1
|
Dagnew EM, Ayalew MB, Alemnew Mekonnen G, Geremew AB, Abdela OA. Drug-related problems and associated factors among adult psychiatric inpatients in Northwest Ethiopia: Multicenter cross-sectional study. SAGE Open Med 2022; 10:20503121221112485. [PMID: 36032653 PMCID: PMC9403454 DOI: 10.1177/20503121221112485] [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: 12/16/2021] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine the prevalence of drug-related problems and the factors
influencing them among adult psychiatric inpatients. Methods: A multi-centre cross-sectional observational study was conducted from April
to July 2021 at five randomly selected hospitals in Northwest Ethiopia. A
total of 325 consecutively sampled patients participated in the study.
Clinical pharmacists assessed the drug-related problems based on clinical
judgement supported by updated evidence-based disease guidelines. We used
the Medscape drug-interactions checker to check drug-to-drug interactions.
The results were summarised using descriptive statistics, including
frequency, mean, and standard deviation. For each variable, an odds ratio
with a 95% confidence interval was calculated, as well as the related
p-value. The value of p ⩽ 0.05 was
considered statistically significant. Results: From the total number of 325 study participants, more than half of them
(52.9%) were females, and the mean age ± (standard deviation) was
30.8 ± 11.3 years. At least one drug-related problem was recorded by 60.9%
to 95% confidence interval (55.7–65.8) of study participants, with a mean of
0.6 ± 0.49 per patient. Additional drug therapy was the most common
drug-related problem (22.8%) followed by non-adherence to medicine (20.6%)
and adverse drug reactions (11%), respectively. Factors independent
associated with drug-related problems were rural residence (adjusted odds
ratio = 1.96, 95% confidence interval: 1.01–2.84,
p-value = 0.046), self-employed (adjusted odds ratio = 6.0,
95% confidence interval: 1.0–36.9, p-value = 0.035) and
alcohol drinkers (adjusted odds ratio = 6.40, 95% confidence interval:
1.12–37.5, p-value = 0.034). Conclusion: The prevalence of drug-related problems among adult psychiatric patients
admitted to psychiatric wards was high. Healthcare providers give more
attention to tackling these problems. Being a rural resident, self-employed,
and alcohol drinkers were associated with drug-related problems.
Collapse
Affiliation(s)
- Ephrem Mebratu Dagnew
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mohammed Biset Ayalew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Pharmacy, School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | - Gizework Alemnew Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alehegn Bishaw Geremew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ousman Abubeker Abdela
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Abdisa E, Fekadu G, Girma S, Shibiru T, Tilahun T, Mohamed H, Wakgari A, Takele A, Abebe M, Tsegaye R. Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. Int J Ment Health Syst 2020; 14:56. [PMID: 32760443 PMCID: PMC7391813 DOI: 10.1186/s13033-020-00391-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 02/01/2023] Open
Abstract
Background Self-stigma associated with mental illness has remained a global public health issue affecting social interactions, health care, productivity and acceptance among others. It is one of important factors contributing to non-adherence to medication that leads to increased hospitalization and higher healthcare costs. Hence, the study aimed to assess self-stigma and medication adherence among patients with mental illness treated at the psychiatric clinic of Jimma University Medical Center (JUMC). Methods A cross-sectional, community-level study was conducted at Jimma town. The patient’s data was collected from records between April and June 2017 and the collected data was analyzed using SPSS version 21. The Internalized Stigma of Mental Illness (ISMI) tool was utilized to measure internalized stigma. Linear regression analysis was performed to get the final model. Statistical significance association was considered at p-values less than 0.05 and 95% confidence interval was used. Results Males comprised more than half (61%) of the total sample of 300 respondents and with a mean age of 34.99 (SD ± 11.51) years. About one-third (32%) of patients had a working diagnosis of schizophrenia followed by major depressive disorder (24.3%). More than half of them, 182 (60.7%) were adherent to their psychotropic medication. The overall mean value of self-stigma was 2.16 (SD = 0.867) and 84 (28%) of the respondents had moderate to high self-stigma. Using ISMI the mean score of alienation was 2.26 (SD = 0.95), stereotype endorsement 2.14 (SD = 0.784), perceived discrimination 2.18 (SD = 0.90), social withdrawal 2.10 (SD = 0.857) and stigma resistance 2.11 (SD = 0.844). Increasing age of the patients (std. β = − 0.091, p = 0.009) and living with kids and spouse (std. β = − 0.099, p = 0.038) were negatively associated with self-stigma whereas increased world health organization disability assessment schedule (WHODAS) score (β = 0.501, p < 0.001), number of relapses (std. β = 0.183, p < 0.01) and medication non-adherence (std. β = 0.084, p = 0.021) were positively associated with self-stigma. Conclusion The study revealed that there was high self-stigma among patients with mental illness and a significant association between overall ISMI score and level of medication adherence. These require mental health professionals and policy-makers should give attention to ways to overcome self-stigma and increase medication adherence among patients with mental illness.
