Mean Number Of Drugs Research Articles

Documentation errors in paediatric drug charts: an Audit

INTRODUCTION:Documentation errors leading to medication errors pose a health risk to hospitalised patents. Maintenance of the drug chart in hospitalized patients is done by nursing staff in Sri Lanka. This audit was carried out in a paediatric unit to assess documentation errors and nature of risk to patients. METHOD:Drug charts of 236 Bed Head Tickets (BHT) were analyzed over a period of one month in a single paediatric unit. Parameters of concern were generic and propriety names of drugs, spelling mistakes, abbreviations and legibility of handwriting. RESULTS:Total of 882 drugs were written in 236 BHTs. The mean number of drugs per one BHT was 3.7. At least one error was observed in 473 (53.6%) names of drugs. 25% (225) of drug documentations had spelling mistakes. In majority of cases with spelling mistakes, there was an error in one letter (88.8%). Abbreviations, propriety names and illeg­ible hand writing were written in 134 (15.1%), 104 (11.7%) and 18 (2%) occasions respectively. Paracetamol was the most commonly documented drug and 30% of the time it was written in abbreviations. Most frequent spelling mistakes were seen in Clarithromycin (95%) and Amoxicillin (74%). Usage of trade name was commonly seen when writing Chlorpheniramine (26.5%). The least number of spelling mistakes were seen in salbutamol (3%). CONCLUSION:There was no standard practice of maintaining drug charts in hospitalized patients and it may pose a significant health risk. Authors would like to suggest doctors to take the responsibility of the maintenance of drug charts in order to minimize this high prevalence of documentation errors.

Fall-risk increasing drugs and prevalence of polypharmacy in older patients discharged from an Orthogeriatric Unit after a hip fracture.

Polypharmacy and fall-risk increasing drugs (FRIDS) have been associated with injurious falls. We aimed to estimate the prevalence of polypharmacy and FRIDS in older patients discharged from an Orthogeriatric Unit after a hip fracture surgery. This study describes the baseline findings of a 2-year retrospective cohort study. We included patients older than 80years discharged from an Orthogeriatric Unit who were able to walk before surgery. Patient's baseline variables, total number of drugs, and FRIDS at hospital discharge were collected. We included 228 patients. The mean number of drugs and FRIDS prescribed at discharge was 11.6 ± 3.0 and 2.9 ± 1.6, respectively. Polypharmacy was prevalent in all patients except in three: 23.3% (5-9 drugs) and 75.9% (≥ 10 drugs). Only 11 patients had no FRIDS and 35.5% were on > 3 FRIDS. The most prevalent FRIDS were: agents acting on the renin-angiotensin system (43.9%) and anxiolytics (39.9%). The number of FRIDS was higher in patients with extreme polypharmacy (3.4 ± 1.5) than in those on 5-9 drugs (1.5 ± 1.0, p < 0.05). Independent people in performing instrumental activities had lower risk of extreme polypharmacy (≥ 10 drugs) or > 3 FRIDS: OR 0.39 (95% CI 0.18-0.83) and OR 0.41 (95% CI 0.20-0.84), respectively. People living in a nursing home had higher risk of > 3 FRIDS: OR 4.03 (95% CI 1.12-14.53). Polypharmacy and fall-risk increasing drugs are prevalent in patients discharged from orthogeriatric care after surgery for a hip fracture. Interventions on drug use at hospital discharge could have a potential impact on falls in this high-risk population.

The threat of carbapenem-resistant gram-negative bacteria in a Middle East region.

