Assessment of drug related problems among type 2 diabetes mellitus patients with hypertension in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia

Prevalence and associated risk factors of Cryptosporidium infection in calves and hospitalized humans in Libo Kemkem, North Western Ethiopia

BACKGROUND

Cryptosporidium infection is one of the major causes of acute gastroenteritis and diarrhoea caused by a protozoan parasite affecting vertebrates and humans. The disease is prevalent in cases of immunocompromised individuals. Despite the impact of the diseases in calf and hospitalized humans, well-documented studies are not available in the study area.

OBJECTIVES

The objectives of this study were to determine the prevalence of Cryptosporidium infection in calves and hospitalized humans and assess the major associated risk factors associated with Cryptosporidium infection in calves and hospitalized humans.

METHOD

A cross-sectional study was conducted from November 2020 to March 2021 on calf and human Cryptosporidium infection in Libo Kemkem District, North West Ethiopia. A total of 193 calves and 122 human stool samples admitted to the hospital were used for this study. Three kebeles were selected purposely, and individual calves were selected using a simple random sampling method. A number of sampled calves were allocated proportionally to the selected kebeles. Human samples were collected using a systematic random sampling method. Faecal and stool samples were examined using a modified Ziehl-Neelsen staining method.

RESULT

The overall prevalence of calf and human Cryptosporidium infection found in this study was 15.5% and 11.5%, respectively. Age of calf, breed, body condition, water source, faecal consistency and hygienic condition were found significantly (p < 0.05) associated with Cryptosporidium infection in the calf. Similarly, the source of potable water, immunocompromisation and contact with domestic animals were found to be significantly (p < 0.05) associated with Cryptosporidium infection in humans.

CONCLUSION

There was a higher prevalence of Cryptosporidium infection in calves and humans in Libo Kemkem District. Therefore, the implementation of proper prevention methods of zoonotic Cryptosporidium infection between calf and human beings through significant risk factors is mandatory. Furthermore, additional studies to investigate the levels of economic importance of the disease should be conducted.

Assessment of Potentially Inappropriate Prescribing for People With Type 2 Diabetes Mellitus Using IMPACT2DM, a New Explicit Tool

Background: People with type 2 diabetes mellitus (T2DM) are at greater risk of potentially inappropriate prescribing (PIP) due to multiple comorbidities and polypharmacy. IMPACT2DM (Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus) is a tool designed to identify PIP for adults with T2DM. Objectives: To assess PIP for adults with T2DM in Ethiopia using the IMPACT2DM and to test the face validity and clinical validity of the tool. Methods: A cross-sectional study was undertaken using data extracted retrospectively from the medical records of adults being managed for T2DM at Debretabore Hospital. PIP was assessed using IMPACT2DM. Some items/item components of IMPACT2DM were modified to increase the tool's applicability for the outpatient setting, to clarify content or to use the terms most common in this particular setting. Multivariant logistic regression analyses were conducted to identify factors associated with PIP. Results: More than 90% of medical records had at least 1 PIP. Prescribing omission (80.9%) was the most commonly identified type of PIP. Adults with prescribing omissions are more likely to be ≥40 years old or to be prescribed with <5 medications. Adults with dosing problems were more likely ≥50 years old, or have had a fasting blood sugar (FBS) level out of the target range (80-130 mg/dL). Conclusions: IMPACT2DM is a clinically valid PIP identification tool for application in an Ethiopian outpatient setting. Health professionals should be alert to check for potential prescribing omissions for adults ≥40 years old and dosing problems for adults with an FBS level out of the target range or >50 years.

The unmet drug-related needs of patients with diabetes in Ethiopia: a systematic review and meta-analysis

Background

Diabetes is a major health concern globally and in Ethiopia. Ensuring optimal diabetes management through minimizing drug therapy problems is important for improving patient outcomes. However, data on the prevalence and factors associated with unmet drug-related needs in patients with diabetes in Ethiopia is limited. This systematic review and meta-analysis aims to provide a comprehensive analysis of the prevalence of unmet drug-related needs among patients with diabetes mellitus in Ethiopia.

Methods

A thorough exploration of databases, including PubMed, Scopus, Hinari, and Embase and Google Scholar, was conducted to identify pertinent studies. Inclusion criteria involved observational studies that reported the prevalence of unmet drug-related needs in Ethiopian patients with diabetes. The quality of the studies was assessed using Joanna Briggs Institute (JBI) checklists. A random-effects meta-analysis was employed to amalgamate data on study characteristics and prevalence estimates, followed by subsequent subgroup and sensitivity analyses. Graphical and statistical assessments were employed to evaluate publication bias.

Results

Analysis of twelve studies involving 4,017 patients revealed a pooled prevalence of unmet drug-related needs at 74% (95% CI 63-83%). On average, each patient had 1.45 unmet drug-related needs. The most prevalent type of unmet need was ineffective drug therapy, 35% (95% CI 20-50). Type 2 diabetes, retrospective study designs, and studies from the Harari Region were associated with a higher prevalence. Frequently reported factors associated with the unmet drug-related needs includes multiple comorbidities, older age, and polypharmacy. Notably, the results indicated significant heterogeneity (I2 = 99.0%; p value < 0.001), and Egger's regression test revealed publication bias with p<0.001.

Conclusion

The prevalence of unmet drug-related needs among diabetes patients with diabetes in Ethiopia is high with the most prevalent issue being ineffective drug therapy. Targeted interventions are needed; especially patients on multiple medications, advanced age, with comorbidities, and prolonged illness duration to improve diabetes management and outcomes.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42024501096.

