Risk Factors For Drug-related Problems Research Articles

Drug-related problems in cancer patients: A systematic review.

Cancer patients are at a significantly increased risk of drug-related problems due to multiple drugs. An inclusive review of drug-related problems would offer an approach for healthcare providers to decrease the frequency of drug-related problems in cancer patients. The purpose of this study was to assess all characteristic components of drug-related problems in cancer patients, and explore actions taken to resolve the detected drug-related problems the results could be used as a baseline for epidemiology and potential related risk factors for drug-related problems in cancer patients. The present systematic review was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search consisted of studies listed from January 2015 and up to May 2023. A systematic review was carried out using an electronic database with a combination of Medical subject Headings of key words Medical Subject Heading terms. This evaluation included 17 studies from 11 different nations having 11 prospective and 6 retrospective studies. Pharmaceutical Care Network Europe classification system is the most commonly used to classify the drug-related problems. The prevalence of drug-related problems varied from 9.6% to 92.8%. The key predictors of the drug-related problems were age, polypharmacy, multiple comorbidities, and the stage of the disease. Drug-related problems are significantly more common among cancer patients. The age, polypharmacy, multiple comorbidities, and the stage of the malignancy all enhance the risk of acquiring drug-related problems. This review raises awareness of drug-related problems, encourages their early detection, and emphasizes the necessity for framing effective drug-related problem management strategies which will enhance patient care.

Impact of a comprehensive medication management program on ambulatory care patients with noncommunicable diseases in a Latin American hospital: A retrospective study

Background Noncommunicable diseases are the leading causes of death and disability in the world, harming life conditions and increasing expenditures within the health care system. Comprehensive Medication Management (CMM) may improve patient safety, adherence, and clinical outcomes by preventing or intervening in drug-related problems (DRPs). Methods Retrospective, cross-sectional study conducted between October 2017 and July 2022 in a CMM of a hospital in Costa Rica. Patients 3–106 years old diagnosed with at least one chronic disease and had risk factors for DRP were included. A clinical pharmacist (CP) identified DRPs and proposed interventions to resolve them. DRPs were classified into four categories: indication, effectiveness, safety, and adherence. Additionally, the severity of the problem was determined by using a scale of potential clinical consequences avoided related to DRPs and medication errors (MEs). The adherence rate was determined by applying validated questionnaires and traceability control of dispensing medication dates. Clinical outcomes were classified as resolved, improved, stable, worsened, and therapeutic failure according to the condition of the DRP until the last appointment by the patient. Results Pharmacotherapy interventions had an overall acceptance rate of 98.3%. Interventions made by the CP were related to effectiveness (38.9%, n = 253), safety (29.6%, n = 193), adherence (20.90%, n = 136), and therapy indications (10.60%, n = 69). The patient adherence rate improved, with a mean value of 74% on the first appointment compared with 88% as the last value calculated after the pharmacist's interventions. Predominant determinants of medication nonadherence were therapy-related factors (30.88%) and patient-related factors (30.15%). In the clinical status assessment of 651 DRPs, 490 (75.3%) resolved, 105 (16.1%) improved, 43 (6.6%) remained stable, 5 (0.8%) worsened, and 8 (1.2%) patients presented with therapeutic failure. Conclusions CPs can help resolve DRPs/MEs which enable patients to achieve medication-related therapeutic goals. The clinical interventions made were characterized according to the outcomes of each patient to obtain the optimal management of a patient's medications.

Drug-related Problems among Inpatients of General Medicine Department of a Tertiary Care Hospital in South India

Background: Identification of drug-related problems (DRPs) is a medication management service that can add value to individual patient care. Determination of DRPs daily is a promising approach for optimizing treatment. Objective: The objective of this study was to analyze the incidence of DRPs identified along with the risk factors that contribute to its development. Setting: This study was conducted in a tertiary care hospital in Central Kerala, India. Methods: A cross-sectional study was conducted among 300 newly admitted patients to the general medicine department. Patient medical records were reviewed in 3 stages – medication reconciliation, medication order review, and discharge summary review, and DRPs were categorized based on the Pharmaceutical Care Network Europe V9.1. Patient characteristics such as age, gender, polypharmacy, comorbidities, nonadherence, and type of illness were recorded. Results: Out of 300 patients, 78.7% had DRPs. The incidence of DRPs was found to be 0.26 cases/people-months. Although age >60 years, gender, polypharmacy, nonadherence, comorbidities, and chronic ailments were risk factors for DRPs, only polypharmacy and comorbidities could be proven statistically. Conclusion: DRPs are an emerging issue within the confines of the health-care system and should be scrutinized to avoid negative outcomes. A stage-wise analysis of patients who are at risk will ensure better patient care.

