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Kassaw AT, Sendekie AK, Minyihun A, Gebresillassie BM. Medication regimen complexity and its impact on medication adherence in patients with multimorbidity at a comprehensive specialized hospital in Ethiopia. Front Med (Lausanne) 2024; 11:1369569. [PMID: 38860203 PMCID: PMC11163062 DOI: 10.3389/fmed.2024.1369569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
Background Medication regimen complexity (MRC) is suspected to hinder medication adherence in patients with multiple illnesses. Despite this, the specific impact on Ethiopian patients with multimorbidity is unclear. This study assessed MRC and its impact on medication adherence in patients with multimorbidity. Methods A hospital-based cross-sectional study was conducted on patients with multimorbidity who had been followed at the University of Gondar Comprehensive and Specialized Hospital (UoGCSH), Ethiopia, from May to July 2021. Medication complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and the Adherence in Chronic Diseases Scale (ACDS) was used to measure medication adherence. Pearson's chi-square test was used to examine associations between MRCI levels and medication adherence. Ordinal logistic regression analysis was used to determine the impact of MRC and other associated variables on medication adherence. Statistical significance was determined using the adjusted odds ratio (AOR) at p-value <0.05 and its 95% confidence range. Results Out of 422 eligible patients, 416 (98.6%) were included in the study. The majority of participants (57.2%) were classified as having a high MRCI score with a mean (±SD) score of 9.7 (±3.4). Nearly half of the patients (49.3%) had low medication adherence. Patients with medium (AOR = 0.43, 95% CI: 0.04, 0.72) and higher (AOR = 0.31, 95% CI: 0.07, 0.79) MRCI levels had lower odds of medication adherence. In addition, monthly income (AOR = 4.59, 95% CI: 2.14, 9.83), follow-up durations (AOR = 2.31, 95% CI: 1.09, 4.86), number of medications (AOR = 0.63, 95% CI: 0.41, 0.97), and Charlson comorbidity index (CCI) (AOR = 0.36, 95% CI: 0.16, 0.83) were significantly associated with medication adherence. Conclusion Medication regimen complexity in patients with multimorbidity was found to be high and negatively impacted the levels of medication adherence. Healthcare providers and other stakeholders should seek interventions aimed at simplifying drug regimen complexity and improving adherence.
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Affiliation(s)
- Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Minyihun
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
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Alsultan MM, Alamer R, Alammar F, Alzlaiq W, Alahmari AK, Almalki ZS, Alqarni F, Alshayban DM, Alotaibi FM, Asiri IM, Alsultan F, Kurdi SM, Almalki BA. Prevalence of polypharmacy in heart failure patients: A retrospective cross-sectional study in a tertiary hospital in Saudi Arabia. Saudi Pharm J 2023; 31:101875. [PMID: 38046462 PMCID: PMC10689949 DOI: 10.1016/j.jsps.2023.101875] [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: 10/10/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
Background Cardiovascular disease is the leading cause of death and disability worldwide. It is a general term used to describe a group of disorders that affect the heart or blood vessels. This study aimed to evaluate the prevalence and predictors of polypharmacy in patients with heart failure. Methods We conducted a cross-sectional study in a tertiary hospital in Saudi Arabia. Data was extracted from an electronic database between January 2019, and December 2022. The study included all adult patients with heart failure who visited outpatient clinics; individuals with cancer were excluded. The outcome variable in our study was "polypharmacy" which was defined as the use of eight or more medications. Descriptive analysis was performed using frequencies and percentages for categorical variables. In addition, Multivariate logistic regression was used to assess the covariates associated with polypharmacy. Results A total of 331 patients with heart failure were included in this study. The prevalence of polypharmacy among our HF population was 39.88 %. Most participants were male (60.73 %), and 60 years or older (68 %). The most frequently used medications were beta-blockers (67.98 %) and diuretics (58.31 %), whereas the least frequently used medications were hydralazine and histamine H2 blockers (5.74, and 3.02 %, respectively). Polypharmacy was likely to be a non-significantly higher in individuals aged between 60 and 69 years (adjusted odds ratio (AOR) = 1.52; 95 % confidence interval (CI) 0.78-2.98) and suffering from hypertension (AOR = 1.48; 95 % CI 0.83-2.64). However, patients with heart failure and diabetes mellitus had a significant six-fold higher of polypharmacy than those without diabetes mellitus (AOR = 6.55; 95 % CI 3.71-11.56). Conclusion Patients with heart failure often use multiple medications. Patients with heart failure together with diabetes have a higher risk of polypharmacy. Therefore, healthcare professionals should manage polypharmacy to improve the outcomes in patients with heart failure.
