Unnecessary Drug Therapy Research Articles

Acute COPD exacerbations and in-hospital treatment-related problems: An observational study.

Treatment-related problems (TRPs) interfere with the ability to attain the desired goals of treatment, adding cost to healthcare systems. Patients hospitalized with acute conditions are at particular risk to experience TRPs. Data investigating such burden in patients with acute exacerbation of COPD (AECOPD) is generally scarce with no studies ever conducted in Jordan. This study aimed to investigate and categorize TRPs among patients hospitalized with AECOPD in Jordan, and to estimate their cost savings and cost avoidance. This was a retrospective population-based cohort study. Patients' cases of AECOPD admitted to the study site from Jan 2017 to Jul 2021 were identified from the electronic clinical database and screened for eligibility. TRPs were identified/categorized using AbuRuz tool and assessed for their severity. Cost saving was estimated by calculating all the extra costs. Cost avoidance was estimated according to Nesbit method. A total of 1243 (mean±SD 3.1±1.5) and 503 (mean±SD 1.3±1.2) TRPs were identified during hospitalization and at discharge respectively, of which 49.4% and 66.7% were classified as "unnecessary drug therapy". In 54.5% of the cases, systemic corticosteroid was administered for a period longer than recommended. Most of the TRPs were of moderate severity. The total direct cost saving, and cost avoidance were estimated to be 15,745.7 USD and 340,455.5 USD respectively. The prevalence and cost of TRPs among AECOPD patients is a concern requiring attention. The study results implicate integrating interventions such as embracing clinical pharmacists' role in the respiratory care units to optimize patients' management.

Drug therapy problems among hospitalized patients with cardiovascular disease

BackgroundOptimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases.MethodA prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients’ medical records. We employed Cipolle’s method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05.ResultsThe study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68–9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47–5.11).ConclusionMore than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.

Drug Therapy Problems Identified by Clinical Pharmacists at a General Surgery Ward of an Academic Referral Hospital in Jordan.

Drug therapy problems (DTPs) continuously occur in hospitalized patients. This study aims to emphasize the role of clinical pharmacists in evaluating the DTP's frequencies, causes, severity ratings, and contributing factors at a general surgery ward in Jordan. This prospective observational study was conducted at one of the major teaching and referral hospitals in Jordan. Data were collected through clinical pharmacist reviews of paper and electronic medical records as well as patient interviews. DTPs were identified using Cipolle's classification system and rated for severity on a scale of 10. Multiple linear regression was performed to identify factors contributing to DTPs. Drug classesprimarily associated with DTPs were specified. During enrollment, a total of 80 patients were recruited in this study. The mean age of the enrolled patients was 52.35 ± 14.82 years, and 49 (61.25%) of them were males. Within the study period, 192 DTPs were identified by clinical pharmacists in 87.5%of the total recruited patients. The mean number of DTPs per patient was 2.40 ± 1.83. The most common categories of DTPs were "needs additional therapy" 46 (23.96%), "unnecessary drug therapy" 45 (23.44%), and "dosage too low" 39 (20.31%). Of the total DTPs, 127 (66.15%) were rated as severe. Multiple linear regression revealed that patients' length of hospital stay and the number of current medications had a statistically significant effect on the number of DTPs identified during hospitalization. Endocrine and metabolic drugs 51 (26.56%) and cardiovascular drugs 36 (18.75%) were the most frequent classes of drugs contributing to DTPs. DTPs are common in the general surgery ward. Clinical pharmacists can provide medication reviews for surgical patients to identify DTPs and rate their severities. Detecting risk factors for DTPs and the most common drug classes associated with them can assist in decision-making relevant to reducing DTPs in the surgical ward.

Frequency, types and predictors of drug therapy problems among non-dialysis chronic kidney disease patients at a tertiary care hospital in Pakistan.

