Prevalence Of Drug-related Problems Research Articles

Determination of drug-related problems according to PAIR criteria in dialysis patients: a cross-sectional study in tertiary care hospital

BackgroundDialysis patients are at high risk for drug-related problems (DRPs), which have significant consequences for their morbidity, mortality, and quality of life. Improved clinical outcomes can be achieved by preventing, identifying, and resolving these problems.MethodsThis is a retrospective observational study. In this study, the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) was validated for use in Turkish. Validation consisted of three stages: translation back-translation with expert panel evaluation, reliability analysis using the test-retest method, and conceptual validity with both Pharmaceutical Care Network Europe (PCNE) and PAIR used to determine DRPs prevalence.ResultsIn total, 104 patients (mean ± SD age, 54.1 ± 15.8 years; 53.8% male) were included in the study. An expert panel evaluated the items in the criterion based on their intelligibility, service of purpose, differentiation, and cultural suitability during the translation stage. Content validity index (CVI) score was found to be 0.95. The reliability analysis was performed by applying the test-retest method and calculating correlation coefficient on 30 randomly selected patients one month later. Correlation coefficient (p) was found to be 0.8. To evaluate conceptual validity, 104 patients’ pharmacotherapy plans were assessed using both the PAIR and PCNE criteria. The prevalence of DRPs according to PAIR criteria (100.0%) and PCNE (73.1%) were statistically significantly different (p < 0.001).ConclusionsAs a result, PAIR criteria can identify clinically relevant DRPs in patients with CKD and is a new, validated tool to be used in Turkey, but may not be adequate for patients receiving dialysis. Therefore, it needs to be reviewed and updated for dialysis patients.

Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study.

In 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalence of drug-related problems (DRPs) before and after CPOE implementation in a psychiatric inpatient setting. The aim of this retrospective before-and-after cohort study was to investigate whether the implementation of a CPOE system with CDSS accompanied by the introduction of regular medication plausibility checks by a pharmacist led to a decrease of DRPs during hospitalization and unsolved DRPs at discharge in psychiatric inpatients. Medication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on 'The PCNE Classification V9.1', the German database DokuPIK, and the 'NCC MERP Taxonomy of Medication Errors'. 325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, p<0.001). The most frequent DRP in cohort I was an erroneous prescription (n=113, 34.8%), which was significantly reduced in cohort II (n=12, 5.6%, p<0.001). During the retrospective in-depth review, more DRPs were identified than during the daily plausibility analyses. At hospital discharge, patients had significantly less unsolved DRPs in cohort II than in cohort I. The implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs.

Impact of a Community Pharmacy Pharmacotherapy Follow-up (PTF) service in patients using opioid analgesic

The use of prescribed major opioid analgesics (fentanyl, tapentadol, morphine and oxycodone and combinations) for non-cancer chronic pain is fraught with risks that may generate Negative Medicine Outcomes (NMO). Among the factors associated with these risks, those related to the patient's characteristics and aberrant behavior, the treatment conditions, and the prescription health settings should be evaluated with the aim of minimizing unsafety during the health care process. The present study addresses, from a community pharmacy, the analysis of Drug Related Problems (DRP) and Negative Medicine Outcomes (NMO) in patients using these major opioid analgesics while it aims to demonstrate the role of pharmaceutical care interventions in promoting safety during the use of these molecules. A three step Pharmacotherapeutic Follow-up (PFT) protocol was designed to prevent, detect, and solve DRP and NMO associated with the use of opioid analgesics. 74.6% of the patients used opioid analgesics to treat musculoskeletal pain. Polypharmacy with benzodiazepines (61.9%); antidepressants (57.1%) and antiepileptics (30.2%) was detected in patients using these opioids. The Morisky-Green Adherence test revealed that 30.2% were nonadherent. It was observed, with statistical significance, that in all patients (63), the impact of the 14-week PFT supervised by the community pharmacist achieved an overall reduction in the prevalence of DRP and NMO. While the reduction in the number of DRPs reached 66.7%. Community pharmacies are a strategic point to promote and implement effective opioid stewardship due to both their central role in healthcare services and frequent interaction with patients.

