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Chowdhury K, Hazra A, Ghosh S, Choudhury S. Drug use survey to identify significant drug-drug interactions and assess clinical importance in the outpatient setting of a tertiary care hospital. Indian J Pharmacol 2024; 56:172-177. [PMID: 39078180 PMCID: PMC11286091 DOI: 10.4103/ijp.ijp_483_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/13/2024] [Accepted: 06/03/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES Drug-drug interactions (DDIs) are a common problem in pharmacotherapy, particularly in situations where multiple disorders must be treated at the same time. We conducted a drug use survey in the general medicine outpatient department of a tertiary care hospital with the objective of assessing the potential for DDI in individual prescriptions for adult patients. MATERIALS AND METHODS Drugs prescribed in the current physician-patient encounter were considered in conjunction with medicines already being received by the patient as well as those discontinued in the past 1 month. Free online DDI checkers (available at https://www.drugs.com/drug_interactions.html and https://reference.medscape.com/) were used to identify potential DDI and categorize them into mild, moderate, and severe categories. We did not consider food, alcohol, or smoking-related interactions. RESULTS A total of 153 prescriptions, having two or more drugs, were collected, and they accounted for 1052 prescribed drugs. Among them, 613 (58.27%) were prescribed in index visits, and the rest 438 (41.63%) were preexisting medication. The number of drugs prescribed in index visits ranged from 1 to 9 (mean ± standard deviation [SD] 4.0 ± 1.86; median 4). Potential DDIs were identified in 103 (67.32%) instances. The total number of interactions identified was 412. Of these, 19.66% had minor, 77.67% moderate, and 7.19% major clinical implications. Potential DDI count in each prescription was found from 0 to 13 in number (mean ± SD 2.7 ± 3.12; median 2.0). This number correlated strongly with the number of drugs being received by individual subjects (Rho 0.744; P < 0.001). CONCLUSIONS Potential DDIs are a reality in day to day prescribing practice. Substantial proportion of these DDIs may have significant clinical implications. Prescribers need to be sensitized to this issue. Combining human expertise with technological solutions such as automated drug interaction alerts can help rectify the situation. Similar surveys are needed on a periodic basis to improve medication safety for patients.
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Affiliation(s)
| | - Avijit Hazra
- Department of Pharmacology, IPGME and R, Kolkata, India
| | | | - Shouvik Choudhury
- Department of Pharmacology, Burdwan Medical College, Bardhaman, West Bengal, India
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Këlliçi S, Elezi E, Hafizi H. Potential drug- drug interactions in hospitalized patients with respiratory diseases. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Suela Këlliçi
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Dibra Street 376, 1005, Tirana, Albania
| | - Evisa Elezi
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Dibra Street 376, 1005, Tirana, Albania
| | - Hasan Hafizi
- Service of Pneumology, University Hospital of Pulmonary Diseases “Shefqet Ndroqi”,1005, Tirana, Albania
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Amponsah OKO, Ayisi-Boateng NK, Nagaraja SB, Nair D, Muradyan K, Hedidor GK, Labi AK, Opare-Addo MNA, Sarkodie E, Buabeng KO. Adherence to Prescribing Indicators at a District Hospital in Ghana: Do We Match WHO Standards? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12260. [PMID: 36231554 PMCID: PMC9566632 DOI: 10.3390/ijerph191912260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Rational use of medicines (RUM) and their assessment are important to ensure optimal use of resources and patient care in hospitals. These assessments are essential to identifying practice gaps for quality improvement. (2) Methods: Assessment of adherence to WHO/International Network for Rational Use of Drugs core prescribing indicators among outpatients in 2021 was conducted at the University Hospital of the Kwame Nkrumah University of Science and Technology in the Ashanti Region of Ghana. We reviewed electronic medical records (EMR) of 110,280 patient encounters in the year which resulted in 336,087 medicines prescribed. (3) Results: The average number of medicines prescribed per encounter was three, with generics being prescribed in 76% of prescriptions. Injections were prescribed in 7% of encounters while 90% of medicines were from Ghana's Essential Medicines List, 2017. (4) Conclusions: With the exception of patient encounters with injections, none of the prescribing indicators assessed in this study met WHO optimum levels, providing targets for quality improvement in RUM. Implementing prescribing guides and policies, regular audits and feedback as well as continuous professional development training may help to improve prescribing practices in the hospital.