Drug therapy problems (DTPs) are common among patients suffering from chronic kidney disease (CKD). However, there is a lack of information about DTPs and its predictors among CKD patients from Pakistan. To evaluate the frequency, type and predictors of various types of DTPs among CKD patients at a tertiary-care hospital in Pakistan. This was a cross-sectional study carried out at Sandeman Provincial Hospital, Quetta between 1-11-2020 and 31-1-2021. It included 303 non-dialysis ambulatory patients of CKD-stage 3 and above. Cipolle et al., criterion was used for classifying the DTPs and a clinician at the study site checked the identified DTPs for accuracy. Data were analyzed by SPSS 23. Multivariate analysis was conducted to find the predictors of individual types of DTPs. A p-value <0.05 was considered statistically significant. The patients received a total of 2265 drugs with a median of eight drugs per patient (range: 3-15 drugs). A total of 576 DTPs were identified among 86.1% patients with a median of two DTPs (interquartile range 1-3) per patient. Dosage too high (53.5%) was the most common DTP followed by adverse drug reactions (ADRs) (50.5%) and need of additional drug therapy (37.6%). In multivariate analysis, patients' age of >40 years emerged as a predictor of unnecessary drug therapy and dosage too high. The odds of needing a different drug product was significantly high in patients with cardiovascular diseases (CVD) and diabetes mellitus (DM). The dosage too low had significant association with CVD. The risk of ADRs was significantly high in elderly patients (>60 years) and those with CVD. The presence of hypertension, DM and CKD stage-5 emerged as predictors of dosage too high. This study revealed a high prevalence of DTPs among CKD patients. Targeted interventions in high risk patients may reduce the frequency of DTPs at the study site.

Drug Therapy Problems and Associated Factors Among Hypertensive Patients in North Wollo Public Hospitals, Northeast Ethiopia: Institutional-Based Cross-Sectional Study.

Drug therapy problems (DTPs) are common in people with hypertension and may threaten the effective management of the disease. The purpose of this study was to determine the prevalence and predictors for DTPs in hypertensive people in North Wollo public hospitals. On patients with hypertension, a cross-sectional study based in a health institution was carried out using an interviewer-administered structured questionnaire and medical record review from 6 November 2022 to 18 January 2023. All hypertensive patients, ages 18 and older, who underwent regular follow-ups for at least 12 months were included in the study using a simple random sampling method. Multivariate logistic regression analysis was used to establish the association between independent variables and the occurrence of DTPs. Unnecessary drug therapy, the need for additional drug therapy, ineffective drugs, dosage too low, dosage too high, adverse drug reactions, and noncompliance were the outcome variables. The study included 376 hypertensive patients. Of the total participants, 258 (68.6%) were female. The mean number of drug therapy problems per patient was 1.55 ± 0.307, with 298 participants (79.3%) reporting having at least one such problem. This study found that the need for additional drug therapy was the most prevalent problem (149, 39.66%). Polypharmacy (AOR = 2.487, 95% CI = 1.375-4.499, p = 0.003), presence of comorbidity (AOR = 1.886, 95% CI = 1.035-3.439, p = 0.038), and uncontrolled BP (AOR = 2.961, 95% CI = 1.669-5.254, p = <0.001) predicts the development of drug therapy problems. Patients with hypertension who are on follow-up experience drug therapy problems frequently. Promoting the involvement of clinical pharmacists in designing, implementing, and monitoring therapeutic plans is recommended to decrease the occurrence of drug therapy problems.

Medication related problems among ambulatory patients with chronic kidney disease at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Medication related problem (MRP) is an event occurring, as a result, the medication therapy that actually or potentially interferes with desired health outcomes. Evidences reported that the prevalence of MRPs may result in a high burden of morbidity and decrease patients' quality of life. The problem is more significant among patients with chronic kidney disease (CKD) as a decline in kidney function and increase number of medications required to treat kidney disease and its complications. Thus, this study aimed to assess MRPs and its associated factors among patients with chronic kidney disease. Hospital-based cross-sectional study was conducted among 248 adult ambulatory patients with CKD (stage 1-4) at St. Paul's Hospital Millennium Medical College. Data were collected through patient interview and medical chart review from 1st of June to 30th of August 2019. MRPs were identified based on the standard treatment guidelines. Cipolle MRPs classification was used to classify the MRPs and Micromedex® was used as drug interaction checker. Binary logistic regression was utilized to identify the associated factors and p value <0.05 was considered as statistically significant. A total of 325 MRPs were identified from 204 (82.3%) study participants giving 1.6 MRPs per participant. One MRP was identified among 114 (55.9%) patients while two MRPs were identified among 64 (31.4%). The most common class of MRPs were need additional drugs 114 (35.1%) followed by non-compliance 54 (16.6%), unnecessary drug therapy 46 (14.2%) and dose too low 46 (14.2%). The two most common reasons for non-compliance were unaffordability of drugs 26(48.1%) and the lack of patient understanding about drug taking instruction 10 (18.5%). The study showed that only occupation (AOR = 5.2, 95% CI: 1.292-21.288, P = 0.020) and angiotensin converting enzyme inhibitor use (AOR = 6.6, 95% CI: 2.202-19.634, P = 0.001) had an association with the occurrence of MRPs. The prevalence of MRPs among ambulatory patients with CKD was high and need of additional drug therapy was the commonest MRPs.