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Affiliation(s)
- Mohammed M. Alsultan
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Rabab Alamer
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Fatimah Alammar
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Wafa Alzlaiq
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abdullah K. Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Faisal Alqarni
- Department of Pharmacy, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Dhfer M. Alshayban
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Fawaz M. Alotaibi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ibrahim M. Asiri
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Fahad Alsultan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sawsan M. Kurdi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Bassem A. Almalki
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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Gebreyohannes EA, Gebresillassie BM, Mulugeta F, Dessu E, Abebe TB. Treatment burden and health-related quality of life of patients with multimorbidity: a cross-sectional study. Qual Life Res 2023; 32:3269-3277. [PMID: 37405663 PMCID: PMC10522511 DOI: 10.1007/s11136-023-03473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE The aim of this study was to investigate treatment burden and its relationship with health-related quality of life (HRQoL) among patients with multimorbidity (two or more chronic diseases) who were taking prescription medications and attending the outpatient department of the University of Gondar Comprehensive Specialized Teaching Hospital. METHODS A cross-sectional study was conducted between March 2019 and July 2019. Treatment burden was measured using the Multimorbidity Treatment Burden Questionnaire (MTBQ), while HRQoL was captured using the Euroqol-5-dimensions-5-Levels (EQ-5D-5L). RESULTS A total of 423 patients participated in the study. The mean global MTBQ, EQ-5D index, and EQ-VAS scores were 39.35 (± 22.16), 0.83 (± 0.20), and 67.32 (± 18.51), respectively. Significant differences were observed in the mean EQ-5D-Index (F [2, 81.88] 33.1) and EQ-VAS (visual analogue scale) scores (F [2, 75.48] = 72.87) among the treatment burden groups. Follow up post-hoc analyses demonstrated significant mean differences in EQ-VAS scores across the treatment burden groups and in EQ-5D index between the no/low treatment burden and high treatment burden, as well as between the medium treatment burden and high treatment burden. In the multivariate linear regression model, every one SD increase in the global MTBQ score (i.e., 22.16) was associated with a decline of 0.08 in the EQ-5D index (β - 0.38, 95%CI - 0.48, - 0.28), as well as a reduction of 9.4 in the EQ-VAS score (β - 0.51, 95%CI -0.60, - 0.42). CONCLUSION Treatment burden was inversely associated with HRQoL. Health care providers should be conscious in balancing treatment exposure with patients' HRQoL.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia.
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, WA, Australia.
- Geospatial Health and Development, Telethon Kids Institute, Perth, WA, Australia.
| | | | - Frehiwot Mulugeta
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Etsegenet Dessu
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Tamrat Befekadu Abebe
- Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Clayton, VIC, Australia
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Kitaw TA, Haile RN. Prevalence of polypharmacy among older adults in Ethiopia: a systematic review and meta-analysis. Sci Rep 2023; 13:17641. [PMID: 37848565 PMCID: PMC10582100 DOI: 10.1038/s41598-023-45095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 10/16/2023] [Indexed: 10/19/2023] Open
Abstract
Polypharmacy is a significant concern for older adults. Taking multiple medicines to prevent and treat comorbidities is very common in older adults, potentially leading to polypharmacy. Polypharmacy is associated with the development of geriatric syndromes, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. The prevalence of polypharmacy varies according to the literature. There is a paucity of data regarding the prevalence of polypharmacy among older adults. Therefore, this study aimed to estimate the pooled prevalence of polypharmacy among older adults in Ethiopia. A comprehensive search of databases, including PubMed, MEDLINE, EMBASE, Hinari, Cumulative Index to Nursing and Allied Health Literature, International Scientific Indexing, Cochrane library and Web of Science, and Google Scholar, was conducted. STATA statistical software (version 17) was used to analyze the data. Forest plot and I2 heterogeneity test were computed to examine the existence of heterogeneity. Subgroup analysis and sensitivity analysis were done to explore the source of heterogeneity. Publication bias was evaluated by using funnel plots and Egger's test. A random effect model was used to determine the pooled prevalence of polypharmacy. After reviewing 123 studies, 13 studies with a total of 3547 older adults fulfilled the inclusion criteria and were included in this meta-analysis. The result from 13 studies revealed that the pooled prevalence of polypharmacy among older adults in Ethiopia was 37.10% (95CI: 28.28-45.91). A Subgroup Meta-analysis showed that the heterogeneity level was slightly lower among studies done in Oromia region (I2 = 46.62, P-value = 0.154). Higher pooled polypharmacy prevalence was found among older adults with cardiovascular disorders (42.7%) and admitted patients (51.4%). In general, it was found that the pooled prevalence of polypharmacy among older adults in Ethiopia was high. More than one in three older adults take five or more medications at a time. Thus, intervention focusing on rational geriatric pharmacotherapy is significant to prevent unnecessary pill burden, adverse drug events, medical costs, geriatric morbidity, and mortality. Furthermore, enhancing pharmacist roles towards medication therapy management and safety monitoring in older adults is also indicated.
