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Niriayo YL, Kifle R, Asgedom SW, Gidey K. Drug therapy problems among hospitalized patients with cardiovascular disease. BMC Cardiovasc Disord 2024; 24:50. [PMID: 38221638 PMCID: PMC10788969 DOI: 10.1186/s12872-024-03710-8] [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: 07/11/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Optimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases. METHOD A prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients' medical records. We employed Cipolle's method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05. RESULTS The study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68-9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47-5.11). CONCLUSION More than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Roba Kifle
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Garedow AW, Mamo MD, Tesfaye GT. Medication Related-Problems and Associated Factors Among Patients with Hypertension at a Tertiary Care Hospital in Ethiopia: A Prospective Interventional Study. Integr Blood Press Control 2023; 16:123-136. [PMID: 38054013 PMCID: PMC10695137 DOI: 10.2147/ibpc.s434072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023] Open
Abstract
Background Hypertension affects more than 1.4 billion people worldwide currently, with that number anticipated to climb to 1.6 billion by 2025 with high mortality and morbidity effects. Medication related problems in cardiovascular disease patients, especially among hypertension patients were found to be high and a critical problem which is associated with high mortality, complication, prolonged hospital stay, compromised quality of life and increase health care cost. Objective To determine medication related problems and its predictors among hypertension patients on chronic follow-up at Jimma Medical Center. Methods A prospective interventional study was conducted among hypertension patients from November 28, 2021 to June 30, 2022 at Jimma Medical Center. Medication related problems were classified and identified based on Pharmaceutical care network Europe drug classification tool version 9.0. Interventions were done through discussion with individual prescriber and patients. Consecutive sampling technique was used. Binary Logistic regression was used to identify independent predictors of medication related problems. Variables having P-values < 0.05 were considered statistically significant. Results Among 384 hypertension patients included in the study, 219 (57.1%) were male. The mean (SD) age was 49.06+17.79. Two thirds of study participants had at least one medication related problem. A total of 483 MRPs were identified among 231 (60.15%) patients. Treatment effectiveness related problem (55.48%) was the most common observed medication related problems. Alcoholism (AOR; 3.15, 95% CI [1.46-7.23]), stage II hypertension (AOR=2.77, 95% CI= [3.53-4.66]); comorbidity (AOR=2.88, 95% CI= [1.47-5.66]) and polypharmacy (AOR=3.07, 95% CI= [1.57-5.99]) were the independent predictors of medication related problems. Conclusion The prevalence of medication related problems was high among hypertensive patients. Alcoholism, stage II hypertension, comorbidity and poly-pharmacy were the predictors of medication related problems. Therefore, to overcome the problems, clinical pharmacists, physicians and other health care professionals have to work in collaboration.
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Biradar SM, Kohima B, Nayak V, Nandikol S, Warad V, Byakod SM, Hunasagi BS, Awasthi SR. Assessment of Drug Related Problems and Pharmacist Interventions in Inpatients with Cardiovascular Disease. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-10-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim. To identify and evaluate the nature and incidence of drug-related problems (DRPs) and to manifest the role of a pharmacist in ensuring safe and efficient use of medications with cardiovascular disease patients by using PCNE Classification to assess and report drug-related problems.Material and Methods. An Observational and Prospective study was conducted in a tertiary care hospital of medicine department of general and intensive/critical care units for a period of 6 months to identify and evaluate the nature and incidence of DRP’s and to manifest the role of a pharmacist in ensuring safe and efficient use of medications with cardiovascular disease patients by using PCNE Classification to assess and report drug-related problems.Results. Of 94 Patient profiles were evaluated out of which 78 (82.9%) patient profiles were identified with 208 DRPs. Among 208, 140 (67.3%) drug interactions, 15 (7.2%) untreated indication, 12 (5.8%) adverse drug reactions, 10 (4.8%) drug use without indication, 8 (3.8%) drug underused, 8 (3.8%) duration of treatment too short, 5 (2.4%) dose unclear, 4 (1.9%) inappropriate drug form, 3 (1.4%) duration of treatment too long, 2 (1.0%) too many drugs prescribed for an indication, 1 (0.5%) drug overused. For 208 DRPs identified and provided with 74 interventions which includes 30 (41.6%) drug discontinuation, 24 (33.3%) addition of a new drug, 4 (5.55%) change of dosage form, and 14 (19.4%) decrease the dose.Conclusion. The present study revealed that patients with cardiovascular diseases suffer from numerous DRPs that can be identified, resolved, or prevented to some extent by pharmacist intervention. Hence the study addresses the importance of clinical pharmacist in the management of DRPs among cardiovascular patients.
