Greece (n = 416, 16.9%), or Vietnam (n = 110,

Discussion

The significance of the current research is that it addresses a gap in current knowledge about the factors leading to medication-related problems in people with diabetes admitted to an adult teaching hospital. The current study revealed that 686 (7.2%) of the 9560 people with diabetes were admitted to hospital for a medication-related problem during the two-year period. This finding is comparable with a multi-national systematic review [31] of 15 studies of medication-related admissions to

Conclusion

In conclusion, the study involved systematically and comprehensively assessing risk factors associated with medication-related problems in people with diabetes. Current findings indicate that the risk factors that predict medication-related problems may depend on the specific disease population. Comparing the clinical audit data from the study with the current literature revealed that, in contrast to other chronic diseases, younger people with diabetes are far more likely to have been admitted

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgements

The Australian Research Council Linkage provided a project grant through a scholarship and St. Vincent's Hospital provided additional funding. The data management team at St. Vincent's Hospital provided data, and The University of Melbourne Mathematic and Statistics Department provided advice on logistic regression analysis.

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    Kate Claydon-Platt received a PhD project grant through a scholarship from the Australian Research Council Linkage and St. Vincent's Heath provided additional funding.

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