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Affiliation(s)
- Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Ribka Nigatu Haile
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Brimavandi M, Abbasi P, Khaledi‐Paveh B, Salari N. Examining the relationship between depression and medication adherence among elderlies suffering from cardiovascular disease referring to the clinics affiliated with Kermanshah University of Medical Sciences: A cross-sectional study. Health Sci Rep 2023; 6:e1503. [PMID: 37599664 PMCID: PMC10435705 DOI: 10.1002/hsr2.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background In recent years, around 30% of all mortalities worldwide has been related to cardiovascular disease (CVD). The most important predictor solution of cardiovascular events is enhancing medication adherence. Meanwhile, the main reason behind development of physical disorders among the elderly is depression. In this regard, the present research was performed to determine the relationship between depression and medication adherence among the elderly suffering from CVD. Methods A cross-sectional study was done via an analytical approach on 188 elderlies fulfilling the inclusion criteria. The participants were chosen through convenience nonrandomized sampling from March to July 2022. The data were collected through demographic and healthcare information form plus Madanloo chronic disease medication adherence and geriatric depression scale. The analysis of the data was done by SPSS 26 plus Stata 14.2. Results The mean depression score was 5.6(4.3) and the mean score of medication adherence in the elderlies was 168.03(23.85). The prevalence of depression was higher in women than in men (p = 0.015), and the elderlies differing from heart failure reported the minimum extent of medication adherence. The findings obtained from analysis of variance showed that age, level of education, and monthly level of income were among the effective demographic factors in the extent of depression and medication adherence (p < 0.05). Meanwhile, 26% of changes in medication adherence can be attributed to depression. Further, the results of the multiple linear regression model reported that depression, age, and polypharmacy are among the predictors of medication adherence. Discussion and Conclusion A weak to moderate relationship existed between depression and medication adherence among these elderlies. Given the growing elderly population, the importance of depression, and lack of medication adherence in incidence of CVD events, it is recommended to train the healthcare team to monitor the elderly regarding depression symptoms.
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Affiliation(s)
- Mina Brimavandi
- Department of Nursing, Student Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Parvin Abbasi
- Department of Nursing, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
| | - Behnam Khaledi‐Paveh
- Department of Psychiatry Nursing, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
| | - Nader Salari
- Department of Biostatics, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
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El-Dahiyat F, Jairoun AA, Al-Hemyari SS, Shahwan M, Hassan N, Jairoun S, Jaber AAS. Are pharmacists' knowledge and practice the key to promoting deprescribing of potentially inappropriate medication: a missing link between treatment and outcomes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023:7146786. [PMID: 37116892 DOI: 10.1093/ijpp/riad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/13/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES Deprescribing is a novel strategy whereby medical professionals aim to optimize a patient's prescription program by removing redundant medications. Few studies have looked at the viewpoints of community pharmacists and other healthcare professionals on deprescribing in daily practice. This study's objectives included evaluating community pharmacists' deprescribing knowledge, attitudes and practices, as well as identifying the obstacles to and enablers of deprescribing in daily practice. METHODS Five pharmacy students in the last year of their studies polled employees of neighbourhood pharmacies in Abu Dhabi, Dubai, and the Northern Emirates from April 2022 to July 2022. The study's questionnaire was divided into two sections: questions that inquired about the respondents' demographic data and questions that evaluated the respondents' understanding and usage of the deprescribing of potentially harmful medications for patients. The original Bloom's cutoff points were revised and modified to assess the general knowledge and deprescribing practices of United Arab Emirates (UAE) community pharmacists. Multivariate logistic regression identified the variables influencing respondents' deprescribing knowledge and practice. KEY FINDINGS The average age of the participants was 30.8 ± 6.4 SD. Of the total, 255 (37.7%) were male and 422 (62.3%) were female. Pharmacists from independent pharmacies