Drug-related admissions to an Australian hospital

This study was conducted to determine the prevalence of drug-related hospital admissions in southern Tasmania, Australia. The causes of consecutive admissions to medical wards of the Royal Hobart Hospital were reviewed. Comprehensive data were collected over a 10-week period on 691 admissions (median age: 67 years and range: 11–97 years; 50.8% males). Sixty-eight (9-8%) of the admissions were classified as being either probably or definitely drug-related. Most of these admissions were attributable to intentional overdose (38.2%) or an adverse drug reaction (30.9%). The overdoses often involved benzodiazepines or antipsychotics. Gastrointestinal bleeding related to the use of nonsteroidal anti-inflammatory drugs was the most common adverse drug reaction (38.1% of all reactions). Other drug-related admission categories were poor compliance (14.7%), dosage decrease or therapy cessation by a doctor producing an exacerbation of symptoms (7.4%), substance abuse (4.4%) and drug interaction (4.4%). Patients with a drug-related admission were, on average, younger than the other medical admissions, with no significant difference in gender. Patients admitted due to an overdose or substance abuse were younger than other drug-related admissions and non-drug related admissions. In conclusion, this study has determined that almost 10% of medical admissions to the hospital are drug-related and it is estimated that 40 to 50 elderly people are admitted each year suffering from gastrointestinal bleeding related to nonsteroidal anti-inflammatory drugs.     

Utilization of antithrombotic therapy for stroke prevention in atrial fibrillation: a cross‐sectional baseline analysis in general practice

What is known and objective: Antithrombotics for stroke prevention in atrial fibrillation (AF) are reportedly underutilised. Since the burden of care lies within general practice, attention must be paid to identifying and addressing practice gaps in this setting. The objective of this study was to determine the contemporary utilisation of antithrombotic therapy for stroke prevention in AF within Australian general practice (GP). Methods: Data pertaining to AF patients’ (aged ≥65 years) were collected from GP surgeries in New South Wales, Australia, using purpose‐designed data collection forms; extracted data comprised patients’ medical histories, current pharmacotherapy, and relevant characteristics. Results and Discussion: Data pertaining to 393 patients (mean age 78·0 ± 7·0 years) were reviewed. Overall, most (98·5%) patients received antithrombotic therapy. Among the 387 patients using antithrombotics, most (94·1%) received mono‐therapy. “Warfarin ± antiplatelet” was most frequently used (81·7%); 77·5% used “warfarin” as a monotherapy, followed by “dabigatran ± clopidogrel” (11·6%), “aspirin” (5·9%) and “clopidogrel” alone (0·8%). High stroke risk and low bleeding risk were associated with increased use of “warfarin ± antiplatelet” therapy. Older patients (≥80 years) were more likely to receive ‘nil therapy’ (P = 0·04), and less likely to receive dual and triple antithrombotic therapy. Conclusion: We found an encouraging improvement compared to previous studies in the utilisation of antithrombotic therapy for stroke prevention in AF within general practice. Warfarin is now utilised as the mainstay therapy, followed by aspirin, although the novel oral anticoagulants are entering the spectrum of therapies used. Consideration needs to be given to the potential impact of the newer agents and their scope of use.