Drug-Related Problems and Pharmacists' Interventions in Hypertensive Outpatients: A Multicenter Prospective Study in 3 Vietnamese Hospitals

Background: Clinical pharmacists' interventions (PIs) on drug-related problems (DRPs) in Vietnamese hypertensive outpatients are limited. Objectives: The objective was to investigate the prevalence and nature of DRPs, and factors which are likely to have DRPs, types of PIs, and their acceptance rate in 3 Vietnamese hospitals. Method: A prospective interventional study was conducted over a period of 3 months in 3 hospitals (from October 2021 to March 2022). Clinical pharmacists conducted medication reviews after collecting patient information from prescriptions and patient interviewing, and then identified the DRPs and suggested PIs according to the Vi-Med tool. These DRPs and PIs were reviewed by other superior clinical pharmacists and a consensus meeting with 3 cardiologists. Results: Of 381 patients included, 344 (90.23%) experienced 1 or more DRPs. A total of 820 DRPs were identified with an average of 2.15 DRPs per patient and 415 (50.61%) were hypertension-related issues. The most common DRPs identified were "administration mode" (46.34%), "missing indication" (18.05%), "non-conformity indication" (17.80%), and "dosage" (11.95%). Comorbidity (adjusted odds ratio [AOR] = 3.985, 95% CI: 1.597-9.942, P = 0.003) was the predictor of DRPs. Clinical pharmacists provided 739 PIs and 94.45% were accepted by physicians. Conclusion: The results of this study showed that DRPs were very common in hypertensive outpatients and highlighted the role of clinical pharmacists to identify and resolve DRPs through prompt interventions.

Determination of drug-related problems among type 2 diabetes outpatients in a hospital in Vietnam: A cross-sectional study

INTRODUCTION

Drug-related problems (DRPs) are common in clinical practice and occur at all stages of the medication process. The major factor contributing to DRPs is prescription, although patients' poor adherence to treatment is also a significant factor. This study evaluated type 2 diabetes outpatients in a hospital in Vietnam for drug-related problems (DRPs) and related variables.

METHODS

A cross-sectional descriptive study was conducted on 495 outpatients who met the criteria and 157 people agreed to participate in the interview. Medication order review and medication adherence review were used to identify DRPs. The types of DRP were based on the Pharmaceutical Care Network Europe (PCNE) categories version 9.0. The identification and assessment DRPs were carried out by clinical pharmacists and get agreed upon by physicians who had not directly prescribed patients who participated in the study.

RESULTS

A total of 762 DRPs were identified via prescribing review process, the average number of DRP on each prescription was 1.54±1.07, while 412 DRPs were determined through patient interviewing. The most frequent DRPs were "ADR (Adverse Drug Reaction) occurring" (68.8%). The main causes were "patient is unable to understand instructions properly" or "patient is not properly instructed", "patient stores insulin inappropriately", "patient decides to use unnecessary drugs" and "patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason" which accounted for 65.0%, 41.4%, 38.2%, and 28.7%, respectively. From the prescribing review, the most observed DRPs were "Inappropriate drug according to guidelines/formulary" and "No or incomplete drug treatment in spite of existing indication", accounting for 45.0% and 42.9%, respectively. There was a significant association between age (OR 3.38, 95% CI: 1.01-11.30), duration of diabetes (OR 3.61, 95%CI: 1.11-11.74), presence of comorbidity (OR 5.31, 95%CI: 1.97-14.30), polypharmacy (OR: 2.95, 95%CI: 1.01-8.72) and DRPs. In patients, poor knowledge of antidiabetic agents was the main reason to lack adherence and occurring ADR (OR 2.73, 95%CI: 1.32-5.66, p = 0.007 and OR 2.49, 95%CI: 1.54-4.03, p = 0.001 respectively).

CONCLUSION

DRPs occurred in the prescribing stage and relating to patient's behavior of drug administration was high. Clear identification of DRPs and the associated factors are essential for building the intervention process to improve effectiveness and safety in the treatment of type 2 diabetes mellitus patients.

Pharmacotherapy problems and associated factors among type 2 adult diabetic patients on follow up at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

BACKGROUND

Over the past few decades, drug therapy problems (DTPs) have become a significant public health concern worldwide. DTPs in patients with diabetes are responsible for uncontrolled glycemia, disease worsening, early development of complications, high healthcare expenses, prolonged and recurrent hospitalizations, and mortality.

OBJECTIVES

This study aimed to identify the prevalence of drug therapy problems and determine the associated factors among patients with type II Diabetes Mellitus at a University Teaching Hospital in Southwest Ethiopia.

METHODOLOGY

Hospital-based cross-sectional study was conducted between September and October 2022. Data were collected through medical record reviews and interviewer-administered structured questionnaires, which were then analyzed using SPSS version 26. Cipolle's method was adapted for classification of DTPs. Bivariate followed by multivariate logistic regression analysis was used to assess the association between predictor variables and the outcome variable. P-value ≤ 0.05 was employed as a cut-off point to determine statistical significance.

