In 2004 and 2008 studies showed that approximately 10.000-16.000 of the acute hospitalisations were related to medication and potentially preventable. The Dutch Ministry of Health, Welfare and Sport drew up recommendations (HARM-Wrestling) in 2009, aiming to decrease of the potential preventable hospitalisations related to medication.

The results of the follow-up study (“Vervolgonderzoek Medicatieveiligheid”), which was commissioned by the ministry, are now available. The study was performed by a project team of the Erasmus MC (under the supervision of Prof. dr. Miriam Sturkenboom and Prof. Patricia van den Bemt), NIVEL, the PHARMO Institute and Radboud UMC. The project team studied, based on anonymised medical records and pharmacy data, if the recommendations were implemented in the period 2009-2014 and the frequency of preventable hospitalisations related to medication between 2008 and 2013. Reasons for (non-)adherence to the recommendations by physicians and pharmacist were determined by means of a survey.

The main findings of the follow-up study included:

– a large part of the recommendations from the HARM-Wrestling report are not implemented adequately;
– implementation of the recommendation regarding measurement of kidney function and sodium/potassium levels before and after initiation of cardiovascular medication needs improvement;
– the surveyed physicians and pharmacists indicated that patients often are not receptive to the preventive measures. In some cases this was related to additional costs associated with these measures;
– the same medications as ten years ago lead to potentially preventive hospitalisations;
– the prevalence of hospitalisations related to medication relative to the number of acute hospitalisations remained stable over time and amounted approximately 10% of acute hospitalisations in patients 65 years or older, 2.6% in patients aged 18-65 years and less that 1% in children;
– due to the implementation of some recommendations, thousands of hospitalisations are prevented. However, the partly implementation of the recommendations was not able to compensate for the increase of the absolute number of hospitalisations (due to the aging population).

The conclusions of the project team are that the recommendations are not adequately implemented and there is no decrease of preventable hospitalisations related to medication.

For the official report, click here (Dutch only)