Pharmacist-led medication reviews in primary healthcare for adult community-dwelling patients – a descriptive study charting a new target group

BackgroundMedication treatment can reduce morbidity but can also cause drug-related problems (DRPs). One method to identify and solve DRPs is medication reviews (MRs) that are aimed at increased patient safety and quality in drug treatment. In Skåne county, Sweden, a well-established multi-professional model for MRs in nursing homes is practiced. However, a demand for MRs regarding community-dwelling patients has emerged. These patients may be extra vulnerable since they have less supervision from healthcare personnel.AIM: To describe the community-dwelling patients in primary healthcare considered in need of an MR, as well as the outcomes of these pharmacist-led MRs.MethodsPersonnel from 14 primary healthcare centers selected patients for the MRs. Based on electronic medical records, the symptom assessment tool PHASE-20 (PHArmacotherapeutical Symptom Evaluation 20 questions) and medication lists, pharmacists conducted MRs and communicated adjustment suggestions via the medical record to the general practitioners (GPs).ResultsA total of 109 patients were included in the study and 90.8% (n = 99) of the patients were exposed to at least one DRP, with an average of 3.9 DRPs per patient. Patients with impaired renal function (glomerular filtration rate, GFR < 45 ml/min) or ≥ 10 medications were exposed to a significantly higher number of DRPs per patient, 5.1 DRP and 5.3 respectively. The most frequent DRP-categories were Unnecessary drug therapy and Adverse drug reaction, which represented 23.0% respectively 22.9% of the total amount of DRPs.ConclusionsOur results indicate a prioritized need for MRs for community-dwelling patients, specifically with impaired renal function or polypharmacy.

Prevalence and factors associated with inappropriate anti- diabetic medication therapy among type 2 diabetes mellitus patients at the medical and surgical wards of Mbarara Regional Referral Hospital, Uganda.

Inappropriate Anti-diabetic Medication Therapy (IADT) refers to a drug-related problem and includes 'ineffective drug therapy', 'unnecessary drug therapy', 'dosage too high', and 'dosage too low'. This study aimed to determine the prevalence and factors associated with IADT among T2DM patients at Mbarara Regional Referral Hospital, Uganda (MRRH). A prospective cross-sectional study was conducted at the medical and surgical wards of MRRH from November 2021 to January 2022. One hundred and thirty-eight adult patients aged 18 years and above, with T2DM, were recruited using consecutive sampling. Patient file reviews and interviewer-administered questionnaire was used for data collection. The data were entered into and analyzed using SPSS version 25. Descriptive analysis was employed to describe the population and determine the prevalence of IADT. Types of IADTs were identified using Cipolle's DRP classification tool. A univariate and multivariate logistic regression analysis was used to identify factors significantly associated with IADT. The P-value of < 0.05 was considered statistically significant at 95% confidence interval. A total of 138 hospitalized T2DM patients were studied. Eighty (58.0%) were females, and 70 (50.7%) were ≥ 60 years of age. Out of a total of 138 participants, 97 experienced at least one IADT, with an estimated prevalence of 70.3%. 'Dosage too high' (29.2%) and 'dosage too low' (27.9%) were the most common type of IADTs. Age ≥ 60 years (AOR, 8.44; 95% CI, 2.09-10.90; P-value = 0.003), T2DM duration of < 1 year (AOR, 0.37; 95% CI, 0.11-0.35; P-value = 0.019), and HbA1c of < 7% (AOR, 9.97; 95% CI, 2.34-13.57; P-value = 0.002) were found to be factors significantly associated with the occurrence of IADTs. The overall prevalence of inappropriate anti-diabetic medication therapy among T2DM patients admitted to medical and surgical wards of MRRH was 70.3%. The most common type of IADT in this study was 'dosage too high', accounting for almost one-third followed by 'dosage too low' accounting for a quarter of total IADTs. Age greater or equal to 60 years, T2DM duration of < 1 year, and HbA1c of < 7% during the current admission were found to be factors significantly associated with the occurrence of IADTs in hospitalized T2DM patients.

Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital.

Introduction:Drug-related problems could potentially worsen the clinical outcomes in critically ill patients. Critically ill patients are generally considered more vulnerable to harm from drug-related problems due to frequent medication-related events and complicated clinical courses. However, drug-related problems identified by on-ward clinical pharmacists in medical intensive care units in Thailand are not well reported. This study reports clinically relevant data with the description of identified problems, common causes of drug-related problems, and pharmacists’ interventions performed in real world, so that it may serve as an educational material for pharmacists who implement a pharmaceutical care and participate in medical intensive care units.Methods:A retrospective descriptive study was conducted at a tertiary university hospital in Bangkok, Thailand, from January 2015 to December 2020. The drug-related problems were categorized according to Cipolle et al.’s classification. The severity of drug-related problems in this study was rated by modifying the definition of The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy of Medication Error to report harm from drug-related problem-related patient outcomes.Results:A total of 698 drug-related problems were detected in 374 critically ill patients. The prevalence of drug-related problems occurring in critically ill patients admitted to the medical intensive care unit was 73.9%. The most frequent drug-related problems were dosage too high (27.7%), ineffective drug (17.2%), need for additional drug therapy (15.3%), unnecessary drug therapy (14.6%), dosage too low (14.3%), adverse drug reaction (9.7%), and non-adherence (1.2%). The severity of drug-related problems in the medical intensive care unit was assessed as a drug-related problem with no harm (78.2%). Pharmacists’ interventions were advised according to drug-related problem identification to provide personalized pharmacotherapy optimization in critically ill patients.Conclusion:The most frequent drug-related problem identified during pharmaceutical care interventions in the medical intensive care unit at tertiary university hospital is dosage too high. The severity of drug-related problems is mostly determined as drug-related problems with no harm.

A study on drug therapy issues in the department of medicine of a tertiary care teaching hospital-prospective observational study

Background: A drug therapy problem (DTP) is any undesirable event experienced by a patient that involves or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy. The improper use of drugs can lead to patient morbidity and even mortality. DTP s are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying the DTPs help patients to achieve their goals of therapy. Identifying DTPs enables risk quantification and determination of the potential impact of prevention strategies. DTPs are associated with prolonged length of stay and increased economic burden and results in increased risk of death.Methods: A hospital based, prospective observational study was conducted at department of medicine in Rajah Muthiah medical college and hospital, 80 patients were enrolled in this study based on the inclusion-exclusion criteria. The DTPs were identified using the Cipolle’s method of classification of DTP.Results: The study has shown that 80 of the patients involved in the study had a total of 136 DTPs. An average of 1.7 DTPs were recorded per patient during the study. The most common DTP identified was unnecessary drug therapy accounting to 47%. The absence of valid medical indication was (30%) and (16%) were due to the duplication of therapy. The second most common DTP was unsafe drug for patients, accounting to 45% were due to patient non-compliance and drug interaction which was minor. Need for additional drug therapy was the third most identified accounting 13% were due to medical indication indicate the need of drug therapy.Conclusions: The foremost commonly observed DTP is unnecessary therapy and patient non-compliance to the drugs. The study suggests that DTPs are significantly occurring in hospital can cause the patient for comorbidity, prolonged hospitalization. The study suggests that clinical pharmacist and general practitioners can work together to spot and resolve the DTPs.

