Incidence Of Drug-related Problems Research Articles

ASSESSMENT OF DRUG RELATED PROBLEMS IN PATIENTS WITH CHRONIC DISEASES IN THE GENERAL MEDICINE UNITS OF A TERTIARY CARE HOSPITAL

Objective: Patients with chronic diseases are more prone to develop drug-related problems (DRPs), which can further worsen their quality of life. The aim of this study was to determine factors and medications associated with DRPs in patients with chronic disease.Methods: This prospective interventional study was conducted for a duration of 6 mo in the in-patients of general medicine department of PSG Hospital, Coimbatore. DRPs were identified, assessed and recorded as per pharmaceutical care network Europe (PCNE) V5.01 criteria. Chi-square and correlation test were used to analyze the data for identifying factors associated with DRPs.Results: A total of 137 patients were enrolled for the study, of which 66 patients developed DRPs. The most prevalent DRP was found to be drug choice problem. The major causes of DRPs were found to be drug and dose selection. Antidiabetic drugs were found to be more associated with drug-related problems. The incidence of drug-related problems was high in patients aged between 50 to 59 y. Association between gender, length of hospital stays and polypharmacy with DRPs was found to be statistically significant. 58.33% of the total drug-related problems were completely solved and 19.05% were partially solved.Conclusion: The incidence of DRPs in the General Medicine department of the hospital was high. The use of an appropriate tool such as PCNE may assist pharmacists and other healthcare professionals to systematically identify, categorize and report drug-related problems.

PHARMACIST INVOLVEMENT TO DECREASE DRUG-RELATED PROBLEMS AMONG GERIATRIC PATIENTS IN INDONESIAN PRIMARY HEALTH CENTERS

Objective: The studies have demonstrated that older people often suffer from multiple diseases and are thus prescribed many different drugs. Therefore, drug-related problems (DRPs) are common in the elderly. The main objectives of this study were to reduce the number of DRPs in the elderly through pharmacist involvement and to analyze differences after pharmacist recommendations.Methods: In a quasi-experimental study, 12 primary health centers were selected and randomly divided into two groups (six in each group). In the first group, the physicians received pharmacist recommendations verbally through discussions, and in the second group, the physicians received recommendations through letters. DRPs were analyzed from all older inpatients’ medical records 1 month before and 1 month after the pharmacist recommendations. The main outcome being measured was the incidence of DRPs, classified into problems, and causes according to the Indonesian translated version of Pharmaceutical Care Network Europe, Version 6.2 (PCNE V 6.2). The problems were identified based on journal articles and other relevant literature.Results: A total of 205 patients were analyzed before pharmacist intervention (Group 1: 121; Group 2: 84) and 202 patients after the intervention (Group 1: 108; Group 2: 94). The most common problem in these elderly patients was that they suffered from toxic effects. The most common cause was inappropriate drug selection. The number of DRPs and causes were decreased significantly through the discussions (Wilcoxon signed-rank test, problems p=0.027, causes p=0.028). DRPs were also significantly decreased through the recommendation letters (paired t-test, number of problems p=0.003, and causes p=0.004). Discussion with physicians seemed more effective and decreased more problems (p=0.001) and causes (p=0.002). Through discussions, the decrease in a number of problems was 20.83±8.931, and the decrease in the number of causes was 25.33±11.431 versus the recommendation letter, at 4.17±1.941 and 5.17±2.483, respectively.Conclusion: Pharmacist involvement decreased DRPs among older inpatients. Discussing DRPs with the physicians treating the patients is more effective than giving recommendations in writing only. The PCNE V 6.2 DRP classification system is useful for documenting DRPs among the elderly as it can help pharmacists develop plans to reduce DRPs.

Role of clinical oncology pharmacist in determination of pharmaceutical care needs in patients with colorectal cancer

ObjectiveTo determine and evaluate the pharmaceutical care needs and quality of life of patients with colorectal cancer.Methods36 Patients with colorectal cancer eligible for chemotherapy after surgery were included in the...

