Drug-drug interactions and pharmacists' interventions among psychiatric patients in outpatient clinics of a teaching hospital in Saudi Arabia

Factors associated with potential drug-drug interactions in psychiatric inpatients

OBJECTIVE

The aim of this study was to investigate the prevalence and severity of potential drug-drug interactions (pDDIs) in hospitalised patients with major psychiatric disorders and to identify factors associated with their occurrence.

METHODS

The research was designed as an observational, cross-sectional study conducted at the Clinic for Mental Disorders (CMD) 'Dr. Laza Lazarevic', Belgrade, Serbia. Medscape, Epocrates and Lexicomp bases were used to detect potential drug interactions among inpatients. Multivariate regression analysis was used to reveal risk and protective factors associated with the number of pDDIs.

RESULTS

The study included 511 patients, average age 44.63±11.81 years. The average number of pDDIs per patient ranged from 5.9±4.7 (Medscape) to 8.2±5.4 (Epocrates) and 8.5±5.1 (Lexicomp). The following risk factors were identified by all three interaction checkers used: C-reactive protein, number of pharmacological subgroups, number of prescribed drugs, antibiotics, antacids, vitamins, number of associated comorbidities, route, form and dose of the drug.

CONCLUSIONS

When making clinical decisions to reduce drug problems, including DDIs, one should consult several interaction databases, which should be reviewed by a multidisciplinary team consisting of an experienced clinical pharmacist, physician, nurse, and so on.

Patterns of drug-related problems and the services provided to optimize drug therapy in the community pharmacy setting

Introduction

Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes.

Objectives

To assess community pharmacists' knowledge and practice regarding DRP-reduction services, as well as the barriers and factors associated with decreased provision of these services.

Methods

This cross-sectional study utilized a validated questionnaire to assess pharmacists' knowledge, practice, and barriers to the provision of DRP-reduction services in the community pharmacy setting. Binary regression model was used to assess the variables associated with the practice of DRP-reduction services.

Results

A total of 412 pharmacists participated in the study. The pharmacists demonstrated strong knowledge but inadequate practice of DRP-reduction services. The most reported DRPs were inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements (52.4%), patients' inability to understand instructions properly (46.1%), inappropriate drug according to guidelines (43.7%), and too high dose (40.3%). The most common barriers to these services were increased workload (60.5%), limited time (53.2%), and lack of good communication skills (49.8%). The presence of a counselling area in the pharmacy increased the practice of DRP-reduction services (OR: 3.532, 95%Cl: 2.010-5.590, P < 0.001), while increased weekly working hours (OR: 0.966, 95%Cl: 0.947-0.986), P < 0.01) and serving < 10 patients daily (OR = 0.208, 95%Cl: 0.072-0.601, P < 0.01) decreased it.

Conclusions

Community pharmacists' practice of DRP-reduction services showed a scope for improvement. Future pharmaceutical care initiatives should increase the number of personnel working in the pharmacy and provide them with opportunities for continued education and training in order to improve the provision of DRP services and optimize patients' outcomes.

Best practices for documentation of psychotropic drug-drug interactions in an adult psychiatric clinic

Introduction

Psychotropic drug-drug interactions (DDIs) contribute to adverse drug events, but many go undetected or unmanaged. Thorough documentation of potential DDIs can improve patient safety. The primary objective of this study is to determine the quality of and factors associated with documentation of DDIs in an adult psychiatric clinic run by postgraduate year 3 psychiatry residents (PGY3s).

Methods

A list of high-alert psychotropic medications was identified by consulting primary literature on DDIs and clinic records. Charts of patients prescribed these medications by PGY3 residents from July 2021 to March 2022 were reviewed to detect potential DDIs and assess documentation. Chart documentation of DDIs was noted as none, partial, or complete.

