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Venugopal J, S S, A R, Karnan D. Drug-related problems in cancer patients: A systematic review. J Oncol Pharm Pract 2024; 30:562-571. [PMID: 38594941 DOI: 10.1177/10781552241229662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Cancer patients are at a significantly increased risk of drug-related problems due to multiple drugs. An inclusive review of drug-related problems would offer an approach for healthcare providers to decrease the frequency of drug-related problems in cancer patients. The purpose of this study was to assess all characteristic components of drug-related problems in cancer patients, and explore actions taken to resolve the detected drug-related problems the results could be used as a baseline for epidemiology and potential related risk factors for drug-related problems in cancer patients. METHODS The present systematic review was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search consisted of studies listed from January 2015 and up to May 2023. A systematic review was carried out using an electronic database with a combination of Medical subject Headings of key words Medical Subject Heading terms. RESULTS This evaluation included 17 studies from 11 different nations having 11 prospective and 6 retrospective studies. Pharmaceutical Care Network Europe classification system is the most commonly used to classify the drug-related problems. The prevalence of drug-related problems varied from 9.6% to 92.8%. The key predictors of the drug-related problems were age, polypharmacy, multiple comorbidities, and the stage of the disease. CONCLUSION Drug-related problems are significantly more common among cancer patients. The age, polypharmacy, multiple comorbidities, and the stage of the malignancy all enhance the risk of acquiring drug-related problems. This review raises awareness of drug-related problems, encourages their early detection, and emphasizes the necessity for framing effective drug-related problem management strategies which will enhance patient care.
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Affiliation(s)
- Jayalakshmi Venugopal
- Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - Shalini S
- Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - Rajasekaran A
- KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
| | - Deepika Karnan
- Department of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, Tamil Nadu, India
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Al-Azayzih A, Kanaan RJ, Altawalbeh SM. Assessment of Drug-Related Problems and Health-Related Quality of Life Domains in Elderly Patients with Type 2 Diabetes Mellitus. Ther Clin Risk Manag 2023; 19:913-928. [PMID: 38023626 PMCID: PMC10655742 DOI: 10.2147/tcrm.s434235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Aims of the Study This study aimed to investigate the prevalence and predictors of Drug-related problems (DRPs), as well as to evaluate the impact of DRPs on the health-related quality of life in geriatric patients with type 2 diabetes mellitus. Methodology A cross-sectional study was conducted over a three-month period. Patients aged 60 years and older visited diabetes clinics from October 1, 2022, to December 31, 2022, were included in the study. Data were collected through structured questionnaires, whereas lab results, medication records, comorbidities, and the consequences of DRPs were collected from electronic medical records. DRPs were identified and classified using the PCNE V501 classification system. Health-related quality of life (HRQoL) was evaluated using the validated EuroQol criteria. Results A total of 491 patients participated in the study, and the mean age of the patients was 67.51 years (SD = 5.84 years). Female patients represented 52.34% of total subjects. A total of 461 (around 94%) experienced at least one drug-related problem (DRP), ranging from one to nine DRPs per patient, with a total number of DRPs equal to 1625 identified. The most common DRP was the drug choice problem, affecting 52.98% of patients. Factors such as high drug frequency, living conditions, the number of diabetes medications, comorbidities, and smoking were significantly associated with higher numbers of DRPs. Higher numbers of DRPs were found to significantly worsen health-related quality of life (HRQoL) among patients. Conclusion Geriatric individuals with type 2 diabetes mellitus encounter a significant prevalence of DRPs, with drug choice problems being the most common followed by dosing problems. Risk factors contributing to these DRPs include high drug frequency, living conditions, high number of diabetes medications, multimorbidity, and smoking. Also, the study concluded that the increased number of DRPs was associated with negative impact on HRQoL domains in geriatric patients with type 2 diabetes.
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Affiliation(s)
- Ahmad Al-Azayzih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Roaa J Kanaan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Bobrova V, Fialová D, Desselle S, Heinämäki J, Volmer D. Identifying Potential Drug-Related Problems Among Geriatric Patients With Use of an Integrated Clinical Decision Support Tool. Front Pharmacol 2022; 13:761787. [PMID: 35418859 PMCID: PMC8995559 DOI: 10.3389/fphar.2022.761787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Drug-related problems (DRPs) which arise from potentially inappropriate medications (PIMs) are a common problem in older people with multi-morbidity and polypharmacy. Aim: To develop an integrated PIM clinical decision support tool for identification of DRPs in geriatric multi-morbid polypharmacy patients, using the EU(7)-PIM and EURO-FORTA lists, with a focus on high-risk medications. Methods: The integrated PIM tool used the information on PIMs in both databases—the EU(7)-PIM and EURO-FORTA. PIMs were classified into four color groups based on risk profile: high-risk PIMs (should be avoided in older patients) as red, moderate-risk PIMs (require dose and/or treatment duration adjustment) as yellow, low-risk PIMs (low DRP risk) as green, and questionable PIMs (incomplete/missing information) as grey. Results: The summarized list of the high-risk (red and some grey) PIMs contained 81 active substances and medication classes. According to the ATC classification, most of the high-risk PIMs (n = 60, 74.1%) belong to the A, C, and N medication groups and 50.6% (n = 41) of the high-risk PIMs have currently marketing authorization in Estonia. The preliminary list of the moderate- and low-risk (yellow, green, and other grey) PIMs contained 240 active substances and medication classes, but sub-classification of this category into one or another group depends mainly on an individual patient´s clinical characteristics in a concrete analyzed study sample and needs further research. Conclusion: The integrated clinical decision support tool based on the EU(7)-PIM and EURO-FORTA criteria addresses the need for more efficient identification of DRPs. It can be applied to identify PIMs and geriatric prescribing problems in different health care settings, and also in a context of little clinical information available.
