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AlAzmi A, Ahmed O, Alhamdan H, AlGarni H, Elzain RM, AlThubaiti RS, Aseeri M, Al Shaikh A. Epidemiology of Preventable Drug-Related Problems (DRPs) Among Hospitalized Children at KAMC-Jeddah: a Single-Institution Observation Study. DRUG HEALTHCARE AND PATIENT SAFETY 2019; 11:95-103. [PMID: 31819660 PMCID: PMC6886556 DOI: 10.2147/dhps.s220081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022]
Abstract
Aim Drug-related problems (DRPs) "are the unwanted effects of drugs that potentially lead to a harmful outcome" thereby requiring considerable attention. Hospitalized pediatric patients, in particular, represent a population at risk of DRPs. The epidemiology of preventable DRPs among children in Saudi Arabia remains scarce, which thus poses distinct challenges to all healthcare professionals. We aim to characterize preventable DRPs among hospitalized children at KAMC-Jeddah. Methods A prospective observational study of children (≤15 years) admitted to pediatric units (excluding cancer units) at KAMC-Jeddah over a 3-month period (May 29 to August 30, 2016) is carried out to determine the incidence of preventable DRPs and investigate the possible associated factors (gender, age, admission location, type of admission, and number of medications). Results A total of 319 DRPs were identified among 235 patients, of which 280 DRPs (87.8%, 280/319) were deemed preventable. The majority of preventable DRPs were related to dose selection (78%, 219/280). None of the preventable DRPs were life threatening or fatal, and the majority were assessed as moderate in severity (94.3%, 264/280). There was no significant difference between DRP incidences with age mean 3.5 (P=0.389), gender mean (P=0.436), and weight mean 13.47 (P=0.323). Younger children (age ≤2years) admitted to PICU were more likely to have DRP (OR 4.44, 95% CI, 1.87 to 10.52, P=0.00001). Scheduled admissions were 2.89 times more likely to be exposed to DRP compared to transferred admissions (OR 2.8, 95% CI, 1.83 to 4.70, P=0.005). Additionally, DRP incidences increased proportionally to the number of medications. Conclusion Our data suggest that establishing appropriate prevention strategies towards improvement and safety in medicine use among this vulnerable patient population is a high priority.
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Affiliation(s)
- Aeshah AlAzmi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Pharmaceutical Care Services Department, Clinical Pharmacy Section, Jeddah, Saudi Arabia.,Princes Noorah Oncology Center (PNOC), Pediatric Oncology/Hematology/BMT Section, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Omaima Ahmed
- Princes Noorah Oncology Center (PNOC), Pediatric Oncology/Hematology/BMT Section, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Hani Alhamdan
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Pharmaceutical Care Services Department, Clinical Pharmacy Section, Jeddah, Saudi Arabia
| | - Hanan AlGarni
- Ibn Sina National College for Medical Studies, Pharmacy College, Jeddah, Saudi Arabia
| | - Rawan Mohammed Elzain
- Ibn Sina National College for Medical Studies, Pharmacy College, Jeddah, Saudi Arabia
| | - Rihad S AlThubaiti
- Ibn Sina National College for Medical Studies, Pharmacy College, Jeddah, Saudi Arabia
| | - Mohammed Aseeri
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Pharmaceutical Care Services Department, Clinical Pharmacy Section, Jeddah, Saudi Arabia
| | - Adnan Al Shaikh
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), King Saud bin Abdulaziz University for Health Sciences, Department of Pediatrics, Chemistry Laboratory, Community Medicine, Jeddah, Saudi Arabia
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Ayalew MB, Tegegn HG, Abdela OA. Drug Related Hospital Admissions; A Systematic Review of the Recent Literatures. Bull Emerg Trauma 2019; 7:339-346. [PMID: 31857995 PMCID: PMC6911719 DOI: 10.29252/beat-070401] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective: To derive findings from different studies done on drug related hospital admissions and comprehensively express the incidence and preventability of drug related hospital admissions; identify the common types of drug related problems that caused hospital admission, and identify factors associated with drug related hospital admission. Methods: Literatures that assessed hospitalization due to drug related problems were searched online using Pub Med and Google Scholar databases. The relevant reference lists of retrieved articles were also searched manually on Google. Prospective and retrospective studies conducted anywhere in the world on drug related hospitalization, published from January 2012 to January 2017 as an original article and written in English language were included. Result: The prevalence of drug related hospital admission varies from 1.3% to 41.3% with the average rate of 15.4%. Among hospitalized patients 2.7% were died due to drug-related problems (DRPs). Drugs that were frequently reported as causing drug related admission were antithrombotic drugs, antihypertensive drugs, analgesics, anti-diabetics, antipsychotics, and anti-neoplastic drugs. Poly pharmacy, old age and female sex were mentioned as determinants for drug related hospitalization by a number of studies. About one third of drug related hospital admissions were definitely preventable and more than 40% were also potentially preventable. Conclusion: Drug related problems contribute for more than 15% of hospital admissions. Higher risk of admission due to DRPs was observed in patients who were on poly pharmacy and those who were old. As most of drug related hospital admissions were preventable an emphasis should be given for preventive strategies to avoid complications and costs associated with admission.
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Affiliation(s)
- Mohammed Biset Ayalew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| | - Ousman Abubeker Abdela
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
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Cristofoletti R, Rowland M, Lesko LJ, Blume H, Rostami-Hodjegan A, Dressman JB. Past, Present, and Future of Bioequivalence: Improving Assessment and Extrapolation of Therapeutic Equivalence for Oral Drug Products. J Pharm Sci 2018; 107:2519-2530. [DOI: 10.1016/j.xphs.2018.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/03/2018] [Accepted: 06/12/2018] [Indexed: 12/28/2022]
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Role of Medicines of Unknown Identity in Adverse Drug Reaction-Related Hospitalizations in Developing Countries: Evidence from a Cross-Sectional Study in a Teaching Hospital in the Lao People's Democratic Republic. Drug Saf 2018; 40:809-821. [PMID: 28528487 PMCID: PMC5569138 DOI: 10.1007/s40264-017-0544-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction The health dangers of medicines of unknown identity (MUIs) [loose pharmaceutical units repackaged in individual bags without labelling of their identity] have been suspected in L/MICs. Using visual and analytical tools to identify MUIs, we investigated the frequency of, and factors associated with, adverse drug reaction (ADR)-related hospitalizations in a central hospital in Vientiane Capital, Lao People’s Democratic Republic (PDR). Methods All unplanned admissions, except for acute trauma and intentional overdose, were prospectively recorded during a 7-week period in 2013, leading to include 453 adults hospitalized for ≥24 h. The patients or their relatives were interviewed to complete the study questionnaire. MUIs suspected of being involved in ADR(s) were identified through comparison of visual characteristics of tablets/capsules with that of reference medicines (photograph tool), and by proton nuclear magnetic resonance and mass spectrometry analyses. Factors associated with ADRs were identified by multivariate logistic regression. Results The frequency of hospitalizations related to an ADR was 5.1% (23/453, 95% confidence interval [CI] 3.1–7.1). Forty-eight (12.8%) patients used MUI(s) in the last 2 weeks preceding hospitalization. They were more likely to be hospitalized because of an ADR (adjusted odds ratio 4.5, 95% CI 1.7–11.5) than patients using medicines of known identity. MUIs were mainly involved in bleeding gastroduodenal ulcers. The photograph tool led to the misidentifications because of look-alike pharmaceutical units in the medicines photograph collection. Conclusion According to the results of this study, there is a need to ensure appropriate labelling of medicines at dispensing and to provide well-suited tools to identify MUIs in clinical settings to improve drug safety and patients’ care in developing countries with limited capacities for drug analysis. Electronic supplementary material The online version of this article (doi:10.1007/s40264-017-0544-z) contains supplementary material, which is available to authorized users.
