Background
Methods
Study design and setting
Study population
Data collection
Outcome measure
Explanatory variables
Statistical analyses
Results
Socio-demographic characteristics
Demographic characteristics | N (%) |
---|---|
Age, Mean (SD) | 67.3 (7.3) |
Sex male | 135 (67.5) |
Marital status | |
Married | 158 (79) |
Widowed | 36 (18) |
Divorced | 6 (3) |
Religion | |
Christian | 50 (25) |
Muslim | 150 (75) |
Educational status | |
No formal education | 132 (66) |
Primary education | 55 (27.5) |
Secondary education | 8 (4) |
Tertiary education | 5 (2.5) |
Residence | |
Rural | 137 (68.5) |
Urban | 63 (31.5) |
Monthly income | |
< 800 birr | 127 (63.5) |
≥ 800 birr | 73 (36.5) |
Relies on caregiver (yes) | 150 (75%) |
Clinical and medication characteristics
Characteristics | n (%) |
---|---|
Admission ward | |
Medical | 131 (65.5) |
Surgical | 69 (34.5) |
Mean number of disease condition per patient, Mean (SD) | 2.20 (1.157) |
Mean number of medications per patient, Mean (SD) | 3.9 (2.108) |
Polypharmacy (yes) | 71 (35.5) |
Disease conditions | |
Heart failure | 48 (24) |
BPH | 26 (13) |
Stroke | 22 (11) |
Acute coronary syndrome | 13 (6.5) |
Acute abdomen | 12 (6) |
Type II DM | 11 (5.5) |
Cancer | 9 (4.5) |
Pneumonia | 8 (4) |
Surgical site infection | 8 (4) |
Chronic kidney disease | 7 (3.5) |
Trauma | 6 (3) |
Hernia | 5 (2.5) |
Hematoma | 5 (2.5) |
Gangrene | 5 (2.5) |
Upper GI bleeding | 5 (2.5) |
Others | 10 (5) |
Prevalence of drug related problems
Total number of DRPs =380 | n (%) |
---|---|
Problem domains | |
P1: treatment effectiveness (3 categories) | 181 (47.6%) |
Suboptimal effect of drug treatment | 102 (56.4) |
Untreated indication | 69 (38.1) |
No effect of drug treatment | 10 (5.5) |
P2: treatment safety | 92 (24.2%) |
Adverse drug event (possibly) occurred | 92 (100) |
P3: Others | 107 (28.2%) |
Unnecessary drug treatment | 81 (75.7) |
Problem with cost effective treatment | 26 (24.3) |
Number of drug related problems | Frequency (%) |
None | 37 (18.5) |
One | 49 (24.5) |
Two | 53 (26.5) |
≥ three | 61 (30.5) |
Drug related problem | Category of DRPs | Description |
---|---|---|
A patient in the age range of 60–70 was admitted to surgical ward with the diagnosis of breast cancer. After one side mastectomy was done, the patient was prescribed with Tamoxifen 20 mg po daily. | Untreated indication | Patient complained severe pain which is 8/10. However, the pain was not treated. Patient has untreated indication and needs morphine 2.5 mg every four hour. |
A patient in the age range of 60–70 was admitted to internal medicine ward with the diagnosis of ischemic heart disease (NST Elevated myocardial infarction). The patient was prescribed with Simvastatin 40 mg | Suboptimal effect of drug treatment | High intensity statins are required for patients with NSTEMI. Simvastatin 40 mg is medium intensity statin. Thus, it will have suboptimal effect. Therefore, we recommended Atorvasatin 80 mg. |
A patient in the age range of 70–80 admitted with the diagnosis of peripheral arterial disease. After admission the patient prescribed with warfarin 5 mg and Heparin 12,500 IU | No effect of drug treatment (Warfarin and Heparin) Untreated indication | Warfarin and Heparin have no effect on peripheral arterial. Patient needs Atorvastatin and Aspirin to treat his condition. |
Known cardiac patient in the age of 80–90 was admitted to internal medicine ward. The patient was taking aspirin and lost around 3 l of blood. | Adverse drug event (possibly) occurred | Aspirin was considered the offensive drug and discontinued for 07 days. The bleeding stopped after aspirin was discontinued. Based on Naranjo scale the bleeding is possibly due to Aspirin. |
Causes of drug related problems
Cause domain (8 categories) total = 466 | n (%) |
---|---|
C1: Drug selection causes | 252 (54.1) |
New indication for drug treatment | 91 (36.1) |
No indication for drug | 52 (20.6) |
Inappropriate drug according to guidelines | 42 (16.7) |
Contra-indicated | 30 (11.9) |
Inappropriate duplication of therapeutic | 20 (7.9) |
Inappropriate combination of drugs, or drugs and food | 17 (6.8) |
