Which drugs cause preventable admissions to hospital? A systematic review

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Abstract
Aims: Previous systematic reviews have found that drug‐related morbidity accounts for 4.3% of preventable hospital admissions. None, however, has identified the drugs most commonly responsible for preventable hospital admissions. The aims of this study were to estimate the percentage of preventable drug‐related hospital admissions, the most common drug causes of preventable hospital admissions and the most common underlying causes of preventable drug‐related admissions.Methods: Bibliographic databases and reference lists from eligible articles and study authors were the sources for data. Seventeen prospective observational studies reporting the proportion of preventable drug‐related hospital admissions, causative drugs and/or the underlying causes of hospital admissions were selected. Included studies used multiple reviewers and/or explicit criteria to assess causality and preventability of hospital admissions. Two investigators abstracted data from all included studies using a purpose‐made data extraction form.Results: From 13 papers the median percentage of preventable drug‐related admissions to hospital was 3.7% (range 1.4–15.4). From nine papers the majority (51%) of preventable drug‐related admissions involved either antiplatelets (16%), diuretics (16%), nonsteroidal anti‐inflammatory drugs (11%) or anticoagulants (8%). From five studies the median proportion of preventable drug‐related admissions associated with prescribing problems was 30.6% (range 11.1–41.8), with adherence problems 33.3% (range 20.9–41.7) and with monitoring problems 22.2% (range 0–31.3).Conclusions: Four groups of drugs account for more than 50% of the drug groups associated with preventable drug‐related hospital admissions. Concentrating interventions on these drug groups could reduce appreciably the number of preventable drug‐related admissions to hospital from primary care.