Hubungan Jumlah Obat yang Digunakan terhadap Risiko Terjadinya Drug-Related Problems pada Pasien Asma Di Suatu Rumah Sakit Di Surabaya

Asthma is a chronic inflammatory disorder of the respiratory tract are at risk of polypharmacy, which is associated with an increased risk of drug-related problems (DRPs) and adverse clinical outcomes. This study aimed to analyze the relationship between the amount of drug used with the incidence of DRPs in hospitalized asthma patients. Research were using retrospective methods, by analyzing the medical records of patients undergoing asthma hospitalizations for 2 years. The number of patients analyzed was 60 people. Results of research conducted by the Spearman test for non-parametric tests, show that there is a correlation between the amount of drug to the type of drugs that are less precise DRPs (p <0.05), so that more and more types of drugs used by patients with asthma, the greater the risk of patients getting the drug less appropriate. Therefore it takes the role of pharmacists in monitoring and recommending rational drug for asthma patients who underwent inpatient in a hospital, for treatment obtained by the patient effective and optimal.

A study of medication-related problems in stroke patients: A need for pharmaceutical care.

Objective:The study was aimed to assess the incidence and characteristics of drug-related problems (DRPs).Methods:A prospective, observational study was conducted among 133 patients with stroke disease who were aged 18 years or older and admitted to the general medicine ward. During the 6 months study period, the incidence of DRPs was identified using the Pharmaceutical Care Network Europe Foundation classification system, version 6.2.Findings:A total of 133 patients were screened for DRPs. Among them, 120 patients have at least one DRP. A total of 254 DRPs were identified (on average, 2.015 DRPs per each patient case).Conclusion:Increasing the evidence of the incidence of medication-related problems in tertiary care hospitals indicates the need for the establishment of a clinical pharmacist in hospital settings.

A prospective study of incidence of medication-related problems in general medicine ward of a tertiary care hospital.

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.

Assessment of drug-related problems in depressive patients.

Background:Drug-related problems (DRPs) frequently occur in modern medical practice, increasing the morbidity and mortality as well as increasing cost of care.Objective:The study is to evaluate the incidence of DRPs in patients admitted to a psychiatric department.Materials and Methods:A prospective observational study was conducted for a period of 4 months at Baliga psychiatric hospital. All prescriptions of the study population were screened for DRPs such as adverse drug reactions (ADRs) and potential drug-drug interactions (pDDIs) by using computerized database system.Results:Out of 120 patients, 19 patients had observed 26 DRPs. Out of 33 patients, 19 patients had observed 26 ADRs and 14 patients had observed 24 pDDIs. The overall incidence of DRPs was 15.83%. Female patients outnumbered the male patients, in which 12 women constitute 10% followed by men 7 (5.83%). The common ADRs observed were hyponatremia and headache. Considering the outcomes, 20 (76.9%) cases recovered from ADRs and 20 (76.9%) of the ADRs were definitely preventable. Majority of ADRs were probable and were found to be mild to moderately severe.Conclusions:Age, female gender and polypharmacy were the risk factors for the developing DRPs.

Characteristics of unplanned hospital admissions due to drug-related problems in cancer patients

Studies have examined drug-related problems (DRPs) that have led to hospital admissions in the general population. However, there is a lack of information on the characteristics of DRPs in the cancer population. The objective of this study was to investigate the type, causality, severity, and preventability of DRPs that result in unplanned hospitalizations among cancer patients. This was a prospective, cohort study conducted in two oncology wards between July and December 2012. All patients who were diagnosed with solid tumor or lymphoma and required unplanned hospitalization were included. The incidence of DRPs among hospital admissions was captured, and the nature of the DRPs (causality, severity, and preventability) was characterized. There were 1,299 admissions and 1,275 were eligible for analysis. Among the 1,275 eligible admissions, 158 (12.4%) were considered to be associated with a DRP. In the 158 admissions associated with DRPs, 164 DRPs were found. The majority of the DRP-related admissions were adverse drug reactions (ADRs) (n=155/164, 94.5%), probable (n=98, 59.8%), moderately severe (n=155, 94.5%), and probably or definitely preventable (n=86, 52.4%). Most patients with DRPs recovered and were discharged. Febrile neutropenia was the most common adverse drug reaction, and drug combinations involving antihypertensives and long-term corticosteroids raised the risks for potential drug-drug interactions among patients with cancer. The incidence of DRP-induced unplanned hospital admissions was 12.4% among cancer patients. Approximately half of these were preventable events.