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Panahi Y, Ghanei M, Maghsoudi H, Saffar Soflaei S, Sahebkar A. Investigation of the efficacy of generic and brand-name salmeterol/fluticasone combination in the management of asthma: a randomized comparative trial. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:186-192. [PMID: 29957750 PMCID: PMC6179023 DOI: 10.23750/abm.v89i2.5411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Asthma is the most chronic inflammatory disease of the airways worldwide. Combination therapy with inhaled fluticasone and salmeterol is a common practice for the long-term management of asthma. Seretide® and Fluticort plus® are two available generic and brand name products of salmeterol/fluticasone. This study aimed to compare the efficacy and safety of these two drugs. MATERIALS AND METHODS In this randomized comparative, clinical trial, 80 asthmatic patients were allocated to Fluticort plus® (n=40) or Seretide® (n=40) for a period of 4 weeks. Patients with mild asthma were instructed to inhale one puff each 12 hours and those with moderate asthma two puffs every 12 hours. Respiratory volumes (assessed using spirometry), quality of life (assessed using St. George's Respiratory Questionnaire [SGRQ]) and control of asthmatic symptoms (assessed using asthma control test [ACT]) were evaluated at baseline and at the end of the study. RESULTS ACT score improved only in the Fluticort plus® group (p=0.012) while it was not significantly changed in the Seretide® group (p=0.178). In both treatment groups, FEV1, FEV1/FVC, and total as well as subscale SGRQ scores were significantly improved by the end of the study (p<0.05). Seretide® more efficiently improved respiratory volumes and SGRQ score in comparison with Fluticort plus® (p<0.05). CONCLUSION Our comparative trial indicated that generic fluticasone/salmeterol product could improve respiratory volumes, quality of life but its efficacy is lower than the brand-name product. However, Fluticort plus® improved asthma control more efficiently compared with Seretide®.
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Affiliation(s)
- Yunes Panahi
- Pharmacotherapy Department, School of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | | | - Sara Saffar Soflaei
- Department of Modern Sciences and Technologies, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Angamo MT, Chalmers L, Curtain CM, Yilma D, Bereznicki L. Mortality from adverse drug reaction-related hospitalizations in south-west Ethiopia: A cross-sectional study. J Clin Pharm Ther 2018; 43:790-798. [PMID: 29722039 DOI: 10.1111/jcpt.12702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/28/2018] [Indexed: 01/19/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Adverse drug reactions (ADRs) are an important cause of mortality during medical care. To our knowledge, no Ethiopian studies have reported on mortality due to ADRs in patients presenting to hospital from the community setting. The aim of this study was to determine the mortality rate attributable to ADRs in patients presenting to hospital, identify drugs implicated in the ADR-related deaths and identify factors contributing to ADR-related mortality at Jimma University Specialised Hospital (JUSH), south-west Ethiopia METHODS: This cross-sectional study included 1001 patients aged ≥18 years consecutively admitted to medical wards from May 2015 to August 2016. ADR-related mortality was determined through detailed review of medical records, laboratory tests and patient interviews followed by causality assessment by the Naranjo algorithm and expert consensus. RESULTS Of 1001 patients, 15, 1.5% (95% confidence interval [CI]: 0.80%-2.30%) died with an ADR. The primary suspected causes of death were drug-induced hepatotoxicity (7, 43.8%) followed by acute kidney injury (4, 25.0%). Isoniazid (6, 33.3%), pyrazinamide (3, 16.7%), efavirenz (2, 11.1%) and tenofovir (2, 11.1%) were commonly implicated drugs. The majority of ADRs (14, 93.8%) were preventable. Unadjusted bivariate comparisons suggested patients who died with ADRs were more likely to have pre-existing liver disease (40.0% vs 7.0%; 95% confidence interval [CI]: 8.1%-57.8%), a history of ADRs (40% vs 1.4%; 95% CI: 13.8%-63.4%), a lower mean (±SD) body mass index (BMI, 17.6 ± 2.1 vs 20.0 ± 2.9 kg/m2 ; 95% CI = 0.9-3.9), exposure to antitubercular (46.7% vs 18.9%; 95% CI: 2.3%-53.1%) and antiretroviral (40.0% vs 7.7%; 95% CI: 7.5%-57.2%) therapies, and a higher mean number of medications (7.1 ± 3.3 vs 3.8 ± 2.1; 95% CI: 2.2-4.4) and Charlson Comorbidity Index (3.9 ± 2.9 vs 1.6 ± 1.8; 95% CI: 1.4-3.2) than surviving patients without ADRs. WHAT IS NEW AND CONCLUSION Fatal ADRs were common in patients presenting to hospital. The drugs implicated were mostly antitubercular and antiretroviral therapies, reflecting the high burden of HIV and tuberculosis in the study population. ADR-related deaths were significantly associated with poor nutritional status. The majority of ADR-related deaths were preventable, highlighting the need to develop a multidisciplinary approach to closely monitor patients who are prescribed antitubercular and antiretroviral therapies, particularly in patients with hepatic disease, a history of ADRs, who are malnourished and who are exposed to multiple medications.
