Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward

PLoS One. 2019 Jul 22;14(7):e0220071. doi: 10.1371/journal.pone.0220071. eCollection 2019.


Background: Knowledge of risk factors for drug-related hospitalizations (DRHs) is limited.

Aim: To examine the prevalence of DRHs and the relationships between DRHs and various variables in multimorbid patients admitted to an internal medicine ward.

Methods: Multimorbid patients ≥ 18 years, using minimum of four regular drugs from minimum two therapeutic classes, were included from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016. Clinical pharmacists prospectively conducted medicines reconciliations and reviews to reveal drug-related problems (DRPs). Blinded for identified DRPs, an interdisciplinary group retrospectively made comprehensive, clinical assessments of each patient case to classify hospitalizations as drug-related (DRH) or non-drug-related (non-DRH). Age, sex distribution, Charlson Comorbidity Index (CCI), renal function, aberrant genotype frequencies, body-mass index, number of drugs, proportion of patients which received assistance for drug administration from the home care service, and/or through multidose-dispensed drugs, and occurrence of specific DRP subgroups, were compared separately between patients with DRHs versus non-DRHs, followed by multiple logistic regression analysis.

Results: Hospitalizations were classified as drug-related in 155 of the 404 included patients (38%). Factors significantly associated with DRHs were occurrence of adverse effect DRPs (adjusted odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4-8.0), adherence issues (OR 2.9, 1.1-7.2), home care (OR 1.9, 1.1-3.5), drug monitoring DRPs (OR 1.9, 1.2-3.0), and CCI score ≥6 (OR 0.33, 0.14-0.77). Frequencies of aberrant genotypes did not differ between the patient groups, but in 41 patients with DRHs (26.5%), gene-drug interactions influenced the assessments of DRHs.

Conclusion: DRHs are prevalent in multimorbid patients with adverse effect DRPs and adherence issues as the most important risk factors.

Publication types

  • Clinical Trial
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Drug-Related Side Effects and Adverse Reactions / genetics
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Genotype
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Multimorbidity
  • Prevalence

Grants and funding

The study was funded by South-Eastern Norway Regional Health Authority (PhD grant number 12/00718 to author ML,, Hospital Pharmacies Enterprise, South Eastern Norway (, Oslo University Hospital ( and Diakonhjemmet Hospital (!/diakon/forside/om-sykehuset/brief-information-in-english). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.