Data on the status of carbapenem-resistant microorganisms in the Middle East countries are scarce. The aim of this review was to collect available data regarding resistance to carbapenems in a Middle East region. Available data regarding carbapenem-resistant isolates were considered for evaluation in this review. Biomedical electronic databases were systematically searched to find related articles. The key terms used were “carbapenem-resistant, resistant gram-negative bacilli, Enterobacteriaceae, fermenting and non-fermenting gram-negative bacilli, Pseudomonas, Acinetobacter, Klebsiella and Iran”. After primary screening, 275 relevant articles were selected to be assessed thoroughly. Resistance rate to carbapenems was reported between 1% and 86% during years 2006–2018. Most of the carbapenem-resistant microorganisms were isolated from burn patients. Modified Hodge test was a commonly used phenotypic test. Only in few studies, genotypic assays were considered. Pattern of antibiotic use can affect emergence of resistant microorganisms. Rational use of drugs, and specifically, antibiotics is a challenging issue in developing countries. Mean number of drugs per prescription in these countries was higher than the World Health Organization standards. Overuse of antibiotics, especially injectable ones, and easy access to antibiotics without prescription is a warning alarm for future antibiotic resistance in developing countries. Establishing antimicrobial stewardship’s programs is new in the hospitals. Unfortunately, rules and regulatory issues to restrict antibiotic access in community pharmacies and prescription by general physicians are limited.

Evaluación de una intervención formativa con revisión estructurada de la medicación en pacientes mayores polimedicados en Atención Primaria

Background and objectiveSeveral interventions have been shown to reduce polypharmacy and potentially inappropriate prescription (PIP). The objective of the study was to evaluate the number of drugs and PIP before and after an educational intervention with the Primary Care physician (PCP), with electronic identification of PIP and structured medication review, in elderly patients with excessive polypharmacy (≥10 drugs). Material and methodsA before-after intervention study was conducted in the Gipuzkoa district of Osakidetza (Basque Country Health System), in a random sample of patients older than 80 years taking ≥ 10 drugs, and whose PCP attended training sessions. Primary outcomes: change in the number of drugs and PIP, registered in computerised health records. Secondary outcomes: benefit/risk ratio assessed by the PCP, safety problems, and therapeutic decision. ResultsOf the 591 eligible patients, 88 were excluded (41: PCP did not attend training sessions, 47: death/transfer/admission), including a total of 503 patients with mean age of 84.9 years, with 67.7% women. The mean number of drugs and PIP per patient decreased significantly, −0.88 (95% CI: −1.04 to −0.72) and −0.19 (95% CI: −0.29 to −0.09), respectively (p<.0001), with a 25.8% reduction in the number of patients with excessive polypharmacy. Secondary outcomes: data collection sheets of 365 patients and 4,168 prescriptions were collected. The benefit-risk ratio was favourable for 75% of the prescriptions, with the most frequent decision being to maintain them (83%). Among the 911 prescriptions with an unfavourable/uncertain benefit/risk ratio, 47.3% were maintained. ConclusionsThe intervention is associated with a reduction in excessive polypharmacy and PPI under real-world conditions.

RATIONAL USE OF MEDICINES AMONGST ELDERLY DIABETIC PATIENTS IN A TERTIARY HOSPITAL IN SOUTHERN NIGERIA

International Diabetes Foundation puts Nigeria's national diabetes prevalence rate at 3.9% in year 2013. Number of drugs per patient is the main factor associated with adverse reactions among elderly patients. Objective was to evaluate prescription pattern for elderly diabetic patients. This was descriptive prospective study of 150 case files of older patients diagnosed with type 2 diabetes and receiving treatment in the endocrinology clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State. Data collected included socio-demographic characteristics and pattern of prescribed medications. Data were analyzed with SPSS version 16. P 0.05 was considered significant. Mean age of the group was 65.8±10.0 years. Metformin was the most frequently prescribed (81.3%) and in combination of other antidiabetics, the highest being that with Metformin+Pioglitazone+ Glimepiride (18%). The most commonly prescribed anti hypertensives was lisinopril/Ramipril (50.0%). Mean number of drugs per prescription was 6.0. Patients mostly encountered a range of 5-7 drugs per prescription (63.3%). Drugs prescribed in generics and from essential drug list were significantly lower than the recommended WHO values (p &gt;0.05). The findings indicate that the prescribing pattern could be said to be in compliant with our treatment guidelines although not in line with WHO's recommendations.

Polypharmacy in Assisted Living and Impact on Clinical Outcomes.

