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

The Association between Drug-Related Problems and Length of Stay of Type 2 Diabetes Mellitus Patients

Introduction

Drug-related problems (DRPs) are treatment-related occurrences that affect therapeutic efficacy. In a previous study, approximately 279 out of 330 (84.5%) patients with type 2 diabetes mellitus (T2DM) had experienced at least one DRP, including non-optimal drug effects (n = 240, 52.7%) and indications without medication (n = 137, 30.1%). Patients who were hospitalised for 5-10 days had the highest number of DRPs. Therefore, this study investigates the association between DRPs and length of stay (LoS) in patients with T2DM.

Methods

A cross-sectional study was conducted from January 2020 to May 2023 at Rumah Sakit Akademik, Universitas Gadjah Mada, Yogyakarta, Indonesia. Clinical pharmacists reviewed electronic health data to examine DRPs. The Fisher's exact test evaluated the association between DRPs and LoS.

Results

A total of 60.7% (n = 17) of the participants were females, with the majority falling into the age group ≥ 65 years old (n = 11, 29.7%). A significant portion experienced LoS > 7 days (n = 17, 60.7%). Antidiabetic monotherapy was predominant, and the categories of DRPs included adverse drug reaction (n = 15, 40.5%), dosage too high (n = 6, 16.2%), wrong drug (n = 6, 16.2%), non-adherence (n = 4, 10.8%), need for additional therapy (n = 4, 10.8%) and dosage too low (n = 2, 5.4%). A significant association was observed between non-adherence and LoS (P = 0.016). The possibility of experiencing LoS of 1-7 days increased by 3.43 times with improved non-adherence (OR = 3.43; 95% CI: 1.83, 6.39). In this context, non-adherence refers to DRPs associated with the non-compliance of patients with the prescribed treatment plan.

Conclusion

This study concludes that non-adherence was significantly associated with hospital LoS.

Drug-related problems at the heart of cardiac surgery

OBJECTIVES

Optimal perioperative success in cardiac surgery requires precise management of drug treatment. This study aimed to determine the prevalence, types and associated factors of drug-related problems (DRPs) during the entire hospital stay.

METHODS

A prospective observational study was conducted at the department of cardiovascular surgery in a university hospital between November 2019 and March 2020. Patients with planned elective cardiac surgery, aged ≥18 years, were included. A clinical pharmacist collaboratively reviewed medications on a daily basis and identified DRPs.

RESULTS

A total of 100 patients (60 male) were included; median (range) age was 62 (19-86) years, and median (IQR) length of stay in hospital was 15 (9) days. A total of 275 DRPs were identified (median (IQR) 3 (2-4)). The number of patients who had at least one DRP was 47 preoperatively, 55 in the postoperative intensive care unit, 100 in the postoperative ward, and 16 at discharge. In order to reduce bias because of the small sample size, Firth's logistic regression analysis was conducted. Statistically significant variables according to univariate analysis were included into a logistic regression model. Therefore the length of hospital stay (OR 1.14, 95% CI 1.03 to 1.26, p=0.008), living arrangements (living alone) (OR 4.24, 95% CI 1.41 to 12.73, p=0.009), number of medications at admission (OR 1.32, 95% CI 1.09 to 1.59, p=0.002), and having coronary artery bypass graft surgery (OR 2.87, 95% CI 1.07 to 7.70, p=0.03) were associated with an increased risk for DRPs in the final model.

CONCLUSION

Hospital stay carries an increased risk for DRPs, especially at the postoperative stage. Modifiable risk factors for DRPs can be managed by required interventions performed by a multidisciplinary healthcare team.

Drug-related problems identified by clinical pharmacists in an academic medical centre in Thailand

Background

Drug-related problems (DRPs) are important issues that interfere with therapeutic outcomes and can cause adverse events. Pharmacists play a vital role in identifying and resolving DRPs. This study aimed to determine the characteristics, and severity of DPRs, including clinical pharmacists' interventions.