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Affiliation(s)
- M T Angamo
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - L Chalmers
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - C M Curtain
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - D Yilma
- Faculty of Medical Sciences, School of Medicine, Jimma University, Jimma, Ethiopia
| | - L Bereznicki
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Amiri P, Rahimi B, Khalkhali HR. Determinant of successful implementation of Computerized Provider Order Entry (CPOE) system from physicians' perspective: Feasibility study prior to implementation. Electron Physician 2018; 10:6201-6207. [PMID: 29588820 PMCID: PMC5853994 DOI: 10.19082/6201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background Health information technology is a solution for medical error reduction through the implementation of Computerized Provider Order Entry (CPOE). Objective The aim of this study was to determine physicians’ attitudes toward the implementation of CPOE. Methods This cross-sectional study was started in March 2017 and completed in June 2017. The study used a questionnaire to collect data from physicians in hospitals affiliated to Urmia University of Medical Sciences. We invited 200 physicians who were not using a CPOE system. Questionnaires were randomly distributed among physicians. In order to understand the physicians’ attitude about implementation the CPOE system, we used the Diffusion of Innovation Theory, developed by E.M. Rogers. Data were analyzed by SPSS version 16.0, using descriptive statistics and one-way ANOVA. A p value <0.05 was considered to be statistically significant. Results Most of the physicians were women (n=54, 60%) and the average age of the physicians was 36.39±8.42 years. About three-quarters of the physicians (76.66%) reported that they found the CPOE system adapted to their specific professional practice. The relative advantage of the CPOE system was estimated to be 42.22% for physicians and the complexity of that was 13.33%. There was no significant relationship between Compatibility, Relative advantages and Complexity with physicians’ experience in HIS use and physicians’ degree of education (p>0.05). Conclusion Since the role of CPOE systems is very important in hospitals in order to reduce medication errors and to improve the quality of care, our results can be used to assist the planning and introduction of CPOE systems.
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Affiliation(s)
- Parasto Amiri
- M.Sc. Student of Medical Informatics, Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Bahlol Rahimi
- Ph.D. of Medical Informatics, Associate Professor, Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Reza Khalkhali
- Ph.D. of Biostatistics, Associate Professor, Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.,Ph.D. of Biostatistics, Associate Professor, Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
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Ferrández O, Grau S, Urbina O, Mojal S, Riu M, Salas E. Validation of a score to identify inpatients at risk of a drug-related problem during a 4-year period. Saudi Pharm J 2018; 26:703-708. [PMID: 29991914 PMCID: PMC6035315 DOI: 10.1016/j.jsps.2018.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/05/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Drug-related problems (DRP) produce high morbidity and mortality. It is therefore essential to identify patients at higher risk of these events. This study aimed to validate a DRP risk score in a large number of inpatients. Material and methods Validation of a previously designed score to identify inpatients at risk of experiencing at least one DRP in a tertiary university hospital from 2010 to 2013. DRP were detected by a pharmacy warning system integrated in the electronic medical record. The score included the following variables associated with a higher risk of DRP: prescription of a higher number of drugs, greater comorbidity, advanced age, specific ATC groups and certain major diagnostic categories. Results The study included a total of 52,987 admissions; of these, at least one DRP occurred in 14.9%. After validation of the score (period range, 2010–2013: 0.746–0.764), the area under the curve (AUC) was 0.751 (95% CI: 0.745–0.756). Conclusions This value is higher than those reported in other studies describing validation of risk scores. The score showed good capacity to identify those patients at higher risk of DRP in a much larger sample of inpatients than previously described in the literature. This tool allows optimization of drug therapy monitoring in admitted patients.
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Affiliation(s)
- O. Ferrández
- Services of Hospital Pharmacy, Hospital Universitari del Mar, Spain
- Corresponding author at: Hospital Pharmacy Service, Hospital Universitari del Mar, Passeig Marítim 25–29, E-08003 Barcelona, Spain.
| | - S. Grau
- Services of Hospital Pharmacy, Hospital Universitari del Mar, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O. Urbina
- Services of Hospital Pharmacy, Hospital Universitari del Mar, Spain
| | - S. Mojal
- Department of Statistics, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Spain
| | - M. Riu
- Direcció de control de gestió, Parc de Salut Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Spain
| | - E. Salas
- Services of Hospital Pharmacy, Hospital Universitari del Mar, Spain
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Drug-Related Harms in Hospitalized Medicare Beneficiaries: Results From the Healthcare Cost and Utilization Project, 2000-2008. J Patient Saf 2017; 12:89-107. [PMID: 24879615 DOI: 10.1097/pts.0000000000000106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We examined drug harms in Medicare beneficiaries using the 2000-2008 data from the Nationwide Inpatient Sample Healthcare Cost and Utilization Project. RESEARCH DESIGN This is a cross-sectional study to examine the national estimates of potentially preventable drug-related hospitalizations and in-hospital adverse drug events identified with the International Classification of Diseases codes excluding intentional harms. RESULTS Hospitalizations related to drug poisoning constituted 0.8% of all Medicare hospitalizations. Annual hospital charges increased from $1.6 billion in 2000 to $4 billion in 2008. In-hospital adverse drug events were noted in 5.3% of all Medicare hospitalizations and increased by 90% from 2000 to 2008. Patients with extreme versus minor loss of function (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.93-2.99) and with extreme versus minor likelihood of dying (OR, 2.30; 95% CI, 2.29-2.33) had increased odds of in-hospital adverse drug events after adjustment for age, sex, and race. The Medicare beneficiaries with more than 5 versus fewer than 5 listed diagnoses had greater odds of in-hospital adverse drug events (OR, 3.79; 95% CI, 3.76-3.82). Each additional diagnosis at discharge was associated with a 13% increase in odds of in-hospital death in the Medicare beneficiaries hospitalized with drug-related diagnoses and with 12% increase in odds of in-hospital death in the Medicare beneficiaries with in-hospital adverse events. CONCLUSIONS Potentially preventable drug harms are a growing clinical and financial burden. Comparative outpatient drug safety should be analyzed using Medicare claim databases. In-hospital management of drug safety should target patients with multimorbidity and functional decline.