The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations. This was a descriptive study using data from a larger study testing the Dissemination and Implementation of Function Focused Care for Assisted Living (FFC-AL-EIT). Participants were recruited from 26 assisted living settings. A total of 242 individuals for cohort 1 consented and completed baseline data collection. Data were obtained from participant medical records, observations, and input from staff. Age, gender, race, ethnicity, comorbidities, cognitive status, medications, falls, emergency room visits, hospitalizations, function based on the Barthel Index and physical activity using the MotionWatch 8. Participants had a mean age of 86.86 (standard deviation [SD] = 7.0), the majority were women (n = 179, 74%) and white (n = 233, 96%), with five (SD = 2) diagnoses. The mean number of drugs was seven (SD = 3.56), and 51% were exposed to polypharmacy. The mean Barthel Index score was 63.06 (SD = 20.20), and they engaged in 111,353 (SD = 87,262) counts of activity daily. Fifty-eight residents fell at least once (24%), 22 were sent to the hospital (9%), and 32 (13%) to the emergency room. Neither hypothesis was supported. Continued research is needed to explore the factors that influence polypharmacy. Identification of these factors will help guide deprescribing so that medication management does not harm older adults physically or cause unnecessary financial burden.

Clinical utility of pharmacogenetic testing in children and adolescents with severe mental disorders

This is a retrospective cohort study of 20 children and adolescents to evaluate the clinical utility of a pharmacogenetic decision support tool. Twenty children and adolescents underwent pharmacogenetic testing between June 2014 and May 2017. All children and adolescents were evaluated at Puerta de Hierro University Hospital-Majadahonda (Madrid, Spain). We report the proportion of patients achieving clinical improvement, amelioration of side effects, and changes in number of drugs. Data normality was assessed with the Shapiro–Wilk test, and changes of pre- and post-pharmacogenetic testing were analyzed with the Wilcoxon test for paired samples. A two-sided p value threshold of 0.05 was considered for significance. Pharmacogenetic testing helped to improve the clinical outcome as measured by the Clinical Global Impressions (CGI) Scale in virtually all children (95%; 19 out of 20 children). The CGI improvement (CGI-I) was 2 (0.79) (range 1–4), 2.1 (0.56) (range 1–3), and 1.9 (0.99) (range 1–4) in foster and non-foster care children, respectively. Pharmacogenetic testing also helped to reduce the number of children using polypharmacy (from 65 to 45%), the mean number of drugs per children (from 3.3 to 2.4 drugs, p = 0.017), and self-reported relevant side effects (p = 0.006). Pharmacogenetic testing helped to improve the clinical outcome, and to reduce polypharmacy and the number of drugs used in children and adolescents with severe mental disorders. More evidence using robust (i.e., clinical trials) independent studies is required to properly determine the clinical utility and cost-effectiveness of pharmacogenetic testing tools in children and adolescents with mental disorders.

Patient at intermediate cardiovascular risk: statins, yes! - antihypertensive therapy, maybe.

Patient at intermediate cardiovascular risk: statins, yes! - antihypertensive therapy, maybe.

Potentially Inappropriate Prescribing in Older Adults with Hypertension or Diabetes Mellitus and Hypertension in a Primary Care Setting in Bahrain

Objectives: The aims of this study were to evaluate: (1) the prevalence and types of potentially inappropriate prescribing in older adults with hypertension or diabetes mellitus and hypertension, and (2) whether or not differences in the training of primary care physicians were associated with potentially inappropriate prescribing. Materials and Methods: Primary care prescriptions issued by family physicians and general practitioners were audited using Screening Tool of Older Persons’ Prescriptions criteria (version 1), with 18 out of 65 applicable criteria. Descriptive statistics were used to test the difference between proportions, and two-tailed t test was used for continuous variables. Results: A total of 2,090 outpatient prescriptions were written during the study period; of these, 712 (34.1%) were potentially inappropriate. The mean number of drugs per patient was 6.03 (±2.5). Of the 712 prescriptions, 543 (76.3%) were used for the treatment of acute medical illnesses. The most common examples of potentially inappropriate prescribing were: orphenadrine (n = 174; 8.33%), long-term nonsteroidal anti-inflammatory drugs for > 3 months (n = 150; 7.18%), proton pump inhibitors for > 8 weeks (n = 135; 6.46%), antihypertensive therapy duplication (n = 59; 2.82%), long-acting glyburide (n = 48; 2.29%), and chlordiazepoxide for > 1 month (n = 44; 2.11%). Family physicians showed a greater tendency toward potentially inappropriate prescribing compared to general practitioners, but the difference was nonsignificant (n = 514 [34.75%] vs. n = 162 [31.3%]; p = 0.16). Conclusions: The prevalence of potentially inappropriate prescribing (i.e., 34.1%) was within the spectrum reported worldwide and unrelated to the training backgrounds of physicians. Most of the identified potentially inappropriate prescribing (76.3%) in older adults was associated with medications for acute medical illnesses and hence inappropriate polypharmacy should be discouraged.