Method

A retrospective study was conducted at Ramathibodi Hospital, a tertiary university hospital in Thailand. We collected data from the drug-related problem system and the electronic medical record. Descriptive statistics were performed with Statistical Package for Social Sciences (SPSS) software version 18.0.

Results

There were 580 patients (20.44%) who had at least one DRP. We classified 1255 DRPs based on Cipolle-Strand-Morley Criteria 2012. The most common DRPs were the need for additional drug therapy (27.09%), followed by dosage too low (26.93%) and dosage too high (22.31%). Anti-infective agents (23.71%) and omeprazole (2.70%) were the most common drug groups and drugs causing DRPs, respectively. The severity of DRPs was mostly categorised to be 'no harm' (95.46%). Almost all of the interventions were completely accepted by physicians (99.12%).

Conclusion

The most common DRPs were the need for additional drug therapy and dosage adjustment of antimicrobial agents. The clinical pharmacists on wards are effective in preventing and resolving DRPs.

Global research trends and hotspots in pharmaceutical care: a bibliometric analysis and visualisation using CiteSpace and VOSviewer

OBJECTIVE

Pharmaceutical care is closely related to the outcome and prognosis of disease treatment. This study analyses the research status, hotspots, frontiers and development trends of pharmaceutical care from the perspective of bibliometrics.

METHODS

Related literature on pharmaceutical care published in the Web of Science Core Collection database was collected and knowledge maps were drawn by science information visualisation software Citespace 6.1 .R3 and VOSviewer 1.6.17.0.

RESULTS

A total of 3289 institutions from 105 countries/regions published 2906 papers in 669 academic journals, which were cited 50 027 times. The top three countries/regions by the number of publications are the USA, UK and Brazil. The top three institutions are Utrecht University and the University of Groningen in the Netherlands, and University College London in the UK. The top three journals are American Journal of Pharmaceutical Education, International Journal of Clinical Pharmacy and American Journal of Health-System Pharmacy. The top three authors are Hersberger KE, Bouvy ML and Hughes CM. The most co-cited is Hepler CD, and the most co-cited influential is Strand LM. COVID-19 pandemic, chronic obstructive pulmonary disease and pharmacy practice are the most cutting edge topics in the field of research in pharmaceutical care. Pharmaceutical service and clinical pharmacy are research hotspots in pharmaceutical care.

CONCLUSION

In the past 10 years, papers in the field of pharmaceutical care have shown a significant growth trend and scholars have become increasingly interested in research on related content in the field of pharmaceutical care. Our research results are of great significance for improving the connotation construction of pharmaceutical care and improving patient satisfaction and prognosis, and can also be used as an important reference for relevant scholars to select scientific research topics for subsequent research. The objective basis for relevant government departments is to modify and formulate health policies or measures.

Prevalence and associated factors of medication-related problems among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: a cross-sectional study

Background

Despite appropriate treatment of epilepsy, the treatment outcome is poor in developing country. Therefore, the study was aimed to identify the magnitude and associated factors of epileptic patients at ambulatory clinic of south western Ethiopian hospital.

Methods

A hospital-based cross-sectional study was conducted on epileptic patients who had follow-up at Mettu Karl Comprehensive Specialized Hospital (MKCSH). Data collection was done through patient interview and medical charts review. The pharmaceutical care network Europe foundation classification system was used to assess the drug therapy problem and Naranjo algorithm of adverse drug reaction was employed to identify the probability of adverse drug reaction. The data were analyzed by SPSS version 23 after data were entered by Epidemiological Information (Epi Info) 7.2.1. The multivariable logistic regressions were utilized and P < 0.05 was used to declare association.

Results

Over the study period, more than half of the participants 172(57.7%) were males. The magnitude of drug-related problems was found to be 164(55.0%). Among epileptic patients about 323 drug-related problems (DRPs) were identified on average, 1.084 drug-related problems (DRPs) per patient. The widely occurred types of drug-related problems were needs additional drug therapy 72(22.29%), dose too low 52(16.09%) and dose to high which accounts 50(15.48%). Regarding the predictors of drug-related problems, being a female (AOR = 3.57, 95% CI:1.85–6.88, P ≤ 0.001), having frequent seizures (AOR = 2.47, 95% CI%:1.33–4.61, P = 0.004) and the presence of poly-pharmacy (AOR = 3.57, 95% CI: 1.49–8.5, P = 0.004) were predictors of drug-related problems.