Risk factors for drug-related problems in hospital mental health units

Risk factors for drug-related problems in hospital mental health units

Clinical Pharmacist Intervention on Drug-Related Problems among Elderly Patients Admitted to Medical Wards of Northwest Ethiopia Comprehensive Specialized Hospitals: A Multicenter Prospective, Observational Study.

Background: Drug therapy in the elderly needs an emphasis on age-related changes in drug pharmacokinetics and pharmacodynamics profile. Hospitalized elderly patients are at risk of more than one disease and polypharmacy associated with these; they are at risk of drug-related problems. This study aimed to assess the role of clinical pharmacy on identifying and resolution of drug-related problems among elderly patients admitted to medical ward of Northwest Ethiopia comprehensive specialized hospitals. Methods: A multicenter prospective observational study was conducted. A systematic sampling technique was used. The identified drug-related problem was recorded and classified using Cipolle, and adverse drug reaction was assessed using Naranjo algorithm of adverse drug reaction probability scale, and Medscape was used for drug-drug interaction. Data were analyzed by using STATA software version 14.1. Logistic regression was used, and results were reported as odds ratios (ORs) with 95% Confidence intervals with P value < 0.05 statistically significant. Result: A total of 389 study participants were included in the study. About 266 (68.4%) of the participants had at least a single drug-related problem. About 503 drug-related problems were identified with a mean of 1.32 (CI: 1.27-1.36) drug-related problem per patient. The three-leading categories of drug-related problems were dose too high 108 (21.5%), nonadherence 105 (20.9%), and adverse drug reaction 96 (19.1%). Alcohol use (AOR = 2.2, 95CI%: 1.23-3.94), source of the drug (AOR = 2.85, 95CI%: 1.63-4.98), length of hospitalization (AOR = 2.32, 95CI%: 1.37-3.95), number of comorbidities (AOR = 1.48, 95CI%: 1.09-1.99), and polypharmacy (AOR = 3.06, 95CI%: 1.72-5.46) were important risk factors for drug-related problems. From the intervention provided, 84.7% were accepted by prescribers. Among the total drug-related problems 67.4% of the problem was totally solved. Conclusion: This study revealed that DRPs were high among elderly patients admitted to medical ward of Northwest Ethiopia. Comorbidity, length of hospitalization, ploy-pharmacy, payer, and alcohol drinker were more likely to developed drug-related problems. Treatment optimizations were also done by clinical pharmacists and interventions were well accepted by prescribers.

Prevalence and Risk Factors for Drug-Related Problems in People With Dementia Living in the Community: A Systematic Review and Meta-Analysis.

The aims of this systematic review were to identify the prevalence and risk factors associated with drug-related problems (DRPs) in people living with dementia in the community. A systematic review and meta-analysis. People with dementia living in the community. Six databases (Embase, Medline, PsycINFO, International Pharmaceutical Abstracts, Scopus, and CINAHL) were searched using a combination of keywords and Medical Subject Heading (MeSH) terms with 4 concepts: dementia, older adults, DRPs, and community-dwelling. Primary outcomes were adverse drug reactions (ADRs), adverse drug events (ADEs), and medication errors (MEs). There were 22 studies included: 4 cross-sectional studies and 18 cohort studies. The number of participants in these studies ranged from 81 to 21,795. The pooled prevalence for any ADEs, including ADRs, in people living with dementia was 19.0% (95% CI 11.6%-27.7%), whereas the pooled prevalence for specific types of ADEs ranged from 2.6% to 10.2%. Furthermore, the prevalence of MEs ranged from 0.9% to 41.3%. Psychotropic medications, polypharmacy, and inappropriate medications contributed to an increased risk of experiencing DRPs, whereas support with medication management was a protective factor. The prevalence of overall DRPs experienced by people with dementia was highly variable in included studies. Awareness that certain medication, patient, and medication management factors are associated with the risk of people with dementia experiencing DRPs may guide clinicians to identify high-risk situations and implement suitable mitigation strategies.

Risk factors for drug-related problems in a general hospital: A large prospective cohort.

ObjectiveTo identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients.MethodologyProspective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample.ResultsThe study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%.ConclusionThis study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice.