Drug-Related Problems Detected in Complex Chronic Patients by Community Pharmacists of Catalonia: Perception of the Person-Centred Approach Necessity.

Community pharmacies are healthcare settings in which pharmacists are in an ideal position to carry out pharmaceutical care. The aim of this study was to analyse the number, type and groups of drugs that caused drug-related problems (DRPs) detected in complex chronic patients who are outpatients, the interventions and actions of community pharmacists and their impact on patient medication adherence. The study was designed as a secondary analysis of a multicentre study in the field of primary healthcare and community pharmacies in Catalonia (Spain). The patients who took part were divided into two groups by the primary care physician depending on whether or not they were considered likely to receive their medication through a monitored dosage system (MDS) based on pre-established criteria. Patients underwent 12 months of follow-up by community pharmacists. The prevalence of DRPs among the studied complex chronic patients was high (n = 689). The most identified DRP was nonadherence (31.20%). In the MDS group, results showed a statistically significant increase of 21% in the number of adherent patients with respect to the baseline visit (p-value = 0.0008). Community pharmacists can have an important role in addressing DRPs and optimizing the safety and effectiveness of medications for these patients and in involving them in their own health conditions.

Impacto de la Intervención Farmacéutica en el tratamiento del paciente mayor pluripatológico

Objectiveto analyze the impact of Pharmacy Intervention (PI), within the healthcare team who manages elderly multi-pathological patients, regarding the evolution of Drug Related Problems (DRPs) and Negative Outcomes Associated with Medication (NOMs). To estimate the prevalence of DRPs, NOMs, and Potentially Inappropriate Prescriptions (PIPs), and the drugs involved, considering the characteristics of their healthcare location. Methodmulticenter, prospective study, on > 65-year-old patients with multiple pathologies, either institutionalized or hospitalized. The Pharmacist reviewed the chronic medication of the patient in order to detect DRPs and NOMs, and issued recommendations to the physician responsible for the patient, and this intervention was subsequently evaluated. DRPs and NOMs were classified according to the Third Consensus of Granada. The STOPP/START Criteria were used for PIP detection. The primary variables were: number of PIs conducted and accepted by the physician. Outcomes338 patients were included, and 326 (96.4%) presented some DRP. 1089 DRPs were detected, with 983 PIs suggested for their solution, and 651 (69.9%) of these were accepted. PIs solved 58.9% of DRPs, and an association was found between PI and the solution for the DRP (p < 0.001). PIs were more accepted in institutionalized than in hospitalized patients (p = 0.002), by physicians with a higher specialization (p < 0.001) and when they involved quantitative safety NOMs (p = 0.042). The STOPP/START Criteria detected 65% of PIPs, and more PIPs not associated with these criteria were found in institutionalized than in hospitalized patients (p < 0.001). Conclusionspharmacy Intervention within the multidisciplinary team can solve in a significant way both DRPs and NOMs in elderly multi-pathological patients, and thus help to improve the quality of their pharmacological therapy. This is the first multicenter clinical trial with these characteristics that has been conducted in Spain.

Assessment of Drug-Related Problems and Health-Related Quality of Life Domains in Elderly Patients with Type 2 Diabetes Mellitus.

