Adverse drug event-related hospitalisation in persons with neurodevelopmental disorders: a state-wide retrospective cohort study.
Psychotropic and opioid drugs are sending twice as many people with NDD to the hospital—time to audit every prescription.
01Research in Context
What this study did
The team looked back at every hospital stay in one state. They pulled records for people with intellectual or developmental disability. They counted how many stays were caused by bad drug reactions.
They compared these people to others without NDD. They checked which medicines caused the harm. They also noted age and income levels.
What they found
Psychotropic and opioid drugs top the list. These medicines sent twice as many people with NDD to the hospital in recent years compared to 2001.
The NDD group was younger and poorer than other patients. Yet they landed in the hospital more often for drug side effects.
How this fits with other research
Lunsky et al. (2012) saw the warning sign first. Half of adults with developmental disability got antipsychotics after a crisis. That heavy use sets the stage for the hospital stays M et al. now report.
Nickerson et al. (2015) tracked the same adults for six months. Aggression dropped a little even though pill doses stayed high. Their data show pills may not help much, yet the risk of harm keeps rising.
Eussen et al. (2016) found good metabolic monitoring in one Medicaid program. That looks like good news. The new study says people still end up in the hospital. Together they tell us: checking labs is not enough; we must also cut unneeded prescriptions.
Why it matters
You can spot over-medication before it turns into an ER trip. Ask the doctor to list every psychotropic and opioid drug. Flag any that lack a clear target behavior or pain goal. Start a team review each quarter to taper or stop one drug at a time. Your clients avoid harm and you free up time for skill teaching.
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02At a glance
03Original abstract
BACKGROUND: Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). OBJECTIVE: The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. METHODS: The all-inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE-related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. RESULTS: A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE-related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14-year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE-related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio-economic disadvantage and less private insurance coverage, suffered with less severe but different co-morbid clinical conditions and incurred more challenges in the acute hospital care setting. CONCLUSION: Although the pattern of ADE-related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group.
Journal of intellectual disability research : JIDR, 2019 · doi:10.1111/jir.12586