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Affiliation(s)
- Obed Kwabena Offe Amponsah
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
| | - Nana Kwame Ayisi-Boateng
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
| | | | - Divya Nair
- International Union Against TB and Lung Disease (The Union), 75006 Paris, France
| | - Karlos Muradyan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | - George Kwesi Hedidor
- WHO Country Office, Ghana, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana
| | - Appiah-Korang Labi
- WHO Country Office, Ghana, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana
| | | | - Emmanuel Sarkodie
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
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Bojuwoye AO, Suleman F, Perumal-Pillay VA. Polypharmacy and the occurrence of potential drug-drug interactions among geriatric patients at the outpatient pharmacy department of a regional hospital in Durban, South Africa. J Pharm Policy Pract 2022; 15:1. [PMID: 34983680 PMCID: PMC8729144 DOI: 10.1186/s40545-021-00401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Polypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice. Little is known about this practice in South Africa. This study aimed to determine the level of polypharmacy and potential drug–drug interactions amongst the geriatric patient population in a facility in South Africa. Method A cross-sectional retrospective prescription chart review for 250 geriatric patients was conducted at the outpatient pharmacy department of a regional hospital. Variables extracted included demographic information, diagnosis, type of prescriber contact, and polypharmacy. Potential drug–drug interactions were determined with web-based multi-drug interaction checkers. Results The average (SD) number of diagnosed clinical problems was 3.54 ± 1.26, with hypertension, diabetes mellitus, and heart disease occurring most frequently. The level of polypharmacy was high with patients receiving an average (SD) of 12.13 ± 4.25 prescribed medicines from 3032 prescribed medicines. The level of polypharmacy was highest within the age categories, 60–64, and 70–74 years of age, respectively. The level of potential drug–drug interactions was also high with an average (SD) of 10.30 ± 7.48 from 2570 potential drug interactions. The majority of these interactions were moderate (72.5%) and pharmacodynamic (73.2%) by nature of the clinical severity of action and mechanism of action, respectively. Polypharmacy and type of prescriber contact were statistically significant contributors to the occurrence of potential drug–drug interactions, (F (2, 249) = 68.057, p < 0.05). However, in a multivariate analysis of variables to determine the strength of the association, polypharmacy was determined to be the strongest contributor to the occurrence of potential drug–drug interactions (p < 0.05) when compared with the type of prescriber contact (p value = 0.467). Therefore, irrespective of the type of prescriber contact, polypharmacy increases the potential for drug interactions among the sampled patient population. Conclusion A comprehensive consideration of disease management guidelines, patient factors, and rational medicine review could be measurable strategies towards improving medicine use. This would also limit the occurrence of significant drug interactions among the geriatric patient population. A national study is required to determine if differences occur across hospitals and regions.
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Affiliation(s)
- Adetola Olaniyi Bojuwoye
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Velisha Ann Perumal-Pillay
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa.
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Dagnew SB, Tadesse TY, Zeleke MM, Yiblet TG, Addis GT, Mekonnen GB, Agegnew Wondm S, Negash EA. Drug–drug interactions among hospitalized elderly in patients at medical wards of Northwest Ethiopia’s Comprehensive Specialized Hospitals: A multicenter observational study. SAGE Open Med 2022; 10:20503121221135874. [PMID: 36385798 PMCID: PMC9647268 DOI: 10.1177/20503121221135874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objective: Drug–drug interactions are of major concern due to links to untoward drug
effects, hospitalizations, and serious health impacts. Elderly patients are
more predisposed to drug interactions than younger patients. The present
study aimed to find out the prevalence of drug–drug interactions at North
West Ethiopian compressive specialized hospitals’ Internal Medicine
wards. Methods: From 30 April to 30 July 2021 GC, a multicenter prospective observational
study was conducted at north Ethiopian specialized hospitals. Data was
collected by using a structured questionnaire adapted from different
literature and medical records at the North West Ethiopian Comprehensive
Specialized Hospitals’ Internal Medicine wards during the study period.