This study aimed to investigate the prevalence and predictors of Drug-related problems (DRPs), as well as to evaluate the impact of DRPs on the health-related quality of life in geriatric patients with type 2 diabetes mellitus. A cross-sectional study was conducted over a three-month period. Patients aged 60 years and older visited diabetes clinics from October 1, 2022, to December 31, 2022, were included in the study. Data were collected through structured questionnaires, whereas lab results, medication records, comorbidities, and the consequences of DRPs were collected from electronic medical records. DRPs were identified and classified using the PCNE V501 classification system. Health-related quality of life (HRQoL) was evaluated using the validated EuroQol criteria. A total of 491 patients participated in the study, and the mean age of the patients was 67.51 years (SD = 5.84 years). Female patients represented 52.34% of total subjects. A total of 461 (around 94%) experienced at least one drug-related problem (DRP), ranging from one to nine DRPs per patient, with a total number of DRPs equal to 1625 identified. The most common DRP was the drug choice problem, affecting 52.98% of patients. Factors such as high drug frequency, living conditions, the number of diabetes medications, comorbidities, and smoking were significantly associated with higher numbers of DRPs. Higher numbers of DRPs were found to significantly worsen health-related quality of life (HRQoL) among patients. Geriatric individuals with type 2 diabetes mellitus encounter a significant prevalence of DRPs, with drug choice problems being the most common followed by dosing problems. Risk factors contributing to these DRPs include high drug frequency, living conditions, high number of diabetes medications, multimorbidity, and smoking. Also, the study concluded that the increased number of DRPs was associated with negative impact on HRQoL domains in geriatric patients with type 2 diabetes.

Prevalence of potentially inappropriate medications among elderly patients with diabetes – study based on STOPP/START criteria

Objective: The prevalence of drug-related problems in elderly patients is a concerning issue that can lead to elevated morbidity, mortality, and health care resource utilisation. This study focuses on the significance of addressing diabetes in the context of an ageing population, where elderly individuals face higher risks of comorbidities and mortality. The main objective of this study was to assess potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among patients with diabetes in Bulgaria, using the explicit STOPP/START criteria, version 2. By evaluating the appropriateness of drug prescriptions in this specific patient population, this study aims to shed light on areas that require optimisation to enhance patient safety and treatment outcomes. Materials and methods: A national prospective questionnaire study was conducted in Bulgaria among patients aged over 65 years. The research was conducted in 25 randomly selected pharmacies. The study supports the use of the STOPP/START criteria based on the clinical information provided. A total of 133 patients with T1DM or T2DM participated in the study. The evaluation of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) was performed in 131 patients. sStatistical differences in demographics and medication numbers between patients with and without PIMs or PPOs were assessed using a Chi-square test, with a p-value of ≤ 0.05 considered statistically significant. Results: The pharmacotherapy of 131 patients with diabetes was assessed, and it was found that 57% of them had polypharmacy. Among the study population, 90 PIMs were identified, indicating that 66% of the patients had inappropriate prescribing. Notably, inappropriate prescribing concerning diabetes was associated with the use of long-acting sulfonylureas (n=10) and beta-blockers (n=13). Applying the START criteria revealed 67 PPOs among 67 patients, representing a prevalence of 50% in the study population. However, no PPOs were detected in the context of diabetes pharmacotherapy. Furthermore, a significant relationship was observed between the number of medications and PIMs, as evidenced by the chi-square test result with a p-value close to zero, indicating statistical significance. Conclusion: The study revealed a high prevalence of PIMs in elderly patients with diabetes in Bulgaria. Endocrine disorders contribute to 26% of PIMs. As Bulgaria’s ageing population faces increasing diabetes challenges, effective management strategies are crucial. These findings underscore the significance of addressing prescribing practises to enhance disease control and prevent complications.

Medication optimization in older adults with advanced cancer and a limited life expectancy: A prospective observational study

IntroductionPolypharmacy is common in older adults with cancer and is associated with drug related problems (DRPs) and potentially inappropriate medication (PIM). We introduced a medication optimization care pathway for older adults with advanced cancer and a limited life expectancy and studied the prevalence of DRPs and PIMs as well as the adherence to medication-related recommendations and the patient satisfaction. Materials and MethodsA medication review was performed in patients aged ≥65 years with polypharmacy and a life expectancy of <24 months. Recommendations on adjustments of medication were discussed in a multidisciplinary team including a pharmacist, an oncologist, and a geriatrician. Implementation of the recommendations was left to the discretion of the oncologist. Four weeks after the implementation, the patient filled a questionnaire to assess satisfaction. ResultsOne hundred twenty patients were included. The mean age was 75 years and 39% were female. A mean of 12 medications was used. The median number of DRP was 6.0 per patient and median number of PIMs was 3.0 per patient. Overtreatment accounted for 26% of DRP and the most frequently involved drug classes were antihypertensive medication (22%), non-opioid analgesics (22%), and antilipemics (12%). The multidisciplinary team accepted 78% of the recommendations of the pharmacist and the oncologist implemented 54% of the recommendations. Overall, patients were satisfied or very satisfied with the intervention. DiscussionDRPs and PIMs are highly prevalent in this population and can be reduced by a multidisciplinary medication optimization intervention. Patients appreciate the medication optimization intervention and are satisfied with the intervention.

