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

Clinical pharmacists' interventions about drug therapy problems and its acceptability by prescribers among pediatric hospitalized patients with infectious diseases in resource-limited settings

BACKGROUND

Infectious disease continues to be a major cause of death among pediatrics. Drug therapy problem (DTP) is a significant public health challenge that is highly prevalent in pediatrics, and it has an impact on the effectiveness and safety of drug therapy to a greater extent than in adults. Thus, this study aimed to determine the magnitude of DTPs, types and acceptability of pharmaceutical interventions by prescribers and its associated factors among hospitalized pediatric patients with infectious diseases at pediatric wards of Public comprehensive specialized hospitals (PCSHs).

METHODS

This multicenter crosssectional study was conducted among pediatric patients with infectious disease admitted to PCSH pediatric wards from December 01, 2023, to February 30, 2024. Cipolle's and Strand's DTP classification methods were used for the identification of DTPs. Pharmaceutical interventions and their acceptance rate by prescribers were classified according to the Pharmaceutical Care Network Europe (PCNE) 2019. Data was entered and analyzed into SPSS version 27. To identify predictors of DTP occurrence, multivariable logistic regression analysis was used. A pvalue of less than 0.05 was considered statistically significant.

RESULTS

A total of 389 pediatric patients were involved in the current study, selected from an initial sample size of 405, resulting in a response rate of 96.05%. The overall prevalence of DTPs was 56.56% which occurred in 220 pediatric hospitalized patients with infectious disease. The most commonly encountered type of pharmaceutical intervention provided was adjusting the dose of medication (25.2%), followed by patient education/counseling/adherence (23.2%), and discontinuation of medications (20.54%). The acceptance level of interventions by prescribers was high (84.0%). Medication non-compliance (43.6%), unnecessary drug therapy (16.0%), and dose too high (12.0%) were common types of DTPs. Patients with the prolonged hospital stay (6-10 days) [AOR = 2.02, 95%CI: 1.33-7.80] and more than ten days in hospital [AOR = 2.89, 95%CI: 1.90-11.23]; patients with high number of medications (≥ 5) [AOR = 4.60, 95%CI: 1.89-8.82]; those who paid for their medications [AOR = 2.19, 95%CI: 1.18, 3.31], and patients with comorbidity [AOR = 3.90, 95% CI: 1.56-8.15] were the predictors of the occurrence of DTPs.

CONCLUSION

This study finding revealed that the magnitude of DTPs was high in pediatric inpatients with infectious diseases at PCSHs. The presence of comorbidity, source of medication fee, polypharmacy, and prolonged hospital stays were factors associated with the occurrence of DTPs. The acceptance rate of interventions by the prescribers was high. Clinical pharmacists' involvement in direct patient care responsibility astutely reduces drug therapy problems and hence increases patient safety.

Drug-drug interaction among elderly patients in Africa: a systematic review and meta-analysis

BACKGROUND

Elderly patients are at a heightened risk of drug-drug interactions due to their high prevalence of comorbidities, polypharmacy, and age-related physiological changes that alter drug metabolism and excretion. In Africa, these risks are compounded by unique healthcare challenges, including limited access to diagnostic tools, and high burdens of communicable diseases. The aim of this study is to estimate the prevalence of drug-drug interactions and its associated factors among elderly patients in Africa.

METHODS

Relevant research articles were identified from databases such as HINARI, Science Direct, Embase, PubMed/MEDLINE, Google Scholar, and Research Gate. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. Egger regression tests and funnel plot analysis were used to check for publication bias, and the I2 statistic was used to evaluate statistical heterogeneity. Sensitivity and subgroup analyses were also conducted to identify potential causes of heterogeneity.

RESULTS

Fifteen articles were analyzed, and a total of 5651 potential drug-drug interactions (pDDIs) were identified in 1952 patients, resulting in an average of 2.89 pDDIs per patient. The overall prevalence of pDDIs among elderly patients was 52.53% (95% confidence interval (CI): 35.40, 69.66). However, the prevalence of pDDIs ranged widely from 2.8 to 90.1%. When the severity of the interactions was considered, the prevalence of pDDIs was 20.59%, 69.4%, 34.32% and 1.59% for major, moderate, minor, and contraindicated DDIs, respectively. Polypharmacy, long hospital stays, hypertension and diabetes mellitus were identified as factors associated with pDDIs among elderly patients in Africa.