Prevalence and risk factors of drug-related problems identified in pharmacy-based medication reviews

Background Medication safety is a major health concern, especially for older patients, in whom drug-related problems occur frequently as a consequence of polypharmacy and frailty, increasing the risk of adverse drug events. Objective To investigate the prevalence and types of drug-related problems in community pharmacies and to identify associated risk factors in order to adjust the focus of care. Setting 300 German community pharmacies in Saxony-Anhalt (Germany). Method In April 2015, community pharmacists conducted brown bag medication reviews for primary care patients, in which they identified and solved drug-related problems with patients or their physicians. Data from these reviews were analyzed, including frequency and nature of problems and their respective resolutions. Potentially inappropriate medications according to the PRISCUS list were identified by post hoc analysis. Risk factors for drug-related problems were determined using bivariate and multivariate logistic regression analysis. Main outcome measure Prevalence and risk factors of drug-related problems. Results 1090 medication reviews were conducted. On average, patients were 72.0 ± 9.1 years old and had 10.6 ± 3.7 medications, 62.0% (n = 676) presented a medication plan. Knowledge gaps about medications were detected in almost a third of patients (n = 345). Drug-related problems were identified in 84.2% (n = 918) of patients (in 3836 medications). Frequent problems concerned drug–drug-interactions (53.7%, n = 585) as well as drug use and adherence (46.7%, n = 509). Most problems (72.2%, n = 2769) were resolved between pharmacist and patient. Knowledge gaps and the number of drugs were independently associated with a higher risk of drug-related problems. For older patients, potentially inappropriate medications were a risk factor in bivariate, but not in multivariate analysis. Conclusion Pharmacists identified and resolved considerable rates of drug-related problems, suggesting that they are capable and well-positioned to conduct medication reviews. Knowledge gaps, the number of drugs, patient age and, in older patients, potentially inappropriate medications may indicate an increased risk for drug-related problems.

Risk assessment of patient factors and medications for drug-related problems from a prospective longitudinal study of newborns admitted to a neonatal intensive care unit in Brazil

ObjectiveTo identify patient factors and medications associated with the occurrence of drug-related problems (DRPs) in neonates admitted to neonatal intensive care units (NICUs).DesignProspective, longitudinal study.SettingNICU of a teaching hospital in...

Exploring Drug-Related Problems in Diabetic Patients during Ramadan Fasting in Saudi Arabia: A Mixed-Methods Study.

This study aimed to identify any drug-related problems (DRPs) in diabetic patients during Ramadan fasting in Saudi Arabia. The study used a mixed-methods approach consisting of two phases and was conducted in Makkah, Saudi Arabia from December 2017 to March 2018. The first phase of the study involved qualitative semi-structured individual interviews with diabetic patients. A 13-item questionnaire was used in the second phase to further identify DRPs in the wider population. The data was mainly presented as frequencies and percentages. Inferential statistics was performed using Statistical Package for Social Sciences (SPSS) version 21 to compare relevant variables/questions using the chi-square test. Twenty patients (10 male, 10 female) attended face-to-face interviews during the first phase of the study while 95 (40 male, 55 female) completed the questionnaire in the second phase of the study. Two possible risk factors for DRPs were identified from the qualitative data: patient-related factors, including changes in their medicine intake during fasting, and healthcare professionals-related factors, including lack of advice from healthcare professionals regarding fasting. The quantitative results indicated that 52 (54%) of the 95 participants who observed fasting reported to have changed the way they were taking their medicines. Furthermore, 41% of the participants experienced general healthcare problems such as hypoglycemia, hyperglycemia, fatigue, excessive sweating, and gastrointestinal disturbances. Healthcare professionals need to educate patients who are at risk of DRPs by providing structured education and counseling.

Prevention of potentially inappropriate medication in internal medicine patients: A prospective study using the electronic application PIM-Check.

Potentially inappropriate medication (PIM) is a risk factor for drug-related problems (DRPs) and an important inpatient safety issue. PIM-Check is a screening tool designed to detect PIM in internal medicine patients. This study aimed to determine whether PIM-Check could help to identify and reduce DRPs. Prospective interventional study conducted on patients admitted to internal medicine wards in a university hospital between 1 September 2015 and 30 October 2015. Adult patients were included if they were hospitalized for more than 48hours. Patients received either usual care (period 1=control) or usual care plus medication screening by the wards' chief residents using PIM-Check (period 2=intervention). An expert panel, composed of a clinical pharmacist, a clinical pharmacologist and two attending physicians in internal medicine, blinded to patient groups, identified DRPs. A total of 297 patients were included (intervention: 109). The groups' demographic parameters were similar. The expert panel identified 909 DRPs (598: control; 311: intervention). The mean number of DRPs per patient was similar in the control (3.2; 95% CI: 2.9-3.5) and intervention groups (2.9; 95% CI: 2.4-3.3) (P=.12). PIM-Check displayed 33.4% of the 311 DRPs identified in the intervention group. In this study, PIM-Check had limited value, as the average number of DRPs per person was similar in both groups. Although one-third of DRPs counted in intervention group had been identified by PIM-Check, this did not lead to a reduction in DRPs. This lack of impact of PIM-Check on drug prescription may be explained by the number of alerts displayed by the application and hospital physicians' reluctance to modify the treatments for chronic conditions previously prescribed by general practitioners.