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Panahi Y, Ghanei M, Behzadi M, Salehi M, Soflaei SS, Sahebkar A. Investigation of the efficacy of generic and brand-name tiotropium bromide in the management of chronic obstructive pulmonary disease: A randomized comparative trial. Saudi Pharm J 2016; 24:147-52. [PMID: 27013907 PMCID: PMC4792902 DOI: 10.1016/j.jsps.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/01/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction: The beneficial effects of tiotropium bromide, a long acting anticholinergic bronchodilator, in the management of chronic obstructive pulmonary disease have been shown in previous studies. The present study aimed to compare the efficacy and safety of generic (Tiova®) and brand-name (Spiriva®) tiotropium preparations in patients with COPD. Methods and materials: In this randomized double-blind parallel-group trial, 79 patients with documented COPD were assigned to Tiova® or Spiriva® for a period of 4 weeks. Assessment of pulmonary function (using spirometry), quality-of-life (using St. George respiratory Questionnaire [SGRQ]) and severity of respiratory symptoms (using breathlessness, cough and sputum scale [BCSS]) was performed at baseline and at the end of treatment period. Results: There were significant increases in FEV1 and reductions in FVC by the end of study in both Tiova® and Spiriva® groups. FEV1/FVC ratio did not change significantly neither in the Tiova® nor in Spiriva® group. Overall SGRQ score as well as subscale scores of symptoms, activity and impacts were improved by both drugs. In the BCSS scale, the frequency and severity of three main symptoms (dyspnea, cough and sputum) was decreased by both drugs. Baseline as well as post-treatment values of spirometric parameters, SGRQ and BCSS scores was comparable between the groups, apart from a lower post-treatment frequency of cough and sputum in the Spiriva® versus Tiova® group. There was no report of adverse events in either of the study groups. Conclusion: The findings of this comparative trial showed equivalent efficacy and safety of Spiriva® and Tiova® in lessening the symptoms as well as improving the quality of life in patients with COPD. This finding has an important translational value given the significantly lower costs of generic versus brand-name products.
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Affiliation(s)
- Yunes Panahi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Corresponding authors at: Biotechnology Research Center, Department of Medical Biochemistry, Mashhad, Iran, P.O. Box 91779-48564, Iran. Tel.: +98 5118002288; fax: +98 5118002287 (A. Sahebkar). Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Molla-Sadra Street, Tehran, P.O. Box 19945-581, Iran. (M. Ghanei).
| | - Mohammad Behzadi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Salehi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sara Saffar Soflaei
- Neurogenic Inflammation Research Center, Department of Modern Sciences and Technologies, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Cardiometabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Corresponding authors at: Biotechnology Research Center, Department of Medical Biochemistry, Mashhad, Iran, P.O. Box 91779-48564, Iran. Tel.: +98 5118002288; fax: +98 5118002287 (A. Sahebkar). Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Molla-Sadra Street, Tehran, P.O. Box 19945-581, Iran. (M. Ghanei).
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Keshavarz A, Zeinaloo AA, Mahram M, Mohammadi N, Sadeghpour O, Maleki MR. Efficacy of Traditional Medicine Product Henna and Hydrocortisone on Diaper Dermatitis in Infants. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24809. [PMID: 27478628 PMCID: PMC4948373 DOI: 10.5812/ircmj.24809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 11/20/2014] [Accepted: 12/15/2014] [Indexed: 12/17/2022]
Abstract
Background Diaper dermatitis (DD) is a common inflammatory disorder in infants, including newborns. Objectives This study aimed to compare the effects of a traditional medicine product (containing natural henna oil 25%) and hydrocortisone 1% cream on DD in infants. Patients and Methods In a triple-blind, randomized trial, 82 children aged two years or less were randomly divided into two groups of 41 children each to receive either hydrocortisone ointment or henna medicinal product. Infants were treated 3 times a day for 5 days. The severity of dermatitis was assessed on the first, third, and fifth days using a six-point scale. The study was conducted in 2013 in a children teaching hospital in Qazvin, Iran. Results Both groups showed an improvement in the severity of DD (mean DD severity on the first, third and fifth days, respectively, was 3.20, 1.39, and 1.20 in the henna group versus 3.20, 2.05, and 1.90 in the hydrocortisone group; P < 0.001). The henna group showed a better response when compared with the hydrocortisone group: the rate of improvement on the fifth day of treatment was 90.2% (37 of 41 children without erythema) in the former versus 61% (25 of 41 patients) in the latter (P = 0.042). No significant side effects were observed in both the groups. Conclusions Henna, a traditional medicine product, can be considered an effective and appropriate treatment for DD in infants and children.
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Affiliation(s)
- Abdollah Keshavarz
- Traditional Medicine Department, Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Ali Akbar Zeinaloo
- Children’s Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Manoochehr Mahram
- Pediatrics Department, Qazvin Children’s Hospital, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, IR Iran
- Corresponding Author: Manoochehr Mahram, Pediatrics Department, Qazvin Children’s Hospital, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, IR Iran. Tel: +98-9121056925, Fax: +98-2833357089, E-mail: ,
| | - Navid Mohammadi
- Preventive Medicine Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Omid Sadeghpour
- Herbal Medicine Department, Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Maleki
- Pediatrics Department, Qazvin Children’s Hospital, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, IR Iran
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Panahi Y, Pishgoo B, Dadjou Y, Mehdirad M, Soflaei SS, Sahebkar A. Efficacy and Safety of Dorocontin(®) versus Sustac(®) in the Treatment of Stable Angina Pectoris: A Randomized, Double-Blind Comparative Trial. Sci Pharm 2015; 82:815-24. [PMID: 26171326 PMCID: PMC4475798 DOI: 10.3797/scipharm.1406-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
Abstract
Background: Development of generic drugs has numerous benefits in terms of cost-efficiency and availability. Slow-release nitroglycerin is a vasodilator drug commonly prescribed for patients with angina pectoris. Objective: The objective of this study was to compare the efficacy and safety of generic slow-release nitroglycerin (Dorocontin®) with that of the innovator brand (Sustac®) in patients with stable angina pectoris. Methods: In this randomized, double-blind comparative trial, 110 patients were allocated to Dorocontin® (n=67) or Sustac® (n=43) at a dose of 6.4 mg TID, for a total period of two months. Maximum endurable MET (metabolic equivalent of task), MPI (myocardial perfusion imaging), along with changes in the ECG and biomarkers of renal (serum creatinine, BUN) and hepatic (AST, ALT, and ALP) function, lipid profile (total cholesterol, LDL-C, HDL-C, VLDL-C, and triglycerides), electrolytes (Na+ and K+), CBC-diff (RBC, WBC, Plt, Hb, Hct, MCV, MCH, MCHC, and RDW), and FBS were assessed at the baseline and at the end of the trial. The frequency of adverse events during the course of the trial was also recorded. Results: Apart from a significantly greater reduction in maximum ST depression in the Sustac® versus the Dorocontin® group (p=0.03), none of the functional (MET, MPI, and ECG) and paraclinical (renal function, hepatic function, lipid profile, electrolytes, and FBS) parameters significantly differed between the study groups. The mean Hb (p=0.035), Hct (p=0.045), and MCH (p=0.032) were decreased by the end of the trial in the Sustac®, but not in the Dorocontin® group, whilst there was no change in other CBC-diff parameters. Reported adverse events were not serious and included headache, vertigo, gastrointestinal upset, and orthostatic hypotension. The frequency of these adverse events was comparable between the study groups. Conclusion: The findings of the present trial showed comparable efficacy and safety of the generic and innovator products of slow-release nitroglycerin in the management of stable angina pectoris.