Results

Chart review identified 146 DDIs among 129 patients. Among the 146 DDIs, 65% were not documented, 24% were partially documented, and 11% had complete documentation. The percentage of pharmacodynamic interactions documented was 68.6% with 35.3% of pharmacokinetic interactions documented. Factors associated with partial or complete documentation included diagnosis of psychotic disorder (p = .003), treatment with clozapine (p = .02), treatment with benzodiazepine-receptor agonist (p < .01), and assumption of care during July (p = .04). Factors associated with no documentation include diagnosis of "other (primarily impulse control disorder)" (p < .01) and taking an enzyme-inhibiting antidepressant (p < .01).

Discussion

Investigators propose best practices for psychotropic DDI documentation: (1) description and potential outcome of DDI, (2) monitoring and management, (3) Patient education on DDI, and (4) patient response to DDI education. Strategies to improve DDI documentation quality include targeted provider education, incentives, and electronic medical record "DDI smart phrases."

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists

In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. The aim of this study was to explore the opinions and knowledge of psychiatrists from around the world on various aspects related to polypharmacotherapy. A total of 1335 psychiatrists from six continents were included in the study. The respondents’ opinion on the problem of hepatotoxicity in psychiatry was also examined. The greatest discrepancy among psychiatrists from different continents in the answers given concerned the definition of polypharmacotherapy (p < 0.001) and the approach to hepatotoxicity (p < 0.001). It is noteworthy that only about 20% of the psychiatrists surveyed (p < 0.001) believe that polypharmacotherapy is associated with a higher rate of patients’ hospitalisations. The most commonly used type of polypharmacy by psychiatrists was antidepressants and antipsychotics. Most of them also stated that polypharmacy was associated with reduced patient compliance with the doctor’s recommendations related to taking medications due to the increased complexity of the therapy. The continent that diversified the analysed questions to the greatest extent was Africa. Future educational activities for trainee psychiatrists should include more discussion of polypharmacotherapy in psychiatry.

The Practice of the Community Pharmacists in Managing Potential Drug-Drug Interactions: A Simulated Patient Visits

Background

Drug-drug interactions (DDIs) can cause treatment failure and serious adverse drug reactions, leading to morbidity and mortality. Due to their significant effects on the patient's health, community pharmacists (CPs) competence in detecting and preventing these interactions is essential to provide optimal health services. Thus, this study aimed to explore the performance of the CPs in situations involving the presence of potential DDIs.

Methods

A cross-sectional, simulated patient study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used to evaluate the performance of the CPs. Ten final year B. Pharm. students were selected to act as simulated patients (SPs); they were trained for two weeks to familiarize their roles. All encounters were documented immediately after leaving the pharmacy by the SPs in the data collection form.

Results

All planned SPs visits were completed, resulting in 470 visits. None of the CPs asked about the patients' medication history in both scenarios. After the SPs provided information about the drug used currently by the patient, 13.6% and 23.4% of the CPs had identified the potential DDIs in scenario 1 and scenario 2, respectively. In scenario 1, 59.4% distinguished the interaction of simvastatin with both drugs, while, in scenario 2, 74.5% recognized the interaction of warfarin with both drugs. In identifying DDIs, around half of the CPs were dependent on their knowledge or using drug interaction checker programs. The most common intervention made by the CPs was referring the patient to the prescriber (56.3% CPs in scenario 1 and 60% CPs in scenario 2).

Conclusion

CPs practice in identifying and managing potential DDIs was poor. The current CPs practices need substantial improvement. Therefore, professional education and the use of software programs in community pharmacies should be encouraged.

Potential drug-drug interactions in patients with cardiovascular diseases: findings from a prospective observational study

Background

Patients with cardiovascular diseases (CVD) are at high risk of experiencing drug–drug interactions (DDIs). The objective of this study was to evaluate the frequency, level and risk factors associated with potential-DDIs (pDDIs) in hospitalized CVD patients at cardiology departments of two tertiary care hospitals in Quetta, Pakistan.

Methods

In the current prospective observational study, a total of 300 eligible CVD inpatients were evaluated for pDDIs using Lexicomp Interact®. The pDDIs were classified into class A (no known interaction); B (no action needed); C (monitor therapy: it is documented that the benefits of an interaction outweigh the risk, appropriately monitor therapy in order to avoid potential adverse outcomes); D (consider therapy modification: it is documented that proper actions must be taken to reduce the toxicity resulting from an interaction); X (avoid combination: the risk of an interaction outweighs the benefits and are usually contraindicated). Multivariate binary logistic regression analysis was used to find factors associated with the presence of Class-D and/or X pDDIs. A p-value < 0.05 was considered statistically significant.