“Childrens are not just “little adults”. The rate of medication related problems and its predictors among patients admitted to pediatric ward of southwestern Ethiopian hospital: A prospective observational study

BackgroundThe rate of medication related problems is high in developing countries due to the complexity of pediatrics medication management. Pediatric population should have their own dosage regimens. The pediatric dosage regimens were derived from the adult dose that might lead to sudden reach of sub or supra-therapeutic doses. As the result, the medication therapy management is difficult in this populations. Despite this, a scanty of studies were conducted on medication related problems among pediatric populations. Therefore, this study examined the prevalence and risk factors for the occurrence of the medication related problems among patients admitted to pediatric ward of Mettu karl referral hospital. Patients and methodsThe pediatric population who were received the pharmacotherapy for their disease was observed and followed for the occurrences of medication related problems at pediatric wards of Mettu karl referral hospital from February 12, 2020 to February 24, 2021. Patients whose age was less than or equal to 18 years and who were on drug therapy or who needs drug therapy during study period were included. The possibility of adverse drug reactions developed from the drug was assessed by using the Naranjo scale. Multivariable logistic regression analysis was used to determine the predictors of medication related problems. ResultOver the study period, a total of 189 pediatric populations were included. Among these, 115 (60.8%) were males, and the mean age of the patients was 1.4339 ± 0.864 years. The mediciation related problems was found among 121(64.01%) of pediatric patients. Among seven types of drug therapy problems unnecessary drug therapy, need additional drug therapy, ineffective drug therapy and dose too high were the most predominantly occured DRP that accounted 74 (27.72%), 67 (25.09%), 43 (16.10%), 36 (13.48%), respectively. The mean number of hospital stay was 4.29 days with minimum and maximum stay of 2 and 9 days and antibiotics 364(51.3%) were the most common class of drugs that was associated with drug related problems. Being a neonate (AOR = 1.48, 95CI%: 1.69–7.42, P = <0.001), hospital stay greater than or equal to seven days (AOR = 1.98, 95CI%: 2.471–12.644, P = 0.016), and the presence of co-morbidity(AOR = 2.507, 95CI%: 3.270–4.949, P = 0.080) were the predictors of the medication related problems. ConclusionThe prevalence of medication-related problems in pediatrics patient was found to be high. Being neonatal, prolonged hospital stay and the presence of a multiple disease were the predictors of medication-related problems in pediatric patients. Therefore special attention should be given for newborns, prolonged hospital stay and patients having co-morbidity. Besides this, the drug information service and the patients round activity should be started by clinical pharmacist to decrease the occurences of any preventable medication related problems.

Integrating Comprehensive Medication Management services at the primary care level-experiences from the pilot project at the county Health centre Zagreb Centre

Introduction Croatia is among the EU Member States with the highest expenditure on medical goods, mainly pharmaceuticals, amounting to 28.5%, compared to an EU average of 18.5%. In addition, a continuous increase in the prevalence of chronic medical conditions with the accompanying polypharmacy has been noted. Hence, chronic patients are at an increased risk of experiencing drug therapy problems (DTPs), thus adding substantial costs to the health care system and exceeding the amount spent on the medications themselves.Short description of practice change implemented To ensure patients’ optimal medication use and improve their clinical outcomes, a comprehensive and systematic management of medications is deemed crucial. Comprehensive Medication Management (CMM) services, officially recognized by the Federal Government of the USA in 2003 (MMA 2003), address this problem. Collaborative practice between pharmacists and general practitioners (GPs), together with patients’ active participation in the definition of treatment regimens, plays an important role in the effectiveness of CMM services.AimThe primary aim of this study is to describe the newly implemented practice management system of CMM services at the county health centre in Croatia.Targeted population and stakeholders• patients who have not reached or are not maintaining the intended therapy goal• patients who are experiencing adverse effects from their medications• patients who have difficulty understanding and following their medication regimen• patients in need of preventive therapy• patients who are frequently readmitted to the hospital Timeline2016 - 2018 Components of the practice management system adapted to Croatian primary health care setting2017- The work flow of the patient care process specific for Croatian primary care level defined2018- Pharmacotherapy counselling service, located in the county health centre, Health Centre Zagreb- Centre, established and started with its workHighlights (innovation, Impact and outcomes)At least one DTP was identified in 81 (96.2%) patients, of which 30.2% had 4 or more DTPs. The most prevalent DTP was “Needs additional therapy” (26.1%), with “Untreated condition” being the most common cause. The second most frequent DTP category was “Dosage too low” (24.5%), followed by “Unnecessary drug therapy” (12.4%) and “Dosage too high” (11.6%).Comments on sustainabilityAs this is a pilot-project, sustainability of the service has not yet been ensured.Comments on transferabilityComponents of the practice management system and protocol on the workflow of the patient care process specific for Croatian primary care level are available to all primary care units in Croatia.Conclusions (comprising key findings)A new pharmacist-led service was successfully piloted and introduced at the Croatian primary health care clinic.DiscussionsA deeper understanding of work processes and resources needed for initial implementation of CMM were of paramount importance for successful introduction of CMM within a primary care setting.Lessons learnedChallenges encountered throughout the process of initial implementation of CMM services were detected; they should be tackled for full implementation of CMM services and need to be taken into consideration in future implementation of this service in other health care settings.