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Affiliation(s)
- Yunes Panahi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bahram Pishgoo
- Cardiovascular Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. ; Department of Cardiology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Yahya Dadjou
- Cardiovascular Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. ; Department of Cardiology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Manouchehr Mehdirad
- Cardiovascular Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. ; Department of Cardiology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sara Saffar Soflaei
- Neurogenic Inflammation Research Center, Department of Modern Sciences and Technologies, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. ; Cardiometabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
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13
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Mouton JP, Mehta U, Parrish AG, Wilson DPK, Stewart A, Njuguna CW, Kramer N, Maartens G, Blockman M, Cohen K. Mortality from adverse drug reactions in adult medical inpatients at four hospitals in South Africa: a cross-sectional survey. Br J Clin Pharmacol 2015; 80:818-26. [PMID: 25475751 DOI: 10.1111/bcp.12567] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022] Open
Abstract
AIMS Fatal adverse drug reactions (ADRs) are important causes of death, but data from resource-limited settings are scarce. We determined the proportion of deaths in South African medical inpatients attributable to ADRs, and their preventability, stratified by human immunodeficiency virus (HIV) status. METHODS We reviewed the folders of all patients who died over a 30 day period in the medical wards of four hospitals. We identified ADR-related deaths (deaths where an ADR was 'possible', 'probable' or 'certain' using WHO-UMC criteria and where the ADR contributed to death). We determined preventability according to previously published criteria. RESULTS ADRs contributed to the death of 2.9% of medical admissions and 56 of 357 deaths (16%) were ADR-related. Tenofovir, rifampicin and co-trimoxazole were the most commonly implicated drugs. 43% of ADRs were considered preventable. The following factors were independently associated with ADR-related death: HIV-infected patients on antiretroviral therapy (adjusted odds ratio (aOR) 4.4, 95% confidence interval (CI) 1.6, 12), exposure to more than seven drugs (aOR 2.5, 95% CI 1.3, 4.8) and increasing comorbidity score (aOR 1.3, 95% CI 1.1, 1.7). CONCLUSIONS In our setting, where HIV and tuberculosis are highly prevalent, fatal in-hospital ADRs were more common than reported in high income settings. Most deaths were attributed to drugs used in managing HIV and tuberculosis. A large proportion of the ADRs were preventable, highlighting the need to strengthen systems for health care worker training and support.
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Affiliation(s)
- Johannes P Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Ushma Mehta
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town.,Independent Pharmacovigilance Consultant, Cape Town
| | - Andy G Parrish
- Department of Medicine, Cecilia Makiwane Hospital and Walter Sisulu University, East London
| | - Douglas P K Wilson
- Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa
| | - Annemie Stewart
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Christine W Njuguna
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Nicole Kramer
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
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14
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Development of an Aggregated System for Classifying Causes of Drug-Related Problems. Ann Pharmacother 2015; 49:405-18. [DOI: 10.1177/1060028014568008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: More than 20 different types of classification systems for drug-related problems (DRPs) and their causes have been developed. Classification is necessary to describe and assess clinical, organizational, and economic impacts of DRPs through documentation of collected data. However, many researchers have judged classification systems incomplete when describing their data, and have modified them or developed their own. This variability between systems has made study comparisons difficult. Objectives: To perform a category-by-category comparison of the content of selected DRP classification systems to construct an aggregated cause-of-DRP classification system containing the content of all systems. Method: DRP classification systems were identified after a literature review, with 7 chosen based on their use in varied health care settings, geographical diversity, frequency of use, and method of development. These systems were critically analyzed, and the content of each category was compared and aggregated where appropriate. A hierarchy of categories was constructed to include all content from all systems. Any modifications that previous studies may have made to the 7 systems were also cross-referenced to ensure that no concepts were missing from the newly aggregated system. Clinical examples to optimize application, and instructions for when or when not to use categories, were developed. Interrater agreement for classification of the causes of DRPs from 10 medication reviews was performed between 3 clinical pharmacists and the authors’ gold standard. Results: We found variation in developmental methods, category descriptions, number and types of categories, and validation methods between the 7 selected systems, together with intermingling of categories identified as causes of DRPs with DRPs themselves. A hierarchical classification system was constructed consisting of 9 cause-of-DRP categories, 33 subcategories, and 58 sub-subcategories, for which interrater agreements were 82.5%, 74.6%, and 58.8%, respectively. Conclusion: An aggregated classification system was constructed through a unique and transparent developmental process that may provide the most comprehensive description of causes of DRPs to date. This may facilitate teaching of pharmaceutical care, comparisons of clinical practice, and measurement of the effectiveness of pharmaceutical care interventions.
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Hakkarainen KM, Gyllensten H, Jönsson AK, Andersson Sundell K, Petzold M, Hägg S. Prevalence, nature and potential preventability of adverse drug events - a population-based medical record study of 4970 adults. Br J Clin Pharmacol 2014; 78:170-83. [PMID: 24372506 PMCID: PMC4168391 DOI: 10.1111/bcp.12314] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/14/2013] [Indexed: 11/30/2022] Open
Abstract
AIMS To estimate the 3 month prevalence of adverse drug events (ADEs), categories of ADEs and preventable ADEs, and the preventability of ADEs among adults in Sweden. Further, to identify drug classes and organ systems associated with ADEs and estimate their seriousness. METHODS A random sample of 5025 adults in a Swedish county council in 2008 was drawn from the Total Population Register. All their medical records in 29 inpatient care departments in three hospitals, 110 specialized outpatient clinics and 51 primary care units were reviewed retrospectively in a stepwise manner, and complemented with register data on dispensed drugs. ADEs, including adverse drug reactions (ADRs), sub-therapeutic effects of drug therapy (STEs), drug dependence and abuse, drug intoxications from overdose, and morbidities due to drug-related untreated indication, were detected during a 3 month study period, and assessed for preventability. RESULTS Among 4970 included individuals, the prevalence of ADEs was 12.0% (95% confidence interval (CI) 11.1, 12.9%), and preventable ADEs 5.6% (95% CI 5.0, 6.2%). ADRs (6.9%; 95% CI 6.2, 7.6%) and STEs (6.4%; 95% CI 5.8, 7.1%) were more prevalent than the other ADEs. Of the ADEs, 38.8% (95% CI 35.8-41.9%) was preventable, varying by ADE category and seriousness. ADEs were frequently associated with nervous system and cardiovascular drugs, but the associated drugs and affected organs varied by ADE category. CONCLUSIONS The considerable burden of ADEs and preventable ADEs from commonly used drugs across care settings warrants large-scale efforts to redesign safer, higher quality healthcare systems. The heterogeneous nature of the ADE categories should be considered in research and clinical practice for preventing, detecting and mitigating ADEs.
