Background
Objectives
Methods
Study design and setting
Study population
Inclusion criteria
Exclusion criteria
Data collection
Definition used in the study
-
Comorbidities were defined as chronic illnesses or diseases which require long term treatment [17].
-
Cardiovascular events referred to the presence of acute coronary syndromes, ischemic heart disease, heart failure, arrhythmias, cardiomyopathy or as stated in the medical records [18].
-
Renal impairment was defined as chronic kidney disease, chronic interstitial nephritis, chronic glomerulonephritis, creatinine clearance of less than 35 mL/min, diabetic nephropathy, nephrosclerosis or as stated in the medical records [19]. The assessment of the creatinine clearance with the use of drugs was based on BNF and Lexicomp.
-
Polypharmacy was defined as the use of five or more medications [21].
-
DRP is defined as “an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes” [22].
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Significant potential drug interactions are defined as interactions that potentially can cause harm to patient and are well documented or can cause moderate harm without well documented studies [23].
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Note: The same drug used with different strengths was counted as one item whereas the same drug with different routes of administration was counted as separate items. Combinations of drugs were counted as a single item. However, this did not apply to antidiabetic and antihypertensive drugs, where the number of drugs used was counted according to the number of classes.
Classification, identification and assessment of DRPs
Modified Beers criteria
Statistical Techniques
Results
Characteristics | Number of patients (Percentage, %) |
---|---|
Sex
| |
Male | 103(51.5) |
Female | 97 (48.5) |
Age
| |
Non-elderly | 115 (57.5) |
Elderly | 85 (42.5) |
Duration of hospital stay
| |
Not more than 7 days | 143 (71.5) |
8 to 14 days | 38 (19.0) |
More than 15 days | 19 (9.5) |
Duration of type 2 diabetes mellitus
| |
Not more than 10 years | 72 (36.0) |
11 to 20 years | 47 (23.5) |
21 to 30 years | 31 (15.5) |
Unknown duration | 50 (25.0) |
Duration of hypertension
| |
Not more than 10 years | 82 (41.0) |
11 to 20 years | 43 (21.5) |
21 to 30 years | 22 (11.0) |
Unknown duration | 53 (26.5) |
A1c
| |
Achieved target (< 6.5) | 48 (24.0) |
Did not achieve target (≥ 6.5) | 146 (73.0) |
Unknown | 6 (3.0) |
Diabetic complications*
| |
Diabetic retinopathy | 43 (21.5) |
Diabetic foot ulcer | 21 (10.5) |
Diabetic neuropathy | 17 (8.5) |
Comorbidities
†
| |
Renal impairment | 100 (50.0) |
Cardiovascular disease | 96 (48.0) |
Dyslipidemia | 64 (32.0) |
Stroke | 40 (20.0) |
Gastrointestinal disease | 14 (7.0) |
Liver impairment | 11 (5.5) |
Bronchial asthma | 7 (3.5) |
Benign prostatic hyperplasia | 7 (3.5) |
Gouty arthritis | 6 (3.0) |
Osteoarthritis | 5 (2.5) |
Code | Problems* | Number of problem (Percentage, %) |
---|---|---|
P1
|
Adverse reactions
|
25 (6.5)
|
P1.1 | Side effects suffered (non-allergic) | 25 (6.5) |
P2
|
Drug choice problems
|
87 (22.5)
|
P2.1 | Inappropriate drug (not most appropriate for indication) | 34 (8.8) |