Drug utilization pattern in geriatric out patient in tertiary care hospital

Background: Inappropriate drug prescribing is a global problem affecting the healthcare system. Aim and objective of the study was to study the drug utilization pattern in geriatric patient at rural tertiary care hospital.Methods: This was a cross- sectional observational study involving 600 geriatric outpatient. This study was carried out from Nov 2015 to May 2016. The data were collected using predesigned proforma specially designed for this purpose. Relevant information was obtained by analyzing prescription for World Health Organization (WHO) core drug indicators.Results: Total number 600 prescriptions analyzed at the end of six months were from general medicine department. The mean age of the patients was 63.9 years in which male (61.33%) outnumber the female. Total number 2598 drugs were prescribed to 600 patients for different diseases. The mean number of drugs per prescription were 4.33, drugs were prescribed by generic name 26.42%. drugs were prescribed from WHO essential drug list86.33. The type of formulations used were tablets and capsules in 88.5%, syrups in 5%, injections 3.5 % and inhalers 2%. Drug for Cardiovascular diseases were the most common (29.66) followed gastrointestinal (16.67), vitamins and minerals (14.66). Analgesic and NSAIDS (14.13) also prescribed commonly. Antimicrobial drugs prescribed in (7.46%) and common antibiotic prescribed were Amoxicillin ciprofloxacin and metronidazole.Conclusions: This study also effectively provides very useful baseline data also demonstrates the prescribing patterns of drugs in the geriatric patients.

Renovascular hypertension: results in adulthood of renal autotransplantation performed in children.

This study describes the long-term results of renal autotransplantation for renovascular hypertension performed in children who are now 21 years of age or older. Sixteen children (4 boys, 12 girls) with a mean age of 11.2 years at the time of the procedure underwent ex-vivo surgery at the university hospital of Saint-Etienne between 1992 and 2008. Acetylsalicylic acid was used for antiplatelet therapy in the postoperative period, without routine anticoagulation. The mean follow-up period was 15years. The clinical course of these patients was retrospectively reviewed in adulthood and the results analyzed. The children were treated with a mean of 2.37 drugs per patient, and the mean preoperative blood pressure of the entire patient population was 151/89mmHg. Mean preoperative creatinine clearance was 80ml/min/1.73 m2. There was no postoperative death. One patient experienced a thrombosis immediately after the surgery, leading to a redo surgery. In this patient diuresis was restarted, but without efficient concentration and filtration, ultimately leading the patient to have a renal transplant after 1year. At the end of the follow-up period, eight of the 16 patients (50%) were cured and the others were improved. At the last follow-up the mean blood pressure was 127/70mmHg, and the mean number of drugs per patient was 0.68. The mean creatinine clearance at last follow-up was 104.3ml/min/1.73 m2. Three patients had secondary procedures, with two undergoing percutaneous angioplasty (at postoperative months 9 and 12, respectively) and one having an hepatorenal bypass at postoperative year 4. Primary patency was 12/16 (75%); primary assisted patency was 15/16 (94%); secondary patency was 16/16 (100%). This study shows that renal autotransplantation has good and stable long-term results and is an effective conservative strategy for treating renovascular hypertension in children, thus avoiding nephrectomy.