RESULT

Among 117 participants, 172 drug therapy problems (DTPs) were identified, with an average of 1.47 DTPs per patient, and83 (70.9%) participants had at least one type of drug therapy problem. Of the seven DTPs identified, need additional drug therapy was the most common, 50 (42.7%), followed by non-compliance with medication, 45 (38.5%) and ineffective drug therapy, 25 (21.4%). Occupational status and comorbidity were factors that associated with the occurrence of DTPs. Farmers were approximately four times more likely to develop DTPs than housewives were (adjusted odds ratio (AOR) = 3.56, 95% CI: 1.12-11.38, P = 0.03). The odds of drug therapy problems were twice as high in those with four comorbid conditions than in those without comorbidities (AOR = 1.95, 95% CI: 0.90-3.76, p = 0.02).

CONCLUSION

In the current study, the proportion of type 2 diabetes patients with drug therapy problems was high. This potentially lead to uncontrolled glycemia and early development of comorbid conditions, increasing morbidity and mortality rates. This could be attributed to the failure to effectively integrate clinical pharmacy services in different hospital wards, which is the case in virtually all hospitals in Ethiopia.

Pharmacist Interventions in Minimizing Drug Related Problems in Diabetes With Co-Existing Hypertension: A Five-Year Overview and Ground Report From India

Objective: The study aimed to investigate the pharmacist interventions in minimizing drug-related problems in diabetes with co-existing hypertension.

Methods: Prospective observational study.

Results: Overall, a total of 628 interventions were recommended for 1,914 patients during the 5-year period of study. Among all the interventions, the majority were suggested regarding “substituting the drug” (39%), change in frequency of administration (25%), and addition of drug (14%). Patient compliance status was found significant (p = 0.29 ± 0.07).

Conclusion: Clinical pharmacists have a crucial role in minimizing drug related problems. Particularly, there should be a greater emphasis on patient counselling and patient follow-up.

Prevalence and factors associated with drug therapy problems among hypertensive patients at hypertension clinic of Mbarara Regional Referral Hospital, Uganda: a |cross-sectional study

BACKGROUND

Despite the use of safe and effective conventional drugs, drug therapy problems (DTPs) pose a threat to the successful management of hypertension. DTPs are of a great concern in health care because of their serious consequences such as poor quality of life, increased health care costs, morbidity and mortality. However, there is no published information regarding the prevalence of DTPs and associated factors among hypertensive patients in Uganda.

OBJECTIVE

The aim of the study was to determine the prevalence and factors associated with DTPs among hypertensive patients at the hypertension clinic of Mbarara Regional Referral Hospital (MRRH).

METHOD

A cross-sectional study was conducted at the hypertension clinic, MRRH, Uganda among 228 hypertensive patients. Data were collected from medical records using a data abstraction tool and patients were interviewed using a structured questionnaire. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0. Descriptive analysis was used to determine the prevalence of DTPs. Logistic regression was used to determine the association between the independent and dependent variables. Variables were considered statistically significant at p-value <0.05.

RESULTS

A total of 178 DTPs were identified among 141 hypertensive patients. The prevalence of antihypertensive-related DTPs was 61.8% (95% confidence interval [CI]: 55.3-67.5) with an average of 1.26 ± 0.52 DTPs per patient. Out of 141 participants with DTPs, 109 (77.3%) had one DTP, 27 (19.1%) had 2 DTPs, and 5 (3.5%) had 3 DTPs. The most common types of antihypertensive-related DTPs were 'dosage too low' which accounted for 53 (29.8%), followed by 'adverse drug reactions' which accounted for 48 (27%). Uncontrolled blood pressure (BP; adjusted odds ratio [AOR]: 4.17; 95% CI: 2.33-7.45, p < 0.001) and routine laboratory test results (AOR: 1.87; 95% CI: 1.04-3.36, p = 0.036) were significantly associated with antihypertensive-related DTPs among hypertensive patients.

CONCLUSION

Almost two-thirds of study participants had antihypertensive-related DTPs. The most common DTPs were 'dosage too low' and 'adverse drug reactions' which both accounted for almost a third of the total DTPs each. Uncontrolled BP and routine laboratory test results were significantly associated with antihypertensive-related DTPs among the study participants. Our study emphasizes the need for improved patient care by clinical pharmacists to identify and prevent DTPs among hypertensive patients.

Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review

BACKGROUND

People living with diabetes often experience multiple morbidity and polypharmacy, increasing their risk of potentially inappropriate prescribing. Inappropriate prescribing is associated with poorer health outcomes.

AIM

The aim of this scoping review was to explore and map studies conducted on potentially inappropriate prescribing among adults living with diabetes and to identify gaps regarding identification and assessment of potentially inappropriate prescribing in this group.

METHOD

Studies that reported any type of potentially inappropriate prescribing were included. Studies conducted on people aged < 18 years or with a diagnosis of gestational diabetes or prediabetes were excluded. No restrictions to language, study design, publication status, geographic area, or clinical setting were applied in selecting the studies. Articles were systematically searched from 11 databases.

RESULTS

Of the 190 included studies, the majority (63.7%) were conducted in high-income countries. None of the studies used an explicit tool specifically designed to identify potentially inappropriate prescribing among people with diabetes. The most frequently studied potentially inappropriate prescribing in high-income countries was contraindication while in low- and middle-income countries prescribing omission was the most common. Software and websites were mostly used for identifying drug-drug interactions. The specific events and conditions that were considered as inappropriate were inconsistent across studies.

CONCLUSION

Contraindications, prescribing omissions and dosing problems were the most commonly studied types of potentially inappropriate prescribing. Prescribers should carefully consider the individual prescribing recommendations of medications. Future studies focusing on the development of explicit tools to identify potentially inappropriate prescribing for adults living with diabetes are needed.