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Affiliation(s)
- Katja M Hakkarainen
- Nordic School of Public Health NHV, Box 12133, 40242, Gothenburg, Sweden; Section of Social Medicine, Department of Public Health and Community Medicine, University of Gothenburg, Box 435, 40530, Gothenburg, Sweden
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Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol 2014; 70:799-815. [DOI: 10.1007/s00228-014-1686-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
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17
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Rashidian A, Jahanmehr N, Jabbour S, Zaidi S, Soleymani F, Bigdeli M. Bibliographic review of research publications on access to and use of medicines in low-income and middle-income countries in the Eastern Mediterranean Region: identifying the research gaps. BMJ Open 2013; 3:e003332. [PMID: 24091422 PMCID: PMC3796279 DOI: 10.1136/bmjopen-2013-003332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We assessed the situation of academic publications on access to and use of medicines (ATM) in low-income and middle-income countries (LMICs) of the Eastern Mediterranean Region (EMR). We aimed to inform priority setting for research on ATM in the region. DESIGN Bibliographic review of published studies. SETTING LMICs in EMR. INCLUSION CRITERIA Publications on ATM issues originating from or focusing on EMR LMICs covering the period 2000-2011. Publications involving multinational studies were included if at least one eligible country had been included in the study. INFORMATION SOURCES AND DATA EXTRACTION We conducted comprehensive searches of the PubMed, Social Science Citation Index and Science Citation Index. We used the WHO ATM framework for data extraction and synthesis. We analysed the data according to the ATM issues, health system levels, year of publication and the countries of origin or focus of the studies. RESULTS 151 articles met the inclusion criteria. Most articles (77%) originated from LMICs in EMR, suggesting that the majority of evidence on ATM in the region is home-grown. Over 60% of articles were from Iran, Pakistan, Jordan and Lebanon (in order of volume), while we found no studies assessing ATM in Somalia, Djibouti and South Sudan, all low-income countries. Most studies focused on the rational use of medicines, while affordability and financing received limited attention. There was a steady growth over time in the number of ATM publications in the region (r=0.87). CONCLUSIONS There is a growing trend, over the years, of more studies from the region appearing in international journals. There is a need for further research on the financing and affordability aspects of ATM in the region. Cross-border issues and the roles of non-health sectors in access to medicines in the region have not been explored widely.
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Affiliation(s)
- Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Jahanmehr
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Samer Jabbour
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Fatemeh Soleymani
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bigdeli
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Hakkarainen KM, Andersson Sundell K, Petzold M, Hägg S. Prevalence and perceived preventability of self-reported adverse drug events--a population-based survey of 7099 adults. PLoS One 2013; 8:e73166. [PMID: 24023828 PMCID: PMC3762841 DOI: 10.1371/journal.pone.0073166] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/17/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose Adverse drug events (ADEs) are common and often preventable among inpatients, but self-reported ADEs have not been investigated in a representative sample of the general public. The objectives of this study were to estimate the 1-month prevalence of self-reported ADEs among the adult general public, and the perceived preventability of 2 ADE categories: adverse drug reactions (ADRs) and sub-therapeutic effects (STEs). Methods In this cross-sectional study, a postal survey was sent in October 2010 to a random sample of 13 931 Swedish residents aged ≥18 years. Self-reported ADEs experienced during the past month included ADRs, STEs, drug dependence, drug intoxications and morbidity due to drug-related untreated indication. ADEs could be associated with prescription, non-prescription or herbal drugs. The respondents estimated whether ADRs and STEs could have been prevented. ADE prevalences in age groups (18–44, 45–64, or ≥65 years) were compared. Results Of 7099 respondents (response rate 51.0%), ADEs were reported by 19.4% (95% confidence interval, 18.5–20.3%), and the prevalence did not differ by age group (p>0.05). The prevalences of self-reported ADRs, STEs, and morbidities due to drug-related untreated indications were 7.8% (7.2–8.4%), 7.6% (7.0–8.2%) and 8.1% (7.5–8.7%), respectively. The prevalence of self-reported drug dependence was 2.2% (1.9–2.6%), and drug intoxications 0.2% (0.1–0.3%). The respondents considered 19.2% (14.8–23.6%) of ADRs and STEs preventable. Although reported drugs varied between ADE categories, most ADEs were attributable to commonly dispensed drugs. Drugs reported for all and preventable events were similar. Conclusions One-fifth of the adult general public across age groups reported ADEs during the past month, indicating a need for prevention strategies beyond hospitalised patients. For this, the underlying causes of ADEs should increasingly be investigated. The high burden of ADEs and preventable ADEs from widely used drugs across care settings supports redesigning a safer healthcare system to adequately tackle the problem.
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Affiliation(s)
| | - Karolina Andersson Sundell
- Nordic School of Public Health NHV, Gothenburg, Sweden
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- Nordic School of Public Health NHV, Gothenburg, Sweden
- Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Hägg
- Nordic School of Public Health NHV, Gothenburg, Sweden
- Division of Clinical Pharmacology, Linköping University, Linköping, Sweden
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Ahern F, Sahm LJ, Lynch D, McCarthy S. Determining the frequency and preventability of adverse drug reaction-related admissions to an Irish University Hospital: a cross-sectional study. Emerg Med J 2013; 31:24-9. [DOI: 10.1136/emermed-2012-201945] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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20
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Rashed AN, Neubert A, Tomlin S, Jackman J, Alhamdan H, AlShaikh A, Attar A, Aseeri M, Wilton L, Wong ICK. Epidemiology and potential associated risk factors of drug-related problems in hospitalised children in the United Kingdom and Saudi Arabia. Eur J Clin Pharmacol 2012; 68:1657-66. [PMID: 22644343 DOI: 10.1007/s00228-012-1302-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/20/2012] [Indexed: 11/30/2022]
Abstract
AIM Drug-related problems (DRP) are "an event or circumstance involving drug therapy that actually or potentially interferes with the desired health outcome". The extent and characteristics of DRPs in children in the UK and the Kingdom of Saudi Arabia (KSA) are unknown. Our aim was to determine the epidemiology of and identify risk factors for DRPs in hospitalised children. METHODS A prospective cohort study was carried out in children aged 0-18 years, admitted to the medical ward, paediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) during a 3-month period in two hospitals. Patients' charts, medical records and laboratory data were reviewed daily to identify DRPs; their preventability and severity were assessed. Logistic regression was used to analyse the potential risk factors associated with DRP incidence. RESULTS Seven hundred and thirty-seven children (median age 2.3 years, interquartile range 6 months to 8 years, 58.1% male) were included. Three hundred and thirty-three patients suffered from 478 DRPs. Overall DRP incidence was 45.2% (95% CI, 41.5-48.8); KSA (51.1%; 95% CI, 45.8-56.3), UK (39.4%; 95% CI, 34.4-44.6). Incidence was highest in the PICU (59.7%; 95% CI, 47.0-71.5). Dosing problems were the most frequently reported DRPs (n = 258, 54%). 80.3% of DRP (n = 384) cases were preventable; 72.2% (n = 345) of DRPs were assessed as minor; 27% (n = 129) as moderate. Number of prescriptions and type of admission (transferred) were potential risk factors for DRP occurrence in children. CONCLUSIONS Drug-related problems were common in the hospitalised children in this study; the most frequent were dosing problems and drug choice problems; the majority of them were preventable. Polypharmacy and transferred admission (another hospital or ward) were potential risk factors. To improve prescribing practices and minimise the risk of DRPs in hospitalised children, paediatric pharmacology and pharmacotherapy are important in medical education.
