1
|
Barceló-Vidal J, Echeverría-Esnal D, Carballo N, De Antonio-Cuscó M, Fernández-Sala X, Navarrete-Rouco ME, Colominas-González E, Luque S, Fuster-Esteva M, Domingo L, Sala M, Duran X, Grau S, Ferrández O. Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic. Front Pharmacol 2022; 13:993158. [PMID: 36506516 PMCID: PMC9730804 DOI: 10.3389/fphar.2022.993158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.
Collapse
Affiliation(s)
- J. Barceló-Vidal
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,*Correspondence: J. Barceló-Vidal,
| | - D. Echeverría-Esnal
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - N. Carballo
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - X. Fernández-Sala
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | | | - S. Luque
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - M. Fuster-Esteva
- Faculty of Medicine, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - L. Domingo
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,Department of Epidemiology and Evaluation, Barcelona, Spain
| | - M. Sala
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,Department of Epidemiology and Evaluation, Barcelona, Spain
| | - X. Duran
- Statistics Deparment, Institut Hospital del Mar D'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - S. Grau
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,Faculty of Medicine, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - O. Ferrández
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| |
Collapse
|
2
|
Shahrami B, Sefidani Forough A, Najmeddin F, Hadidi E, Toomaj S, Javadi MR, Gholami K, Sadeghi K. Identification of drug-related problems followed by clinical pharmacist interventions in an outpatient pharmacotherapy clinic. J Clin Pharm Ther 2022; 47:964-972. [PMID: 35218217 DOI: 10.1111/jcpt.13628] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pharmacotherapy is an essential strategy for the treatment of many medical conditions especially chronic disease and often involves multiple medications being used simultaneously. Increasing the use of medications may pose some challenges to safe and effective drug therapy and if not identified and prevented by the pharmacists eventually can lead to drug-related problems (DRPs). The present study aimed to examine the incidence of DRPs in Iranian patients and to evaluate patients' adherence to the clinical pharmacist interventions as well as the physicians' acceptance of these recommendations. METHODS This study was conducted in a university-affiliated outpatient pharmacotherapy clinic over a 22-month period. Patients aged 18 years and older with at least one chronic disease receiving at least four medications were included in the study. The patients were interviewed by a clinical pharmacist for comprehensive medication review. DRPs were identified using the DOCUMENT classification system. Recommendations were provided by the clinical pharmacist including interventions involving patient and/or physician to resolve DRPs. The patients were followed up after 2 weeks to evaluate their compliance and physician acceptance of clinical pharmacist recommendations. RESULTS AND DISCUSSION Two hundred patients were included in this study. Overall, 875 DRPs were identified with an average of 4.37 per patient. The most prevalent DRPs were related to patient education or information (22.8%), undertreated indications (17.4%) and patient compliance (17.2%). The most common drugs associated with DRPs were alimentary and metabolism (22.2% of DRPs) followed by the cardiovascular system (19.2%) and nervous system (9.6%) medications. The DRP incidence correlated with gender only and was higher in females (p = 0.019). The clinical pharmacist provided 912 interventions with an average of 4.56 and 1.04 interventions per patient and per DRPs respectively. Patient education (41.3%), medication initiation or discontinuation (24.5%), and non-pharmacological interventions (12.9%) were the most common clinical pharmacist interventions. Out of 912 interventions, 665 were followed up, out of which 427 were patient dependent and 228 involved physicians. The patient's compliance with clinical pharmacist recommendations was 81.2%. The physician acceptance rate of the recommendations was 44.1%. WHAT IS NEW AND CONCLUSION The study shows that especially designed services such as pharmacotherapy clinics running by clinical pharmacists are necessary to detect and resolve DRPs in an effective way. The high compliance rate of the patients indicates patients' confidence in the clinical pharmacist services provided in the pharmacotherapy clinic. The low acceptance rate of the physicians highlights the need to improve interprofessional collaboration between clinical pharmacists and physicians in an outpatient setting.
Collapse
Affiliation(s)
- Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Farhad Najmeddin
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Hadidi
- 13-Aban Pharmacotherapy Clinic, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Toomaj
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Javadi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Sadeghi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Hsu KL, Fink JC, Ginsberg JS, Yoffe M, Zhan M, Fink W, Woods CM, Diamantidis CJ. Self-reported Medication Adherence and Adverse Patient Safety Events in CKD. Am J Kidney Dis 2015; 66:621-9. [PMID: 25979348 PMCID: PMC4586079 DOI: 10.1053/j.ajkd.2015.03.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/06/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Promoting medication adherence is a recognized challenge for prescribers. In this study, we examine whether lower medication adherence is associated with adverse safety events in individuals with decreased estimated glomerular filtration rates (eGFRs). STUDY DESIGN Cross-sectional baseline analysis of prospective cohort. SETTING & PARTICIPANTS Baseline analysis of the Safe Kidney Care (SKC) Cohort Study, a prospective study of individuals with eGFRs<60 mL/min/1.73 m(2) intended to assess the incidence of disease-specific safety events. Kidney transplant recipients were excluded. PREDICTOR Self-reported medication adherence based on responses to 3 questions ascertaining degree of medication regimen adherence. OUTCOMES Adverse safety events were self-reported at baseline (class I events), such as hypoglycemia or fall thought to be related to a medication, or detected incidentally during the baseline visit (class II events), for example, hypotension or hyperkalemia. Potential drug-related problems (DRPs) were determined by analyzing participants' medications with respect to dosing guidelines based on their screening eGFRs at the time of medication reporting. MEASUREMENTS Relationship between medication adherence and disease-specific patient safety events. RESULTS Of 293 SKC participants, 154 (53%) were classified as having lower medication adherence. After multivariable adjustment, lower medication adherence was significantly associated with a class I or II safety event (prevalence ratio [PR], 1.21; 95% CI, 1.04-1.41) and potential DRPs (PR, 1.29; 95% CI, 1.02-1.63). Lower medication adherence was also significantly associated with multiple (≥2) class I events (PR, 1.71; 95% CI, 1.18-2.49), multiple class I or II events (PR, 1.35; 95% CI, 1.04-1.76), and multiple potential DRPs (PR, 2.11; 95% CI, 1.08-2.69) compared with those with higher medication adherence. LIMITATIONS Use of self-reported medication adherence rather than pharmacy records. Clinical relevance of detected safety events is unclear. CONCLUSIONS Lower medication adherence is associated with adverse safety events in individuals with eGFRs<60 mL/min/1.73 m(2).
Collapse
Affiliation(s)
- Kailin L Hsu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Medicine, Veterans Affairs Maryland Health Care System, Baltimore, MD
| | - Jennifer S Ginsberg
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Marni Yoffe
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Min Zhan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Wanda Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - Clarissa J Diamantidis
- Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC.
| |
Collapse
|