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Affiliation(s)
- S. M. Biradar
- SSM College of Pharmacy and Research Centre;
Shri B.M. Patil Medical College Hospital and Research Centre
| | - B. Kohima
- SSM College of Pharmacy and Research Centre
| | - V. Nayak
- SSM College of Pharmacy and Research Centre
| | | | - V. Warad
- Shri B.M. Patil Medical College Hospital and Research Centre
| | - S. M. Byakod
- Shri B.M. Patil Medical College Hospital and Research Centre
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Wondesen A, Berha AB, Woldu M, Mekonnen D, Engidawork E. Impact of medication therapy management interventions on drug therapy problems, medication adherence and treatment satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia: a one-group pre-post quasi-experimental study. BMJ Open 2022; 12:e054913. [PMID: 35414550 PMCID: PMC9006832 DOI: 10.1136/bmjopen-2021-054913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the impact of medication therapy management interventions on drug therapy problems (DTPs), medication adherence and treatment satisfaction among ambulatory heart failure (HF) patients. STUDY DESIGN, SETTING AND PARTICIPANTS A one-group pre-post quasi-experimental study was conducted on 423 ambulatory HF patients at Tikur Anbessa Specialised Hospital (TASH), Addis Ababa, Ethiopia. All ambulatory HF patients ≥18 years old attending the adult cardiac clinic of TASH and having a complete medical record and fully met the inclusion criteria were taken as study participants. INTERVENTIONS Educational interventions along with a brochure with information on the nature of HF disease and its treatment were provided to study participants. DTPs encountered were resolved by a team of pharmacists and physicians. RESULTS In the preintervention phase, 288 DTPs were identified with a mean (SD) of 1.3±1.1. A significant reduction of DTPs (0.67±1.1, p<0.001) was observed in the postintervention phase compared with the preintervention phase. At the postintervention phase, 36.4%, 61.9% and 1.7% of HF patients were highly, medium and low adherent to their treatment regimens, respectively. The total composite score for treatment satisfaction of the study participants was 80.35%. CONCLUSIONS The findings of this study demonstrated that by teaming up clinical pharmacists with cardiologists and cardiology fellows, it was possible to reduce the occurrence of DTPs, improve medication adherence and increase treatment satisfaction of HF patients attending at the outpatient cardiac clinic.
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Affiliation(s)
- Abate Wondesen
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Woldu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Tsige AW, Yikna BB, Altaye BM. Drug-Related Problems Among Ambulatory Heart Failure Patients on Follow-Up at Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Ther Clin Risk Manag 2021; 17:1165-1175. [PMID: 34785901 PMCID: PMC8591109 DOI: 10.2147/tcrm.s337256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/27/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose The purpose of this study was to assess drug-related problems (DRPs) among ambulatory heart failure (HF) patients attending at medical referral clinic of Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted among 344 HF patients. Drug-related problems were classified using modified Cipolle’s DRP classification schemes and drug–drug interactions were assessed using Micromedex, up-to-date, and drug.com drug–drug interaction checkers. The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics were used to summarize patients’ characteristics. Univariable and multivariable binary logistic regression analysis was performed to identify associated factors with dependent variables. P < 0.05 was considered statistically significant. Results The mean age of the study participants was 53.38 ± 18.84 years and nearly half (45%) were in the age group of 31–60 years. Drug-related problems were found in 80.8% of HF patients. A total of 416 DRPs were identified. Adverse drug reaction (35.58%) was the top DRPs identified followed by the need for additional drug therapy (30.53%) and ineffective drug therapy (26.9%), respectively. Diuretics (45%), beta-blockers (BBs) (12.42%), and angiotensin-converting enzyme inhibitors (ACEIs) (10%) were the commonly used drug classes by study participants. The presence of comorbidity (p ˂ 0.001) and level of education of study participants (p = 0.03) had a significant association with the occurrence of DRPs. Conclusion The prevalence of DRPs among ambulatory HF patients was high. The presence of comorbidity and the educational level of study participants had a significant association with the occurrence of DRPs. Checking potential drug–drug interactions before starting a new therapy, monitoring adverse drug reactions, ensuring sustainable availability of medications, and regular education programs are recommended to minimize DRPs.
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Affiliation(s)
- Abate Wondesen Tsige
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Berhan Begashaw Yikna
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhanetensay Masresha Altaye
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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Laatikainen O, Sneck S, Turpeinen M. Medication-related adverse events in health care-what have we learned? A narrative overview of the current knowledge. Eur J Clin Pharmacol 2021; 78:159-170. [PMID: 34611721 PMCID: PMC8748358 DOI: 10.1007/s00228-021-03213-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/28/2021] [Indexed: 11/08/2022]
Abstract
Purpose Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care. Methods Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted. Results The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them. Conclusions Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting.
