RESUMO
The Queen Elizabeth Hospital (QEH) is the major secondary and tertiary health care facility in Barbados, and patients who reach this hospital either present directly to the Accident and Emergency Department (A+E), or are referred by physicians. Over a six-month period all diabetic admissions to the hospital were identified, each patient was interviewed and examined, and hospital progress and outcome recorded. Of the 539 patients identified, 201 (37 percent) came directly to the A+E, while 338 (63 percent) had been referred to hospital. Three hundred and sixty-two (69 percent) had seen a physician within three months of admission. The main reasons for admission were the diabetic septic foot (33 percent), followed by heart failure (13 percent) and acute myocardial infarct 12.5 percent. Because the diabetic septic foot is considered a largely preventable problem, the high admission rate suggests that preventive care, assessment and management at the primary care level are inadequate. Patients who visited their primary care physicians within three months of admission, but nevertheless ended up in hospital, had lower mortality rates but prolonged hospital stays (AU)
Assuntos
Humanos , Diabetes Mellitus , Admissão do Paciente , Pé Diabético , Barbados/epidemiologiaRESUMO
This study reports on a prospective Adverse Drug Reaction (ADR) surveillance programme at the Queen Elizabeth Hospital, Barbados, from September 1989 to November, 1992. ADR forms were prominantly displayed in each ward of the Queen Elizabeth Hospital and completed forms were collected by Hospital Pharmacy staff. Data were analysed in terms of frequency of ADRs with reference to age, gender, therapeutic category, the monthly variation in reporting according to department and medical team. A total of 145 reports were considered complete and valid. Antidiabetic agents were implicated in 35 per cent of all reports, while the most commonly reported ADR was hypoglycaemia (32 per cent). The frequency of ADRs was uniform over the age range 10 - 60 years, but increased greatly in patients over 60 years of age. Frequency of reports was dependent on intensity of education and lobbying of doctors to report, and fell sharply when two key team members left the hospital. This study, the first known report of ADR surveillance in the Caribbean, clearly demonstrates that adverse drug reactions contribute significantly to morbidity in our elderly population, as in other reports. Reporting is subject to many variables and is clearly incomplete, but it is an important aspect of total patient care and drug use review. It highlights the risks of some drugs (e.g. sulphonylureas, sulphonamides, potassium sparing diuretics) which may be carelessly used, as well as rare ADRs (AU)