P2.2 | Inappropriate drug form (not most appropriate for indication) | 4 (1.0) |
P2.3 | Inappropriate duplication of therapeutic group or active ingredient | 4 (1.0) |
P2.4 | Contraindication for drug | 29 (7.5) |
P2.5 | No clear indication for drug use | 1 (0.3) |
P2.6 | No drug but clear indication | 15 (3.9) |
P3
|
Dosing problems
|
62 (16.0)
|
P3.1 | Drug dose too low or dosage regime not frequent enough | 5 (1.3) |
P3.2 | Drug dose too high or dosage regime too frequent | 44 (11.3) |
P3.3 | Duration of treatment too short | 8 (2.1) |
P3.4 | Duration of treatment too long | 5 (1.3) |
P4
|
Drug use problems
|
50 (12.9)
|
P4.1 | Drug not taken/administered at all | 50 (12.9) |
P5
|
Interactions
|
63 (16.3)
|
P5.1 | Potential interaction | 63 (16.3) |
P6
|
Others
|
100 (25.8)
|
P6.1 | Patient dissatisfied with therapy despite taking drug(s) correctly | 5 (1.3) |
P6.2 | Insufficient awareness of health and diseases (possibly leading to future problems) | 90 (23.2) |
P6.4 | Therapy failure (reason unknown) | 5 (1.3) |
Code | Causes* | Number of problem (Percentage, %) |
---|---|---|
C1
|
Drug/Dose selection
|
158 (47.0)
|
C1.1 | Inappropriate drug selection | 70 (20.8) |
C1.2 | Inappropriate dosage selection | 58 (17.2) |
C1.5 | Synergistic/preventive drug required and not given | 15 (4.5) |
C1.8 | Manifest side effect, no other cause | 15 (4.5) |
C2
|
Drug use process
|
36 (10.7)
|
C2.1 | Inappropriate timing of administration and/or dosing intervals | 2 (0.6) |
C2.2 | Drug underused/under-administered | 33 (9.8) |
C2.6 | Patient unable to use drug/form as directed | 1 (0.3) |
C3
|
Information
|
13 (3.9)
|
C3.1 | Instructions for use/taking not known | 1 (0.3) |
C3.2 | Patient unaware of reason for drug treatment | 6 (1.8) |
C3.4 | Patient unable to understand local language | 6 (1.8) |
C4
|
Patient/Psychological
|
124 (36.9)
|
C4.1 | Patient forgets to use/take drug | 14 (4.2) |
C4.2 | Patient has concerns with drugs | 4 (1.2) |
C4.3 | Patient suspects side-effect | 10 (3.0) |
C4.5 | Patient unwilling to bother physician | 6 (1.8) |
C4.7 | Patient unwilling to adapt life-style | 28 (8.3) |
C4.8 | Burden of therapy | 47 (14.0) |
C4.9 | Treatment not in line with health beliefs | 15 (4.4) |
C5
|
Logistic
|
5 (1.5)
|
C5.1 | Prescribed drug not available (anymore) | 3 (0.9) |
C5.2 | Prescribing error (only in case of slip of the pen) | 2.(0.6) |
Factors | Adverse reactions (n = 25) Frequency (Percentage, %) | Drug choice problem (n = 76) Frequency (Percentage, %) | Dosing problem (n = 55) Frequency (Percentage, %) | ||||||
---|---|---|---|---|---|---|---|---|---|
Yes | No |
p -value | Yes | No |
p -value | Yes | No |
p -value | |
Elderly
| |||||||||
Yes | 11 (44.0) | 74 (42.3) | > 0.999a
| 28 (36.8) | 87 (70.2) | < 0.001a* | 34 (61.8) | 81 (70.4) | 0.548a
|
No | 14 (56.0) | 101(57.7) | 48 (63.2) | 37 (29.8) | 21 (38.2) | 64 (29.6) | |||
Polypharmacy
| |||||||||
Yes | 19 (76.0) | 134 (76.6) | > 0.999a
| 60 (78.9) | 93 (75.0) | 0.640a
| 38 (69.1) | 115 (79.3) | 0.182a
|
No | 6 (26.0) | 41 (23.4) | 16 (21.1) | 31 (25.0) | 17 (30.9) | 30 (20.7) | |||
Duration of hospital stay
| |||||||||
≤ 1 week | 17 (68.0) | 126 (72.0) | 0.859a
| 45 (59.2) | 98 (79.0) | 0.004a* | 40 (72.7) | 103 (71.0) | 0.951a