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Affiliation(s)
- O Laatikainen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland. .,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.
| | - S Sneck
- Oulu University Hospital, Oulu, Finland
| | - M Turpeinen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland.,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Bekele F, Bereda G, Tamirat L, Geleta BA, Jabessa D. "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. Ann Med Surg (Lond) 2021; 70:102827. [PMID: 34540216 PMCID: PMC8435910 DOI: 10.1016/j.amsu.2021.102827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 01/18/2023] Open
Abstract
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. DRP is the problem that interferes with a patient's pharmacotherapy that results in poor treatment outcomes. The rate of medication related problems in developing countries is high. “Children are not just “little adults” in which they should have their own pharmacokinetic and pharmacodynamics profile.
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Affiliation(s)
- Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Gudisa Bereda
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Lalisa Tamirat
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Bonsa Amsalu Geleta
- Department of Nursing, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Dabala Jabessa
- Department of Statistics, College of Natural and Computational Science, Mettu University, Mettu, Ethiopia
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Adem F, Abdela J, Edessa D, Hagos B, Nigussie A, Mohammed MA. Drug-related problems and associated factors in Ethiopia: a systematic review and meta-analysis. J Pharm Policy Pract 2021; 14:36. [PMID: 33902729 PMCID: PMC8077957 DOI: 10.1186/s40545-021-00312-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/04/2021] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Jemal Abdela
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bisrat Hagos
- Department of Pharmaceutical Supply Chain Management, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Nigussie
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bekele F, Tsegaye T, Negash E, Fekadu G. Magnitude and determinants of drug-related problems among patients admitted to medical wards of southwestern Ethiopian hospitals: A multicenter prospective observational study. PLoS One 2021; 16:e0248575. [PMID: 33725022 PMCID: PMC7963049 DOI: 10.1371/journal.pone.0248575] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
- * E-mail:
| | - Tesfaye Tsegaye
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Efrem Negash
- Department of Public Health, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Science, Wollega University, Nekemte, Ethiopia
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Marques TC, Silva RDOS, Dos Santos Júnior GA, de Jesus Júnior FC, Silvestre CC, Rocha KSS, da Rocha CE, Brito GDC, de Lyra-Jr DP. Evaluation of process indicators of a medication review service between pharmacists and physicians. J Eval Clin Pract 2020; 26:1448-1456. [PMID: 31883204 DOI: 10.1111/jep.13332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians. METHOD This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05. RESULTS A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ2 = 33.83, P < .0001). Of the DRP identified, 183 (42.33%) were resolved. Patients who had between one and two pharmaceutical consultations were 1.22 times more likely not to have their DRP resolved compared with the group with more than three consultations (χ2 = 3.44, P < .05). Of the 173 pharmaceutical interventions made to the medical students and physicians, the majority (98.7%) was accepted. CONCLUSION The collaborative medication review service optimized the process indicators. Drug-related problems identification and resolution required more than three pharmaceutical consultations. Most of the pharmaceutical interventions were accepted by prescribers. Thus, collaborative medication review services may be fundamental to the construction of more effective and safe health systems.
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Affiliation(s)
- Tatiane C Marques
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Rafaella de Oliveira Santos Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Genival A Dos Santos Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Francisco C de Jesus Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Carina C Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Kérilin S S Rocha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Chiara E da Rocha
- Department of Pharmacy, Federal University of Sergipe, Lagarto, Brazil
| | | | - Divaldo P de Lyra-Jr
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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11
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Seid E, Engidawork E, Alebachew M, Mekonnen D, Berha AB. Evaluation of drug therapy problems, medication adherence and treatment satisfaction among heart failure patients on follow-up at a tertiary care hospital in Ethiopia. PLoS One 2020; 15:e0237781. [PMID: 32857798 PMCID: PMC7454938 DOI: 10.1371/journal.pone.0237781] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Drug therapy problems (DTPs) are major concerns of healthcare and have been identified to contribute to negative clinical outcomes. The occurrence of DTPs in heart failure patients is associated with worsening of outcomes. The aim of this study was to assess DTPs, associated factors and patient satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH). METHODS A hospital based prospective cross-sectional study was conducted on 423 heart failure patients on follow up at TASH. Data was collected through patient interview and chart review. Descriptive statistics, binary and multiple logistic regressions were used for analyses and P < 0.05 was used to declare association. RESULTS Majority of the patients were in NYHA class III (55.6%) and 66% of them had preserved systolic function. DTPs were identified in 291(68.8%) patients, with an average number of 2.51±1.07.per patient. The most common DTPs were drug interaction (27.3%) followed by noncompliance (26.2%), and ineffective drug use (13.7%). β blockers were the most frequent drug class involved in DTPs followed by angiotensin converting enzyme inhibitors. The global satisfaction was 78% and the overall mean score of treatment satisfaction was 60.5% (SD, 10.5). CONCLUSION Prevalence of DTPs as well as non-adherence among heart failure patients on follow up is relatively high. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient's quality of life and optimize healthcare costs.