Identifying Drug-Therapy Problems among Syrian Refugees in Zaatari Refugee Camp

Background: Due to a lack of proper pharmaceutical care, Syrian refugees in the Zaatari refugee camp are more likely to have drug-related issues, such as prescription errors and adverse drug occurrences. Aim: The current study aims to identify drug-therapy problems among Syrian refugees in the Zaatari refugee camp. Method: This is a retrospective cross-sectional study. Patients’ files were collected from the Zaatari camp database. Patients who were 18 years or older and were previously diagnosed with a chronic disease were included. A classification of drug therapy problems (DTPs) was adapted. Results: The data of 1530 adult patients (896 females) were collected. The mean age of the sample was 53.7 years and the mean Body mass Index (BMI) was 27.20. The mean of all taken medications was 4.01 (±2.33) medications, with a maximum number of 13. A total of 3572 DTPs was identified, with a mean of 2.33 (±1.26) DTPs per patient. Based on the above-mentioned classification, 70.32% of the DTPs were related to indication, 26.65% were related to effectiveness, and 3.03% were related to safety. Conclusion: This study found that refugees in the Zaatari refugee camp have numerous DTPs among their medications. Greater focus should be placed on their medical care, in order to prevent any future complications due to DTPs.

Drug-Related Hospital Admissions and Associated Factors among Adults Admitted to Felege Hiwot Comprehensive and Specialized Hospital, North West Ethiopia

Background

A drug-related problem (DRP) is an event involving drug therapy that actually or potentially interferes with the desired therapeutic outcome. Drug-related hospital admission (DRHA) is hospitalization due to one or more DRPs.

Objective

This study was aimed at assessing the prevalence of DRHA and factors associated with it among adults admitted to the internal medicine wards of Felege Hiwot Comprehensive Specialized Hospital.

Methods

A prospective cross-sectional study was conducted using a previously validated tool, AT-HARM 10. Data were collected by two clinical pharmacists from July 1 to September 15, 2020. The data were entered into EpiData software (version 4.2.0.0) and then transported to Statistical Package for Social Sciences (SPSS®) software (version 24) (IBM Corporation) for analysis. Descriptive statistics were presented using frequency and proportion. Binary logistic regression was applied to identify factors associated with DRHAs with a 95% confidence level, and significance was declared at a p value <0.05.

Results

The prevalence of DRHAs was 31.9% (95% CI = 27.7%–36.4%). From this, noncompliance (37.8%) (95% CI = 29.6–45.9), untreated indication (31.9%) (95% CI = 23.7–40), and adverse drug reaction (15.6%) (95% CI = 9.6–21.5) cause the majority of DRHAs. More than a quarter (28.8%) of all admissions were preventable. Most DRHAs were moderate (76.3) and preventable (80.7%). Lower to medium Charlson comorbidity index scores, longer duration of therapy, and not having health insurance were significantly associated with DRHAs.

Conclusion

The prevalence of DRHAs was considerably high. Noncompliance, untreated indications, and adverse drug reactions were the commonest DRPs that caused DRHAs. Lower to medium Charlson comorbidity index scores, longer duration of therapy, and not having health insurance were significantly contributing factors of DRHAs. Therefore, all healthcare providers should prevent, identify, and resolve DRPs to decrease DRHAs in the hospital.

"Childrens are not just "little adults". The rate of medication related problems and its predictors among patients admitted to pediatric ward of southwestern Ethiopian hospital: A prospective observational study

Background

The rate of medication related problems is high in developing countries due to the complexity of pediatrics medication management. Pediatric population should have their own dosage regimens. The pediatric dosage regimens were derived from the adult dose that might lead to sudden reach of sub or supra-therapeutic doses. As the result, the medication therapy management is difficult in this populations. Despite this, a scanty of studies were conducted on medication related problems among pediatric populations. Therefore, this study examined the prevalence and risk factors for the occurrence of the medication related problems among patients admitted to pediatric ward of Mettu karl referral hospital.

Patients and methods

The pediatric population who were received the pharmacotherapy for their disease was observed and followed for the occurrences of medication related problems at pediatric wards of Mettu karl referral hospital from February 12, 2020 to February 24, 2021. Patients whose age was less than or equal to 18 years and who were on drug therapy or who needs drug therapy during study period were included. The possibility of adverse drug reactions developed from the drug was assessed by using the Naranjo scale. Multivariable logistic regression analysis was used to determine the predictors of medication related problems.

Result

Over the study period, a total of 189 pediatric populations were included. Among these, 115 (60.8%) were males, and the mean age of the patients was 1.4339 ± 0.864 years. The mediciation related problems was found among 121(64.01%) of pediatric patients. Among seven types of drug therapy problems unnecessary drug therapy, need additional drug therapy, ineffective drug therapy and dose too high were the most predominantly occured DRP that accounted 74 (27.72%), 67 (25.09%), 43 (16.10%), 36 (13.48%), respectively. The mean number of hospital stay was 4.29 days with minimum and maximum stay of 2 and 9 days and antibiotics 364(51.3%) were the most common class of drugs that was associated with drug related problems. Being a neonate (AOR = 1.48, 95CI%: 1.69–7.42, P = <0.001), hospital stay greater than or equal to seven days (AOR = 1.98, 95CI%: 2.471–12.644, P = 0.016), and the presence of co-morbidity(AOR = 2.507, 95CI%: 3.270–4.949, P = 0.080) were the predictors of the medication related problems.