Drug Related Problems (DRP's) Analysis of Antipsychotics Use in Schizophrenia Patients at Mental Hospitals of Southeast Sulawesi Province in 2021

Schizophrenia is a psychiatric disorder with a high incidence at the Mental Hospital of Southeast Sulawesi. Problems related to the use of drugs that are often encountered in hospitals are inaccuracies in drug administration, inaccurate dosing and drug abuse. This problem can affect the success of therapy. This study aims to determine the pattern of drug use and the prevalence of Drug Related Problems (DRPs) in Schizophrenia patients based on the correct dosage parameter. This research is an observational type with a cross sectional design. The duration of the study was 1 month taking into account the inclusion and exclusion criteria.. Patients with a diagnosis of schizophrenia, aged &gt;17 years and have a complete medical record are the inclusion criteria whereas patients with incomplete medical records, death status/forced to go home and still being treated are exclusion criteria. The total number of samples analyzed was 250 patient medical records. The results showed that the majority of Schizophrenia patients at the Mental Hospital of Southeast Sulawesi Province were male (80%) with an age range of 20-45 years (71.6%). The last education level is in the medium category (65.2%). Based on the diagnosis of the type of schizophrenia, the patient was in the category of paranoid schizophrenia (51.6%) with positive symptoms (74.8%). The pattern of psychotic drug use used by Schizophrenia patients at the Mental Hospital of Southeast Sulawesi Province in 2021 is a single pattern and the most widely used single drug combination pattern is risperidone (atypical) (35.6%) and a combination pattern, namely chlorpromazine + risperidone (typical +atypical) (27.2%). The prevalence of DRP's based on the correct dose is 0%. DRP's did not occur for the use of antipsychotic drugs in Schizophrenia patients at the mental hospital of Southeast Sulawesi Province in 2021.

Drug-related problems among transfusion-dependent thalassemia patients: A real-world evidence study.

Introduction: Thalassemia is among the most common genetic disorders globally and many patients suffer from iron overload (IOL) complications that mainly affect the heart, liver and endocrine system. These events may be further complicated by drug-related problems (DRP), an inherent issue among patients with chronic diseases. Objective: The study aimed to evaluate the burden, associated factors and impacts of DRP in transfusion-dependent thalassemia (TDT) patients. Method: Eligible TDT patients under follow-up in a tertiary hospital between 01 March 2020 to 30 April 2021 were interviewed and their medical records were reviewed retrospectively to identify any DRP. DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. The incidence and preventability of DRP were assessed and the associated risk factors were estimated by univariate and multivariate logistic regression. Results: A total of 200 patients were enrolled with a median (interquartile range: IQR) age of 28years at enrolment. Approximately 1 in 2 patients were observed to suffer from thalassemia-related complications. Throughout the study period, 308 DRPs were identified among 150 (75%) participants, with a median DRP per participant of 2.0 (IQR 1.0-3.0). Of the three DRP dimensions, treatment effectiveness was the most common DRP (55.8%) followed by treatment safety (39.6%) and other DRP (4.6%). The median serum ferritin level was statistically higher in patients with DRP compared with patients without DRP (3833.02 vs. 1104.98μg/L, p < 0.001). Three risk factors were found to be significantly associated with the presence of DRP. Patients with frequent blood transfusion, moderate to high Medication Complexity Index (MRCI) and of Malay ethnicity were associated with higher odds of having a DRP (AOR 4.09, 95% CI: 1.83, 9.15; AOR 4.50, 95% CI: 1.89, 10.75; and AOR 3.26, 95% CI: 1.43, 7.43, respectively). Conclusion: The prevalence of DRP was relatively high amongst TDT patients. Increased medication complexity, more severe form of the disease and Malay patients were more likely to experience DRP. Hence, more viable interventions targeted to these groups of patients should be undertaken to mitigate the risk of DRP and achieve better treatment outcomes.