Matricial Support and Arterial Hypertension Control

Abstract Background: A continuing education program for health professionals improves their performance and increases hypertension control rates. Objective: To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at Primary Health Care Units after a continuing education program focused on cardiology for health professionals. Methods: A cross-sectional study was carried out, which included cluster sampling and analysis of medical records. We evaluated 463 patients with high blood pressure and analyzed the blood pressure, medications, and therapeutic increments in 2013, which were compared to the data obtained in 2007. Results: There was prevalence of female patients and appointments at the Family Health Care Units. The age ranged between 24 and 92 years (mean of 61.7 years). There was a reduction in the mean blood pressure (148.62/91.60 ± 23.52/14.51 mmHg to 137.60/84.03 ± 21.84/12.72) between the first and last records, and BP control in 58% of the sample, that is, higher than the 36.6% found in 2007. In the analyzed period, there was a therapeutic increment of 39% in appointments, which benefited 52% patients with high blood pressure, higher than the 12% and 29.5%, respectively, found in 2007. The mean number of drugs per patient increased from 1.85 to 2.05, with a predominance of diuretics and angiotensin-converting-enzyme inhibitors. Conclusion: There was a reduction in the clinical inertia and increased control of arterial hypertension was observed, compared with the findings of the previous study. The result suggests that the matricial support program for health professionals and other measures to improve disease control in the Primary Health Care Units were effective.

Potential intravenous drug interactions in intensive care.

To analyze potential intravenous drug interactions, and their level of severity associated with the administration of these drugs based on the prescriptions of an intensive care unit. Quantitative study, with aretrospective exploratory design, and descriptive statistical analysis of the ICU prescriptions of a teaching hospital from March to June 2014. The sample consisted of 319 prescriptions and subsamples of 50 prescriptions. The mean number of drugs per patient was 9.3 records, and a higher probability of drug interaction inherent to polypharmacy was evidenced. The study identified severe drug interactions, such as concomitant administration of Tramadol with selective serotonin reuptake inhibitor drugs (e.g., Metoclopramide and Fluconazole), increasing the risk of seizures due to their epileptogenic actions, as well as the simultaneous use of Ranitidine-Fentanyl®, which can lead to respiratory depression. A previous mapping of prescriptions enables the characterization of the drug therapy, contributing to prevent potential drug interactions and their clinical consequences. Analisar as potenciais interações medicamentosas intravenosas e seu grau de severidade associadas à administração desses medicamentos a partir das prescrições do Centro de Terapia Intensiva. Estudo quantitativo, tipologia retrospectiva exploratória, com análise estatística descritiva das prescrições medicamentosas do Centro de Terapia Intensiva de um Hospital Universitário, no período de março-junho/2014. A amostra foi composta de 319 prescrições e subamostras de 50 prescrições. Constatou-se que a média de medicamentos por paciente foi de 9,3 registros, e evidenciou-se maior probabilidade para ocorrência de interação medicamentosa inerente à polifarmácia. O estudo identificou interações medicamentosas graves, como a administração concomitante de Tramadol com medicamentos inibidores seletivos da recaptação da serotonina, (exemplo: Metoclopramida e Fluconazol), aumentando o risco de convulsões devido às suas ações epileptogênicas, além do uso simultâneo de Ranitidina-Fentanil®, que pode ocasionar depressão respiratória. O mapeamento prévio das prescrições possibilita a caracterização da terapêutica medicamentosa, contribuindo para obstar as potenciais interações medicamentosas e suas consequências clínicas.

Pharmacoeconomic evaluation of diabetic nephropathic patients attending nephrology department in a tertiary care hospital.