Drug-related problems cause many admissions to a Brazilian hospital paediatric emergency unit: A prospective and observational study

BackgroundPaediatric patients are one of the most vulnerable patient populations. There are many unlicensed medicines and the so-called ‘off-label’ uses for which they are prescribed may increase the risk of...

Can a year of pharmacotherapeutic follow-up reduce the incidence of drug-related problems and increase CD4 counts in HIV-positive outpatients?

BackgroundSurrogate markers for HIV infection are important and should be used simultaneously with definitive indicators of health and well-being such as drug-related problems (DRPs) within a patient population. Few studies...

Pharmacist intervention in an elderly care facility

Abstract The effectiveness of a pharmacist-initiated drug regimen review (DRR) in reducing the incidence of drug-related problems (DRPs), such as drug interactions, additive adverse effects and duplicate therapy, in the elderly was investigated. The medication profiles of 85 patients aged over 65 years, in an elderly care facility in South Africa, were evaluated for potential DRPs. It was found that 77 per cent of the patients were receiving one or more drugs at a dose exceeding the recommended geriatric dose. Some 68 per cent were receiving six or more drugs. Potential drug interactions and duplicate therapy were identified in 64 per cent and 34 per cent, respectively. A total of 85 pharmacist-initiated recommendations was presented to seven medical practitioners over a period of 16 weeks. Of these, 66 (77.7 per cent) met with the approval of the prescribers. Statistical interpretation of results showed that the incidence of all DRPs declined significantly post-recommendation. The cost benefit of the study was clearly illustrated by a 41 per cent reduction in the incidence of polypharmacy (P<0.01).

Assessment of Drug‐Related Problems and Clinical Pharmacists' Interventions in an Indian Teaching Hospital

Aim: To identify drug‐related problems (DRPs) at a major Indian teaching hospital, to assess the acceptance of recommendations made by clinical pharmacists and evaluate the level of involvement of pharmacists in drug therapy decisions.Method: A prospective study was conducted over a six‐month period in the medical wards of the Jagadguru Shri Shivarathreeshwara (JSS) Medical College Hospital, Mysore, India. A decision‐making model proposed by Campagna (and modified by Wood) was applied to evaluate pharmacists' involvement in drug therapy decisions.Results: Of the 245 DRPs identified, 237 involved active clinical pharmacist interventions. The most common DRPs were inappropriate dosage (31%), inappropriate drug selection (17%) and adverse drug reactions (13%). Ninety per cent of the pharmacists' recommendations were accepted and led to change in therapy in 79% of cases. Most of the interventions were classified (according to the decision‐making model) as corrective (78%) or proactive (19%).Conclusion: The incidence of DRPs identified in this study is higher than reported in some studies in developed countries. But the acceptance rate of clinical pharmacists' interventions was comparable to studies conducted in countries where clinical pharmacy is well‐developed and indicate the acceptance and recognition of clinical pharmacists as active members of the healthcare team at JSS Medical College Hospital.

Identification of medication-related attendances at an A & E department.

The use of medication is the most common medical intervention, but it has associated risks. These have been described as drug-related problems (DRPs). Other non-UK studies have reported DRPs to be the cause of 3-16% of hospital admissions and around 4% of attendances at emergency departments. The size of the problem in the UK has not been quantified. The aim of this study was to identify the number of patients attending a central London accident and emergency (A & E) department with symptoms or conditions caused by DRPs. A 2-week retrospective, case-review study was conducted in the A & E department of St Thomas' Hospital, London, during March 1999. DRPs were identified using recognized criteria. Statistical analysis identified patient characteristics which could be associated with the incidence of DRPs. The types of DRP and the drugs involved were identified. During the study period, 106 patients attended the A & E department with a DRP. This equates to 4% of the A & E population. During this period the demographics of the A & E attenders were no different to the annual A & E cohort. The most common DRPs were adverse drug reactions and overdose. The most frequently involved drugs included analgesics, antibiotics, those with narrow therapeutic indices and illegal drugs. The mean age of this patient group was 38 years (non-significant). They attended significantly more frequently during the early hours of the morning and on Saturdays than the A & E general population (chi-squared P = 0.004 and P = 0.003, respectively). The incidence of DRP as a cause of attendance at A & E reflects that in the literature. No statistical association with a specific age group of patients could be made, but the mean age of 38 years is younger than previously reported. The demographic differences which were statistically significant can be explained by the increased incidence of DRP associated with the use of illegal drugs than reported in other studies. Other drug groups identified by this study are representative of other reports. DRPs account for 4% of attendances at a central London A & E Department.

