Assessing risk of adverse drug reactions in the elderly: a feasibility study

Background: Adverse drug reactions are common in Australian general practice and can be a cause of, or contribute to, preventable hospital admissions. Developing practical tools to assist in identifying patients who are at high risk of serious adverse drug reactions is an important step in preventing these hospitalisations.

Objective:The aims of the study were to apply the Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (PADREC) Score to assess the risk of medication-related hospitalisation among patients aged ≥65 years attending a rural general practice, and to investigate general practitioners’ acceptance of the PADR-EC Score.

Setting: The project was based in a multicentre rural general practice in southern Tasmania, Australia.

Method: We conducted a cross-sectional study wherein the PADR-EC score was administered to patients aged ≥65 years attending a general practice. A focus group of general practice doctors was conducted and thematic analysis of the transcript used to explore their views regarding the utility of the PADR-EC score.

Main Outcome Measures: Successful application of the PADR-EC Score and an evaluation of general practitioners’ acceptance of the PADR-EC Score are the two outcome measures of the project.

Results: The PADR-EC score was applied by the practice pharmacist and reported to GPs for 428 patients aged ≥65 years, with 24.8% classified as high-risk. The focus group found the PADR-EC score helped raise awareness of the risk of adverse drug reactions in the general practice setting. Doctors demonstrated good understanding of the PADR-EC Score and there were no negative reactions to the delivery model used. No changes to prescribing were implemented directly as a result of the PADR-EC Score, but more caution was used when doctors provided their usual clinical care.

Conclusion: Doctors used the PADR-EC score to complement their decision making. The PADR-EC Score was used as a reminder to review existing medication lists, follow-up on pathology results that may impact drug treatment and assess patients for prevalent ADRs. Further research is needed to validate the PADR-EC score in this setting.