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Affiliation(s)
- Elham Seid
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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Saldanha V, de Araújo IB, Lima SIVC, Martins RR, Oliveira AG. Risk factors for drug-related problems in a general hospital: A large prospective cohort. PLoS One 2020; 15:e0230215. [PMID: 32369489 PMCID: PMC7199929 DOI: 10.1371/journal.pone.0230215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/24/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients. METHODOLOGY Prospective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample. RESULTS The study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%. CONCLUSION This study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice.
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Affiliation(s)
- Valdjane Saldanha
- Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ivonete Batista de Araújo
- Pharmacy Department, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Sara Iasmin Vieira Cunha Lima
- Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Rand Randall Martins
- Pharmacy Department, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Antonio Gouveia Oliveira
- Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Pharmacy Department, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Saldanha V, Randall Martins R, Lima SIVC, Batista de Araujo I, Gouveia Oliveira A. Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort. BMJ Open 2020; 10:e035848. [PMID: 32332007 PMCID: PMC7204863 DOI: 10.1136/bmjopen-2019-035848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the incidence and types of drug-related problems (DRP) in a general teaching hospital and to evaluate the acceptability of pharmaceutical interventions by the medical team. DESIGN Prospective cohort study during 2 years. SETTING Conducted in a Brazilian University Hospital. PARTICIPANTS The patient cohort consisted of 9303 patients with a total of 12 286 hospitalisation episodes. PRIMARY OUTCOME MEASURES DRP detected by pharmacists' review of 100% medication orders using Pharmaceutical Care Network Europe 6.2 classification. RESULTS Patients with a mean age of 52.6±17.7 years and 50.9% females. A total of 3373 DRP in 1903 hospital episodes were identified, corresponding to a cumulative incidence of 15.5%. 'Treatment ineffectiveness' (11.5%) and 'Treatment costs' (5.90%) were the most common DRP and 'Drug use process' (18.4%) and 'Treatment duration' (31.0%) the main causes of DRP. The medicines involved most often involved in DRP were anti-infectives (36.0%), mainly cephalosporins (20.2%), antiulcer (38.6%), analgesics/antipyretics (61.2%), propulsives (51.2%), opioids (38.5%) and antiemetics (57.4%). From 1939 pharmaceutical interventions, at least, 21.4% were not approved by the medical team. CONCLUSION DRP detected by 100% medication order review by hospital pharmacists occur in a significant proportion of hospital episodes, the most frequent being related to treatment effectiveness and treatment costs. The medications mostly involved were cephalosporins, penicillins, antidyspeptics, analgesics, antipyretics, opioids and antiemetics. Pharmaceutical interventions had low acceptability by the medical staff.
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Affiliation(s)
- Valdjane Saldanha
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rand Randall Martins
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sara Iasmin Vieira Cunha Lima
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ivonete Batista de Araujo
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Antonio Gouveia Oliveira
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Kovačević M, Vezmar Kovačević S, Radovanović S, Stevanović P, Miljković B. Potential drug-drug interactions associated with clinical and laboratory findings at hospital admission. Int J Clin Pharm 2019; 42:150-157. [PMID: 31865593 DOI: 10.1007/s11096-019-00951-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
Background Drug-drug interactions represent one of the causes of adverse therapy outcomes through deteriorated efficacy or safety. However, the true extent of harm related to drug-drug interactions is not well established due to a lack of recognition and understanding. Objective The aim of this study was to investigate the association of potential drug-drug interactions with patients variables recorded at admission. Setting A cross-sectional correlation study was performed on the Cardiology ward of the University Clinical Hospital Center in Belgrade, Serbia. Method Data were retrospectively obtained from medical records and LexiInteract was used as the screening tool for potential drug-drug interactions. Main outcome measure Clinical and laboratory parameters recorded at the patients admission. Results A total of 351 patient records entered the analysis, with the mean age of 70 ± 10 years. The prevalence of potentially relevant drug-drug interactions was 61% (N = 213). After controlling for patient characteristics, nine potential drug-drug interactions were significantly associated with laboratory values outside the range and five potential drug-drug interactions with inadequate clinical parameter values. Potential drug-drug interactions were associated with abnormalities in blood count, metabolic parameters, electrolyte imbalance and renal function parameters. Association with inadequate control of systolic, diastolic blood pressure, as well as heart rhythm was also shown. Conclusion Drug-drug interactions were associated with patients clinical and laboratory findings. Our findings may assist in the identification of patients with increased likelihood of suboptimal therapy outcomes. Generating evidence through post-marketing drug-drug interactions research would lead to improvement in clinical decision-support systems, increased effectiveness and utilization in everyday clinical practice.