Thereafter checked the completeness of the collected data was checked
drug–drug interactions by using Medscape. Epi data version 4.6.2 software
was used as data clearance and STATA version 14.1 was used for further data
analysis. Result: A total of 389 subjects participated in the study of which more than half
(55.53%) of them were female with a mean (SD) age of 68.9 ± 7.46 years. A
total of 641 drug–drug interactions were detected in this investigation of
which, 225(35.1%) were major, 299(46.6%) were significant interactions, and
117(18.3%) were minor interactions. Hospital stay (AOR = 5.95 CI:
3.49–10.12), retire (AOR = 6.71 CI: 1.26–35.78), 5–9 drugs (AOR = 5.30 CI:
2.91–9.67) and more than 10 drugs (AOR = 8.03 CI: 2.47–26.07) were important
risk factors for drug–drug interactions. Conclusion: The findings of this study suggest that drug–drug interactions were high
among hospitalized elderly patients. The presence of polypharmacy, to be
retired, and hospital stayed were all found to be strongly linked with
drug–drug interactions.
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Affiliation(s)
- Samuel Berihun Dagnew
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tesfaye Yimer Tadesse
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Molla Zeleke
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tesfagegn Gobezie Yiblet
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getu Tesfaw Addis
- Social and Administrative Pharmacy Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Binega Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samuel Agegnew Wondm
- Clinical Pharmacy Unit, School of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Erkihun Assefa Negash
- Clinical Pharmacy Unit, School of Pharmacy, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
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Rodrigues PS, Francisco PMSB, Fontanella AT, Borges RB, Costa KS. Use and sources of psychotropic drugs by Brazilian adults and seniors. CIENCIA & SAUDE COLETIVA 2020; 25:4601-4614. [PMID: 33175066 DOI: 10.1590/1413-812320202511.35962018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/22/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.
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Affiliation(s)
- Patrícia Silveira Rodrigues
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Campinas (UNICAMP). R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Priscila Maria Stolses Bergamo Francisco
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Campinas (UNICAMP). R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil. .,Faculdade de Ciências Médicas, UNICAMP. Campinas SP Brasil
| | - Andréia Turmina Fontanella
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre RS Brasil
| | - Rogério Boff Borges
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre RS Brasil
| | - Karen Sarmento Costa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Campinas (UNICAMP). R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil. .,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre RS Brasil
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Diksis N, Melaku T, Assefa D, Tesfaye A. Potential drug-drug interactions and associated factors among hospitalized cardiac patients at Jimma University Medical Center, Southwest Ethiopia. SAGE Open Med 2019; 7:2050312119857353. [PMID: 31217972 PMCID: PMC6560803 DOI: 10.1177/2050312119857353] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/23/2019] [Indexed: 12/18/2022] Open
Abstract
Background Concomitant use of several drugs for a patient is often imposing increased risk of drug-drug interactions. Drug-drug interactions are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. This study is aimed to assess the prevalence of potential drug-drug interactions and associated factors among hospitalized cardiac patients at medical wards of Jimma University Medical Center, Southwest Ethiopia. Methods A hospital-based prospective observational study was conducted among hospitalized cardiac adult patients based on the inclusion criteria. Patient-specific data were collected using structured data collection tool. Potential drug-drug interaction was analyzed using Micromedex 3.0 DRUG-REAX® System. Data were analyzed using statistical software package, version 20.0. To identify the independent predictors of potential drug-drug interaction, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at a p-value < 0.05. Written informed consent from patients was obtained and the patients were informed about confidentiality of the information obtained. Results Of the total 200 patients, majority were male (52.50%) and with a mean(±standard deviation) age of 42.54(±7.89) years. Out of 673 patients' prescriptions analyzed, 521 prescriptions comprised potential drug interactions and it was found that 967 drug interactions were present. The prevalence rate of potential drug-drug interactions among the study unit was 4.83 per patient and 1.44 per prescription regardless of the severity during their hospital stay. Overall the prevalence rate of potential drug interactions was 74.41%. Older age (adjusted odds ratio (95% confidence interval): 1.067 (2.33-27.12), p = 0.049), long hospital stay (⩾7 days) (adjusted odds ratio (95% confidence interval): 2.80 (1.71-4.61), p = 0.024), and polypharmacy (adjusted odds ratio (95% confidence interval): 1.64 (0.66-4.11), p = 0.041) were independent predictors for the occurrence of potential drug-drug interactions. Conclusion This study demonstrated a high prevalence of potential DIs among hospitalized cardiac patients in medical wards due to the complexity of pharmacotherapy. The prevalence rate is directly related to age, number of prescribed drugs, and length of hospital stay. Pharmacodynamic drug-drug interaction was the common mechanism of drug-drug interactions. Therefore, close monitoring of hospitalized patients is highly recommended.