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Affiliation(s)
- Asia N Rashed
- Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
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Hakkarainen KM, Andersson Sundell K, Petzold M, Hägg S. Methods for Assessing the Preventability of Adverse Drug Events. Drug Saf 2012; 35:105-26. [DOI: 10.2165/11596570-000000000-00000] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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22
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Carpenter CR, Shah MN, Hustey FM, Heard K, Gerson LW, Miller DK. High yield research opportunities in geriatric emergency medicine: prehospital care, delirium, adverse drug events, and falls. J Gerontol A Biol Sci Med Sci 2011; 66:775-83. [PMID: 21498881 PMCID: PMC3143344 DOI: 10.1093/gerona/glr040] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/10/2011] [Indexed: 11/13/2022] Open
Abstract
Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls.
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Affiliation(s)
| | - Manish N. Shah
- Department of Emergency Medicine, University of Rochester, New York
| | | | - Kennon Heard
- Rocky Mountain Poison and Drug Center, Denver, Colorado
- Department of Emergency Medicine, University of Colorado, Aurora
| | - Lowell W. Gerson
- Department of Emergency Medicine, Summa Health System, Akron Ohio
- Department of Behavioral and Community Health Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown
| | - Douglas K. Miller
- Center for Aging Research, Indiana University, Indianapolis
- Regenstrief Institute, Inc., Indianapolis, Indiana
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Study on drug related hospital admissions in a tertiary care hospital in South India. Saudi Pharm J 2011; 19:273-8. [PMID: 23960769 DOI: 10.1016/j.jsps.2011.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/25/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Accidental and intentional poisonings or drug overdoses constitute a significant source of aggregate morbidity, mortality, and health care expenditure. Studies evaluating drug related hospitalization have estimated that approximately 5-10% of all hospital admissions are drug related. The present study was carried out to investigate type, nature and incidence of drug related admissions in our hospital settings. METHOD A hospital based retrospective study was conducted in 575 cases of drug related admissions. The case records of patients admitted in various clinical departments of Amrita Institute of Medical Sciences (AIMS) Hospital during last 8 years (January 2002-December 2009) were collected and analyzed. RESULTS During the retrospective study, the total number of drug related cases reported were 575. Out of these, 35.5% cases were induced by central nervous system (CNS) drugs, 19.8% were by cardiovascular system (CVS) drugs, 12.3% were by NSAIDs, 11.3% were by antibiotics and 9.9% were by anticoagulants, 11.3% by other drugs which includes hormones, cytotoxic drugs, hypolipidemics, etc. Four hundred and forty cases were admitted to emergency department. Common drug related problems resulting in hospital visits were due to intentional, accidental and overdose. The incidence of drug related hospital admissions was found to be 0.20%. CONCLUSION The most of the accidental and suicidal cases were reported are by CNS drugs. Psychiatric patients intentionally taking medicines as suicidal attempt and as a part of their illness. As drug related problems are so significant, increased awareness and enhanced collaborative efforts among patients, physicians, pharmacists and caregivers within community and hospital have the potential to minimize the impact of this problem.
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Singh H, Kumar BN, Sinha T, Dulhani N. The incidence and nature of drug-related hospital admission: A 6-month observational study in a tertiary health care hospital. J Pharmacol Pharmacother 2011; 2:17-20. [PMID: 21701641 PMCID: PMC3117563 DOI: 10.4103/0976-500x.77095] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess and evaluate the frequency, severity and classification of drug-related problems (DRP) resulting in hospitalization in an internal medicine department of a large tertiary care hospital and to identify any patient, prescriber, drug, and system factors associated with these events. MATERIALS AND METHODS A prospective and descriptive study carried out in Department of Medicine, Government Medical College, Jagdalpur. The DRP and relevant data were recorded on the personal record of every individual patient, filled during the course of treatment. RESULT A total of 3560 patient's records were analyzed. Among them118 admissions were due to DRP. The most common DRP noted was noncompliance in part of patient's i.e 55 (46.6%). Statistically significant correlations were found in the number of prescribed drugs and over the counter drugs (OTC) used by patients. CONCLUSION The DRP that attributed to hospital admission are mostly avoidable through proper patient education and strengthening the need of pharmacovigilance with little more vigilance in patient care.