Conclusion

The prevalence of medication-related problems in pediatrics patient was found to be high. Being neonatal, prolonged hospital stay and the presence of a multiple disease were the predictors of medication-related problems in pediatric patients. Therefore special attention should be given for newborns, prolonged hospital stay and patients having co-morbidity. Besides this, the drug information service and the patients round activity should be started by clinical pharmacist to decrease the occurences of any preventable medication related problems.

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DRP is the problem that interferes with a patient's pharmacotherapy that results in poor treatment outcomes.

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The rate of medication related problems in developing countries is high.

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“Children are not just “little adults” in which they should have their own pharmacokinetic and pharmacodynamics profile.

Development and validation of explicit criteria to identify potentially inappropriate prescribing for adults with type 2 diabetes mellitus

BACKGROUND

Early detection and timely resolution of potentially inappropriate prescribing (PIP) prevents adverse outcomes and improves patient care. An explicit tool specifically designed to detect PIP among people with Type 2 Diabetes Mellitus (T2DM) has not been published.

OBJECTIVES

This study aims to develop and validate the Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus (IMPACT2DM); an explicit tool that can be used to identify PIP for adults with T2DM.

METHODS

Current national and international guidelines for the management of T2DM and drug information software programs were used to generate potential items. The content of the IMPACT2DM was validated by 2 consecutive rounds of Delphi method. Physicians and clinical pharmacists experienced in providing care for people with diabetes and authors of selected diabetes guidelines were invited to participate in the Delphi panel. Consensus was assumed if 90% (first round) and 85% (second round) of expert panelists showed agreement to include or exclude an item.

RESULTS

A total of 95 potential items were generated from selected diabetes guidelines and drug information software programs. After the first Delphi round 27 items had ≥90% agreement and were included in the tool; 19 items were considered not PIP and were excluded from the tool. The second round contained 49 items; of these 43 were included and 6 were excluded from the tool. The final IMPACT2DM contains 70 items categorized by type of PIP and arranged in terms of medical conditions and medication classes. IMPACT2DM can be applied using information on medical charts and requires minimal or no clinical knowledge to assess quality of diabetes care and improve medication selection.

CONCLUSIONS

IMPACT2DM has been developed from current quality evidence and undergone content validation. It is the first explicit tool specifically designed to identify PIP for adults with T2DM.

Identification and resolution of drug-related problems among diabetic patients attending a referral hospital: a prospective observational study

BACKGROUND

People living with diabetes are more vulnerable to drug-related problems due to the presence of multiple diseases. This study aimed to identify drug-related problems and contributing factors among diabetic patients.

METHODS

This study used a prospective observational study design. The study was conducted among diabetic patients during follow-up at Mettu Karl Referral Hospital from 15 April to 09 August 2019. The consecutive sampling was utilized to collect data. The identification of drug-related problems was performed using the Pharmaceutical Care Network Europe version 8.03. Following data collection, data were entered into Epidata manager version 4.4.2 and exported to the SPSS version 24.0 for analysis. Multivariable logistic regression analysis was done to identify predictors of drug-related problems.

RESULTS

A total of 330 people with diabetes were included in the study, among whom 279 (84.5%) had at least one drug-related problem. A total of 455 drug-related problems were identified. Effects of drug treatment not being optimal (52.7%) and untreated symptoms or indications (30.1%) were the most commonly identified drug-related problems. About 865 interventions were provided for identified drug-related problems and 79.8% was accepted. Diabetes duration [Formula: see text] years [AOR = 2.02; 95% CI (1.06, 3.85); p = 0.033] and the presence of comorbidity [AOR: 2.33; 95% CI (1.18, 4.60); p = 0.015] were factors identified as predictors of drug-related problems.

CONCLUSION

The present study identified that drug-related problems are common among diabetic patients. Effects of drug treatment not being optimal and untreated symptoms or indications were the most commonly identified drug-related problems. Longer diabetes duration and the presence of comorbidities were predictors of drug-related problems.

Drug-related problems and associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Drug-related problems (DRPs) can occur at any stages of medication use processes, and a single drug could be associated with multiple DRPs. Once happened, it adversely affects health outcomes. In Ethiopia, evaluation of the magnitude and factors associated with DRPs had not been attempted at the national level.

METHOD

The literature search was conducted in the following databases; PubMed, Embase, Medline, and Google Scholar. The quality of the included studies was checked using Joanna Brigg's Institute (JBI's) checklist, and data were analyzed using Stata software (version 14.0). The pooled estimate of DRPs was computed by a Random effect model (DerSimonian-Laird method). Cochran's Q test (I²) statistic)), and Begg's correlation and Egger's regression test were assessed for heterogeneity and publication bias, respectively.

RESULT

Overall, 32 studies with a total sample size of 7,129 were included in the review. The estimated pooled prevalence of DRPs was 70% [0.70 (95% CI 0.64-0.76; I² = 97.6% p = 0.000)]. Polypharmacy (taking ≥ 5 drugs) [RR = 1.3], medical comorbidity [RR = 1.3], poor medication adherence [RR = 1.7], uncontrolled blood pressure [RR = 1.4], substance use [RR = 1.2], type 2 diabetes [RR = 1.8], significant drug interaction [RR = 1.33], and a negative medication belief [RR = 3.72] significantly influenced the occurrence of DRPs.