C2: Drug form causes | 16 (3.4) |
In appropriate drug form | 16 (100) |
C3: dose selection causes | 68 (14.6) |
Drug dose too high | 46 (67.6) |
Drug dose too low | 22 (32.4) |
C4: treatment duration causes | 24 (5.2) |
Duration of treatment too long | 22 (91.7) |
Duration of treatment too short | 2 (8.3) |
C5: dispensing causes | 20 (4.3) |
Prescribed drug not available | 18 (90) |
Prescribing error (necessary information missing) | 2 (10) |
C6: drug use process causes | 57 (12.2) |
Drug not administered at all | 40 (70.2) |
Drug under administered | 11 (19.3) |
Drug over administered at all | 6 (10.5) |
C7: patient related causes | 22 (4.7) |
Patient uses unnecessary drug | 7 (31.8) |
Patient administered/uses drug in a wrong way | 5 (22.7) |
Patient cannot afford drug | 5 (22.7) |
Patient unable to use drug/form as directed | 5 (22.7) |
C8: other causes | 7 (1.5) |
No or inappropriate outcome monitoring | 7 (100) |
Clinical pharmacist interventions
Intervention domain (N = 731) | n (%) |
---|---|
I0: No intervention | 61 (8.3) |
I1: intervention at prescriber level | 300 (41.0) |
Intervention proposed and discussed with prescriber | 248 (82.7) |
Prescriber informed only | 52 (17.3) |
I2: intervention at patient /care giver level | 108 (16.1) |
Patient drug counseling | 84 (77.8) |
Spoken to family /care giver | 24 (22.2) |
I3: intervention at drug level | 262 (39.1) |
Drug stopped | 80 (30.5) |
New drug started | 80 (30.5) |
Dosage changed | 40 (15.3) |
Drug changed | 33 (12.6) |
Instruction for use changed | 17 (6.5) |
Formulation changed | 12 (4.6) |
I4: other intervention or activity | 0 |
Intervention acceptance domain (N = 300) | |
A1: intervention accepted at prescriber level | 275 (91.7) |
Intervention accepted and fully implemented | 249 (90.5) |
Intervention accepted but not implemented | 23 (8.4) |
Intervention accepted, implementation unknown | 0 |
Intervention accepted and partially implemented | 3 (0.1) |
A2: intervention not accepted | 25 (8.3) |
Intervention not accepted; no agreement | 24 (96) |
Intervention not accepted not feasible | 1 (4) |
A3: other (no intervention on acceptance) | 0 |
Problem status domain (N = 380) | |
O0: problem status unknown | 5 (1.3) |
O1: problem totally solved | 250 (65.8) |
O2: problem partially solved | 20 (5.3) |
O3: problem not solved | 105 (27.6) |
Lack of coordination of prescriber | 56 (53.3) |
No possibility to solve problem | 47 (44.8) |
Lack of coordination of patient | 2 (1.9) |
Determinants of drug related problems
Univariable logistic regression analysis | Multivariate logistic regression analysis | |||||
---|---|---|---|---|---|---|
Determinants | Yes, n (%) | No, n (%) | P value | COR (95% C.I) | P value | AOR (95% C.I) |
Sex | ||||||
Male | 108 (66.3) | 27 (73 s) | Reference | Reference | ||
Female | 55 (33.7) | 10 (27) | 0.43 | 1.37 (0.62–3.04) | 0.33 | 1.6 (0.62–4.12) |
Marital status | ||||||
Married | 128 (78.5) | 30 (81.1) | Reference | Reference | ||
Divorced | 4 (2.5) | 2 (5.4) | 0.39 | 0.47 (0.08–2.68) | 0.72 | 1.2 (0.4–3.9) |
Widowed | 31 (19) | 5 (13.5) | 0.48 | 1.45 (0.52–4.04) | 0.12 | 5.7 (0.6–52) |
Educational level | ||||||
Educated | 56 (34.4) | 12 (32.4) | Reference | Reference | ||
No formal education | 107 (65.6) | 25 (67.6) | 0.82 | 1.09 (0.51–2.33) | 0.42 | 1.2 (0.4–3.2) |
Reliance on care giver | ||||||
No | 39 (23.9) | 11 (29.7) | Reference | Reference | ||
Yes | 124 (76.1) | 26 (70.3) | 0.463 | 1.35 (0.61–2.96) | 0.55 | 1.3 (0.5–3.5) |
Economic status | ||||||
≥ 800 Birr | 61 (37.4) | 12 (32.4) | Reference | Reference | ||
< 800 Birr | 102 (62.6) | 25 (67.6) | 0.57 | 0.80 (0.38–1.71) | 0.48 | 1.4 (0.5–3.6) |
Residence | ||||||
Urban | 52 (31.9) | 11 (29.7) | Reference | Reference | ||
Rural | 111 (68.1) | 26 (70.3) | 0.79 | 0.903 (0.415–1.966) | 0.47 | 0.7 (0.3–1.8) |
Polypharmacy | ||||||
No | 97 (59.5) | 32 (86.5) | Reference | Reference | ||
Yes | 66 (40.5) | 5 (13.5) | 0.004 | 4.36 (1.61–11.75) | 0.02 | 3.35 (1.21–9.26) |
Comorbidities, mean (SD) | 2.20 (1.157) | 0.006 | 1.79 (1.18–2.71) | 0.04 | 1.588 (1.03–2.45) |