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Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary care
R Singh1, E A McLean-Plunckett, R Kee
1Primary Care Research Institute, State University of New York at Buffalo, Buffalo, New York 14215, USA. rs10@buffalo.edu
Insights
A trigger tool can help identify adverse drug events (ADEs) in older adults. Nine key triggers identified most ADEs, suggesting a shorter tool could be effective for quality improvement in primary care.
Area of Science:
- Pharmacovigilance
- Health Services Research
- Geriatric Medicine
Background:
- Adverse drug events (ADEs) are a significant concern in older adults.
- Ambulatory primary care settings require efficient methods for ADE detection.
- Existing trigger tools may not be optimized for primary care environments.
Purpose of the Study:
- To assess the effectiveness of a 39-item trigger tool in identifying ADEs in older adults within primary care.
- To determine the performance characteristics, specifically positive predictive values (PPVs), of individual triggers.
- To identify a core set of high-yield triggers for ADE detection.
Main Methods:
- Retrospective chart review of 1289 patients aged 65+ with cardiovascular diagnoses across six primary care practices.
- Utilized a 39-item trigger tool to flag potential ADEs.
- Physician and pharmacist review of flagged charts to confirm ADEs.
Main Results:
- 50% of reviewed charts contained at least one trigger.
- 232 ADEs were identified from 908 triggers.
- Nine specific triggers demonstrated high PPVs and accounted for 94.4% of all detected ADEs.
Conclusions:
- A subset of triggers can effectively identify the majority of ADEs in older adults in primary care.
- The findings support the development of a more concise trigger tool for quality improvement.
- Further research is needed on physician adoption of such tools in practice.
Objective:
To evaluate the performance of a trigger tool for identifying adverse drug events (ADEs) among older adults in ambulatory primary care practices.
Methods:
Manual 12-month retrospective chart review at six practices using a 39-item trigger tool. Patients aged 65 or above with cardiovascular diagnoses were included. Charts with triggers underwent detailed review by a physician and pharmacist to identify ADEs.
Results:
Of 1289 charts reviewed, 645 (50%) had at least one trigger. A random sample of 383 of these charts underwent further review (mean 64 charts per practice). Among the 908 triggers in these charts, 232 were deemed to represent ADEs, of which 92 were deemed preventable and 30% of these were severe. The most common triggers and their positive predictive values (PPVs) for ADEs were "Medication stop" (26.3%), "Hospitalisation" (21.8%) and "Emergency Room" visit (14.9%). Only nine of the triggers had PPVs >5%. These nine triggers accounted for 94.4% (219/232) of the ADEs detected.
Discussion:
Trigger tools have a potential role in driving quality improvement in ambulatory primary care. In our study using a 39-item ADE trigger tool, most triggers had very low PPVs. Nine of the 39 triggers accounted for 94.4% of ADEs detected, suggesting the possibility of a much briefer tool. Practical issues related to adoption of such tools by practising physicians should be further explored.
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