Aims:To evaluate the cost of pharmacotherapy and its determinants in diabetic nephropathy (DN) in the nephrology department of a tertiary care hospital.Materials and Methods:A prospective observational study was conducted among adult patients visiting nephrology outpatient department (February–July 2015). Data on demography, investigations, and medications prescribed, direct cost and indirect costs were analyzed. We used Chi-squared test for categorical variables and multivariate linear regression analysis to identify determinants of cost of pharmacotherapy and total cost.Results:Of 100 patients, 50 were above 60 years and 75 were male. Ninety-seven patients had hypertension, which was the most common comorbidity. The majority (60 patients) belonged to Stage 5 DN and 59 patients were on dialysis. The mean number of drugs per patient was 7.60 ± 2.44. The total monthly cost per patient amounted to INR 24,203.27 with total direct cost of INR 21,013.90 (87%) and indirect cost of INR 3189.30 (13%). The monthly cost of dialysis and pharmacotherapy per patient were INR 9060.00 (37%) and INR 2535.98 (11%), respectively. Stage of DN (unstandardized coefficient, B = 7553.96, 95% confidence interval [CI] [6175.09–8932.82], P < 0.001) was a significant determinant of total cost. Number of drugs (B = 636.694, 95% CI [335.670–937.718], P < 0.001) and stage of DN (B = 852.986, 95% CI [297.043–1408.928], P = 0.003) were predictors of cost of pharmacotherapy.Conclusion:Stage of DN and number of drugs prescribed were major determinants of cost of pharmacotherapy.

PP.32.02] IMPROVED TREATMENT AND CONTROL OF HYPERTENSION IN SWEDISH PRIMARY CARE

Objective: To study changes in hypertension control and antihypertensive treatment in patients treated in primary care from 2001–02 to 2007–08. Design and method: The SPCCD includes extractions from computerized medical records of 74,751 hypertensive patients treated in Swedish primary care 2001–08. The main outcome measures of this retrospective analysis were blood pressures in relation to clinical characteristics, comorbidity and pharmacotherapy. Results: The mean age of women and men in 2001–02 was 69 ± 12 and 66 ± 12 years respectively. This increased to 70 ± 13 and 67 ± 12 years. In 2001–02 72% of women and 64% of men had cardiovascular (stroke, IHD, CHF, AF) and/or diabetic comorbidity while in 2007–08 this proportion was 60% and 50% respectively. Mean blood pressure (BP) was 152 ± 19/82 ± 10 mmHg in women and 150 ± 18/84 ± 10 mmHg in men in 2001–02. In 2007–08 mean BP was 143 ± 18/79 ± 10 mmHg and 142 ± 17/81 ± 11 mmHg respectively. The proportion of all patients with BP <140/90 mmHg increased from 2001–02 to 2007–08 (22% vs 41%, p < 0.001) with the gretest improvement amongst patients with comorbidities. In patients with diabetes and cardiovascular comorbidity, BP in women decreased 151 ± 21/78 ± 11 mmHg to 141 ± 19/75 ± 11 mmHg and in men from 148 ± 19/80 ± 10 mmHg to 139 ± 18/76 ± 11 mmHg and the proportion with BP <140/90 mmHg increased from 22% to 43% and from 25% to 49% respectively (all p < 0.001). Main drug classes used in 2001–02 and 2007–08 were ACEI (17% and 28%), ARB (9% and 16%), beta-blockers (48% and 41%), calcium antagonists (23% and 22%), and diuretics (34% and 42%), respectively. The mean number of drugs used to treat was 1.5 in both genders in 2001–02 and 1.7 in women and 1.8 in men in 2007–08 (p < 0.001). The mean number of drugs used to treat patients who reached BP <140/<90 mmHg was 1.5 in women and 1.6 in men in 2001–02 and 1.7 and 1.8 respectively in 2007–08 (p < 0.001). Conclusions: Blood pressure control in Swedish primary care has improved as did the use of ACEI and ARBS. However, the combination of several drug classes in patients with insufficient blood pressure control remains underused. There is room for further improvement.