Prevalence of Drug-Related Problems in Elderly Cancer Patients: A Prospective Observational Study in a Cancer Specialty Hospital

Abstract: Background: The geriatric population comprises the majority of patients with oncological disorders. They are highly vulnerable to drug-related problems (DRPs) due to multiple comorbidities, polypharmacy, altered pharmacokinetics and pharmacodynamics. This study aimed to determine the rate and pattern of drug-related problems in elderly cancer patients. Materials and Methods: A observational study was conducted prospectively for a period of 4 months, where cancer patients of any gender above 60 years were enrolled and followed daily. All necessary data like patient demographics, past and current medication history were obtained from various data sources including medical records, treatment charts, patient interviews etc. DRPs were identified and assessed. Results: A total of 50 patients were enrolled into the study. From which, 96 DRPs were identified among 74% of the patients. Commonly observed DRPs were Adverse Drug Reactions (40%) and Drug-Drug Interactions (20.8%). More than half of the patients who developed DRPs (67.6%) had comorbidities, 86% were currently on chemotherapy alone or in combination and majorly (81%) were in the advanced cancer stage (Stage III and stage IV). Hyper polypharmacy was observed in 67.6% of the patients with DRPs. Conclusion: Our study revealed that DRPs are highly prevalent amongst elderly cancer patients and geriatric cancer patients need careful follow-up to identify DRPs and reduce adverse outcomes. Keywords: Drug-related problems, Geriatric oncology, Cancer, Polypharmacy.

Drug-Related Problems and Factors Involved in the Imbalance of Oral Anticoagulants in Lebanese Patients: A Cross-Sectional Study

The goal of this study was to identify drug-related problems (DRPs) and the factors involved in the imbalance of new oral anticoagulants (NOACs) and vitamin K antagonists in a Lebanese adult population with cardiovascular diseases. An imbalance in the hemostatic systems between procoagulant and anticoagulant factors in circulating blood produces either hemorrhagic or thrombotic conditions. A prospective cross-sectional study was conducted during 5 months in a teaching hospital. All patients at least 18 years of age taking oral anticoagulants were included in the study. A standardized questionnaire was used, and information was obtained from the patients’ profiles and electronic medical records. DRPs were identified and categorized according to the Pharmaceutical Care Network Europe classification system. A total of 258 patients were included. The overall prevalence of DRPs was 87.2%; the highest prevalence was observed in patients taking acenocoumarol (96.0%), in contrast to 76.7% and 59.0% in patients taking dabigatran and rivaroxaban, respectively. Drug interaction was the most frequent DRP (83.3%), followed by inappropriate monitoring (42.6%) and excessive dose (26.7%). Having renal disease, and taking proton-pump inhibitors or nonsteroidal anti-inflammatory drugs were among the factors affecting the international normalized ratio (INR) range (adjusted odds ratio [ORa] = 2.513, 95% confidence interval [CI] 1.238, 5.101; ORa = 2.487, 95% CI 1.139, 5.430 and ORa = 2.114, 95% CI 1.043, 4.286, respectively), whereas smoking and renal disease significantly affected activated partial thromboplastin time (aPTT) (ORa = 8.325, 95% CI 1.577, 43.965 and ORa = 6.922, 95% CI 1.471, 32.570, respectively). Patients taking NOACs had greater aPTT control and fewer DRPs, with a wide therapeutic index enabling administration of fixed doses.

Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities

BackgroundMedication reviews contribute to protecting long-term care (LTC) residents from drug related problems (DRPs). However, few controlled studies have examined the impact on patient-relevant outcomes so far.ObjectiveWe examined the impact of a one-time, pharmacist-led medication review on medication changes (primary endpoint) including discontinued medication, the number of chronic medications, hospital admissions, falls, and deaths (secondary endpoints).MethodsA prospective, controlled intervention study was performed in three LTC facilities. In the intervention group (IG), after performing a medication review, a pharmacist gave recommendations for resolving DRPs to physicians, nurses and community pharmacists. The control group (CG) received usual care without a medication review. (i) We assessed the number of medication changes and the secondary endpoints in both groups before (t0) and after (t1, t2) the intervention. (ii) Additionally, the medication review was evaluated in the IG with regard to identified DRPs, the healthcare professional’s feedback on the forwarded pharmacist recommendations and whether DRPs were finally resolved.Results107 (IG) and 104 (CG) residents were enrolled. (i) More medication changes were identified in the IG than in the CG at t1 (p = 0.001). However, no significant difference was identified at t2 (p = 0.680). Mainly, medication was discontinued in those medication changes. Chronic medications increased in the CG (p = 0.005) at t2 while hospital admissions, falls, and deaths showed no differences. (ii) Overall, 1252 DRPs (median: 10; minimum-maximum: 2–39) were identified. Recommendations for 82% of relevant DRPs were forwarded to healthcare professionals, of which 61% were accepted or clarified. 22% were not accepted, 12% required further review and 6% remained without feedback. 51% of forwarded DRPs were finally resolved.ConclusionsWe found more medication changes in the IG compared to controls. Mostly, medication was discontinued. This suggests that our intervention was successful in discontinuing unnecessary medication. Other clinical outcomes such as falls, hospitalisations, and deaths were not improved due to the one-time intervention. The medication review further identified a high prevalence of DRPs in the IG, half of which were finally resolved.Trial registrationGerman Clinical Trials Register, DRKS00026120 (www.drks.de, retrospectively registered 07/09/2021).

Drug-related problems and determinants among elective surgical patients: A prospective observational study.

Objectives:The aim of this study was to assess drug-related problems and determinants among elective surgical patients admitted to Jimma University Medical Center.Methods:A hospital-based prospective observational study was conducted at Jimma University Medical Center, from April 10 to July 10, 2018. Data were collected through patients’ interview and physicians’ medication orders and charts review using pre-tested questionnaire and data abstraction formats. Drug-related problems were assessed for each patient using drug-related problem classification tool. Data were analyzed using Statistical Package for Social Science for windows; version 21.0. The predictors of drug-related problems were determined by multivariable logistic regression analysis. A p-value of less than or equal to 0.05 was considered to be statistically significant.Results:Of the total 141 participants, 98 (69.5%) of them had at least one drug-related problem during their hospital stay. A total of 152 drug-related problems were identified among 141 elective surgical patients. The most common identified drug-related problems were indication-related problems (39%) followed by effectiveness-related problems (21%) and safety-related problems (21%). The presence of complication (adjusted odds ratio = 2.90, 95% confidence interval (1.302, 3.460)), American Society of Anesthesiologists Physical Status ⩾ 2 (adjusted odds ratio = 6.01, 95% confidence interval (1.0011, 9.500)), and postoperative antibiotics (adjusted odds ratio = 6.027, 95% confidence interval (1.594, 22.792)) were independent predictors of drug-related problems.Conclusion:The prevalence of drug-related problems is high among elective surgical patients. The indication-related problems were the most common category of drug-related problem identified among elective surgical patients. The presence of complication, American Society of Anesthesiologists Physical Status ⩾ 2, and postoperative antibiotics were the independent predictors of drug-related problems.

Clinical pattern and drug-related problems among colorectal cancer patients at oncology center in Ethiopia: A hospital-based study.