constituted 52.9% of the study sample and 47.1% were from Chain pharmacies. Among the participants, 58.8% (n = 398) had 1-5 years of experience and 41.2% (n = 279) had more than 5 years. Nearly three-quarters of the pharmacists (72.1%, 488) graduated from local universities and 27.9% (n = 189) graduated from regional/international universities. The vast majority of the study sample (84.8%, 574) were bachelor's degree holders and 88.3% (n = 598) were pharmacists in charge. Of the total, 69.3% (n = 469) received deprescribing training to treat patients with multimorbid diseases. The knowledge and practice score was 71.3% with a 95% confidence interval [70.2%, 72.4%]. Of the total participants, 113 (16.7%) had poor knowledge and practice about deprescribing, 393 (58.1%) had moderate knowledge and practice and 171 (25.3%) had good knowledge and practice. CONCLUSION This study highlights the level of understanding of community pharmacists about deprescribing in the UAE. Although most of the respondents in this study received training on deprescribing, less than half of the community pharmacists were unaware of certain classes (long-acting sulfonylureas, anti-diabetic, antihyperlipidemic and psychotropic drugs) of drugs that are candidates for potential deprescribing. This finding indicates that their knowledge about deprescribing was insufficient. Several barriers community pharmacists face in deprescribing were also identified, with patients' resistance and insufficience being the most prevalent. Therefore, there is a need for improved deprescribing practices to ensure drug safety.
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Affiliation(s)
- Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, UAE
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, UAE
| | - Ammar Abdulrahman Jairoun
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
- Health and Safety Department, Dubai Municipality, Dubai, UAE
| | - Sabaa Saleh Al-Hemyari
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, UAE
| | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, UAE
| | - Nageeb Hassan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, UAE
| | - Sumaya Jairoun
- Pharmacy Department, Valiant Hospital, Dubai, UAE
- Department of Clinical Pharmacy & Pharmacotherapeutics, Dubai Pharmacy College for Girls, Al mizhar Dubai, UAE
| | - Ammar Ali Saleh Jaber
- Department of Clinical Pharmacy & Pharmacotherapeutics, Dubai Pharmacy College for Girls, Al mizhar Dubai, UAE
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Mohsenzadeh P, Ardekani A, Poustchi H, Mohammadi Z, Abdipour Mehrian SR, Bazrafshan Drissi H, Rahimian Z, Taherifard E, Nabavizadeh A, Kamalipour A, Mesgarpour B, Malekzadeh F, Molavi Vardanjani H. Population-based pattern of medication use and prevalence of polypharmacy among patients with cardiovascular diseases: results of the Pars cohort study from Iran. BMC Cardiovasc Disord 2022; 22:435. [PMID: 36203125 PMCID: PMC9536013 DOI: 10.1186/s12872-022-02872-7] [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: 07/21/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Polypharmacy in patients with cardiovascular diseases (CVDs) has been linked to several adverse outcomes. This study aimed to investigate the pattern of medication use and prevalence of polypharmacy among CVDs patients in Iran.
Method We used the baseline data of the Pars cohort study (PCS). The participants were asked to bring their medication bags; then, the medications were classified using the Anatomical Therapeutic Chemical classification. Polypharmacy was defined as using five or more medications concurrently. Poisson regression modeling was applied. The adjusted prevalence ratios (PR) and its 95% confidence interval (CI) were estimated. Results Totally, 9262 participants were enrolled in the PCS, of whom 961 had CVDs. The prevalence of polypharmacy in participants with and without CVDs was 38.9% and 7.1%, respectively. The highest prevalence of polypharmacy (51.5%) was among obese patients. Abnormal waist-hip ratio (PR: 2.79; 95% CI 1.57–4.94), high socioeconomic status (PR: 1.65; 95% CI 1.07–2.54), tobacco-smoking (PR: 1.35; 95% CI 1.00–1.81), patients with more than three co-morbidities (PR: 1.41; 95% CI 1.30–1.53), high physical activity (PR: 0.66; 95% CI 0.45–0.95), use of opiate ever (PR: 0.46; 95% CI 0.26–0.82), and healthy overweight subjects (PR: 0.22; 95% CI 0.12–0.39) were associated with polypharmacy. Cardiovascular drugs (76.1%), drugs acting on blood and blood-forming organs (50.4%), and alimentary tract and metabolism drugs (33.9%) were the most frequently used drugs. Agents acting on the renin-angiotensin system were the mostly used cardiovascular system drugs among men and those above 60 years old, while beta-blocking agents were mostly prevalent among cardiovascular system drugs in women with CVDs. Conclusion Given the high prevalence of polypharmacy among CVDs patients, and subsequent complications, programs to educate both physicians and patients to prevent this issue is crucial.
