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Tool identifies adverse drug events in limited situations

A tool that researchers dubbed the “patient-report adverse drug event instrument” only identified adverse drug events in older patients in certain situations, according to findings published in Annals of Family Medicine.

“To date, few patient-reported instruments to assess adverse drug events exist and none have been established for use in older populations,” Caitriona Cahir, PhD, of the division of population health sciences at the Royal College of Surgeons in Ireland, said during an interview.

Researchers of the retrospective cohort study asked 859 residents of Ireland older than 70 years if they had experienced any one of 74 physiologic symptoms in the past 6 months; felt such symptoms were physiologic, connected to their medication and/or bothersome; if the symptom(s) had been discussed with their family doctor; and required hospitalization to resolve. Each instrument implementation took from 10 to 45 minutes.

Researchers reported that in determining adverse drug events, the “instrument” had specificity of 93% (95% CI, 92-94), accuracy of 75% (95% CI, 77-79) and sensitivity of 29% (95% CI, 27-31). Patients who reported a symptom were more likely to have an adverse drug event (positive likelihood ratio = 4.22; 95% CI, 3.78-4.72). The most bothersome adverse drug event was weakness or muscle pain, followed by, in order of prevalence, lightheadedness or dizziness, cough and maintaining balance. In addition, just 39% of patients reported the adverse drug event to their doctor, 4% attended an ED because of it and 3% of patients attended a hospital outpatient clinic because of it.

Cahir and colleagues wrote that based on these findings, their instrument would work best when symptomatic older people need adverse drug events confirmed and/or when the symptoms might be attributable to an adverse drug event or to chronic disease. Cahir also said the tool would likely need further tweaking to be successfully utilized stateside.

“Our instrument is a generic instrument and not specific to any country but does need to be adapted to focus only on the more prevalent and bothersome symptoms. This would enable a more efficient and clinically relevant method of confirming a symptom as an adverse drug event or not in clinical practice,” Cahir told Healio Primary Care.

“For staff, the instrument can be time-consuming and does need to be adapted and shortened. [But] patients were willing and interested in completing the instrument and it provides a good opportunity to review and discuss their medications,” Cahir said. – by Janel Miller