Objective:Despite the fact that cancer patients are highly susceptible to drug-related problems due to the effects of cytotoxic agents, data are limited due to a lack of studies on those patients. Hence, we aimed to investigate drug-related problems among patients diagnosed with colorectal cancer.Method:A registry-based cross-sectional study was conducted on colorectal cancer patients at the Felege Hiwot Comprehensive Specialized Hospital. Socio-demographic and disease-related characteristics, treatment regimens, and drug-related problems were recorded by reviewing medical records. Standard guidelines, protocols, and databases were used to evaluate the occurrence of drug-related problems and the severity of adverse drug reactions. For the analysis, Stata version 16/MP for Windows was used. Logistic regression analysis was employed to investigate the potential-associated factors of drug-related problems. A p-value ⩽ 0.05 was used to declare the statistical significance of each independent variable.Results:A total of 150 colorectal cancer patients were included, with a mean age of 51.4 ± 13.8 years. About 30% and 41.3% had stage II and stage III cancers, respectively. About three-quarters (73.8%) of the patients were given 5-fluorouracil-based combination regimens. The prevalence of drug-related problems was found to be 48.7%, with a mean of 2.12 ± 0.93 drug-related problems. In the Felege Hiwot Comprehensive Specialized Hospital, drug–drug interactions and adverse drug reactions were the most prevalent drug-related problems, which accounted for 50 (32.7%) and 49 (32%) cases, respectively. Being elderly (>50 years old) (p = 0.013), having co-morbidity (p = 0.001), and being on five or more medications (p = 0.002) were independent predictors of drug-related problems.Conclusion:Fluorouracil-based chemotherapy was the most frequently used treatment regimen. Almost, half of the colorectal cancer patients had one or more drug-related problems. About one-third of patients had adverse drug reactions and drug–drug interactions. Furthermore, age, co-morbidity status, and the number of medications used were significantly associated with drug-related problems. Clinical pharmacy services should be implemented to optimize drug therapy because the majority of colorectal cancer patients have one or more drug-related problems.

Retrospective Assessment of the Clinical Pharmacist Sheets among a Few Iraqi General Hospitals

Background: Clinical pharmacist sheet is an essential part of the medical record; it highlights the pharmacist’s role during hospitalisation through the concept of pharmaceutical care and specific pharmacist collaboration with a patient and other health care teams. Objective: To assess the documentation completeness level of the clinical pharmacist sheet, pharmacist intervention, type and prevalence of Drug-Related Problems. Methodology: A retrospective observational study that included revised 3900 clinical pharmacist sheets from Baghdad and Thiqar Hospitals for 2018, 2019, and 2020. The forms from four departments of the hospitals (internal medicine, surgery, paediatrics, gynaecology and obstetrics). In addition, assessment completeness of the pharmacist documentation level in the clinical pharmacist sheets, and Pharmacist interventions. Results: The overall documentation completeness level in the clinical pharmacist sheets was generally poor (less than 50% of the sheet items were filled in). The best documentation level was presented in the surgery ward (52.34%). A total of 3900 clinical pharmacist sheets were analysed within multi-ward hospitals that revealed variable percentages of DRPs (10%, 8.55%, 12.44%, and 7.42%) in internal medicine, surgery, gynaecology and obstetrics, and paediatric respectively. Findings also revealed a significant decline in pharmacist interventions over the last three years. Conclusion: There was poorn documentation completeness level and pharmacist interventions over the last 3 years among clinical pharmacist sheets. Drug selection, dosing, and substituting unavailable drugs with an alternative were the commonest causes of DRPs.

Drug-Related Problems in Emergency Department Visits and Intensive Care Units at Healthcare Facilities in Saudi Arabia: A Review of the Literature

The burden of drug-related problems (DRPs) is becoming an issue of healthcare concern. It has been responsible for many intensive care unit (ICU) admissions and emergency department (ED) visits in Saudi Arabia. We aim to summarise available data on ED visits and ICU admissions linked to DRPs in Saudi Arabia and provide recommendations for preventive measures. A systematic search of the literature was conducted using PubMed and Google Scholar databases to identify eligible studies. The review included research on ED visits and ICU admissions linked to DRPs performed in Saudi Arabia from the database’s inception to January 2020. Study selection, data extraction and assessment were performed based on the Preferred Reporting Items for Systematic Review and MetaAnalysis (PRISMA) guidelines. The initial search of literature generated 267 articles. After the study selection, 15 articles met our eligibility criteria and were included in the review. The commonly implicated DRPs were adverse drug reactions, medication non-adherence, drug overdose and drug interactions. Central nervous system drugs and cardiovascular drugs were the most frequently involved drugs. Most of these visits resulted in moderate harm. The prevalence of DRPs associated with ED visits and ICU admissions is high in Saudi Arabia. Sixteen out of a hundred ED visits and ICU admissions are related to DRPs. Therefore, the Saudi government should implement interventions to improve the awareness of rational drug use in the general public.