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Affiliation(s)
- Netsanet Diksis
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Desta Assefa
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Andualem Tesfaye
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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van Heerden JA, Burger JR, Gerber JJ, Vlahović-Palčevski V. Prevalence of potentially serious drug-drug interactions among South African elderly private health sector patients using the Mimica Matanović/Vlahović-Palčevski protocol. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:156-164. [PMID: 28665037 DOI: 10.1111/ijpp.12383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence of potentially serious drug-drug interactions (DDIs) and their relationship with gender and age, among elderly in South Africa. METHODS A cross-sectional study was conducted using pharmaceutical claims data for 2013, for a total of 103 420 medical scheme beneficiaries' ≥65 years. All medications dispensed within one calendar month where the days' supply of medication dispensed overlapped, were grouped as one prescription. DDIs per prescription were then identified using the Mimica Matanović/Vlahović-Palčevski DDI protocol. Results were interpreted using effect sizes, that is Cramér's V, Cohen's d and Cohen's ƒ2 . KEY FINDINGS A total of 331 659 DDIs were identified on 235 870 (25.8%, N = 912 713) prescriptions (mean 0.36 (SD 0.7) (95% CI, 0.36 to 0.37)). Women encountered 63.5% of all DDIs. Effect sizes for the association between DDIs and age group (Cramér's V = 0.06), and gender (Cramér's V = 0.05) was negligible. There was no difference between men and women regarding the mean number of DDIs identified per prescription (Cohen's d = 0.10). The number of medicine per prescription (ƒ2 = 0.51) was the biggest predictor of the DDIs. The most frequent interacting drug combinations were between central nervous system medicines (30.6%). CONCLUSION Our study is the first to report the prevalence of potentially serious DDIs among an elderly population in the South African private health sector utilising the Mimica Matanović/Vlahović-Palčevski DDI protocol. Overall, we identified DDIs in approximately 26% of the prescriptions in our study. Age and gender were not found to be predictors of potentially serious DDIs.
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Affiliation(s)
- Julandi A van Heerden
- Medicine Usage in South Africa (MUSA), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Jan J Gerber
- Medicine Usage in South Africa (MUSA), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
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Ofori-Asenso R, Brhlikova P, Pollock AM. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015). BMC Public Health 2016; 16:724. [PMID: 27545670 PMCID: PMC4993007 DOI: 10.1186/s12889-016-3428-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences.