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Affiliation(s)
- Milena Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia.
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia
| | - Slavica Radovanović
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Bezanijska Kosa bb, 11080, Belgrade, Serbia.,University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, University of Belgrade School of Medicine, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Predrag Stevanović
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Bezanijska Kosa bb, 11080, Belgrade, Serbia.,University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, University of Belgrade School of Medicine, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia
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15
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Implementation of medication management services at the primary healthcare level - a pilot study. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2019; 69:585-606. [PMID: 31639091 DOI: 10.2478/acph-2019-0055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 01/19/2023]
Abstract
This study employed a mixed-method approach to enable the implementation of comprehensive medication management (CMM) services in Croatia's primary care setting. Drug therapy problems (DTPs) and factors associated with their occurrence were determined in patients with chronic diseases from January 2018 to April 2019. The pre-implementation stage established the foundations for the early implementation stage, in which the practice was set up, the patients' recruitment initiated and various challenges identified. During the study period, 86 patients were recruited for CMM provision. Overall, 2.8 DTPs (± 1.6) per patient were identified and the majority (96.2 %) presented with at least one DTP. Multiple regression analysis showed that type 2 diabetic patients (p = 0.025) and patients using five or more medications (p = 0.011) should be prioritized to receive CMM services as potentially they have a higher number of DTPs, and could, therefore, obtain a greater benefit from the service.
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Daliri S, Hugtenburg JG, ter Riet G, van den Bemt BJF, Buurman BM, Scholte op Reimer WJM, van Buul-Gast MC, Karapinar-Çarkit F. The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before-After prospective study. PLoS One 2019; 14:e0213593. [PMID: 30861042 PMCID: PMC6413946 DOI: 10.1371/journal.pone.0213593] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge. METHODS A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data. RESULTS We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79). CONCLUSIONS A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, the Netherlands
- Community Pharmacy Westwijk, Amsterdam, the Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, the Netherlands
| | - Bianca M. Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
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Niriayo YL, Kumela K, Kassa TD, Angamo MT. Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia. PLoS One 2018; 13:e0206120. [PMID: 30352096 PMCID: PMC6198973 DOI: 10.1371/journal.pone.0206120] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Drug therapy problem (DTP) is any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. Heart failure (HF) patients are more likely to experience DTP owing to multiple prescriptions and comorbidities. Despite the serious negative impact of DTP on treatment outcomes, there is a dearth of study on DTP among HF patients in Ethiopia. OBJECTIVE The main aim of this study was to assess the prevalence and contributing factors of DTP among ambulatory HF patients in Jimma University Specialized Hospital, Ethiopia. METHODS A hospital based prospective observational study was conducted. Written informed consent was obtained from each patient after full explanation of the study. Data were collected through patient interview and expert review of medical, medication and laboratory records of one-year follow-up from May 2015 to April 2016. DTPs were identified using Cipolle's method followed by consensus review with experts. Binary logistic regression was performed to identify factors contributing to DTP. A p<0.05 was considered statistically significant in all analyses. RESULT Of 340 study participants; male to female ratio was equivalent, the mean (± SD = standard deviation) age was 50.5±15.6 years. Eight hundred eighty DTPs were identified equating 2.6 ±1.8 DTPs per patient. The frequently identified DTPs were dosage too low (27.8%), ineffective drug therapy (27.6%) and need additional drug therapy (27.4%). Most commonly implicated drugs were beta-blockers (34.4%), angiotensin converting enzyme inhibitors (24.8%), statins (16.5%) and antithrombotics (13.1%). Factors contributing to DTP were age >50 years (AOR [adjusted odd ratio] = 5.43, 95%CI [95% confidence interval] = 2.03-14.50); negative medication belief (AOR = 3.50, 95%CI = 1.22-10.05); poor involvement of patients in the therapeutic decision makings (AOR = 4.11, 95%CI = 1.91-8.88); number of co-morbidity≥2(AOR = 5.26, 95%CI = 2.38-11.65) and number of medications ≥5 (AOR = 3.68, 95%CI = 1.28-10.51). CONCLUSION DTPs are common among ambulatory care HF patients. Patients with older age, negative medication belief, polypharmacy, co-morbidities and those who were poorly involved in the therapeutic decision were more likely to experience DTP. Despite traditional prescription refilling, an integrated multidisciplinary approach involving patients and clinically trained pharmacists should be implemented in the patient care process at ambulatory care clinics in order to improve overall outcomes and reduce DTPs and associated burdens in HF patients.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mulugeta Tarekegn Angamo
