Table 2.
Characteristics of Included Studies on MRPs.
| Study design Country | Setting age (in years) | MRPs type methods of identification prevalence | Indicator of deterioration/rate of medicines related hospitalization | Number of indicators associated with MRPs | Medicines implicated in MRPs | Risk factors recorded Most affected patient group |
|---|---|---|---|---|---|---|
| Barber et al (2009)47 Mixed method prospective study UK |
Care home Mean age 85 |
Medication error identified via interviews and observations prevalence:69.5% | No specific indicator but potential for and cause of harm from MRPs was identified | 0 | ACEI (angiotensin- converting enzyme inhibitors) | High workload inadequate knowledge Lack of teamwork Inefficient ordering system Inaccurate medicines records Prevalence of verbal communication |
| Barnett et al (2011)41 Retrospective cohort study UK |
Care home and Own home Mean age 75.2 |
Potentially Inappropriate medicines (PIM) Identified by the Beers Criteria Prevalence of PIM: 20-46% | Death | 0 | Long acting benzodiazepines Fluoxetine Muscle relaxants Nitrofurantoin Amitriptyline NSAIDs | Living in care, Older age, and additional polypharmacy |
| Lau et al (2005)50 Analysis of retrospective longitudinal data USA |
Care home (Nursing home) Mean age 85 |
PIM Identified by Beers Criteria |
Hospitalization Death PIM related = 33% |
2 | Antihistamine, oxybutynin chloride, amitriptyline hydrochloride, iron supplement, ranitidine | Intermittent PIM |
| Gurwitz et al (2005)16 Prospective case control study Canada |
Care home Mean age 86 ± 8 |
Medication error, ADR. Prevalence of ADR 9.8 per 100 resident months | Delirium death fall | 3 | warfarin Atypical antipsychotic loop diuretic opioids antiplatelet ACEI |
Polypharmacy |
| Budnitz et al (2011)49 Secondary data analysis. USA |
Hospital Mean age ≥ 65 |
ADR Unintentional overdose PIM Identified by Beers criteria |
Hospitalization ADR related = 37.5% | 1 | warfarin Insulin Oral antiplatelet Oral hypoglycaemic |
Polypharmacy |
| Endres et al (2016)36 Prospective cohort study Germany |
Hospital Mean age ≥ 65 |
PIM Identified by PRISCUS list Prevalence: 23.5% |
Hospitalization PIM related = 6% | 1 | Benzodiazepines Analgesics Antidepressants Muscle relaxants Antihypertensives | Polypharmacy |
| Hofer-Dueckelmann et al (2011)35 Prospective observational study Austria |
Hospital Mean age, 66.5 ± 15.8 |
ADR Prevalence: 7.6% |
Hospitalization ADR related = 7.6% |
1 | Diuretic Vitamin K antagonist ACEI NSAID Beta blockers |
Impaired
renal function, Polypharmacy cognitive impairment, need for care, female gender |
| Howard et al (2008)48 Qualitative case studies UK |
Hospital | Medication error Identified using a framework of Reason’s model | Hospitalization | 1 | Not reported | communication problems, Knowledge gap |
| Laatikainen et al (2016)38 Retrospective study Finland |
Hospital Mean age ≥ 65 |
ADR Prevalence MR- hospitalization 23.1% |
Hospitalization falls delirium ADR related = 23.1% | 3 | Opioids, benzodiazepines levodopa, memantine isosorbide mononitrate, carbamazepine, | Poly pharmacy |
| Leendertse et al (2008)37 Prospective multicentre study Netherlands |
Hospital | ADR medication error prevalence MR-hospitalization 5.6% | Hospitalization ADR related = 5.6% | 1 | Antiplatelets diuretics insulin oral antidiabetic β-Blockers | Impaired cognition ≥4 comorbidities dependent living renal impairment nonadherence to medication regimen polypharmacy |
| Pirmohamed et al (2004)11 Prospective analysis UK |
Hospital Age range was 65-83 years |
ADR Prevalence of ADR = 6.5% |
Hospitalization Death ADR related = 6.5% |
2 | NSAID Diuretics Warfarin ACEI Antidepressants |
Medication interaction |
| Van der Stelt et al (2015)45 A nested case control study Netherlands |
Hospital Age range was ≥ 65 |
PIMs and PPO (potential prescribing
omission) Identified by Beers criteria and by STOPP/START criteria Prevalence PIM = 34.1% to 44.4% PPO = 57.7% |
Hospitalization PIM related = 5.6% | 1 | NSAIDs Benzodiazepine |
Impaired cognition, polypharmacy ≥3 comorbidities, renal impairment |
| Wierenga et al (2012)5 Prospective cohort study Netherlands |
Hospital Mean age: 77.8 |
ADR | Hospitalization Delirium (25.9%) Falls (12%) ADR related = 12%-25.9% |
3 | Diuretics Prednisolone NSAID Antidepressant Antipsychotic |
Co-morbidity Functional impairment Cognitive impairment |
| Beer et al (2010)34 Prospective observational cohort study Australia |
Community Mean age: 77 ± 3.6 |
PIM According to Australian criteria for assessment Prevalence: PIM = 48.7% |
Fall Hospitalization Death |
3 | NSAIDs, Allopurinol Antihypertensives Benzodiazepine Digoxin Tricyclic antidepressants, Antihistamine |
Polypharmacy Underutilization of medicines |
| Cahir et al (2014)40 Retrospective study Ireland |
General practices Mean age:78 |
PIM Identified by STOPP criteria ADR Prevalence: PIM = 42% |
Use of health services | 1 | anti-thrombotic anti-inflammatory psycholeptics psychoanaleptics | Number of different repeat drug classes, medication possession ratio (a measure of medication adherence) |
| Henschel et al (2015)39 Retrospective analysis Germany |
Age range ≥ 65 | PIM Identified with the PRISCUS list |
Hospitalization PIM related = 10% |
1 | Analgesics Cardiovascular drugs Antibiotic Antidepressants Antiplatelet Sedatives |
Greater age Higher co-morbidity Preceding events of hospitalization |