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Affiliation(s)
- Pooran Mohsenzadeh
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ardekani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohammadi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Abdipour Mehrian
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan Drissi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rahimian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Taherifard
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Nabavizadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Kamalipour
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, CA, USA
| | - Bita Mesgarpour
- Vice Chancellery for Research and Technology, National Institute for Medical Research and Development (NIMAD), Tehran, Iran
| | - Fatemeh Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Molavi Vardanjani
- MPH Department, School of Medicine, Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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8
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Amankwa Harrison M, Marfo AFA, Buabeng KO, Nkansah FA, Boateng DP, Ankrah DNA. Drug-related problems among hospitalized hypertensive and heart failure patients and physician acceptance of pharmacists' interventions at a teaching hospital in Ghana. Health Sci Rep 2022; 5:e786. [PMID: 36032513 PMCID: PMC9401642 DOI: 10.1002/hsr2.786] [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: 09/12/2021] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Hypertensive and heart failure patients frequently require multiple drug therapy which may be associated with drug-related problems (DRPs). Aim To determine the frequency, types, and predictors of DRPs, and acceptance of pharmacists' interventions among hospitalized hypertensive and heart failure patients. Method It was a prospective cross-sectional study at the internal medicine department wards of Korle Bu Teaching Hospital (KBTH) between January and June 2019 using a validated form (the pharmaceutical care form used by clinical pharmacists at the medical department). DRPs were classified based on the Pharmaceutical Care Network Europe (PCNE) Classification scheme for DRPs V8.02. Descriptive and inferential statistics were used for data analysis. Results A total of 247 DRPs were identified in 134 patients. The mean number of DRPs was 1.84 (SD: 1.039) per patient. Most DRPs occurred during the prescribing process (40.5%; n(DRPs) = 100), and the highest prescribing problem was untreated indication (11.7%; n = 29). Other frequent DRPs were medication counseling need (25.1%; n = 62), administration errors 10.1%(n = 25), drug interaction (10.5%; n = 26), and "no" or inappropriate monitoring (10.5%; n = 26). The number of drugs received significantly predicted the number of DRPs (adjusted odds ratio [AOR]: 9.85; 95% CI: 2.04-47.50; p < 0.001). Clinical variables were significant predictors of number of DRPs (diabetic status: AOR: 0.41, 95% CI: 0.18-0.98, p < 0.05; statin use: AOR: 0.34, 95% CI: 0.14-0.81, p < 0.05; antiplatelet use: AOR: 5.95, 95% CI: 2.03-17.48, p < 0.01). Average acceptance of interventions by physicians was 71.6% (SD: 11.7). Most (70.6%; n = 48) accepted interventions were implemented by physicians (resolved). Conclusion DRPs frequently occur, with most problems identified in the prescribing process. Medication counseling was frequently needed. Patients' number of drugs and clinical factors predicted the occurrence of DRPs. Physicians accepted and implemented most interventions. Our findings suggest that clinical pharmacists have an important role in cardiovascular patient care, but this study should be replicated in other hospitals in Ghana to corroborate these findings.