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobar, Australia
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Sagita VA, Bahtiar A, Andrajati R. Evaluation of a Clinical Pharmacist Intervention on Clinical and Drug-Related Problems Among Coronary Heart Disease Inpatients: A pre-experimental prospective study at a general hospital in Indonesia. Sultan Qaboos Univ Med J 2018; 18:e81-e87. [PMID: 29666686 DOI: 10.18295/squmj.2018.18.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/07/2017] [Accepted: 10/26/2017] [Indexed: 01/19/2023] Open
Abstract
Objectives This study aimed to evaluate the role of a clinical pharmacist intervention in decreasing subsequent clinical and drug-related problems (DRPs) among coronary heart disease (CHD) inpatients with at least one previous DRP. Methods This pre-experimental study with a pre-post design was carried out from January to April 2017 among inpatients with at least one previous DRP at a general hospital in Tangerang District, Banten, Indonesia. Clinical and DRPs were documented prospectively by a clinical pharmacist, with DRPs classified using Version 6.2 of the DRP classification scheme of the Pharmaceutical Care Network Europe Foundation. The intervention consisted of a discussion of identified DRPs with physicians, patients, pharmaceutical logistics clerks, nurses and nutritionists. Following this, any subsequent clinical and DRPs were re-identified and further interventions were conducted as necessary. Results A total of 75 inpatients were included in the study. Pre-intervention, there were 443 DRPs and 202 clinical problems. The most frequent DRPs were adverse drug reactions (52.6%), followed by drug effects (41.8%). Most DRPs were of moderate severity and would have resulted in moderate consequences had the pharmacist not intervened. The interventions resulted in a significant reduction in the number of DRPs, type of DRPs and number of clinical problems (P <0.05 each). Patients with complications were 26.047 times more likely to have no reduction or an increased number of clinical problems compared to patients without complications (P <0.05). Conclusion Clinical pharmacist interventions were found to reduce subsequent DRPs and clinical problems among CHD patients with at least one previous DRP.
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Affiliation(s)
- Vina A Sagita
- Faculty of Pharmacy, University of Indonesia, Depok, West Java, Indonesia
| | - Anton Bahtiar
- Department of Pharmaceuticals, University of Indonesia, Depok, West Java, Indonesia
| | - Retnosari Andrajati
- Department of Pharmaceuticals, University of Indonesia, Depok, West Java, Indonesia
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Zhai XB, Gu ZC, Liu XY. Clinical pharmacist intervention reduces mortality in patients with acute myocardial infarction: a propensity score matched analysis. Eur J Hosp Pharm 2018; 26:248-252. [PMID: 31656610 DOI: 10.1136/ejhpharm-2017-001344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 11/04/2022] Open
Abstract
Background Is it possible that the mortality rate from acute myocardial infarction (AMI) may decline after interventions by pharmacists? Objective To evaluate the impact of clinical pharmacist on the mortality of AMI. Methods Clinical pharmacists did not perform any interventions during phase 1 (pre-intervention), and consulted with physicians to address drug related problems (DRPs) during phase 2 (post-intervention). The main outcome was a decrease in mortality from AMI. The two phases were compared using propensity score matching (PSM). Results 1388 interventions were suggested by clinical pharmacists during phase 2, of which 1239 (89.2%) were accepted. Logistic regression analysis demonstrated that interventions of clinical pharmacists were significantly associated with a reduced mortality in patients with both ST segment elevation myocardial infarction (STEMI) (OR 0.449; 95% CI 0.296 to 0.680) and non-ST segment elevation myocardial infarction (NSTEMI) (OR 0.268; 95% CI 0.125 to 0.572). Using PSM analysis, mortality reduced from 6.8% to 4.3% in STEMI patients (P=0.0034) and from 3.2% to 0.7% in NSTEMI patients (P=0.0202) after the interventions. Conclusions DRPs that caused or contributed to possible mortality were detected by clinical pharmacists in patients with AMI. Correcting these DRPs after pharmacists' interventions could result in a significant decrease in mortality.