Conclusion

More than half of the patients had a drug therapy problem. Number of medications taken by the patients, gender and the seizure frequency had a significant association with occurrence of drug therapy problems (DTPs). Therefore, the pharmaceutical care in general and drug information services in particular should be established to hinder any undesirable medication effects in our study area.

Characteristics of drug-related problems and pharmacist's interventions in hospitalized patients in Thailand: a prospective observational study

Drug-related problems (DRPs) are a major health concern. A better understanding of the characteristics of DRPs throughout the hospital stay may help to tailor pharmaceutical care services (PCS). This study aims to describe the characteristics of DRPs and to compare DRP pattern in different stages of hospital stay. DRPs were identified by clinical pharmacists as part of their routine services. Pharmacist assessed causality, severity and preventability of DRP. A total of 316 preventable DRPs occurred in 257 patients with the median of 1 (rang 1-3) DRPs per patient. 46.8% of DRPs occurred at discharge than at other stages. The most frequent cause of DRP was no drug treatment in spite of existing indication, accounting for 32.3% of all DRPs. No drug treatment with existing indication was detected frequently at discharge (56.1%) compared with other stages (p-value < 0.001). The common intervention to physician was starting a drug (34.0%) and the acceptance rate was 95.8%. DRPs in hospitalized patients occur at any stage of the hospital stay. Systematic identification of DRP characteristics enables pharmacists to tailor optimal type of PCS required and hence improve patient safety.

Clinical Pharmacist Intervention on Drug-Related Problems among Elderly Patients Admitted to Medical Wards of Northwest Ethiopia Comprehensive Specialized Hospitals: A Multicenter Prospective, Observational Study

Background: Drug therapy in the elderly needs an emphasis on age-related changes in drug pharmacokinetics and pharmacodynamics profile. Hospitalized elderly patients are at risk of more than one disease and polypharmacy associated with these; they are at risk of drug-related problems. This study aimed to assess the role of clinical pharmacy on identifying and resolution of drug-related problems among elderly patients admitted to medical ward of Northwest Ethiopia comprehensive specialized hospitals. Methods: A multicenter prospective observational study was conducted. A systematic sampling technique was used. The identified drug-related problem was recorded and classified using Cipolle, and adverse drug reaction was assessed using Naranjo algorithm of adverse drug reaction probability scale, and Medscape was used for drug-drug interaction. Data were analyzed by using STATA software version 14.1. Logistic regression was used, and results were reported as odds ratios (ORs) with 95% Confidence intervals with $P\text{value}<0.05$ statistically significant. Result: A total of 389 study participants were included in the study. About 266 (68.4%) of the participants had at least a single drug-related problem. About 503 drug-related problems were identified with a mean of 1.32 (CI: 1.27-1.36) drug-related problem per patient. The three-leading categories of drug-related problems were dose too high 108 (21.5%), nonadherence 105 (20.9%), and adverse drug reaction 96 (19.1%). Alcohol use ( $\text{AOR}=2.2$ , 95CI%: 1.23-3.94), source of the drug ( $\text{AOR}=2.85$ , 95CI%: 1.63-4.98), length of hospitalization ( $\text{AOR}=2.32$ , 95CI%: 1.37-3.95), number of comorbidities ( $\text{AOR}=1.48$ , 95CI%: 1.09-1.99), and polypharmacy ( $\text{AOR}=3.06$ , 95CI%: 1.72-5.46) were important risk factors for drug-related problems. From the intervention provided, 84.7% were accepted by prescribers. Among the total drug-related problems 67.4% of the problem was totally solved. Conclusion: This study revealed that DRPs were high among elderly patients admitted to medical ward of Northwest Ethiopia. Comorbidity, length of hospitalization, ploy-pharmacy, payer, and alcohol drinker were more likely to developed drug-related problems. Treatment optimizations were also done by clinical pharmacists and interventions were well accepted by prescribers.

