Drug-related emergency department visits in older patients: an applicability and reliability study of an existing assessment tool

Int J Clin Pharm. 2022 Aug;44(4):1078-1082. doi: 10.1007/s11096-022-01456-x. Epub 2022 Jul 15.

Abstract

Background: AT-HARM10 is a research tool to identify possible drug-related hospital admissions. It is unclear whether the tool can be applied to emergency department visits as well.

Aim: The aim of this study was to investigate the applicability and reliability to identify drug-related emergency department visits in older patients with AT-HARM10.

Method: A random sample of 400 patients aged 65 years or older from a clinical trial in four Swedish hospitals was selected. All patients' emergency department visits within 12 months after discharge were assessed with AT-HARM10. The main outcome measures were the percentage of successfully assessed visits for applicability and the interrater reliability (Cohen's kappa).

Results: Of the initial sample (n = 400), 113 patients [median age (interquartile range): 81 (76-88) years] had at least one emergency department visit within 12 months. The patients had in total 184 visits, of which 179 (97%) were successfully assessed. Fifty-three visits (29%) were possibly drug-related. The Cohen's kappa value was 0.70 (substantial).

Conclusion: It seems applicable and reliable to identify possible drug-related emergency department visits in addition to hospital admissions in older patients with AT-HARM10. As a consequence, the tool has been updated to support its novel use in clinical research.

Keywords: Drug therapy; Emergency service; Health care; Hospital; Outcome assessment; Patient harm; Quality of health care; Reliability of results.

MeSH terms

  • Aged
  • Emergency Service, Hospital*
  • Hospitalization*
  • Hospitals
  • Humans
  • Patient Discharge
  • Reproducibility of Results