PIM-Check© used by physicians to reduce drug-related problems in internal medicine

Background and objectives Drug related problems (DRPs) are important issues for inpatient safety and may conduct to adverse drug events, increase length of stay and hospital costs. Potentially inappropriate medication (PIM) including over-prescription (medication without a valid indication or with contra-indication), under-prescription (failure to prescribe a clinically indicated drug) and mis-prescription (unwanted drug- interaction; incorrect prescribing) is a risk factor for DRPs. Several tools have recently been developed to target PIM. One of them, PIM-Check©, is dedicated to internal medicine patients. The aim of this study was to determine if PIM-Check© electronic application, used by physicians, can decrease DRPs in internal medicine patients. Methods Open label, 2 consecutive periods of one month, prospective study, conducted on patients admitted for more than 48 h in 7 internal medicine wards in a university hospital. In period 1, patients were treated with usual care (control group). In period 2, patients were treated with usual care preceded by a medication review performed by chief residents within 24 h after admission using PIM-Check© electronic application (intervention group). At 48 h, all medications, lab results, comorbidities and active diagnosis were collected for each patient. DRPs were identified by a “gold standard” group, composed of a clinical pharmacist, a clinical pharmacologist and two attending-physicians of internal medicine analysing all patients-dataset (blinded to period group). Results Two hundred ninety-seven patients were included: 188 in control group and 109 in intervention group. A total of 909 DRPs (mean/patient ± SD: 3.1 ± 2.2) were identified: 3.2 ± 2.2 in control group and 2.9 ± 2.2 in intervention group (P-value 0.21). Both groups were comparable (age, sex, number of drugs, co-morbidities) and had similar mean of DRPs/patients. Top 5 active compound involved in DRPs were: esomeprazole, paracetamol, tobacco, aspirin and thiamine. In the intervention group, the mean number of statements suggested by PIM-Check© was 13.9 ± 7/patients. Among the 311 DRPs identified in this group, 33.4% (n = 104) were suggested by PIM-Check©, but no treatment modification were performed. Discussion and conclusions PIM-Check© allowed identifying one third of DRPs approved by a gold standard group. However, the number of DRPs did not decrease in the intervention group when physicians used PIM-Check©. The high number of statements displayed by the electronic application, and the hesitancy of hospital physicians to change treatment associated with chronic medical conditions, especially in the first 48 h of hospitalization may explain the lack of impact on the number of DRPs.

Drug-related problems in a clinical setting: a literature review and cross-sectional study evaluating factors to identify patients at risk

ObjectivesThis study aims to summarise existing evidence on risk factors for drug-related problems (DRPs) in hospitals as well as ambulatory care or nursing homes and adds additional empirical evidence on...

Determination of risk factors for drug-related problems: a multidisciplinary triangulation process

Introduction and objectivesDrug-related problems (DRPs) constitute a frequent safety issue among hospitalised patients leading to patient harm and increased healthcare costs. Because many DRPs are preventable, the specific risk factors...

Drug Related Problems in Chemotherapy of Cancer Patients

Background: Drug Related Problems (DRPs) in cancer chemotherapy can have severe consequences originating from the high toxicity and narrow therapeutic range of anticancer drugs. Objective: This study was conducted to investigate drug-related problems and factors associated with it in hospitalized cancer patients at Tikur Anbessa Specialized Hospital. Method: A cross-sectional study was conducted at Tikur Anbessa Specialized Hospital from January to June 2013. A total of 367 study participants were recruited by simple random sampling technique and data were collected by medical chart review using data abstraction format. Results: Four hundred seventy four drug-related problems were identified in 274 patients among the 367 patients, which gave rise to a prevalence of 74.7%. The most prevalent drug-related problems was adverse drug reaction (45.5%) followed by dosing problem (37.9%). The risk factors for DRPs were number of medications, comorbidity and length of hospital stay. Conclusion: Drug related problems were common among cancer patients in our set up indicating a need for intervention like involvement of a pharmacist for better therapeutic outcome.