CONCLUSION

DDIs are prevalent among elderly patients in Africa and are often associated with polypharmacy, prolonged hospitalizations, and the presence of chronic comorbidities, particularly hypertension and diabetes mellitus. Moderate-severity interactions were the most prevalent DDIs. The study suggests addressing this issue requires targeted interventions, including improved pharmacovigilance, enhanced prescribing practices, and integration of DDI risk assessment into routine clinical care. The study also suggests that the database itself could have modified the DDI prevalence rate. As a result, a single DDI identification database needs to be authorized; otherwise, clinical knowledge should be taken in to account when interpreting the information obtained.

Exploration of drug therapy related problems in a general medicine ward of a tertiary care hospital of Eastern Nepal

Background

Inpatients are at higher risk of Drug Therapy Related Problems (DTRPs), and early identification and management of these DTRPs is crucial for optimal treatment outcomes and ensuring rational drug therapy.

Objective

This study aims to assess DTRPs in a general medicine ward of a tertiary care hospital in eastern Nepal.

Methods

A three-month prospective observational study was conducted on inpatients admitted to the general medicine ward of the hospital. Pharmacists routinely performed patient drug therapy reviews, by which suspected DTRPs were identified and recorded as per the Pharmaceutical Care Network Europe Association (PCNE) v.9.1 guidelines. Binary logistic regression analysis was used to determine the influence of predictor variables on the occurrence of DTRPs.

Results

A total of 301 inpatients were enrolled, out of which 233 (77.4%) had one or more DTRPs. Altogether, 528 DTRPs with an average of 2.27 ± 0.92 DTRPs per patient were identified. The primary causes of the DTRPs were drug selection (40.47%), treatment duration (16.71%), dispensing (15.75%), and dose selection (13.12%). Antimicrobials were involved in 55.18% of the DTRPs. DTRPs were more prevalent in elderly, comorbid patients, patients with longer hospital stay days, and polypharmacy, which was statistically significant (p<0.05). Furthermore, multivariate binary logistic regression analysis showed that geriatric patients had a higher risk of experiencing DTRPs, with an adjusted odds ratio of 1.832 (1.021-3.286) at p-value < 0.05.

Conclusion

DTRPs are frequently prevalent in hospital wards, emphasizing the crucial role of clinical pharmacists in identifying, resolving, and preventing DTRPs in inpatient settings for optimal treatment outcomes.

Drug-related problems among type 2 diabetic patients in Sunwal Municipality of Western Nepal

BACKGROUND

Several diseases co-exist with diabetes such as hypertension, and dyslipidemia, leading to cases of non-adherence, several drug interactions, and an increased risk of adverse drug reactions among patients, which are often termed as drug-related problems (DRPs). The role of pharmacists in high-income countries is well-defined in identifying DRPs among type 2 diabetes patients. However, these roles still need to be explored within low- and middle-income countries. The study aimed to identify DRPs in Type 2 diabetic patients.

METHODS

A community-based cross-sectional study was conducted in the Sunwal Municipality, Lumbini Province, Nepal from April to November 2021 where a stratified random sampling technique was employed to collect the data. The study included patients aged ≥ 18 years of either gender with type 2 diabetes who were prescribed at least one anti-diabetic medication. Patients were visited at their homes once identified through the community pharmacies, and a prescription review was conducted to identify the DRPs by using the Pharmaceutical Care Network Europe (PCNE) V8.02 tool and pertinent guidelines.