CONCLUSION

The estimated national prevalence of DRPs in Ethiopia was high. Presence of medical comorbidity, using multiple drugs, significant drug interaction, poor medication adherence, uncontrolled blood pressure, type 2 diabetes, substance use and a negative belief about medication significantly influenced the occurrence of DRPs. Initiating and/or strengthening pharmaceutical care services at the health care facilities could lower the occurrence of DRPs. PROSPERO registration number CRD42020162329.

Drug-related problems in Ethiopian public healthcare settings: Systematic review and meta-analysis

Identification and prevention of drug-related problems have become the central role of patient-centered pharmacy practitioners. After the initiation of patient-oriented pharmacy service, many studies evaluating magnitude of drug-related problems at facility level in Ethiopia have been conducted, though the extent of the problem at a national level remains unknown. Hence, this systematic review and meta-analysis is undertaken with the aim of quantifying the prevalence of drug-related problems in Ethiopian public healthcare settings using Cipolle/Strand classification system. Electronic databases were searched including PubMed, EMBASE, Web of Science, MEDLINE and HINARI, Google Scholar and ResearchGate for both published and unpublished works. Data on study characteristics and outcomes were extracted using the format developed on Microsoft Excel. The primary measure was the pooled prevalence of drug-related problems. The meta-analysis was conducted using OpenMeta[Analyst].A total of 17 studies were included in this systematic review and meta-analysis. The pooled prevalence of drug-related problems of patients who experienced at least one drug-related problem during their therapy was found to be 69.4% (95% confidence interval: 61.5-77.4). The most frequently reported types of drug-related problems were "need for additional drug and "noncompliance," together accounting for more than half of the drug-related problems. The most frequently reported factors associated with drug-related problems were patients' age, polypharmacy, comorbidities and the number days of hospital stay.The prevalence of drug-related problems in Ethiopian public healthcare settings was found to be high. Inconsistent reporting of drug-related problems was observed across the studies. It is imperative to design and implement interventions aimed at reducing drug-related problems. Responsible stakeholders should adopt uniform drug-related problem classification approach to ensure uniform reporting of drug-related problems in Ethiopian healthcare settings.

Magnitude and determinants of drug-related problems among patients admitted to medical wards of southwestern Ethiopian hospitals: A multicenter prospective observational study

BACKGROUND

Drug-related problem (DRP) is an event involving drugs that can impact the patient's desired goal of therapy. In hospitalized patients, DRPs happen during the whole process of drug use such as during prescription, dispensing, administration, and follow-up of their treatment. Unrecognized and unresolved DRPs lead to significant drug-related morbidity and mortality. Several studies conducted in different hospitals and countries showed a high incidence of DRPs among hospitalized patients. Despite the available gaps, there were scanties of studies conducted on DRPs among patients admitted to medical wards in Ethiopia. Therefore, this study assessed the magnitude of drug-related problems and associated factors among patients admitted to the medical wards of selected Southwestern Ethiopian hospitals.

PATIENTS AND METHODS

A multicenter prospective observational study was conducted at medical wards of Mettu Karl Hospital, Bedele General Hospital and Darimu General Hospital. Adult patients greater than 18 years who were admitted to the non-intensive care unit (ICU) of medical wards and with more than 48 h of length of stay were included. Identified DRPs were recorded and classified using the pharmaceutical care network Europe foundation classification system and adverse drug reaction was assessed using the Naranjo algorithm of adverse drug reaction probability scale. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. Multivariable logistic regression was used to analyze the associations between the dependent variable and independent variables.

RESULT

Of the 313 study participants, 178 (56.9%) were males. The prevalence of actual or potential DRPs among study participants taking at least a single drug was 212 (67.7%). About 125 (36.63%) patients had one or more co-morbid disease and the average duration of hospital stay of 7.14 ± 4.731 days. A total of 331 DRPs were identified with an average 1.06 DRP per patient. The three-leading categories of DRPs were unnecessary prescription of drugs 92 (27.79%), non-adherence (17.22%) and dose too high (16.92%). The most common drugs associated with DRPs were ceftriaxone (28.37%), cimetidine (14.88%), and diclofenac (14.42%). The area of residence (AOR = 2.550, 95CI%: 1.238-5.253, p = 0.011), hospital stay more than 7 days (AOR = 9.785, 95CI%: 4.668-20.511, p≤0.001), poly pharmacy (AOR = 3.229, 95CI%: 1.433-7.278, p = 0.005) were predictors of drug-related problem in multivariable logistic regression analysis.

CONCLUSION

The magnitude of drug therapy problems among patients admitted to the medical wards of study settings was found to be high. Therefore, the clinical pharmacy services should be established in hospitals to tackle the DTPs in this area. Additionally, healthcare providers of hospitals also should create awareness for patients seeking care from health facilities of the importance of rational drug usage.

Magnitude and determinants of drug therapy problems among type 2 diabetes mellitus patients with hypertension in Ethiopia

Introduction

Type 2 diabetes mellitus patients with hypertension are at high risk of drug therapy problems since they are subject to receive multiple drug therapies due to comorbidities.

Objectives

To determine the magnitude of drug therapy problems and its determinants among Type 2 diabetes mellitus patients with hypertension.