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Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Afia F. A. Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Kwame O. Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Florence A. Nkansah
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
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Tegegn HG, Gebresillassseie BM, Erku DA, Elias A, Yabeyu AB, Ayele AA. Deprescribing practice in a resource-limited setting: Healthcare providers' insights. Int J Clin Pract 2021; 75:e14356. [PMID: 33974310 DOI: 10.1111/ijcp.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS Inappropriate polypharmacy poses risks of adverse drug events, high healthcare costs and mortality. Deprescribing could minimise inappropriate polypharmacy and the consequences thereof. The aim of this study was to evaluate healthcare providers' (HCPs') attitudes toward and experiences with deprescribing practice in Ethiopia. METHODS We conducted an institution-based cross-sectional survey among HCPs at the University of Gondar Comprehensive Specialized Hospital, Ethiopia. We used a validated questionnaire developed by Linsky et al. The tool included questions that explore medication characteristics, current patient clinical factors, predictions of future health states, patients' resources to manage their own health and education and experience. One-way ANOVA was used to test the association between sociodemographic variables and their perception of deprescribing decisions. RESULTS Of 85 HCPs approached, about 82 HCPs completed the survey, giving a response rate of 96.5%. Most of the participants (n = 73, 89%) have scored less than 1.5 points showing they are reluctant to proactively deprescribe. Physicians seem to be affected by the significant physical health conditions (mean = 1.68) and clinical endpoint like blood pressure (mean = 1.5) to make deprescribing decisions. According to the post hoc analysis of one-way ANOVA, clinical pharmacists seemed to have a better attitude toward deprescribing decisions compared with physicians (P = .025). CONCLUSION HCPs' decision to discontinue a medication could be multifactorial. Physicians could be influenced by physical health condition and clinical endpoints for deprescribing decision. Future studies should emphasise on barriers and facilitators to deprescribing practice specific to the context in Ethiopia.
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Affiliation(s)
- Henok Getachew Tegegn
- School of Rural Medicine, Pharmacy, University of New England, Armidale, NSW, Australia
- College of Medicine and Health Science, Clinical Pharmacy Department, University of Gondar, Gondar, Ethiopia
| | | | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Asrat Elias
- College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abdella Birhan Yabeyu
- Collage of Health Science, Department of Pharmacology and Clinical Pharmacy, Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Asnakew Achaw Ayele
- College of Medicine and Health Science, Clinical Pharmacy Department, University of Gondar, Gondar, Ethiopia
- School of Health, University of New England, Armidale, NSW, Australia
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Bhagavathula AS, Seid MA, Adane A, Gebreyohannes EA, Brkic J, Fialová D. Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia. Pharmaceuticals (Basel) 2021; 14:844. [PMID: 34577544 PMCID: PMC8468438 DOI: 10.3390/ph14090844] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 01/05/2023] Open
Abstract
Few studies have been conducted on multimorbidity (two or more chronic diseases) and rational geriatric prescribing in Africa. This study examined the prevalence and determinants of multimorbidity, polypharmacy (five or more long-term medications), and potentially inappropriate medication (PIM) use according to the 2019 Beers criteria among the older adults attending chronic care clinics from a single institution in Ethiopia. A hospital-based cross-sectional study was conducted among 320 randomly selected older adults from 12 March 2020 to 30 August 2020. A multivariable logistic regression analysis was performed to identify the predictor variables. The prevalence of multimorbidity, polypharmacy, and PIM exposure was 59.1%, 24.1%, and 47.2%, respectively. Diuretics (10%), insulin sliding scale (8.8%), amitriptyline (7.8%), and aspirin (6.9%) were among the most frequently prescribed PIMs. Older patients experiencing pain flare-ups were more likely to have multimorbidity (adjusted odds ratio (AOR): 1.64, 95% confidence intervals: 1.13-2.39). Persistent anger (AOR: 3.33; 1.71-6.47) and use of mobility aids (AOR: 2.41, 1.35-4.28) were associated with polypharmacy. Moreover, cognitive impairment (AOR: 1.65, 1.15-2.34) and health deterioration (AOR: 1.61, 1.11-2.32) increased the likelihood of PIM exposure. High prevalence of multimorbidity and PIM use was observed in Ethiopia. Several important determinants that can be modified by applying PIM criteria in routine practice were also identified.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic; (J.B.); (D.F.)
| | - Mohammed Assen Seid
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
| | - Aynishet Adane
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
| | | | - Jovana Brkic
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic; (J.B.); (D.F.)
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic; (J.B.); (D.F.)
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
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11
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Bhagavathula AS, Gebreyohannes EA, Fialova D. Prevalence of Polypharmacy and Risks of Potentially Inappropriate Medication Use in the Older Population in a Developing Country: A Systematic Review and Meta-Analysis. Gerontology 2021; 68:136-145. [PMID: 33975303 DOI: 10.1159/000516075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia. METHODS We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI). RESULTS We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16-2.51) was significantly associated with PIM use. CONCLUSION This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czechia
| | | | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czechia.,Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
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12
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Correction: Prevalence and determinants of polypharmacy in cardiovascular patients attending outpatient clinic in Ethiopia University Hospital. PLoS One 2020; 15:e0236328. [PMID: 32663231 PMCID: PMC7360026 DOI: 10.1371/journal.pone.0236328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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