RESULTS

Among 182 patients, 97 (53.3%) had DRPs. Most of the patients were 50-60 years (n = 46; 25.3%), with a mean ± SD age of 55.43±14.46, as most were female (n = 94; 51.6%). Biguanides and sulfonylureas were the common classes of drugs prescribed. The major class of drug associated with DRPs were biguanides (n = 85; 49.7%), followed by sulfonylureas (n = 42; 24.6%). Metformin was the major drug associated with DRPs (n = 85; 49.4%). The major type of DRP identified was treatment effectiveness (n = 82; 79.61%), while patients not adhering to drug therapy (n = 97; 71.85%) was the leading cause of DRPs. DRPs were significantly associated with the duration of diabetes (p = .007) and the number of fruit servings (p = .007).

CONCLUSION

The majority of the patients were found to have DRPs. The visiting patients at home by the pharmacists helped in identifying the DRPs and associated factors among type 2 diabetes patients, which may aid in the prevention and management of the disease.

Prevalence of potential drug‒drug interactions and associated factors among elderly patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

The occurrence of potential drug‒drug interactions (pDDIs) is a serious global issue that affects all age groups, with the elderly population being the most vulnerable. This is due to their relatively high rates of comorbidity and polypharmacy, as well as physiological changes that can increase the potential for DDIs and the likelihood of adverse drug reactions. The aim of this study was to estimate the prevalence of pDDIs and associated factors among elderly patients in Ethiopia.

METHODS

A comprehensive literature search using the preferred reporting items for systematic review and meta-analysis statement was conducted on HINARI, Science Direct, Embase, PubMed/MEDLINE, Google Scholar, and Research Gate. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. Egger regression tests and funnel plot analysis were used to check publication bias, and the I2 statistic was used to evaluate statistical heterogeneity. Sensitivity and subgroup analyses were also conducted to identify potential causes of heterogeneity.

RESULTS

Seven articles were analyzed, and a total of 1897 pDDIs were identified in 970 patients, resulting in an average of 1.97 DDIs per patient. The number of DDIs per patient ranged from 0.18 to 5.86. The overall prevalence of pDDIs among elderly patients was 50.69% (95% CI 18.77-82.63%). However, the prevalence of pDDIs ranged widely from 2.80 to 90.1%. When the severity of the interactions was considered, the prevalence of potential DDIs was found to be 28.74%, 70.68%, and 34.20% for major, moderate, and minor pDDIs, respectively. Polypharmacy and long hospital stays were identified as factors associated with pDDIs among elderly patients in Ethiopia.

CONCLUSIONS

The overall prevalence of pDDIs among elderly patients was high, with a wide range of prevalence rates. Moderate-severity interactions were the most prevalent. Polypharmacy and long hospital stays were identified as factors associated with pDDIs among elderly patients. The study suggests that DDIs identification database itself could have modified the DDIs prevalence rate. As a result, a single DDIs identification database needs to be authorized; otherwise, clinical knowledge should be taken into account when interpreting the information obtained.

The Prevalence and Impact of Clinical Pharmacists' Intervention on Drug-Related Problems in Patients With Chronic Kidney Disease

Chronic kidney disease (CKD) is a global health issue of growing concern. According to projections from the Worldwide Health Observatory, it is currently one of the rapidly increasing contributors to global mortality. The prevalence of CKD and end-stage renal disease (ESRD) is increasing globally. The objective was to evaluate the prevalence and impact of clinical pharmacist intervention in resolving drug-related problems (DRPs) among patients with CKD. A single-arm, pre- and post-intervention study design was used, which was assessed to be suitable in testing for the feasibility of the implementation of an intervention in clinical practice. With this study pre- and post-intervention variables of interest were measured before and after an intervention in the same patients to evaluate the impact of clinical pharmacists on ambulatory patients with CKD. The findings of this study indicate a high prevalence of DRPs, with every patient experiencing at least one DRP. The mean DRP per patient was found to be 2.903 with STD ± 1.148. The study assessed the considerable influence of clinical pharmacist intervention on DRPs. The predominant form of DRP was drug interaction 167 (45.1%) which was reduced to 76 (20.5%) after intervention carried out by clinical pharmacists statistically significant (p = 0.032). Another common DRP was found to be poor compliance issues in pre-interventions (n = 144 (38.9%)) and was reduced to 80 (21.6%) at post-intervention significantly (p = 0.042). Untreated indications were noticed in 137 cases (37.0%), after pharmacist intervention, this number was significantly reduced to 27 cases (7.3%), with a statistically significant difference (p = 0.004). However, it is noteworthy that medication compliance among patients in our study was unsatisfactory and fell below expectations. As a clinical pharmacist played an important role in reducing the prevalence of poor medication adherence to lower levels in these CKD outpatients. This research emphasizes the vital role of clinical pharmacists in mitigating DRPs among CKD patients, resulting in improved medication management and potentially better health outcomes.

