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. 2021 Apr 23;21(1):376.
doi: 10.1186/s12913-021-06346-y.

Detection of adverse drug events in e-prescribing and administrative health data: a validation study

Bettina Habib  1 , Robyn Tamblyn  2   3   4 , Nadyne Girard  2 , Tewodros Eguale  4   5 , Allen Huang  6
Affiliations

Detection of adverse drug events in e-prescribing and administrative health data: a validation study

Bettina Habib et al. BMC Health Serv Res. .

Abstract

Background: Administrative health data are increasingly used to detect adverse drug events (ADEs). However, the few studies evaluating diagnostic codes for ADE detection demonstrated low sensitivity, likely due to narrow code sets, physician under-recognition of ADEs, and underreporting in administrative data. The objective of this study was to determine if combining an expanded ICD code set in administrative data with e-prescribing data improves ADE detection.

Methods: We conducted a prospective cohort study among patients newly prescribed antidepressant or antihypertensive medication in primary care and followed for 2 months. Gold standard ADEs were defined as patient-reported symptoms adjudicated as medication-related by a clinical expert. Potential ADEs in administrative data were defined as physician, ED, or hospital visits during follow-up for known adverse effects of the study medication, as identified by ICD codes. Potential ADEs in e-prescribing data were defined as study drug discontinuations or dose changes made during follow-up for safety or effectiveness reasons.

Results: Of 688 study participants, 445 (64.7%) were female and mean age was 64.2 (SD 13.9). The study drug for 386 (56.1%) patients was an antihypertensive, and for 302 (43.9%) an antidepressant. Using the gold standard definition, 114 (16.6%) patients experienced an ADE, with 40 (10.4%) among antihypertensive users and 74 (24.5%) among antidepressant users. The sensitivity of the expanded ICD code set was 7.0%, of e-prescribing data 9.7%, and of the two combined 14.0%. Specificities were high (86.0-95.0%). The sensitivity of the combined approach increased to 25.8% when analysis was restricted to the 27% of patients who indicated having reported symptoms to a physician.

Conclusion: Combining an expanded diagnostic code set with e-prescribing data improves ADE detection. As few patients report symptoms to their physician, higher detection rates may be achieved by collecting patient-reported outcomes via emerging digital technologies such as patient portals and mHealth applications.

Keywords: Administrative health data; Adverse drug event; Electronic prescribing data; Validation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
MOXXI stop/change option: indicating the reason for changing or discontinuing a medication
Fig. 2
Fig. 2
CONSORT diagram of eligible, enrolled, and interviewed patients
See this image and copyright information in PMC

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References

    1. Canadian Institute for Health Information(CIHI). National Health Expenditure Trends, 1975 to 2017. Ottawa: Canadian Institute for Health Informatin (CIHI); 2017.
    1. Martin AB, Hartman M, Benson J, Catlin A. National Health Spending in 2014: faster growth driven by coverage expansion and prescription drug spending. Health Aff. 2016;35(1):150–160. doi: 10.1377/hlthaff.2015.1194. - DOI - PubMed
    1. Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. Can Med Assoc J. 2008;178(12):1563–9. 10.1503/cmaj.071594. - PMC - PubMed
    1. Hohl CM, Robitaille C, Lord V, Dankoff J, Colacone A, Pham L, et al. Emergency physician recognition of adverse drug-related events in Elder patients presenting to an emergency department. Acad Emerg Med. 2005;12(3):197–205. 10.1197/j.aem.2004.08.056. - PubMed
    1. Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42(7):1017–1025. doi: 10.1345/aph.1L037. - DOI - PubMed

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