Methods

A cross-sectional study was employed among 423 randomly selected participants based on the inclusion criteria. A structured questionnaire and review of patients' medical record were employed in the data collection. The classification system used by Cipolle was used to classify and evaluate drug therapy problems. Data were analyzed using Statistical Package for the social sciences version 25.0 software. Multivariate logistic regression analysis was used to identify determinants of drug therapy problems with a statistical significance of p ⩽ 0.05.

Results

A total of 491 drug therapy problems with a mean of 1.86 ± 0.53 drug therapy problems per patient were identified, and 62.4% (264) of them experienced at least one drug therapy problem. Non-compliance (197, 40.1%), needs of additional drug therapy (119, 24.2%), and dosage too low (91, 18.5%) were the most frequently observed drug therapy problems in the study setting. Anti-diabetic medications (88.4%), statins (44.5%), and aspirin (33.5%) were the most commonly involved drugs in drug therapy problems. The determinants of drug therapy problems were very low family income (adjusted odds ratio = 4.64, p = 0.010), age (45-65 years old) (adjusted odds ratio = 2.55, p = 0.008), presence of comorbidity (adjusted odds ratio = 9.19, p < 0.001), and taking ⩾5 medications (adjusted odds ratio = 2.84, p = 0.001).

Conclusion

Approximately three out of five patients had one or more drug therapy problems encountered. In this study, the most common types of drug therapy problems were non-compliance, needs additional drug therapy, and dosage too low. Family monthly income, age, comorbidities, and number of medications were the significant determinants of drug therapy problems. Therefore, patient education regarding medication adherence, routine medication review, and strengthening clinical pharmacy services should be promoted.

Medication-related problems and adverse drug reactions in Ethiopia: A systematic review

Medication-related problems (MRPs) are an important healthcare problem. This study aimed at reviewing the published literature in Ethiopia to estimate the prevalence of MRPs and to summarize associated factors. A comprehensive systematic search was conducted in PubMed, EMBASE, CINAHL, Scopus, Google Scholar, and Google databases from inception to April 2020. Articles that addressed MRPs were eligible for inclusion. Article screening, data extraction, and study quality analysis were performed independently by two reviewers. Studies targeting specific disease condition were considered as specific, while the remaining were nonspecific. The prevalence of MRPs was then computed in medians and interquartile ranges (IQR), while associated factors were summarized in a table. Of the thirty-two studies included in this review, the majority of them (n = 24) targeted MRPs, while the remaining studies (n = 8) investigated adverse drug reactions (ADRs). Studies varied in the study design, study population, and definition of MRPs and ADRs used. The overall median prevalence was 70.8% (IQR = 61.0-80.2) with a range of 16.0% to 88.7%. The median prevalence of MRPs in specific and nonspecific patients was 71.2% (IQR = 60.7-71.2) and 69.3% (IQR = 60.7-82.0), respectively. In addition, a median of 36.6% (IQR = 10.0-85.7) of patients experienced ADRs. Indication-related and effectiveness-related MRPs were commonly reported in both specific and nonspecific patients, while noncompliance MRPs were more prevalent among specific patients than nonspecific patients. Increasing age, presence of co-morbidity, and an increasing number of drugs were the commonly identified contributing factors of MRPs. The review showed that more than two-thirds of the study participants developed MRPs. Hence, an integrated approach should be designed to improve the optimal use of pharmacotherapy to reduce the burden of MRPs. Further, future research should be undertaken to prepare cost-effective and efficient prevention mechanisms to reduce or halt the development of MRPs.

Assessment of Drug Therapy Problems Among Type 2 Diabetes Patients with Hypertension Comorbidity in Indonesia

Type 2 diabetes mellitus (T2DM) is a major chronic disease that affects a large number of people worldwide. Hypertension is a common disease comorbidity among T2DM patients, and often those patients received polypharmacy and complex treatment in long term duration. This condition may lead to an increased risk of drug therapy problems (DTPs). This study aimed to assess and determine potential drug therapy problems in type 2 diabetic patients with hypertension comorbidity. Retrospective cross-sectional design was conducted in a hospital setting, especially data sources from the prescription of ambulatory T2DM patients with hypertension. A total of 190 patients were studied. More than half of the participants were female (53.68%). The majority age range of participants was 50-59 years (46.84%). Almost all antidiabetic agents were prescribed as polypharmacy (73.16%). Metformin was the most antidiabetic agent prescribed as monotherapy and combination therapy (63.16%). Almost all antihypertensive agents were prescribed as polypharmacy (63.26%). Amlodipine was the most antihypertensive agent prescribed as monotherapy and combination therapy (34.74%). Among the study participants, 56.84% have at least one of DTPs. Adverse drug reaction was the most frequent (47.22%), followed by ineffective drug therapy (29.63%). Since the potential of DTPs in T2DM patients with hypertension comorbidity is relatively high, early identifying, resolving, and preventing drug therapy problems by the pharmacist is needed to achieve goals of treatment.

Potentially inappropriate prescribing for adults with diabetes mellitus: a scoping review protocol

OBJECTIVE

This scoping review aims to explore and map studies investigating potentially inappropriate prescribing (PIP) for adults with diabetes mellitus.

INTRODUCTION

Inappropriate prescribing for people with diabetes mellitus has been reported by various authors focusing on different aspects of inappropriateness. A preliminary search revealed no published reviews on PIP for adults with diabetes mellitus. As a result, it is difficult to obtain a comprehensive map of PIP in this patient group.