Potentially inappropriate medication prescribing based on 2019 Beers criteria and the impact of pharmacist intervention in elderly patients with kidney diseases: A report from Iran

Background and Aims

A potentially inappropriate medication (PIM) is a pharmaceutical agent that poses a greater risk of harm than potential benefit to elderly patients. This study aimed to detect PIMs and their risk factors in hospitalized elderly patients with kidney disease.

Methods

This cross-sectional study assessed medication orders of elderly patients (≥65 years old) with kidney diseases admitted to the hospital. In the first 6 months, we retrospectively evaluated all medications to identify PIMs according to the 2019 Beers criteria. In the second phase, a clinical pharmacist prospectively evaluated all medications and suggested modifications as needed. Data were analyzed to determine risk factors for prescribing PIMs.

Results

Based on our evaluation of 258 patients, we observed that the utilization of PIMs was prevalent among the study population. Of the total patients evaluated, 273 instances of PIM use were identified, with only 23.3% of patients not having any PIMs. Notably, proton pump inhibitors and benzodiazepines were the most frequently prescribed PIMs. The risk of experiencing a PIM was significantly amplified by a higher degree of polypharmacy, with odds approximately 2.68 times higher (p < 0.01). Several factors were found to be associated with an increased likelihood of having a PIM, including being male, undergoing hemodialysis, having chronic kidney disease or other comorbidities, and having an extended hospital stay. The second phase of study, in terms of addressing these issues, physicians adhered to 67.5% of the 120 recommendations made by pharmacists regarding the discontinuation of PIM usage.

Conclusion

High prevalence of PIMs was detected in our study population. Preventing medication-associated harms in the elderly can reduce the financial burden imposed on healthcare systems. Therefore, routine evaluation of medications with clinical pharmacists and/or implementation of computerized medication decision support systems is recommended to prevent PIMs use.

Prevalence of polypharmacy among older adults in Ethiopia: a systematic review and meta-analysis

Polypharmacy is a significant concern for older adults. Taking multiple medicines to prevent and treat comorbidities is very common in older adults, potentially leading to polypharmacy. Polypharmacy is associated with the development of geriatric syndromes, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. The prevalence of polypharmacy varies according to the literature. There is a paucity of data regarding the prevalence of polypharmacy among older adults. Therefore, this study aimed to estimate the pooled prevalence of polypharmacy among older adults in Ethiopia. A comprehensive search of databases, including PubMed, MEDLINE, EMBASE, Hinari, Cumulative Index to Nursing and Allied Health Literature, International Scientific Indexing, Cochrane library and Web of Science, and Google Scholar, was conducted. STATA statistical software (version 17) was used to analyze the data. Forest plot and I2 heterogeneity test were computed to examine the existence of heterogeneity. Subgroup analysis and sensitivity analysis were done to explore the source of heterogeneity. Publication bias was evaluated by using funnel plots and Egger's test. A random effect model was used to determine the pooled prevalence of polypharmacy. After reviewing 123 studies, 13 studies with a total of 3547 older adults fulfilled the inclusion criteria and were included in this meta-analysis. The result from 13 studies revealed that the pooled prevalence of polypharmacy among older adults in Ethiopia was 37.10% (95CI: 28.28-45.91). A Subgroup Meta-analysis showed that the heterogeneity level was slightly lower among studies done in Oromia region (I2 = 46.62, P-value = 0.154). Higher pooled polypharmacy prevalence was found among older adults with cardiovascular disorders (42.7%) and admitted patients (51.4%). In general, it was found that the pooled prevalence of polypharmacy among older adults in Ethiopia was high. More than one in three older adults take five or more medications at a time. Thus, intervention focusing on rational geriatric pharmacotherapy is significant to prevent unnecessary pill burden, adverse drug events, medical costs, geriatric morbidity, and mortality. Furthermore, enhancing pharmacist roles towards medication therapy management and safety monitoring in older adults is also indicated.