|
> 1 week | 8 (32.0) | 49 (28.0) | 31 (40.8) | 26 (21.0) | 15 (27.3) | 42 (29.0) | |||
Microvascular complications
| |||||||||
Yes | 17 (68.0) | 107 (61.1) | 0.660a
| 53 (69.7) | 71 (57.3) | 0.106a
| 40 (72.7) | 84 (57.9) | 0.078a
|
No | 8 (32.0) | 68 (38.9) | 23 (30.3) | 53 (42.7) | 15 (27.3) | 61 (42.1) | |||
Cardiovascular events
| |||||||||
Yes | 12 (48.0) | 109 (62.3) | 0.193b
| 47 (61.8) | 74 (59.7) | 0.877a
| 36 (65.5) | 85 (58.6) | 0.471a
|
No | 13 (52.0) | 66 (37.7) | 29 (38.2) | 50 (40.3) | 19 (34.5) | 60 (41.4) | |||
Renal impairment
| |||||||||
Yes | 12 (48.0) | 88 (50.3) | > 0.999a
| 46 (60.5) | 54 (43.5) | 0.029a* | 35 (63.6) | 65 (44.8) | 0.027a* |
No | 13 (52.0) | 87 (49.7) | 30 (39.5) | 70 (56.5) | 20 (36.4) | 80 (55.2) | |||
Liver impairment
| |||||||||
Yes | 1 (4.0) | 10 (5.7) | > 0.999b
| 6 (7.9) | 5 (4.0) | 0.399a
| 5 (9.1) | 6 (4.1) | 0.306a
|
No | 24 (96.0) | 165 (94.3) | 70 (92.1) | 119 (96.0) | 50 (90.9) | 139 (95.9) | |||
Hyperlipidemia
| |||||||||
Yes | 7 (28.0) | 57 (32.6) | 0.819a
| 17 (22.4) | 47 (37.9) | 0.033a* | 15 (27.3) | 49 (33.8) | 0.476a
|
No | 18 (72.0) | 118 (67.4) | 59 (77.6) | 77 (62.1) | 40 (72.7) | 96 (66.2) |
Factors | Drug use problems (n = 50) Frequency (Percentage, %) | Drug interactions (n = 63) Frequency (Percentage, %) | Other problems (n = 97) Frequency (Percentage, %) | ||||||
---|---|---|---|---|---|---|---|---|---|
Yes | No |
p -value | Yes | No |
p -value | Yes | No |
p -value | |
Elderly
| |||||||||
Yes | 17 (34.0) | 68 (45.3) | 0.215a
| 37 (58.7) | 78 (56.9) | 0.933a
| 57 (58.8) | 58 (56.3) | 0.836a
|
No | 33 (66.0) | 82 (54.7) | 26 (41.3) | 59 (43.1) | 40 (41.2) | 45 (43.7) | |||
Polypharmacy
| |||||||||
Yes | 34 (68.0) | 119 (79.3) | 0.149a
| 58 (92.1) | 95 (69.3) | 0.001a* | 74 (76.3) | 79 (76.7) | > 0.999a
|
No | 16 (32.0) | 31 (20.7) | 5 (7.9) | 42 (30.7) | 23 (23.7) | 24 (23.3) | |||
Duration of hospital stay
| |||||||||
≤ 1 week | 37 (74.0) | 106 (70.7) | 0.786a
| 44 (69.8) | 99 (72.3) | 0.854a
| 65 (67.0) | 78 (75.7) | 0.227a
|
> 1 week | 13 (26.0) | 44 (29.3) | 19 (30.2) | 38 (27.7) | 32 (33.0) | 25 (24.3) | |||
Microvascular complications
| |||||||||
Yes | 31 (62.0) | 93 (62.0) | > 0.999a
| 41 (65.1) | 83 (60.6) | 0.652a
| 65 (67.0) | 59 (57.3) | 0.204a
|
No | 19 (38.0) | 57 (38.0) | 22 (34.9) | 54 (39.4) | 32 (33.0) | 44 (42.7) | |||
Cardiovascular disease
| |||||||||
Yes | 27 (54.0) | 94 (62.7) | 0.358a
| 53 (84.1) | 68 (49.6) | < 0.001a* | 63 (64.9) | 58 (56.3) | 0.270a
|
No | 23 (46.0) | 56 (37.3) | 10 (15.9) | 69 (50.4) | 34 (35.1) | 45 (43.7) | |||
Renal impairment
| |||||||||
Yes | 22 (44.0) | 78 (52.0) | 0.414a
| 33 (52.4) | 67 (48.9) | 0.761a
| 49 (50.5) | 51 (49.5) | > 0.999a
|
No | 28 (56.0) | 72 (48.0) | 30 (47.6) | 70 (51.1) | 48 (49.5) | 52 (50.5) | |||
Liver impairement
| |||||||||
Yes | 4 (8.0) | 7 (4.7) | 0.472b
| 0 (0) | 11 (8.0) | 0.018b* | 5 (5.2) | 5 (5.8) | > 0.999a
|
No | 46 (92.0) | 143 (95.3) | 63 (100) | 126 (92.0) | 92 (94.8) | 97 (94.2) | |||
Hyperlipidemia
| |||||||||
Yes | 17 (34.0) | 68 (45.3) | 37 (58.7) | 78 (56.9) | 57 (58.8) | 58 (56.3) | 0.836a
| ||
No | 33 (66.0) | 82 (54.7) | 0.215a
| 26 (41.3) | 59 (43.1) | 0.933a
| 40 (41.2) | 45 (43.7) |