Prevalence and predictors of prolonged length of stay among patients admitted under general internal medicine in a tertiary government hospital in Manila, Philippines: a retrospective cross-sectional study

BACKGROUND

Prolonged hospitalization leads to poorer health outcomes and consumes limited hospital resources. This study identified factors associated with prolonged length of stay (PLOS) among internal medicine patients admitted in a tertiary government hospital.

METHODS

We reviewed the medical records of 386 adult patients admitted under the primary service of General Internal Medicine at the Philippine General Hospital from January 1 to December 31, 2019. PLOS was defined as at least 14 days for emergency admissions or 3 days for elective admissions. Sociodemographics, clinical characteristics, admission- and hospital system-related factors, disease-specific factors, outcome on the last day of hospitalization, and hospitalization costs were obtained. We determined the proportion with PLOS and reviewed reasons for discharge delays. We conducted multiple logistic regression analyses to assess associations between various factors and PLOS.

RESULTS

The prevalence of PLOS is 19.17% (95% CI 15.54, 23.42). Positive predictors include being partially dependent on admission (aOR 2.61, 95% CI 0.99, 6.86), more co-managing services (aOR 1.26, 95% CI 1.06, 1.50), and longer duration of intravenous antibiotics (aOR 1.36, 95% CI 1.22, 1.51). The only negative predictor is the need for intravenous antibiotics (aOR 0.14, 95% CI 0.04, 0.54). The most common reason for discharge delays was prolonged treatment. The median hospitalization cost of patients with PLOS was PHP 77,427.20 (IQR 102,596).

CONCLUSIONS

Almost a fifth of emergency admissions and a quarter of elective admissions had PLOS. Addressing factors related to predictors such as functional status on admission, number of co-managing services, and use of intravenous antibiotics can guide clinical and administrative decisions, including careful attention to vulnerable patients and judicious use of resources.

Evaluation of Adverse Drug Reactions in Paediatric Patients: A Retrospective Study in Turkish Hospital

Drug safety in paediatric patients is a serious public health concern around the world. The paediatric patients are more prone to adverse drug reactions (ADRs) than adults. Moreover, there is a scarcity of information about ADRs in paediatric patients. This study was conducted to determine the frequency, causality, severity, preventability of paediatric patients’ ADRs reported in a tertiary care hospital in Adana, Turkey. A retrospective study was conducted on all spontaneously reported ADRs between January 01, 2020, to July 30, 2021, in paediatric patients. The ADRs reports were evaluated in terms of gender, age, ADR characteristics, suspected drugs and reporting source. All included ADRs reports were characterized according to the Naranjo Algorithm/World Health Organization (WHO) causality scales, Hartwig/Siegel and Common Terminology Criteria for Adverse Events (CTCAE) severity scales, the modified Schoumock and Thornton preventability scale and hospital pharmacovigilance center criteria for seriousness. Therapeutic groups were also coded using the WHO-Anatomical Therapeutic and Chemical (ATC) classification. During the study period, 8,912 paediatric patients who were admitted had 16 ADRs with 1.7 ADRs/1,000 admissions. The majority of ADRs were found in infants (31.2%) and children (56.2%) as compared to adolescents (12.5%). ADRs were observed more in females (81.2%) than males. Skin (62.5%) was the most affected organ due to the ADRs, and maculopapular rash and erythema multiforme were the most commonly reported symptoms. Most ADRs were probable/likely (93.7%), severe (50%), preventable or probably preventable (43.7%) and serious (37.5%). Antibiotics (93.7%) were found to be the most common cause of ADRs in paediatric patients. The majority of ADRs were associated with vancomycin (68.7%). Most of the ADRs were reported by a medical doctor in this study. This small sample size study highlights significant problems of ADRs in paediatric patients, mainly caused by antibiotics and with a majority of ADRs manifest as skin reactions. Furthermore, a high proportion of the identified ADRs were found to be preventable. More focused efforts are needed at the national level to avoid preventable ADRs in hospitals. Monitoring and management of ADRs and future studies would be beneficial for better patient care and safety.

Knowledge, Attitude, and Practice of Medical, Pharmacy, and Nursing Students Towards Pharmacovigilance and Adverse Drug Reaction Reporting at University of Gondar College of Medicine and Health Sciences, Northwest Ethiopia: A Cross-Sectional Study

BACKGROUND

The adequate knowledge, attitude, and practice (KAP) of pharmacovigilance and ADRs reporting is crucial for health care students.

OBJECTIVE

This study aimed at assessing the KAP of final-year medical, pharmacy, and nursing (MPN) students towards pharmacovigilance and ADRs reporting at the University of Gondar, College of Medicine and Health Sciences, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted among 296 final-year MPN students at the University of Gondar College of Medicine and Health Sciences from November 1, 2020 to January 30, 2021. A close-ended, structured, self-administered questionnaire was used for data collection prospectively. SPSS^® (IBM Corporation) version 24 was used to analyze the data with descriptive and inferential statistics. The comparison of the KAP of groups was made by using a Kruskal-Wallis test and Mann-Whitney U-test. Statistical significance was declared at a p-value < 0.05.

RESULTS

Among 296 participants, the majority of them had a poor level of knowledge (69.9%), practice (95.9%), and moderate attitude (62.5%) towards pharmacovigilance and ADRs reporting. The median (interquartile range) score of the students' knowledge (maximum score = 15), attitude (maximum score = 50), and practice (maximum score = 5) towards PV and ADR reporting was 6 (5-8), 32 (28.25-35), and 1 (0-1), respectively. The KAP of the students has shown differences with age, sex, hearing of the term PV, and discipline. A lack of training on ADRs (49%) reporting and not knowing where and how to report ADRs (47.3%) were among the main reasons of MPN students for not reporting ADRs.

CONCLUSION

A majority of final-year MPN students had poor knowledge, practice, and a moderate attitude towards PV and ADRs reporting. The school of medicine, pharmacy, and nursing should adequately cover the issue of PV and ADRs reporting in the undergraduate curriculum.