Pharmacists' contribution to benzodiazepine deprescribing in older outpatients: a systematic review and meta-analysis

BACKGROUND

Consolidated and reliable evidence regarding the effectiveness of pharmacist interventions for deprescribing benzodiazepines in older outpatients is lacking.

AIM

This study evaluated and summarized the impact of pharmacist interventions on benzodiazepine deprescribing among older outpatients.

METHOD

A literature search was conducted until August 2022 in PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials databases. The review included randomized controlled trials that assessed the impact of pharmacist interventions on deprescribing benzodiazepine in older outpatients. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment. Meta-analyses were conducted using random-effect models in the RStudio software.

RESULTS

A total of 893 records were identified. Five studies, including 3,879 patients, met the inclusion criteria and were included in the systematic review. All five studies used health education as an intervention strategy, and three also conducted medication reviews. There was no evidence of the pharmacist's authority to modify prescriptions during benzodiazepine deprescribing. One study was classified as having a low risk of bias, whereas the other had some concerns or a high risk of bias. Three studies were included in the meta-analysis and a significant impact of pharmacist interventions on benzodiazepines deprescribing rates in older outpatients was observed (RR = 2.75 [95%CI 1.29; 5.89]; p = 0.04; I2 = 69%; low certainty of evidence).

CONCLUSION

Pharmacists may contribute to deprescribing benzodiazepines in older outpatients. Further studies are needed to increase the reliability of these findings. PROSPERO registration number: CRD42022358563.

Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS®) Programs

Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients (established as "surgical pharmacy" by Guangdong Province Pharmaceutical Association (GDPA)) is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death. In order to reduce DRPs further, and promote the rapid recovery of surgical patients, the need for pharmacists in the ERAS program is even more pressing. However, the medication therapy management services of surgical pharmacy and how surgical pharmacists should participate in ERAS programs are still unclear worldwide. Therefore, this article reviews the main perioperative medical management strategies and precautions from several aspects, including antimicrobial agents, antithrombotic agents, pain medication, nutritional therapy, blood glucose monitoring, blood pressure treatment, fluid management, treatment of nausea and vomiting, and management of postoperative delirium. Additionally, the way surgical pharmacists participate in perioperative medication management, and the relevant medication pathways are explored for optimizing medication therapy management services within the ERAS programs. This study will greatly assist surgical pharmacists' work, contributing to surgeons accepting that pharmacists have an important role in the multidisciplinary team, benefitting medical workers in treating, counseling, and advocating for their patients, and further improving the effectiveness, safety and economy of medication therapy for patients and promoting patient recovery.

Pharmaceutical intervention in the pharmacological therapy of elderly patients in San Luis-ECUADOR

Population's aging leads to a frequent usage of pharmaceutical medications to treat or control various ailments because of aging, increasing the probability of occurrence of problems related to its usage. The primary objective of this study was to conduct pharmaceutical interventions in elderly patients from San Luis - Riobamba, using surveys to identify the sociodemographic characteristics, diseases, and medicines usage. Once the problems related to pharmacological therapy were identified, pharmaceutical interventions were carried our prior the acceptance of each patient. The study had the participation of 422 elderly patients, with the prevalence of females (59.7%), aged between 60 and 70 years (45.5%); we identified that 82.5% of the elderly patients have diseases, finding that joint pain such as Arthritis/Osteoarthritis has the higher incidence (38.8%), and 50% of the surveyed people consume medication to treat the disease. 40.28% (n=170) of the participants conciliate the treatment review to identify any medication-related problem (MRP), finding interactions (21.2%) and adverse effects probability (21.2%), starting from the PRM identified, 170 pharmaceutical interventions were conducted, considering as priority (67.6%) the education on non-pharmacological measures. The pharmaceutical interventions done through the study benefited the elderly patients and will contribute to reduce the appearance of PRM.