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Affiliation(s)
- Veera Bobrova
- Faculty of Medicine, Institute of Pharmacy, University of Tartu, Tartu, Estonia
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czechia.,Department of Geriatrics and Gerontology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Shane Desselle
- Touro University California College of Pharmacy, Vallejo, CA, United States
| | - Jyrki Heinämäki
- Faculty of Medicine, Institute of Pharmacy, University of Tartu, Tartu, Estonia
| | - Daisy Volmer
- Faculty of Medicine, Institute of Pharmacy, University of Tartu, Tartu, Estonia
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Krejčí V, Murínová I, Mohoutová J, Staňková P. Do we care enough about the medication in the elderly? (Case of the geriatric care facility at Military University Hospital Prague). Vnitr Lek 2021; 67:17-22. [PMID: 35459388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this paper is a complex evaluation of clients medication in the geriatric care facility Domov Vlčí mák (DVM) with regard to the most common drug related risk factors in elderly. The paper shows ways of identification, resolution and prevention of drug related problems from the perspective of a clinical pharmacist. METHODS The medication was evaluated in 74 DVM clients. The sample consisted of 45 women (61 %) and 29 men (39 %) with an average age of 90 years. The project took place in the period from April to June 2020. Patients pharmacotherapy was graded as low, medium or high risk in accordance with the methodology and concept of clinical pharmaceutical care in the Czech Republic developed by the Czech Professional Society of Clinical Pharmacy ČLS JEP. For all clients, medication was also assessed in terms of the risk of falls. RESULTS There was a total of 62 (84 %) high, 4 (5 %) medium and 8 (11 %) low risk clients. A plan for medication adjustments was proposed for a total of 67 clients in the form of pharmacotherapeutic recommendations. A total of 170 drug related problems was identified and pharmacotherapeutic intervention was performed. The most common problem (in 42 % of cases) was a missing drug in terms of effective therapy. Medication discontinuation was recommended in 33 % of cases, mainly due to the risk of side effects, missing indications or drug necessity. Inadequate dosing was found in 15 % of cases, usually it was recommended to reduce the dose to the so-called “senior dose”. In 6 % of cases laboratory testing was indicated and in 4 % of cases timing of the drug administration was changed. CONCLUSION Identified drug related problems did not represent major errors that could endanger the quality or safety of the healthcare provided. One of the reasons for the good outcome is an established multidisciplinary cooperation in this facility.
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Kibsdal KP, Andersen S, Gazerani P, Plet H. Rates and correlates of pharmacotherapy-related problems among psychiatric inpatients: a representative Danish study. Ther Adv Psychopharmacol 2020; 10:2045125320957120. [PMID: 32974001 PMCID: PMC7491228 DOI: 10.1177/2045125320957120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/17/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Drug related problems (DRPs) occur frequently among psychiatric patients due to common prescribing errors and complex treatment schedules. Clinical pharmacists (CPs) are thought to play an important role in preventing DRPs and, consequently, to increasing the quality of inpatient care. There is, however, limited information available on DRPs within the psychiatric field in Denmark. The aim of this study was to identify rates and correlates of pharmacotherapy-related problems among psychiatric inpatients in a Danish psychiatric hospital. METHODS A retrospective descriptive study was conducted by two CPs and data were obtained from the medical records available in two psychiatric wards. Chart-reviews were conducted for the period of June 2015 to February 2017. The analyses focussed on the prevalence of DRP categories, implementation and acceptance rates, and drugs associated with the DRPs. Extracted data were discussed with the wards' physicians and registered in a DRP-database. RESULTS In total, 607 medical records were reviewed and, on average, 2.5 DRPs per medication review were found. There was a positive correlation between the number prescribed drugs and the average number of DRPs. The most frequent categories of DRPs were 'drug dosage', 'inappropriate drug' and 'interactions'. The drugs represented most frequently in DRPs were olanzapine, quetiapine and pantoprazole. The overall acceptance rate was 49% with 33% of those implemented clinically. CONCLUSION DRPs were commonly observed among psychiatric patients, particularly in those with multiple prescriptions, in relation to drugs dosage, inappropriate prescriptions and drug interactions. Particular attention must be paid to olanzapine, quetiapine and pantoprazole. Strategies to minimise DRPs among psychiatric patients are warranted and CPs can play an important role.