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Affiliation(s)
| | - Petra Brhlikova
- Centre for Primary Care and Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Allyson M Pollock
- Centre for Primary Care and Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
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Sonuga BO, Hellenberg DA, Cupido CS, Jaeger C. Profile and anticoagulation outcomes of patients on warfarin therapy in an urban hospital in Cape Town, South Africa. Afr J Prim Health Care Fam Med 2016; 8:e1-8. [PMID: 27247158 PMCID: PMC4913441 DOI: 10.4102/phcfm.v8i1.1032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Warfarin is the most frequently used oral anticoagulant worldwide and it is the oral anticoagulant of choice in South Africa for reducing thrombosis-related morbidity and mortality. However, the safety and efficacy of warfarin therapy depends mainly on careful monitoring and maintenance of the international normalised ratio (INR) within an optimal therapeutic range. AIM The aim of this study was to describe the profile and the anticoagulation outcomes of patients on warfarin therapy in a major warfarin clinic in the Western Cape Province of South Africa. SETTING Victoria Hospital - a district hospital in Cape Town. METHODS A cross sectional review of clinical records of patients on warfarin therapy who attended the INR clinic from 01 January 2014 to 30 June 2014 was done. Data analysis was done with STATA to generate appropriate descriptive data. RESULTS Our study showed that atrial fibrillation (AF) was the commonest indication for warfarin use in this study and hypertension was the commonest comorbidity among these patients. Only 48.5% achieved target therapeutic range; 51.5% were out-of-range. There was a significant association between alcohol consumption and poor anticoagulation outcomes (p-value < 0.022). Anticoagulation outcomes were better among the older age groups, male patients and in those with AF. The prevalence of thrombotic events while on warfarin treatment was 2.2%, while prevalence of haemorrhagic events was 14%. Most of the patients with bleeding events were on concurrent use of warfarin and other medications with potential drug interactions. CONCLUSION In our study, patients who achieved target therapeutic control were less than the acceptable 60%.
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Affiliation(s)
- Babatunde O Sonuga
- Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town.
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Borges TL, Miasso AI, Vedana KGG, Telles Filho PCP, Hegadoren KM. Prevalência do uso de psicotrópicos e fatores associados na atenção primária à saúde. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo Investigar a prevalência de uso de psicotrópicos e fatores associados na atenção primária à saúde com fatores sociodemográficos, farmacoterapêuticos, histórico de saúde e Transtornos Mentais Comuns. Método Estudo transversal que incluiu 430 pacientes de atenção primária à saúde. O instrumento de pesquisa foi o Self-reporting Questionnaire e prontuários. Para análise, utilizou-se teste qui-quadrado na análise univariada e regressão logística na multivariada. Resultados A prevalência de uso de psicotrópicos foi de 25,8%. Houve associação entre uso de psicofármacos e transtornos mentais comuns, uso de medicamentos não psicofármacos, número de medicamentos prescritos, número de comprimidos/dia, patologias clínicas, idade e escolaridade. Na análise multivariada os preditores para uso de psicofármacos foram: transtornos mentais comuns, patologias clínicas e escolaridade. Conclusão A prevalência de uso de psicofármacos e os fatores associados variaram conforme a análise uni ou multivariada.
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Bhagavathula AS, Berhanie A, Tigistu H, Abraham Y, Getachew Y, Khan TM, Unakal C. Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia. Asian Pac J Trop Biomed 2014; 4:S204-8. [PMID: 25183081 DOI: 10.12980/apjtb.4.2014c1172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital. METHOD A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors. RESULT In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications. CONCLUSION We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.
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Affiliation(s)
| | - Alemayehu Berhanie
- Department of Clinical Pharmacy Research, School of Pharmacy, University of Gondar, Ethiopia
| | - Habtamu Tigistu
- Faculty of Pharmacy, School of Pharmacy, Gondar, University of Gondar Ethiopia
| | - Yishak Abraham
- Faculty of Pharmacy, School of Pharmacy, Gondar, University of Gondar Ethiopia
| | - Yosheph Getachew
- Faculty of Pharmacy, School of Pharmacy, Gondar, University of Gondar Ethiopia
| | - Tahir Mehmood Khan
- Jeffery Chee School of Medicine and Health Sciences, Monash University, Sunway Campus, 46150, Selangor Darul Ehsan, Malaysia
| | - Chandrashekhar Unakal
- Department of Medical Microbiology, School of Medicine and Health Sciences, University of Gondar, Ethiopia
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13
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Ogunbanjo GA. Editor's focus. S Afr Fam Pract (2004) 2013. [DOI: 10.1080/20786204.2013.10874293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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