Drug-Related Problems of Patients in Primary Health Care Institutions: A Systematic Review.

Xiao-Feng Ni,Ling-Li Zhang,Chun-Song Yang,Zi-Xian Hu,Yu-Mei Bai

doi:10.3389/fphar.2021.698907

Abstract

Introduction: Drug-related problems (DRPs) are not only detrimental to patients' physical health and quality of life but also lead to a serious waste of health care resources. The condition of DRPs might be more severe for patients in primary health care institutions.Objective: This systematic review aims to comprehensively review the characteristics of DRPs for patients in primary health care institutions, which might help find effective strategies to identify, prevent, and intervene with DRPs in the future.Methods: We searched three English databases (Embase, The Cochrane Library, and PubMed) and four Chinese databases (CNKI, CBM, VIP, and Wanfang). Two of the researchers independently conducted literature screening, quality evaluation, and data extraction. Qualitative and quantitative methods were combined to analyze the data.Results: From the 3,368 articles screened, 27 met the inclusion criteria and were included in this review. The median (inter-quartile range, IQR) of the incidences of DRPs was 70.04% (59%), and the median (IQR) of the average number of DRPs per patient was 3.4 (2.8). The most common type of DRPs was “treatment safety.” The causes of DRPs were mainly in the prescribing section, including “drug selection” and “dose selection”, while patients' poor adherence in the use section was also an important cause of DRPs. Risk factors such as the number of medicines, age, and disease condition were positively associated with the occurrence of DRPs. In addition, the medians (IQR) of the rate of accepted interventions, implemented interventions, and solved DRPs were 78.8% (22.3%), 64.15% (16.85%), and 76.99% (26.09%), respectively.Conclusion: This systematic review showed that the condition of DRPs in primary health care institutions was serious. In pharmaceutical practice, the patients with risk factors of DRPs should be monitored more closely. Pharmacists could play important roles in the identification and intervention of DRPs, and more effective intervention strategies need to be established in the future.

Highlights

Drug-related problems (DRPs) are detrimental to patients’ physical health and quality of life and lead to a serious waste of health care resources
The causes of DRPs were mainly in the prescribing section, including “drug selection” and “dose selection”, while patients’ poor adherence in the use section was an important cause of DRPs. Risk factors such as the number of medicines, age, and disease condition were positively associated with the occurrence of DRPs
This systematic review showed that the condition of DRPs in primary health care institutions was serious

Summary

Introduction

Drug-related problems (DRPs) are detrimental to patients’ physical health and quality of life and lead to a serious waste of health care resources. Unresolved or potential DRPs could lead to unnecessary outpatient visits, hospital admissions, and long-term care, which interfered with clinical treatment and increased patients’ financial burden (Stafford et al, 2009; Ucha-Samartín et al, 2013; Lenssen et al, 2016). In the United States, DRPs were one of the main causes of death (Budnitz et al, 2006), with approximately 3–6% (700,000/ year) of hospital admissions and a cost of 130 billion dollars each year (World Health Organization, 2016 and International Pharmaceutical Federation, 2016). DRPs have caused damage to patients’ physical health and quality of life to a certain extent and have led to a significant waste of health care resources. Up to 88% of DRPs could have been avoided (Beijer and de Blaey, 2002; Mcdonnell and Jacobs, 2002; Baena et al, 2006)

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Conclusion