Quality of blood pressure control in hypertensive patients attending the Kigali University Teaching Hospital (CHUK)

Background: Kigali university teaching hospital (KUTH) is one of the referral hospitals that receive patients from all over the country. Hypertension is among others; an important risk factor for the development of cardiovascular diseases and a significant public health problem. We investigated the proportion of treated hypertensive patients with uncontrolled blood pressure. Objective: To determine the adequacy of blood pressure (BP) control in hypertensive patients and to investigate the burden of other cardiovascular risk factors and related cardiovascular diseases. Methods: From 1st July 2009 to 31st March 2010, 150 patients - after their informed consent to participate in the study - were included in our cross-sectional and descriptive study. We collected data on socio-demographic features, weight and height, cardiovascular risk factors and cardiovascular diseases. We also investigated the patients’ awareness of the disease and their compliance to treatment. Blood pressure values were recorded, as well as the duration of hypertension; the number of antihypertensive drugs used, and the compliance to treatment. Based on the guidelines of the European Society of Hypertension and the JNC-7, BP were considered controlled at a level below 140/90 mm Hg, and in diabetics if the systolic BP 5(sBP) <130 mmHg and the diastolic BP (dBP) <80 mmHg. Data were analyzed using SPSS 11.0, Pearson Chi-Square test, and the Fisher’s exact test. The statistical significant difference was considered at p < 0.05. Odds Ratio with 95 % CI. Results: 150 patients with Hypertension were enrolled, including 56% women and 44% men; sex-ratio (F/M) =1.27:1, with a mean age of 52.75± 6.08 years. Among the total cohort, 28% of patients (42) were diabetic, 15.3% had an elevated total cholesterol, and 24% were smokers or used to smoke in the past. Obesity (BMI≥30) was recorded in 22.7% of our sample and the mean BMI was 26.24±1.8. The duration of the disease is beyond 5 years for only 34% of our patients, the mean duration is 8.5±0.7. The mean number of drugs used was 1.84±0.7. Only 21.3% of our patients had a well controlled BP (<140/90 mm Hg and 130/80 for diabetics). Left ventricular hypertrophy on an Electrocardiogram (EKG-LVH) was present in 36% of the patients. Chronic renal failure was documented in 18%, but the proportion of patients with positive albuminuria was higher: 50 patients (33.3%), and 26 out of 50 were diabetic: p=0.000. The clinical diagnosis of stroke was made in 23 patients (15.3%). Almost a half of our patients (48%) had enough information about the arterial hypertension, its consequences and the need of a long term treatment; however, only 35.3% try to comply with both the pharmacological treatment and lifestyle modifications. Independent predictors of poor control were diabetes (aOR=3.367 ; 95% CI ; 1.103-10.287), smoking (aOR=6.145; 1.390-27.154), and poor compliance to treatment (OR=0.066; 0.025-0.177) Conclusion: We have a high rate of patients with poor BP control. Independent predictors of poor BP control were diabetes, smoking and poor compliance to treatment.The majority of our patients is not aware of their condition and they are not properly compliant to treatment. Target organ damages (cardiovascular diseases) though not prominent, are considerably present especially ECG-LVH and albuminuria.

Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India

BackgroundDue to the lack of clear, comprehensive, and rational drug policy, the production of pharmaceutical preparations in India is distorted for the most part. Indian markets are flooded with more than 70,000 formulations, compared to approximately 350 formulations listed in the World Health Organization (WHO) Essential Drug List. Studies have indicated that majority of prescriptions in India are of drugs of “doubtful efficacy.” To promote rational drug use in developing countries, assessment of drug use patterns with the WHO drug use indicators is becoming increasingly necessary. The aim of this study was to assess the patterns of drug use by using WHO core drug use and complementary indicators.MethodsOne thousand fifty-two patients were prospectively interviewed and their prescriptions analyzed according to WHO guideline five randomly selected busy community pharmacies in northern district of the State of Tamil Nadu, South India to analyze the WHO core drug use and complementary indicators using an investigator-administered data collection form. The main outcome measured is patterns of drug use measured using WHO core drug use and complementary indicators.ResultsThe data obtained showed that, out of total drugs prescribed (3936), only 2.5 % (100) drugs were prescribed by generic name. Mean number of drugs per encounter was 3.7. Use of antibiotics was 22 %, percentage of encounters with an injection was 7.2 %, and the percentage of drugs prescribed from formulary was 99.8 %.ConclusionsBrand name prescribing is dominated even in rural India. There is a need to improve the availability of essential guidelines and key drugs in the stock in rural areas of India. Prescriptions studied were conforming to most indicators of WHO except the number of drugs prescribed & generic name prescription practice, which deviated. In India the healthcare is dominated by private practitioners at the primary level. Prescription practices of the individual community-based clinician needs consistent monitoring with respect to generic name prescribing habits as well as the number of drugs prescribed. The WHO drug use indicator guidelines need to be promoted amidst the primary care clinicians and should not be just limited to hospitals having a formulary. The data collected by this study can be used by policymakers to monitor and improve the prescribing and consumption of pharmaceutical products in Southern India.