Collapse
Affiliation(s)
- Eba Abdisa
- Department of Psychiatry, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Clinical Pharmacy Department, School of Pharmacy, Institute of Health Sciences, Wollega University, P.O Box 395, Nekemte, Ethiopia
| | - Shimelis Girma
- Department of Psychiatry, College of Health Science, Jimma University, Jimma, Ethiopia
| | - Tesfaye Shibiru
- Department of Pediatrics and Child Health, Wollega University Referral Hospital, Nekemte, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Habib Mohamed
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Aaga Wakgari
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Amsalu Takele
- Department of Surgery, School of Medicine, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Milkias Abebe
- Medical Microbiology Unit, Department of Medical Laboratory Science, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Reta Tsegaye
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
3
|
Tareke M, Tesfaye S, Amare D, Belete T, Abate A. Antipsychotic medication non-adherence among schizophrenia patients in Central Ethiopia. S Afr J Psychiatr 2018; 24:1124. [PMID: 30263211 PMCID: PMC6138084 DOI: 10.4102/sajpsychiatry.v24i0.1124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 11/22/2017] [Indexed: 01/10/2023] Open
Abstract
Background Despite the fact that adherence to antipsychotic medications is the cornerstone in the treatment and prevention of relapse of the disease, non-adherence is a major problem among schizophrenia patients. The purpose of this study was to assess the magnitude and factors associated with antipsychotic medication non-adherence among schizophrenia patients in Amanuel Mental Specialized Hospital. Method An institution-based cross-sectional study was conducted among 412 people with schizophrenia at Amanuel Mental Specialized Hospital from April to May 2014. Non-adherence was assessed using the questionnaire of Morisky medication adherence rating scale and semi-structured questions for assessment of associated factors. Logistic regression analysis was used to assess predictors of non-adherence. Results Prevalence of non-adherence was 41.0% among schizophrenia patients. Living in rural areas (adjusted odds ratio [AOR] = 2.07; 95% confidence interval [CI]: 1.31, 3.28), current substance use (AOR = 1.67; 95% CI: 1.09, 2.56), long duration of treatment (AOR = 2.07; 95% CI: 1.22, 3.50) and polypharmacy (AOR = 2.13; 95% CI: 1.34, 3.40) were found to be significantly associated with non-adherence. Conclusion The results indicate that non-adherence to antipsychotic medication was a major problem among patients with schizophrenia. Reducing the number of antipsychotic medications and availing drugs in rural areas may decrease the level of non-adherence.
Collapse
Affiliation(s)
- Minale Tareke
- College of Medicine and Health Science, Bahir Dar University, Ethiopia
| | - Siranesh Tesfaye
- Department of Psychiatry, Felege Hiwot Referral Hospital, Ethiopia
| | - Desalegn Amare
- College of Medicine and Health Science, Bahir Dar University, Ethiopia
| | - Tilahun Belete
- College of Health Science, Psychiatry Unit, Department of Nursing, Mekelle University, Ethiopia
| | - Andargie Abate
- College of Medicine and Health Science, Bahir Dar University, Ethiopia
| |
Collapse
|
4
|
Pauly A, Wolf C, Mayr A, Lenz B, Kornhuber J, Friedland K. Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients. PLoS One 2015; 10:e0139302. [PMID: 26437449 PMCID: PMC4593549 DOI: 10.1371/journal.pone.0139302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common non-adherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy. METHODS 269 patients from a German university hospital were included in a prospective, open, clinical trial with consecutive control and intervention groups. Control patients (09/2012-03/2013) received usual care, whereas intervention patients (05/2013-12/2013) underwent a program to enhance adherence during their stay and up to three months after discharge. The program consisted of therapy simplification and individualized patient education (multi-dimensional component) during the stay and at discharge, as well as subsequent phone calls after discharge (inter-sectoral component). Adherence was measured by the "Medication Adherence Report Scale" (MARS) and the "Drug Attitude Inventory" (DAI). RESULTS The improvement in the MARS score between admission and three months after discharge was 1.33 points (95% CI: 0.73-1.93) higher in the intervention group compared to controls. In addition, the DAI score improved 1.93 points (95% CI: 1.15-2.72) more for intervention patients. CONCLUSION These two findings indicate significantly higher medication adherence following the investigated multi-dimensional and inter-sectoral program. TRIAL REGISTRATION German Clinical Trials Register DRKS00006358.
Collapse
Affiliation(s)
- Anne Pauly
- Molecular & Clinical Pharmacy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carolin Wolf
- Molecular & Clinical Pharmacy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kristina Friedland
- Molecular & Clinical Pharmacy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
5
|
Ibrahim AW, Yahya S, Pindar SK, Wakil MA, Garkuwa A, Sale S. Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria. Pan Afr Med J 2015; 21:39. [PMID: 26405475 PMCID: PMC4564429 DOI: 10.11604/pamj.2015.21.39.6664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/09/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses (SMIs) as it negatively impacts on the course of the illness and the treatment outcome. In this study, the levels of adherence, prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting. Methods Three hundred and seventy (370) respondents with diagnoses of schizophrenia, bipolar disorder or severe depression were randomly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri in northeastern Nigeria. An anonymous sociodemographic questionnaire and a clinical proforma designed by the authors, Oslo social support scale and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection. Results The prevalence of sub-optimal adherence was 55.7%. The independent predictors of sub-optimal adherence were; seeking for traditional/ spiritual treatment (Odds Ratio (O.R.) = 6.523, 95% C.I. = 3.773 - 11.279, P = < 0.001), male gender (O.R. = 3.307, 95% C.I. = 1.907 - 5.737, P = < 0.001), low levels of insight (O.R. = 1.753, 95 C.I. = 1.220 - 2.519, P = 0.002), and low social support levels (O.R. = 1.528, 95% C.I. = 1.097 - 2.129, P = 0.012). Conclusion Based on the outcome of the study, we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa.
Collapse
Affiliation(s)
- Abdu Wakawa Ibrahim
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | - Shuaibu Yahya
- Department of Community Medicine, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | - Sadique Kwajafa Pindar
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | - Musa Abba Wakil
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | - Adamu Garkuwa
- Department of Clinical Services, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi state, Nigeria
| | - Shehu Sale
- Department of Psychiatry, Bayero University Kano, Kano State, Nigeria
| |
Collapse
|