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Affiliation(s)
- Xiao-Bo Zhai
- Department of Pharmacy, Shanghai East Hospital, Affiliated to Tongji University Shanghai, Shanghai, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao-Yan Liu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Saxby KJE, Murdoch R, McGuinness J, Steinke DT, Williams SD. Pharmacists' attitudes towards a pharmaceutical assessment screening tool to help prioritise pharmaceutical care in a UK hospital. Eur J Hosp Pharm 2017; 24:315-319. [PMID: 31156965 DOI: 10.1136/ejhpharm-2016-001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 11/03/2022] Open
Abstract
Objective To establish the thoughts of pharmacists using the pharmaceutical assessment screening tool (PAST) when assigning a patient acuity level (PAL) and establish other decision factors. A PAL is a pharmaceutical assessment of a patient (lowest=1 to highest=3), higher PALs highlight the requirement for a more intensive pharmaceutical input to reduce potential harm. Method A questionnaire designed to elicit attitudes about the PAST was circulated to 32 pharmacists working in a 900 bed UK university teaching hospital. Respondents were asked to document what PAL they would assign for six theoretical patient cases with an explanation. The data collected was analysed using Microsoft Excel and further analysis was undertaken about the strength of agreement to PAST using the κ statistic using Stata V.12 (StataCorp, Texas, USA). Results The questionnaire was completed by 28/32 pharmacists (87.5% response rate). The mean confidence (SD) for assigning a PAL was 81% (±20%). 26/28 pharmacists (93%) agreed or strongly agreed that professional judgement guided them most when allocating a PAL. The PAL assigned to the case studies presented both overestimations and underestimations compared with the guidance but overall the strength of agreement was considered to be 'fair' (κ=0.202). Conclusions Pharmacists feel confident about using PAST to help them assign a PAL. However, the use of professional judgement to assign an acuity level overrides any predicted level from PAST.
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Affiliation(s)
| | - Ruth Murdoch
- University Hospital of South Manchester, Manchester, UK
| | | | - Douglas T Steinke
- University Hospital of South Manchester, Manchester, UK.,Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - Steven D Williams
- University Hospital of South Manchester, Manchester, UK.,Manchester Pharmacy School, University of Manchester, Manchester, UK
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21
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Zhai XB, Gu ZC, Liu XY. Effectiveness of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: a propensity score-matched analysis. Ther Clin Risk Manag 2016; 12:241-50. [PMID: 26937196 PMCID: PMC4762444 DOI: 10.2147/tcrm.s98300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pharmacist-led medication review services have been assessed in the meta-analyses in hospital. Of the 135 relevant articles located, 21 studies met the inclusion criteria; however, there was no statistically significant difference found between pharmacists’ interventions and usual care for mortality (odds ratio 1.50, 95% confidence interval 0.65, 3.46, P=0.34). These analyses may not have found a statistically significant effect because they did not adequately control the wide variation in the delivery of care and patient selection parameters. Additionally, the investigators did not conduct research on the cases of death specifically and did not identify all possible drug-related problems (DRPs) that could cause or contribute to mortality and then convince physicians to correct. So there will be a condition to use a more precise approach to evaluate the effect of clinical pharmacist interventions on the mortality rates of hospitalized cardiac patients. Objective To evaluate the impact of the clinical pharmacist as a direct patient-care team member on the mortality of all patients admitted to the cardiology unit. Methods A comparative study was conducted in a cardiology unit of a university-affiliated hospital. The clinical pharmacists did not perform any intervention associated with improper use of medications during Phase I (preintervention) and consulted with the physicians to address the DRPs during Phase II (postintervention). The two phases were compared to evaluate the outcome, and propensity score (PS) matching was applied to enhance the comparability. The primary endpoint of the study was the composite of all-cause mortality during Phase I and Phase II. Results Pharmacists were consulted by the physicians to correct any drug-related issues that they suspected may cause or contribute to a fatal outcome in the cardiology ward. A total of 1,541 interventions were suggested by the clinical pharmacist in the study group; 1,416 (92.0%) of them were accepted by the cardiology team, and violation of incompatibilities had the highest percentage of acceptance by the cardiology team. All-cause mortality was 1.5% during Phase I (preintervention) and was reduced to 0.9% during Phase II (postintervention), and the difference was statistically significant (P=0.0005). After PS matching, all-cause mortality changed from 1.7% during Phase I down to 1.0% during Phase II, and the difference was also statistically significant (P=0.0074). Conclusion DRPs that were suspected to cause or contribute to a possibly fatal outcome were determined by clinical pharmacist service in patients hospitalized in a cardiology ward. Correction of these DRPs by physicians after pharmacist’s advice caused a significant decrease in mortality as analyzed by PS matching. The significant reduction in the mortality rate in this patient population observed in this study is “hypothesis generating” for future randomized studies.