Results

With a median of 8.50 pDDIs per patient, all patients (100%) had ≥ 1 pDDIs. Out of total 2787 pDDIs observed, 74.06% (n = 2064) were of moderate and (n = 483) 17.33% of major severity. Class C pDDIs were most common (n = 1971, 70.72%) followed by D (n = 582, 20.88%), B (n = 204, 7.32%) and X (n = 30, 1.08%). Suffering from cardiovascular diseases other than myocardial infarction (OR 0.053, p-value < 0.001) and receiving > 12 drugs (OR 4.187, p-value = 0.009) had statistical significant association with the presence of class D and/or X pDDIs.

Conclusion

In the current study, pDDIs were highly prevalent. The inclusion of DDI screening tools, availability of clinical pharmacists and paying special attention to the high-risk patients may reduce the frequency of pDDIs at the study sites.

Mental health research studies in Saudi Arabia for the years 2009-2019; a systematic scoping review

BACKGROUND

An updated systematic scoping review and narrative analysis of all possible mental health studies done during the concerned immediate years clarifies its present condition and status for all professionals, and concerned researchers.

AIMS

To synthesize published mental health research studies in and for Saudi Arabia for the years 2009-2019 with the confidence to evaluate current situation, identify research gaps and limitations (if any), and assist in conceptualizing the forthcoming directions of future mental health research activities.

METHODS

Scoping systematic review and modified narrative analysis were the methods utilized to achieve the aim and objective set for this formal academic endeavor.

RESULTS

Of the 1006 published studies identified from chosen databases, a total of 241 papers were included and had passed the stringent criteria set for the scoping review process. Basic characteristics of the reviewed studies were quantitative survey type with about 101-500 size range of respondents, utilizing non-patients and adults for participants which were common and randomly chosen from selected population, and most research activities were self-funded. Four major research themes were found including a list of research limitations.

CONCLUSIONS

This systematic scoping review identified a wide range of results characterizing the different studies that qualified using pre-determined inclusion-exclusion criteria. Though of increasing publication volume in the past decade, most researches done were quantitative survey type whose themes seemed to show no drastic difference or change from the previous years of output. More variety in research themes would further improve the over-all quality of mental health publications.

Drug-Related Problems and Pharmacist Intervention at a General Hospital in the Jazan Region, Saudi Arabia

Objective

This study examined the incidence of drug-related problems (DRPs) in different inpatient departments along with the medical team response to pharmacist’s action in addressing DRPs at Jazan Hospital, Saudi Arabia.

Patients and Methods

This retrospective study was conducted among inpatients at Ministry of Health hospital in Jazan, a region in southwestern Saudi Arabia. We collected data for a 2-year period (from 2016 to 2017). For any detected DRP of the ordered medications for dispensing, the inpatient pharmacist is sending report for that particular DRP with recommendation to the medical team which in turn might accept or reject such recommendation. Serious drug–drug interactions, as part of DRP, were assessed by utilizing three different online DDI checkers, including Lexi-Comp, Medscape, and Drugs.com.

Results

The most common type of DRP was serious drug–drug interactions (49%). Over the study period, most incidences of DRPs were decreased. Of the DRPs in 2016 and 2017, antibiotics were the most commonly involved (51% and 69.5%) of cases, respectively, followed by proton pump inhibitors (25.3% and 14.1%) and statins (12.9% and 9.4%). Interestingly, of the 241 interventions for DRPs in 2016, 199 (82.5%) were accepted, resulting in a change in drug therapy (p=0.006). In 2017, 90 (70.3%) interventions out of 128 were accepted by the physician and the drug therapy changed (p=0.029).

Conclusion

Pharmacist interventions appear to decrease the incidence of DRPs, which emphasize the importance of an optimal pharmaceutical care plan for clinical care settings.