Therapy related hospital admission in patients on polypharmacy in Singapore: a pilot study.

To estimate the incidence of drug-related problems (DRPs)-associated hospital admission, and its correlation to polypharmacy and age. A retrospective, cross-sectional study in in-patients on polypharmacy in Singapore. Significant differences (P < 0.05) between number of medications taken and age of patients were tested with the chi-square test. The study population consisted of 347 patients (aged 16-97) on a mean of 7.4 +/- 2.1 medications. 10.8% of the study population had DRPs on admission: 71.9% of which were dominant reasons for admission, and DRPs contributed partly in the remaining cases. These DRPs were mostly avoidable, and can be broadly classified into non-compliance, adverse drug reactions, require synergistic therapy, inappropriate dose and untreated condition. 52% of these cases were made up of geriatric patients. No statistical difference was found between patients on polypharmacy and those on major polypharmacy (10 and more drugs) in having a DRP. In this study, DRPs contributing to hospital admission appeared to be avoidable. Geriatrics were more susceptible to DRPs and future efforts are required in managing medications prescribed for these patients to reduce such incidences.

A Comparison of Computer-Based Versus Pencil-and-Paper Assessment of Drug Use

Objective: This randomized trial explores whether client responses to a structured interview differed when the interview was administered using a paper instrument or a computer. Method: 100 clients in substance abuse treatment were randomly assigned to undergo a comprehensive clinical assessment by either standard pencil-and-paper interview or computer-assisted interview. The reported use of drugs and incidence of drug-related problems were compared across the two types of administration using ANOVA, independent sample t tests, and chi-square statistics. The difference in the effect of the computerized interview on clients with and without pending legal issues was also evaluated. Results: In general, clients provided the same responses to standard pencil-and-paper interviews and computer-assisted interviews. Having pending legal issues did not affect the client’s sensitivity to the computer-assisted interview. Conclusion: We found no evidence that the use of computerized clinical assessments by social work practitioners compromises the validity of client responses.

Illicit drugs and fitness to drive: assessment in Spanish Medical Driving Test Centres

This study investigated the incidence of problems related to illicit drugs and fitness to drive among 8043 Spanish drivers assessed in 25 Medical Driving Test Centres at national level. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from illicit drug-related problems. A small percentage (0.3%; n=24) of drivers interviewed had problems relating to drug use (abuse, dependence and induced disorders) and half of them ( n=12) were also diagnosed as having problems with alcohol. Drivers with illicit drug-related problems were more often involved in road accidents and committed more traffic infractions during the last year (33.3%, n=8, and 79.2%, n=19, respectively) than those without problems related to illegal drug taking (12.3%, n=986, and 9.3%, n=748, respectively). Of drivers with drug problems 70.8% ( n=17) were considered fit to drive. The results show that the incidence of drug-related problems is rare among Spanish drivers, and that in three out of four cases drivers with drug-related problems were considered fit to drive.

The incidence of drug-related problems as a cause of hospital admissions in children.

To determine the incidence of hospital admissions for drug-related problems (DRPs) among children, and to examine cases for causality, preventability and clinical severity. Prospective assessment involving review of case notes and parent interview to determine if an admission was associated with a DRP. All patients admitted to a large university-affiliated paediatric hospital in Melbourne, Victoria, for medical reasons (i.e., not surgical, trauma or oncology patients) during 56 consecutive days from 24 June to 19 August 1996 for which a DRP could be identified. Patients whose parents or guardians could not communicate adequately in English were excluded. The incidence, type, causality, preventability and clinical severity of DRPs associated with admission. Of 1682 eligible patients admitted to the Royal Children's Hospital during the study period, 58 admissions (3.4%) were associated with DRPs. Non-compliance was implicated in 50%. Causality was ranked as "definite" (34.5%), "possible" (56.9%) and "doubtful" (8.6). Two-thirds of admissions associated with DRPs were deemed preventable. Although no patients died from DRPs, four were admitted to the intensive care unit. The incidence of DRPs as a cause of hospital admission in this study falls within the range of incidences published for the Australian adult population (range, 2.4%-22%). In contrast to findings among Australian adults, a high proportion of admissions for DRPs in this study were associated with non-compliance. The high percentage of preventable admissions indicates that further study is necessary to characterise risk factors within this population and to test prevention strategies.

Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment.

although drug-related problems (DRPs) are known to be prevalent in elderly patients, the literature on prevention of iatrogenic disease is sparse. The present study addresses this requirement. to assess the incidence of DRPs in elderly patients admitted to Tayside hospitals before (phase I) and after (phase II) implementation of preventive strategies. all elderly people admitted to hospital were screened by a pharmacist; individual case reviews were prepared for all those with a potential DRP and reviewed by a three-member panel which made a final decision on the presence of a DRP and its contribution to admission. all hospital wards admitting elderly patients in the Tayside region of Scotland. 1011 elderly patient admissions over a 9-month period (phase I); 857 elderly patient admissions over an 8-month period (phase II). incidence of DRPs before and after targeted intervention strategies (information bulletin for general practitioners, patient information leaflet, oral presentation to trainee general practitioners). in phase I, the incidence of DRPs was 144/1011 (14.2%), with 54/1011 (5.3%) of the admissions identified as being definitely or probably drug-related. Non-steroidal anti-inflammatory drugs (NSAIDs) were the main drug group involved, being responsible for 15/54 (28%) of admissions primarily due to a DRP. Over 66% of admissions due to adverse effects of NSAIDs were considered to be definitely preventable. In phase II, after targeted intervention strategies, there was no significant reduction in total incidence of DRPs or incidence of DRPs related to NSAIDs. However, there appeared to be an improvement in the first 4 months, and a significant drop in NSAID prescribing in Tayside compared with the rest of Scotland was observed. DRPs remain a significant problem in elderly patients and NSAIDs are the major contributor. The intervention strategies used in the study were not demonstrably effective, but a continuous programme of education may be necessary to limit NSAID use.

Drug history taking and the identification of drug related problems in an accident and emergency department.

To determine the incidence of drug related problems that fail to be noted on casualty cards in patients subsequently admitted, and to compare medication histories as recorded by accident and emergency (A&E) senior house officers (SHOs) and a pharmacist. An initial retrospective survey of 1459 acute inpatient admissions through A&E over a three month period was followed by a prospective study of 33 elderly patients. In the retrospective survey, 52 medication related problems were confirmed after examination of the medical records, of which only 16 were identified in A&E. In the prospective study, 125 currently prescribed items were identified by the pharmacist compared to 77 by A&E SHOs; 66% of the missed information was clinically relevant. Of 17 previous adverse drug reactions identified by the pharmacist only six were also recorded by the A&E officer. Only four over the counter medicines were identified by the A&E SHOs compared to 30 by the pharmacist. More accurate recording of drug history on casualty cards should be undertaken, particularly in respect of over the counter medication and the identification of drug related problems.

Sumatriptan use in a large group-model health maintenance organization

The outcomes of sumatriptan use at a health maintenance organization (HMO) were studied. The study was conducted during one year beginning immediately after sumatriptan was added to the formulary of a large group-model HMO. Subjects were included on the basis of drug-use evaluation criteria, a positive response to the first dose of sumatriptan (administered at the HMO by a nurse), and ability to participate in a telephone survey. Responders to the first dose were eligible to receive up to six doses of sumatriptan for home use. The telephone survey was designed to assess sumatriptan's effects on migraine headache and to capture data on quality of life, perceived problems with sumatriptan, and patient satisfaction. Patients who received sumatriptan between April and September 1993 were interviewed in late September 1993; patients who received sumatriptan between September and April 1994 were interviewed in late April 1994. Of 180 patients surveyed, 160 (89%) had evaluable responses. Migraine headache improved in two thirds of the patients. Sumatriptan was more effective than previously used agents in three fourths. The mean number of migraine headaches per patient per month decreased from 7.4 to 4.2. Quality-of-life indicators, such as time spent with friends, improved in three fourths. Eighty-three percent reported missing fewer days from work. Ninety percent said they would continue to take the drug, despite a 44% incidence of drug-related problems. There were no unexpected problems. A retrospective review showed that utilization of the HMO's resources was reduced with sumatriptan. Placing sumatriptan on an HMO's formulary led to favorable effects on the frequency and severity of migraine headache, patient quality-of-life indicators and productivity, and resource utilization by the organization.