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Affiliation(s)
- Xiao-Bo Zhai
- Department of Pharmacy, Shanghai East Hospital, Affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Zhi-Chun Gu
- Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiao-Yan Liu
- Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Abdela OA, Bhagavathula AS, Getachew H, Kelifa Y. Risk factors for developing drug-related problems in patients with cardiovascular diseases attending Gondar University Hospital, Ethiopia. J Pharm Bioallied Sci 2016; 8:289-295. [PMID: 28216952 PMCID: PMC5314827 DOI: 10.4103/0975-7406.199335] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cardiovascular diseases (CVDs) are often accompanied with comoribidities and complications leading to taking multiple drugs and thus are more liable to be exposed to drug-related problems (DRPs). DRPs can occur at any stages of medication process from prescription to follow-up treatment. However, a few studies have assessed the specific risk factors for occurrence of at least one potential DRP per patient with CVDs in sub-Saharan African region. Aim: We aim to assess the risk factors for developing potential DRPs in patients with CVDs attending Gondar University Referral Hospital (GUH). Methodology: This was a cross-sectional study. A structured systematic data review was designed focusing on patients with CVDs (both out and inpatients) with age >18 years of both genders attending GUH from April to June 2015. All DRPs were assessed using drugs.com and Medscape. The causes of DRPs were classified using Pharmaceutical Care Network Europe version 6.2. Risk factors that could cause DRPs were assessed using binary logistic regression showing odds ratio with 95% confidential interval. Statistical significance was set at P < 0.05. Results: A total of 227 patients with CVDs were reviewed with a mean age of 52.0 ± 1.7 years. Majority were females (143, 63%), outpatients (133, 58.6%), and diagnosed with heart failure (71, 31.3%). Diuretics (199, 29.5%) were the most commonly prescribed drugs. A total of 265 DRPs were identified, 63.4% of patients have at least one DRP (1.17 ± 1.1). The most common DRPs were found to be an inappropriate selection of drug (36.1%) and dose (24.8%). The most identified risk factors causing DRPs were: Need of additional drug therapy and lack of therapeutic monitoring. Conclusion: The most identified risk factors for developing DRPs were the need of additional drug therapy and lack of therapeutic monitoring. There is a need for clinical pharmacist interventions to monitor and prevent the risk of developing DRPs and contribute to improve the clinical outcome in patients with CVDs.
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Affiliation(s)
- Ousman Abubeker Abdela
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Henok Getachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Kelifa
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Movva R, Jampani A, Nathani J, Pinnamaneni SH, Challa SR. A prospective study of incidence of medication-related problems in general medicine ward of a tertiary care hospital. J Adv Pharm Technol Res 2015; 6:190-4. [PMID: 26605161 PMCID: PMC4630727 DOI: 10.4103/2231-4040.166502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The study is aimed to assess the incidence of drug-related problems (DRPs) and provide pharmacist interventions for identified DRPs. A prospective, observational study was conducted among 189 patients with cardiovascular disease who were aged 18 years or older and admitted to the general medicine in-patient ward. During the 6 months study period, the incidence of DRPs was identified using Pharmaceutical Care Network Europe Foundation classification system version 6.2. A total of 189 patients were screened for DRPs. Among them, 130 patients have at least one DRP. A total of 416 DRPs were identified (on average, 2.2 DRPs per each patient). Of the 416 DRPs, 125 (30.04%) interventions were accepted, 7 (1.68%) interventions were not accepted, while remaining (68.26%) accepted but no action taken. The results of the study indicate that incidence of DRPs is substantial and pharmacist-led interventions resulted in resolution of DRPs. This represents the need for the active role of the clinical pharmacist in the developing countries like India.
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Affiliation(s)
- Ramya Movva
- Department of Pharmacy Practice, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada, Andhra Pradesh, India
| | - Anusha Jampani
- Department of Pharmacy Practice, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada, Andhra Pradesh, India
| | - Jyothsna Nathani
- Department of Pharmacy Practice, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada, Andhra Pradesh, India
| | - Sri Harsha Pinnamaneni
- Department of Pharmacy Practice, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada, Andhra Pradesh, India
| | - Siva Reddy Challa
- Department of Pharmacy Practice, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada, Andhra Pradesh, India ; Department of Pharmacology, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada, Andhra Pradesh, India
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