Assessment of Medication-Related Problems in Geriatrie Patients of a Rural Tertiary Care Hospital

Total world population consists 21% of geriatric population, and the 1991 census report shows that there are 57 millions in India. The high rate chronic problems of elderly patients attributes to various drug-related problems (DRP). It was a prospective observational study where eligible patients were enrolled after obtaining their consent. The patient data were collected in a well-designed data collection form, and the data were data were analyzed statistically. The results showed that among 163 geriatric patients, males were more, i.e. 107 (65.6%), than females 56 (34.4%). A total of 149 (90.2%) patients needed medication counselling (*P = 0.012) and 13 (8%) prescriptions had drug–drug interaction (P = 0.152). Thirty-one (19%) patients were using medication inappropriately (P < 0.001) and 40 (24.5%) patients had risk factors for DRPs (P < 0.001). Laboratory tests were required in 32 (19.6%) patients (P = 0.001) and medical chart errors were reported in 7 (4.3%) patients (P = 0.005). The majority of the patients, 136 (83.4%), had medication-related problems (MRP, P = 0.032). This study concluded that most of the enrolled geriatric patients were using medication inappropriately and most of them had MRP.

Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams

To investigate pharmacist contribution in the therapeutic hospital team by studying drug-related problems (DRPs), pharmacist therapy advice and consequences of the advice. From May to December 2002, 827 patients in five Norwegian hospitals were included in the study. Demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors were recorded prospectively at the wards. DRPs, patients characteristics, pharmacist advice to physicians, nurses or patients, response to the pharmacist advice, and reasons (stated by the pharmacist) for not discussing an identified DRP, were reported. An independent quality assessment team retrospectively assessed the DRPs for a randomly selected number of the study population. On average 2.6 DRPs per patient were found. A total of 2128 DRPs were registered and of these 1583 (74%) DRPs were brought up for discussion. Physician immediate acceptance rates varied from 80% (for extremely important clinically significant DRPs) to 50% (for DRPs of minor clinical significance). High age, use of many drugs at admission, existence of many DRPs and many clinical/pharmacological risk factors for DRPs were associated with low immediate acceptance rate. Type of DRP influenced how the DRP was discussed; adverse drug reaction (ADR) and unnecessary drug were discussed with physicians while e.g. medical chart error and need for patient education were discussed with nurses/patients. Reasons for not discussing DRPs in the team were: not given priority (37%), no longer relevant (31%) and others (31%). DRPs of minor clinical significance were most often excluded from discussion (37%) as opposed to 14% and 22% of those of moderate and major clinical significance. The majority of patients had one or more DRPs. The problems identified as DRPs by the pharmacists were accepted as such by the physicians and to a high degree acted upon. Both clinical significance of the DRP and patient characteristics influenced physician immediate acceptance rate. Some DRPs could be solved by direct contact with nurses or the patients. Awareness of DRPs increases through participation of pharmacists in the multidisciplinary therapeutic hospital team.

Implementing disease management in community pharmacy practice

Disease management (DM) is a comprehensive approach to preventing and treating disease that: (1) targets patients with specific diseases; (2) provides integrated services across organizational and professional boundaries; (3) utilizes services based on the best scientific evidence available; and (4) focuses on outcomes. DM differs from pharmaceutical care in that pharmaceutical care targets not only patients with specific diseases but also those with risk factors for drug-related problems, a history of nonadherence, and frequent changes in medication regimens. Steps to starting a DM program include: (1) identifying a target population based on the population's strategic importance to the goals and aims of the organization; (2) assessing the organization's available resources, both internal and external; (3) defining key indicators with which to assess the program for the purposes of internal quality control and of obtaining compensation from third-party payers; (4) implementing the program using the best scientific methods available; and (5) assessing the impact of the program. The development of a smoking cessation program at a nationwide retail pharmacy chain is used as an example of a DM program initiated in community pharmacy practice. Pharmacists are well positioned to take a major role in DM, because they are accessible to the community and because DM frequently involves drug therapy. DM is also widely used in managed care. It is important that community pharmacists be closely involved in the DM approach as it evolves.

Risk factors for drug-related problems in elderly ambulatory patients

Medication use among elderly patients in ambulatory care, home health care, and long-term care settings has become increasingly complicated during the past decade. Home intravenous therapy, multiple drug regimens to treat multiple chronic diseases, increased acuity of nonhospitalized patients, and increased longevity have placed elderly patients at increased risk for drug-related problems.