Prevalence of inappropriate medication prescription in the elderly in Nigeria: A comparison of Beers and STOPP criteria.

Inappropriate medication prescription among the elderly is a major problem with significant negative health consequences. The Beers and STOPP (Screening Tool of Older Persons' potentially inappropriate Prescription) criteria are common tools used for screening of potentially inappropriate medications. The primary objective of the study was to estimate the incidence of PIM among elderly Nigerian patients using the earlier mentioned tools. This prospective study was conducted among elderly patients attending the general outpatients' clinics of two tertiary healthcare institutions in the South-Western part of Nigeria. The patients' age, gender, diagnosis for which the patient was receiving treatment and prescribed drugs were the information retrieved from the medical records. The WHO drug use indicators were applied in the drug utilization aspect of the study while the Beers and STOPP criteria were used to define the inappropriateness or otherwise of the prescribed medications. The mean number of drugs per prescription was 4.1 ± 1.2 while the median number of drugs prescribing by generic name was 46.5% (IQR: 35). Using Beers criteria for the assessment of prescription of potentially inappropriate medications, 106 (30.3%) of all patients had at least one inappropriate medication prescribed with a total of one hundred and twenty six cases recorded. Screening for PIM using the STOPP criteria, we found 55 (15.7%) of the study participants with at least one potential encounter. Female sex, number of prescribed medications and co-morbidities were positively associated with prescription of a PIM using both tools. Prescription of PIM is highly prevalent among elderly Nigerian patients. There is a need for continuing education of prescribers on rational prescribing in the elderly using some of the screening tools.

A Multicomponent Intervention to Optimize Psychotropic Drug Prescription in Elderly Nursing Home Residents: An Italian Multicenter, Prospective, Pilot Study.

Older nursing home residents often have a large number of diseases and frequently require multiple medications; the high consumption of psychotropic drugs is of particular concern. The majority of residents in nursing homes suffer from dementia, and the use of psychotropic drugs in these patients is very high. Prescription for short periods of time only are usually recommended to avoid the risk of adverse drug reactions and potentially severe drug-drug interactions (DDIs). The aim of this multicenter, prospective study was to optimize the prescription of psychotropic drugs, according to the Beers recommendations, in a sample of older patients living in nursing homes in Italy, through a multicomponent intervention, education of general practitioners, and the use of INTERcheck. The study was run in ten nursing homes in Northern Italy from September 2013 to May 2014 (9 months), with the voluntary participation of 14 general practitioners. Each physician was asked to enroll at least 20 consecutive unselected patients. Three educational interventions ('ex cathedra' presentations) were organized by the researchers involved in the project, and a fourth training session was also held on the use of INTERCheck, a Computerized Prescription Support System (CPSS) developed to optimize drug prescription for older people with multimorbidity. Drug prescription information and sociodemographic characteristics of each patient were collected at three different time points-before the educational and training sessions (T0), after 5 months (T1), and after 9 months (T2). Among the 272 patients included in the analysis, a significant reduction was observed in the mean number of drugs, and in the percentage receiving psychotropic drugs and potentially inappropriate psychotropic drugs (11.5 and 30.6 %, respectively; p < 0.0001). Patients exposed to at least one potentially severe DDI also decreased from 145 (53.3 %) at the first time point to 87 (32.0 %) at the last time point (p < 0.0001). Results were confirmed in the 181 patients for whom information regarding drug treatment was available at all time points. The combination of an educational intervention and the CPSS can achieve a significant reduction in potentially inappropriate psychotropic drug use, psychotropic duplicates, and potentially severe DDIs in nursing homes.

Influence of bariatric surgery on the use of medication.

Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage. In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.