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.

Essential oil related seizures (EORS): A multi-center prospective study on essential oils and seizures in adults

ObjectiveEssential oils (EOs) like eucalyptus and camphor have pro-convulsant properties. These EOs are present in many over- the- counter balms and oils. The effect of exposure to these EOs and occurrence of seizure is not systematically studied. The aim of this study was to evaluate the relationship between essential oils and the first episode of seizure and breakthrough seizures in known epileptic patients. MethodsThis was a multi-center prospective study, conducted in four hospitals over four years. Every person presenting with the first episode of seizure or breakthrough seizure was asked about exposure to EOs, mode of exposure, time to onset of a seizure in relationship to exposure, duration of seizure, type of seizure, and antiepileptic drug therapy. ResultsDuring the four-year period there were 55 patients with essential oil-related seizure (EORS). 22(40 %) had essential oil-induced seizures (EOIS) and 33(60 %) had essential oil-provoked seizures (EOPS). The female: male ratio was 1:1.1, the age of the patients ranged from 8 months to 77 years. In the EOIS group, 95 % had generalized tonic-clonic seizures and 5% had focal impaired awareness seizures. In the EOPS group, 42.4 % had focal impaired awareness seizures, 27.3 % generalized tonic-clonic seizures, 15 % focal to bilateral tonic-clonic seizures, and 15 % focal aware motor seizures. EOs implicated were preparations containing eucalyptus and camphor. ConclusionExposure to essential oils of eucalyptus and camphor is an under-recognized cause of the first and breakthrough seizure. Identifying the true causative factor will prevent unnecessary antiepileptic drug therapy and future recurrence.

Drug therapy problems identified among patients receiving antiretroviral treatment in a HIV clinic: a prospective study in North Central, Nigeria.

Introduction:despite improved life expectancy for people living with HIV (PLWH), aging, comorbidities, and associated drug treatment increase the risk for drug therapy problems (DTPs). We assessed pharmacists´ identification and resolution of DTPs among PLWH.Methods:a prospective study was conducted among PLWH aged ≥10 years (N=100) in a Nigerian HIV clinic. Trained pharmacists delivered a six-step intervention that included the establishment of patient-provider relationship, gathering and validation of patient´s data, identification of DTPs, intervention, outcome identification, and documentation. Descriptive statistics were used to examine data collected via a pharmaceutical care assessment tool.Results:in all, 215 DTPs were identified and classified as unnecessary drug therapy [27.4% (n=59)], non-adherence [21.9% (n=47)], needs additional drug therapy [16.7% (n=36)], adverse drug reaction [(14.0% (n=30)], wrong drug [(10.7% (n=23)], and dosage variation [n=20 (9.3%)]. Within each DTP class, the most common cause was addiction/recreational drug use [39.0% (n=23)], drug product not available [63.8% (n=30)], untreated condition(s) [61.1% (n=22)], undesirable effects [66.7% (n=20)], condition refractory to drug [34.8% (n=8)], and drug interaction [45.0% (n=9)], respectively. The most common interventions were medication information/recommendation to patients/prescribers (30.4%) and initiation of drug therapy (22.2%). Six-month resolution rate was 90% (n=194) with the most common outcomes being improvement in patient adherence [23.6% (n=50)], addition of a drug [18.9% (n=40)], and reduction in drug overuse [15.6% (n=33)].Conclusion:pharmacists´ intervention resulted in 90% resolution of detected DTPs, implying that pharmacists are crucial in improving antiretroviral treatment outcomes.