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Affiliation(s)
- Harminder Singh
- Department of Pharmacology, Govt. Medical College, Jagdalpur, Chhattisgarh, India
| | - Bithika Nel Kumar
- Department of Pharmacology, Govt. Medical College, Jagdalpur, Chhattisgarh, India
| | - Tiku Sinha
- Department of PSM, Govt. Medical College, Jagdalpur, Chhattisgarh, India
| | - Navin Dulhani
- Department of Medicine, Govt. Medical College, Jagdalpur, Chhattisgarh, India
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Leendertse AJ, Visser D, Egberts AC, van den Bemt PM. The Relationship Between Study Characteristics and the Prevalence of Medication-Related Hospitalizations. Drug Saf 2010; 33:233-44. [DOI: 10.2165/11319030-000000000-00000] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kazemi A, Fors UGH, Tofighi S, Tessma M, Ellenius J. Physician order entry or nurse order entry? Comparison of two implementation strategies for a computerized order entry system aimed at reducing dosing medication errors. J Med Internet Res 2010; 12:e5. [PMID: 20185400 PMCID: PMC2855204 DOI: 10.2196/jmir.1284] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 12/09/2009] [Accepted: 12/09/2009] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the significant effect of computerized physician order entry (CPOE) in reducing nonintercepted medication errors among neonatal inpatients, only a minority of hospitals have successfully implemented such systems. Physicians' resistance and users' frustration seem to be two of the most important barriers. One solution might be to involve nurses in the order entry process to reduce physicians' data entry workload and resistance. However, the effect of this collaborative order entry method in reducing medication errors should be compared with a strictly physician order entry method. OBJECTIVE To investigate whether a collaborative order entry method consisting of nurse order entry (NOE) followed by physician verification and countersignature is as effective as a strictly physician order entry (POE) method in reducing nonintercepted dose and frequency medication errors in the neonatal ward of an Iranian teaching hospital. METHODS A four-month prospective study was designed with two equal periods. During the first period POE was used and during the second period NOE was used. In both methods, a warning appeared when the dose or frequency of the prescribed medication was incorrect that suggested the appropriate dosage to the physicians. Physicians' responses to the warnings were recorded in a database and subsequently analyzed. Relevant paper-based and electronic medical records were reviewed to increase credibility. RESULTS Medication prescribing for 158 neonates was studied. The rate of nonintercepted medication errors during the NOE period was 40% lower than during the POE period (rate ratio 0.60; 95% confidence interval [CI] .50, .71;P < .001). During the POE period, 80% of nonintercepted errors occurred at the prescription stage, while during the NOE period, 60% of nonintercepted errors occurred in that stage. Prescription errors decreased from 10.3% during the POE period to 4.6% during the NOE period (P < .001), and the number of warnings with which physicians complied increased from 44% to 68% respectively (P < .001). Meanwhile, transcription errors showed a nonsignificant increase from the POE period to the NOE period. The median error per patient was reduced from 2 during the POE period to 0 during the NOE period (P = .005). Underdose and curtailed and prolonged interval errors were significantly reduced from the POE period to the NOE period. The rate of nonintercepted overdose errors remained constant between the two periods. However, the severity of overdose errors was lower in the NOE period (P = .02). CONCLUSIONS NOE can increase physicians' compliance with warnings and recommended dose and frequency and reduce nonintercepted medication dosing errors in the neonatal ward as effectively as POE or even better. In settings where there is major physician resistance to implementation of CPOE, and nurses are willing to participate in the order entry and are capable of doing so, NOE may be considered a beneficial alternative order entry method.
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Affiliation(s)
- Alireza Kazemi
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
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Abstract
The market of generic drugs is in continuous development in all countries, including Belgium. Their low cost explains their success in western and developed countries. However, clinical concerns have been raised when generics are used. Indeed, various studies suggest that generic substitution can be associated with reduced efficacy or (and) increased side-effects, particularly with drugs used in severe diseases or pathological states such as epilepsy, cardiac arrhythmia, prevention of graft-rejection, ... The generic drugs must have systemic bioavailability similar to that of the original drug. Thus, they have supposed similar therapeutic bioequivalence. However, similar pharmacokinetics does not imply identical therapeutic activity, particularly with drugs having narrow therapeutic indices such as anti-epileptics, anti-arrythmics ... In this case, switchability rather than prescribability may cause problems. Low pharmaceutical quality is more frequent when drugs are produced in certain countries, in some cases causing a real concern when activity and safety are considered.
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Affiliation(s)
- F R Heller
- Département de Médecine Interne, Centre Hospitalier Jolimont-Lobbes, Haine St Paul, Belgique.
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The effect of Computerized Physician Order Entry and decision support system on medication errors in the neonatal ward: experiences from an Iranian teaching hospital. J Med Syst 2009; 35:25-37. [PMID: 20703588 DOI: 10.1007/s10916-009-9338-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 06/23/2009] [Indexed: 12/13/2022]
Abstract
Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P < 0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations.
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Cousins D. Current status of the monitoring of medication practice. Am J Health Syst Pharm 2009; 66:S49-56. [DOI: 10.2146/ajhp080605] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- David Cousins
- National Patient Safety Agency, 4-8 Maple Street, London, WIT 5HD, United Kingdom
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Mastroianni PDC, Varallo FR, Barg MS, Noto AR, Galduróz JCF. Contribuição do uso de medicamentos para a admissão hospitalar. BRAZ J PHARM SCI 2009. [DOI: 10.1590/s1984-82502009000100020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As Reações Adversas a Medicamentos (RAM) podem ser responsáveis por 2,4% a 11,5% das admissões hospitalares. O estudo objetivou conhecer o perfil demográfico dos pacientes internados por possíveis RAM, identificar os medicamentos e as queixas mais freqüentemente relacionadas e estimar a incidência de admissão hospitalar pelo uso de medicamentos. Durante um mês, os pacientes internados em um hospital geral foram entrevistados quanto ao uso de medicamentos antes da internação e as queixas que o levaram ao hospital; as informações foram analisadas, usando-se a base de dados MICROMEDEX® e outras bases oficiais. Observou-se que as admissões por uso de medicamentos ocorreram predominantemente em idosos [47,5% (66/139)] e mulheres [62% (87/139)]. Os medicamentos mais freqüentes foram: omeprazol (16), analgésicos (31), antihipertensivos (31), sinvastatina (7) e formoterol (6); e normalmente os sintomas associados foram do sistema digestório (20,5%), circulatório (20,2%), respiratório (18,2%) e SNC (13,9%). Estima-se que em 15,5% (139/897) das internações, possivelmente, a razão foi o uso de medicamentos. Os dados sugerem medidas de prevenção, como o acompanhamento farmacoterapêutico dos pacientes no âmbito da assistência primária à saúde, principalmente aos idosos, aos portadores de doenças crônicas e aos polimedicados, além da orientação farmacêutica na compra e dispensação de medicamentos, principalmente os isentos de prescrição.
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Santamaría-Pablos A, Redondo-Figuero C, Baena M, Faus M, Tejido R, Acha O, Novo F. Resultados negativos asociados con medicamentos como causa de ingreso hospitalario. FARMACIA HOSPITALARIA 2009. [DOI: 10.1016/s1130-6343(09)70730-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kazemi A, Ellenius J, Tofighi S, Salehi A, Eghbalian F, Fors UG. CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital. Int J Med Inform 2008; 78:199-207. [PMID: 18760960 DOI: 10.1016/j.ijmedinf.2008.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 07/10/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. OBJECTIVES The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. METHODS Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. RESULTS The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. CONCLUSIONS The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems provide significant benefits. A pilot study in a limited setting and a comprehensive analysis of health outcomes and economic indicators should be performed, to assess the merits of introducing Computerised Physician Order Entry with decision support capabilities in Iran.
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Affiliation(s)
- Alireza Kazemi
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
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The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol 2008; 64:183-99. [PMID: 18180915 DOI: 10.1007/s00228-007-0422-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 11/16/2007] [Indexed: 12/22/2022]
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