Management Practice and Drug Related Problems and Its Contributing Factors Among Cervical Cancer Patients at Oncologic Center in Ethiopia: A Hospital-Based Retrospective Study

Introduction

In cervical cancer therapy, there is a high prevalence of drug-related problems (DRPs) due to the high toxicity and complexity of most antineoplastic regimens. However, there is a paucity of data about DRPs among patients with cervical cancer in Ethiopia. Hence, the present study was aimed at investigating management practices and DRPs among patients diagnosed with cervical cancer.

Methods

A registry-based retrospective cohort study was employed among cervical cancer patients at the oncology center of Felege Hiwot Comprehensive Specialized Hospital (FHCSH). All patients with a histologically confirmed diagnosis of cervical cancer from January 2016 to December 2020 were included. Relevant information was recorded by reviewing medical records. The possibility of DRPs was evaluated by comparing with standard guidelines. Logistic regression analysis was employed.

Results

A total of 184 cervical cancer patients were included, with a mean age of 50.2±10.7 years. A total of 216 DRPs were identified from 93 cervical cancer patients, translating to a prevalence of 50.5% and a mean of 2.32±1.11 DRPs per patient. ADR (27.3%), DDI (25%), and the need for additional drug therapy (22.2%) were the most prevalent DRPs. DRPs were associated with the presence of co-morbidity (AOR = 4.23, 95% CI = 1.78–10.05, p = 0.001), complications (AOR = 2.99, 95% CI = 1.28–6.99, p = 0.011), being treated with ≥5 medications (AOR = 5.1, 95% CI = 2.38–10.95, p < 0.001), being stage II (AOR = 0.14, 95% CI = 0.02–0.90, p = 0.038), and stage III (AOR = 0.04, 95% CI = 0.01–0.32, p = 0.003).

Conclusion

Cisplatin-based chemotherapy was the frequently used therapeutic option. Co-morbidity and complication status, number of medication and stage of cancer were significantly associated with DRPs. The study highlights the need of clinical pharmacy services to optimize drug therapy and reduce DRPs.

Non-Adherence to Antiepileptic Drugs and Associated Factors among Epileptic Patients at Ambulatory Clinic of Southwestern Ethiopian Hospital: A Cross-Sectional Study

BACKGROUND

Non-adherence to anti-epileptic drugs (AEDs) was the most common drug therapy issue that hampered epileptic patients' treatment success. As a result, the barriers to patients adhering to their treatment should be investigated in depth in order to prevent poor treatment outcomes.

METHODS

A hospital-based cross-sectional study was conducted on epileptic patients who had followed up at Mettu Karl Comprehensive Specialized Hospital (MKCSH). Data collection was done through patient interview and medical charts review. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. The data were analyzed using SPSS version 23 after data were entered by Epi Info7.2.1. The multivariable logistic regressions were utilized and P < 0.05 was used to declare association.

RESULTS

Over the study period, more than half of the participants 172 (57.7%) were males, and the median age of participants was 29 years. The magnitude of non-adherence to ant-epileptic drugs (AEDs) was 120 (40.27%). The results of multivariable analysis revealed that patients who had experienced the medication side effects, adjusted odds ratio (AOR) = 2.199; 95% CI: 1.21, 4.00, P = 0.010, a poly-pharmacy, adjusted odds ratio (AOR) = 5.166; 95% CI: 2.63, 10.14, P = <0.001 and the presence of a co-morbidity, adjusted odds ratio (AOR) =3.70; 95% CI: 2.058, 6.65, P = <0.001 were the predictors of medication non-adherence.

CONCLUSION

The magnitude of non-adherences to AEDs was found to be high. Phenobarbitone was the most prescribed AEDs. The number of medications taken by the patients, the presence of co-morbidity and the occurrence of medication side effects had a significant association with non-adherence to AEDs. Therefore, the pharmaceutical care in general and drug information services in particular should be established to enhance medication adherence in our study area.

"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.