Characterization of Medication Related Problems Among Patients with Cardiovascular Disease in Medical Ward of Mettu Karl Referral Hospital, South Western, Ethiopia: A Prospective Observational Study

Background: Medication related problem is defined as: ‘an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. Drug related problems are of a major concern in health care because of increased cost, morbidity and mortality. cardiovascular diseases are a group of disorders of the heart and blood vessels. Objective: To discover characterization of medication related problems and contributing factors among cardiovascular patients in the medical ward of Mettu Karl Referral Hospital. Methods: A facility based prospective observational study design was carried from April 07 /2021 to June 09/2021. Data was collected through employing check list and semi-structured questioner. Data was entered and descriptive statistical analysis was done using statistical packages for social sciences 25.0 version statistical software. Both bi-variable and multivariable analysis performed to determine the association between outcome and predictors variables. A p-value of less than 0.05 was considered significant. Results: The overall rate of medication related problems among cardiovascular patients in medical ward was 53 (58.2%). The patient’s age group was in line of 36-59 years 49 (53.8%). Unnecessary drug therapy 15 (28.3%) were the mostly identified type of drug therapy problem followed by dosage too high 11 (20.8%). ACEIs 229 (17.1%) was commonly prescribed medication and potassium sparing 19 (2.2%) was least prescribed drugs. Age ≥ 60 years (AOR: 2.76; 95%CI: 1.342-3.945; P=0.004), rural area residents (AOR: 2.76; 95%CI: 1.014-2.758; P=0.003), length of hospital stay >7 days (AO R: 4.75; 95%CI: 2.986-11.723; P=0.007), number of medication >5 (AOR: 3.632-17.893; 95%CI: 2.986-11.723; P=0.001) were associated factor significantly causes medication related problems. Conclusion and Recommendation: The prevalence of medication related problems amid cardiovascular patients in medical ward was high. Less than half of patients were found to have co-morbidities and were had have social substance users. Hospitals and ministry of Health should have to establish pharmaceutical care services for better patient care.

Hubungan antara Drug-Related Problems dan Lama Rawat Inap pada Pasien dengan Diabetes Tipe 2

Drug-Related Problems have been associated to blood glucose control along with the morbidity and mortality of type 2 diabetes patients through previous studies. However, studies that associate Length of Stay (LOS) with DRPs in type 2 diabetes patients have not been done. The study that had been done was to associate between LOS and Medication Errors (ME). Medication errors include DRPs because other researchers state that errors are also kind of problem. This study was aimed to identify Drug-Related Problems (DRPs) and to associate between DRPs and LOS in type 2 diabetes patients who were hospitalized. This study was a prospective observation study with a cross-sectional design. Sample collection was carried out by consecutive sampling method in type 2 diabetic patients hospitalized in internal medicine ward in one academic hospital in Yogyakarta. Data analysis was done descriptively to see DRPs description and the association between DRPs and LOS was analyzed using Chi-square or Fisher's exact test whenever Chi-square test conditions were not met. Data collection was carried out in January till April 2018. The results showed that the DRPs in hospitalized type 2 diabetic patients were 80.56% with unnecessary drug therapy occurring at 34.72%; dosage too low of 25%; needs additional drug therapy 13.38%; dosage too high 12.5%; ineffective drug 11.11%; and there was no association seen between DRPs and LOS.

Insulin autoimmune syndrome.