Drug-Related Problems Among Ambulatory Heart Failure Patients on Follow-Up at Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

PurposeThe 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 MethodsA 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.ResultsThe 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.ConclusionThe 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.

A retrospective study of drug related problems and contributing factors among type 2 diabetes mellitus patients on follow up at public health institutions of kemisse town, north east Ethiopia

BackgroundDrug related problems interfere with the desired treatment outcomes of type 2 Diabetes mellitus. This study was conducted to determine prevalence of drug related problems and associated factors among patients with type 2 Diabetes Mellitus in public health institutions of Kemisse town, northeast Ethiopia from May 01 to 30, 2019. MethodsInstitution based retrospective cross sectional study was conducted among type 2 Diabetes Mellitus patents on follow up at public health institutions of Kemisse town, northeast Ethiopia. ResultFrom the total of 156 patients included in the study, 126 (80.8%) patients have at least one drug related problem with a total of 149 drug related problems. The most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Identified causes of need for additional drug therapy were the need for prophylactic drug therapy (statins and antiplatelet), 83.3%; presence of untreated medical condition (Hypertension, diabetic nephropathy and diabetic foot ulcer), 11.7%; and the need for combination therapy for better efficacy, 5%. This study revealed that age ≥45 years (AOR = 5.59, 95% CI = 1.38–20.64, P = 0.016), presence of comorbid condition (AOR = 3.22, 95% CI = 1.75–13.47, P = 0.014 and emergency visit in the last one year (AOR = 5.08, 95% CI = 1.14–18.71, P = 0.033) were significantly associated with the occurrence of drug related problems. ConclusionA total of 149 drug related problems were identified in 80.8% of type 2 diabetes mellitus patients. The three most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Additionally, age ≥45 years (AOR = 5.59, P = 0.016), presence of comorbidity (AOR = 3.22, P = 0.014) and emergency visit in the last one year (AOR = 5.08, P = 0.033) were significantly associated with the occurrence of drug related problem.

The effectiveness of an independent anti-neoplastic medication therapy management system in ambulatory cancer patients.

BackgroundCancer has always been a serious health threat for human. Patients with cancer are at high risk of drug-related problems (DRPs) due to multi-morbidity associated polypharmacy. However, data is lacking in identifying and addressing potential DRPs in cancer patients in China. This study aims to investigate the prevalence of DRPs and evaluate the effectiveness of an independent anti-neoplastic medication therapy management (MTM) system in ambulatory cancer patients.MethodsThis is a retrospective study. An independent anti-neoplastic MTM system in Shanghai Jiao Tong University affiliated sixth People's Hospital was established in 2018 with the collaboration of oncologists, clinical pharmacists and software engineers. The system contains an independent clinic of pharmacy and MTM software. The software consisted of six modules to help clinical pharmacists serve the tumor patients. The six modules include medication therapy review, intervention plan, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow-up.ResultsA total of 173 eligible tumor patients visited the anti-neoplastic pharmaceutical clinic and were recorded in the independent anti-neoplastic MTM system from Jun 2018 to May 2019. The average clinic visits were 2.4 times of the study participants. Two thirds patients (117/173) had one or more identified DRPs in medication therapy review. Adverse drug reaction, potential drug interaction and non-adherence were the leading DRPs. 85.8% of DRPs could be resolved (cured or improved) in four weeks. Tumor patients showed medication adherence reached 84–100% after three or four times of follow-up and intervention.ConclusionsThe participation of clinical pharmacists in managing polypharmacy tumor patients, with the independent anti-neoplastic MTM system, facilitated the identifying and solving DRPs, especially improving medication adherence of patients, and thus enhancing the effectiveness, safety and rational use of medication.