INCLUSION CRITERIA

This scoping review will consider all studies on PIP for adults with the diagnosis of type 1 or type 2 diabetes mellitus from any clinical setting. Studies conducted in pediatric populations or in adults with pre-diabetes or gestational diabetes will be excluded.

METHODS

A three-step search strategy (i.e. an initial limited search in PubMed and ProQuest Central databases, a main search of eight databases and gray literature, and manual searches of reference lists of included articles) will be utilized. No language restrictions will be applied. All retrieved articles will be screened against the inclusion/exclusion criteria at title, abstract, and full-text stages. Data to be extracted from each study will include, but not be limited to, country, objective, study population, study methodology, type of PIP studied, examples of PIP events, medications involved, and criteria used for PIP identification. Data will be extracted by study team members using an online application for conducting systematic synthesis of evidence.

Drug-Related Problems and Their Predictors Among Patients with Diabetes Attending the Ambulatory Clinic of Gebre Tsadik Shawo General Hospital, Southwest Ethiopia

BACKGROUND

Patients with diabetes are vulnerable to experiencing drug-related problems. Thus, this study aimed to assess drug-related problems and their predictors among patients with diabetes attending the ambulatory clinic of Gebre Tsadik Shawo General Hospital.

METHODS

A cross-sectional study was conducted from September 1, 2019 to November 30, 2019. Drug-related problems were identified using the Pharmaceutical Care Network Europe version 5.01. Patient's written informed consent was obtained after explaining the purpose of the study. The data were collected using structured questionnaires and entered into Epi data version 4.0.2. Then, it was exported to SPSS version 21.0 for analysis. To identify predictors of the occurrence of drug-related problems, multiple stepwise backward logistic regression analysis was done. For the accuracy of data analysis, a 95% confidence interval was used, and statistical significance was considered at p-values <0.05.

RESULTS

From a total of 141 patients with diabetes included in the study, 58.2% of them had at least one drug-related problem during the 3-month study period. A total of 156 drug-related problems were identified in 141 patients. Drug interactions (30.76%) and drug choice problems (25%) were the most common type of drug-related problems identified. Presence of disease comorbidity (AOR=4.12, 95% CI=1.71-9.91), poly-pharmacy (AOR=6.27, 95% CI=1.67-23.52) and more than 5 years diabetes duration (AOR=3.89, 95% CI=1.52-9.95) were independent predictors of drug-related problems.

CONCLUSION

Drug-related problems were high among patients with diabetes in the study setting. Early detection of drug-related problems ensures the appropriateness of drug therapy. Therefore, a sustainable pharmaceutical care service is needed for early identification, prevention and resolution of drug-related problems.

Critical evaluation of the validity of drug promotion materials in Ethiopia

PURPOSE

This study was conducted to evaluate the validity of drug promotion materials (DPMs) in Ethiopia.

METHODS

A cross sectional document review was done. DPMs were evaluated for fulfilment of the World Health Organization's (WHO) criteria for ethical promotion of drugs. They were also evaluated for font size, type of formulation, claims made, pictures depicted, retrievability and source of references used.

RESULTS

A total of 235 DPMs were collected from the community and hospital pharmacies. Documents promoting devices and equipment, orthopedic appliances, reminder cards and drug lists were excluded, leaving 173 promotional materials. Antimicrobials were the most promoted drugs (27.2%) followed by respiratory drugs (11.0%) and gastrointestinal drugs (9.8%). Brand name was written in all of the DPMs while approved generic names, indication and active ingredient per dosage form were written in 94.8%, 92.5% and 62.4% respectively. Side effects and contraindications were written in 27.2% and 18.5% of the DPMs. A total of 223 claims were made. Efficacy was the dominant claim (62.3%) followed by safety (8.5%). Pictorial demonstrations were used in 84.4% of the DPMs. Almost half of the pictures depicted, 47.3%, were the cover of the drug products. Only 48.6% of the DPMs has supported their claims with references. Review articles account for 23.3% of the references. Only 5.8% of the journal articles were published after the year 2013.

CONCLUSION

We conclude that the design and content of studied drug promotional materials are most effective as sales materials rather than thorough informational vehicles. The WHO and Food, Medicine and Health Care Administration and Control Authority of Ethiopia recommendations are rarely met.

Diabetic retinopathy in Ethiopia: A systematic review and meta-analysis

AIMS

this systemic review and meta-analysis was aimed at determining the level of diabetic retinopathy among diabetes mellitus patients in Ethiopia.

MATERIALS AND METHODS

PubMed, Science Direct, Google Scholar and Excerpta Medica Database (EMBASE) were searched. The data were extracted using Microsoft Excel and analyzed by using STATA version 11. Publication bias was checked by funnel plot and more objectively through Egger's regression test, with P < 0.05 considered to indicate potential publication bias. Heterogeneity of studies was checked using the I² test. Pooled analysis was conducted. Subgroup analysis was done by region. Sensitivity analysis was employed to see the effect of single study on the overall estimation. STATA version 11 statistical software was used for meta-analysis.

RESULTS

The overall prevalence of retinopathy was 19.48% (95% CI: 15.95, 23.01) Based on the subgroup analysis the prevalence of retinopathy was 12.48% in SNNPR, 24.8% in Oromia, 19.99% in Amhara, and 16.29% in Addis Ababa.

CONCLUSION

The prevalence of diabetic retinopathy among Diabetes mellitus patients is high. Therefore, close monitoring of the patient prognosis and appropriate prevention techniques is essential.