SummaryInsulin autoimmune syndrome (Hirata’s disease) is a disorder caused by development of autoantibodies to insulin and manifested by hypoglycaemic syndrome. The overwhelming majority of physicians do not include it in the differential diagnosis of hypoglycaemic states because of a misconception of an extremely low prevalence of this condition. This results in unnecessary drug therapy and unjustified surgical interventions in patients that otherwise would be successfully treated conservatively. This disease is strongly associated with certain alleles of the HLA gene. In most cases, this condition develops in predisposed individuals taking drugs containing sulfhydryl groups. Formation of autoantibodies to insulin may be observed in patients with other autoimmune disorders, as well as in those with multiple myeloma or monoclonal gammopathy of undetermined significance. This paper presents the first Russian case report of insulin autoimmune syndrome in an adult patient.Learning points:Insulin autoimmune syndrome, Hirata’s disease, anti-insulin antibodies, and hypoglycaemia.

INVESTIGATION OF DRUG-RELATED PROBLEMS IN TYPE 2 DIABETES MELLITUS PATIENTS WITH MACROVASCULAR COMPLICATIONS: A CROSS-SECTIONAL STUDY

Objective this study to identify and classify DRPs in type 2 diabetes mellitus patients with macrovascular complications. Method A cross-sectional observational study was conducted in type 2 diabetes mellitus outpatients with macrovascular complications at Makassar Regional Hospital, for two months (July and August 2018). The study complied with all clinical research requirements in accordance with the Declaration of Helsinki. Ethics committee approval was obtained from UIN Alauddin Makassar. Thirty eight prescriptions were collected for this study. Samples were recruited based on inclusion and exclusion criteria. The identification and classification of DRPs were according to the PCNE tool v 8.02. Result: The most common drug-related problems were adverse drug reactions (n = 73; 77.7%) of the therapeutic safety domain, followed by optimal therapeutic effects (n = 15; 15.9%) of the effectiveness domain and finally unneeded drugs therapy (n = 4; 4.3%) from other domains. The highest cause of DRPs was the required of drug information was not available (n = 73; 77.7%), followed by drugs not in accordance with the guidelines (n = 10; 10.6%). The results of identification and causes of DRPs obtained 101 causes of DRPs in T2DM patients with macrovascular complications. Interventions that have been made by pharmacists to doctors in the form of providing information, interventions given to patients in the form of giving drug counseling and providing interventions on drugs in the form of drug replacement and drug dosage and stopping drugs. The implementation of the intervention given by the pharmacist was well received but the implementation was not known to be the highest, at 58.8%. The status of the PTO intervention by the pharmacist was unknown because patients were outpatients at 58.8%. Conclusion : Pharmacists have identified and categorized DRPs that occur in T2DM patients with macrovascular complications in the form of potential problems that are adverse drug reactions (may) occur as well as problems that have occurred namely the effect of suboptimal drug therapy, unnecessary drug therapy and symptoms or indications that are not treated.

IDENTIFICATION OF DRUG-RELATED PROBLEMS IN ADULTS WITH TUBERCULOSIS AT THE TEBET SUBDISTRICT HEALTH CENTER FROM JULY TO DECEMBER 2018

Objective: Tuberculosis (TB) is a highly prevalent infectious disease caused by Mycobacterium tuberculosis. The recommended TB treatment is acombination of various antibiotics in the form of a fixed-dose combination tablet or kombipak; however, this increases the prevalence of drug-relatedproblems. Therefore, this study aimed to identify drug-related problems of patients receiving TB therapy at the Tebet Subdistrict Health Center fromJuly 2018 to December 2018.Methods: The study was designed as a cross-sectional study using the retrospective data retrieval method from prescriptions of patients withTB from July 2018 to December 2018. The classification system prepared by Cipolle, Strand, and Morley was used for the classification of drugrelatedproblems; this system includes unnecessary drug therapy, required additional drug therapy, ineffective drug, dosage error, and druginteraction.Results: The percentage of unnecessary drug therapy, required additional drug therapy, ineffective drug, dosage error, and drug interaction was2.85%, 6.89%, 1.54%, 12.46%, and 66.18%, respectively, with the occurrence of drug-related problems being the highest.Conclusion: The administration of anti-TB drugs can potentially cause drug-related problems. Therefore, the assessment needs to be optimizedbefore the administration of medications to patients and medications should be prescribed and monitored regularly to achieve rational drug use