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Affiliation(s)
| | | | - Parisa Gazerani
- Laboratory of Molecular Pharmacology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 5B, Aalborg E, 9220, Denmark
| | - Hanne Plet
- Research and Development, Pharmacist, Hospital Pharmacy of North Denmark Region, Porsvej 1, Aalborg, 9000, Denmark
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Al-Taani GM, Al-Azzam SI, Alzoubi KH, Aldeyab MA. Which drugs cause treatment-related problems? Analysis of 10,672 problems within the outpatient setting. Ther Clin Risk Manag 2018; 14:2273-2281. [PMID: 30532550 PMCID: PMC6247959 DOI: 10.2147/tcrm.s180747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Treatment-related problems (TRPs) may pose risks for patients if unaddressed. With the increased complexity of health care, it is important to target pharmacists' efforts to patients that are at high risk for TRPs. Objectives The present study aimed to identify medications most commonly associated with TRPs. Setting Outpatient departments of five public and teaching hospitals in Jordan. Method TRPs and drugs most commonly implicated with TRPs were assessed for patients recruited from outpatient clinics in five major hospitals in Jordan using a standardized and validated pharmaceutical care manual. Main outcome measure Drugs associated with different types of TRPs. Results Ultimately, 2,747 patients, with a total of 10,672 TRPs, were included in the study. The medication groups most commonly associated with TRPs were cardiovascular (53.0%), endocrine (18.1%), and gastrointestinal (7.7%) drugs. The most common specific drugs associated with TRPs from any category were atorvastatin (12.5%), metformin (8.5%), simvastatin (6.2%), and enalapril (5.9%). Cardiovascular medications were the most common drugs implicated with multiple subtypes of TRPs - most commonly, allergic reaction or undesirable effect (88.5%), drug product not available (87.3%), safety interaction issues (81.8%), a need for additional or more frequent monitoring (78.0%), and more effective drugs available (77.2%). Hypertension, diabetes mellitus, and dyslipidemia were the most common diseases associated with different subtypes of TRPs. Conclusion The present study identified high-risk drugs for TRPs, which can be used as identification of targeting approach TRPs. Such an approach would improve care provided to patients and can inform health care policies.
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Affiliation(s)
- Ghaith M Al-Taani
- Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan,
| | - Sayer I Al-Azzam
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mamoon A Aldeyab
- School of Pharmacy and Pharmaceutical Science, University of Ulster, Coleraine, County Londonderry, UK
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Falconer N, Barras M, Cottrell N. Systematic review of predictive risk models for adverse drug events in hospitalized patients. Br J Clin Pharmacol 2018; 84:846-864. [PMID: 29337387 PMCID: PMC5903258 DOI: 10.1111/bcp.13514] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/21/2017] [Accepted: 01/03/2018] [Indexed: 12/23/2022] Open
Abstract
AIM An emerging approach to reducing hospital adverse drug events is the use of predictive risk scores. The aim of this systematic review was to critically appraise models developed for predicting adverse drug event risk in inpatients. METHODS Embase, PubMed, CINAHL and Scopus databases were used to identify studies of predictive risk models for hospitalized adult inpatients. Studies had to have used multivariable logistic regression for model development, resulting in a score or rule with two or more variables, to predict the likelihood of inpatient adverse drug events. The Checklist for the critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) was used to critically appraise eligible studies. RESULTS Eleven studies met the inclusion criteria and were included in the review. Ten described the development of a new model, whilst one study revalidated and updated an existing score. Studies used different definitions for outcome but were synonymous with or closely related to adverse drug events. Four studies undertook external validation, five internally validated and two studies did not validate their model. No studies evaluated impact of risk scores on patient outcomes. CONCLUSION Adverse drug event risk prediction is a complex endeavour but could help to improve patient safety and hospital resource management. Studies in this review had some limitations in their methods for model development, reporting and validation. Two studies, the BADRI and Trivalle's risk scores, used better model development and validation methods and reported reasonable performance, and so could be considered for further research.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
| | - Michael Barras
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
- Princess Alexandra HospitalMetro South Health199 Ipswich Road, WoolloongabbaBrisbaneQLD4102Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of ExcellenceThe University of QueenslandBrisbaneQLD4102Australia
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Tezcan S, İzzettin FV, Sancar M, Turhal NS, Yumuk PF. Role of clinical oncology pharmacist in determination of pharmaceutical care needs in patients with colorectal cancer. Eur J Hosp Pharm 2018; 25:e17-e20. [PMID: 31157061 PMCID: PMC6457159 DOI: 10.1136/ejhpharm-2016-001188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/31/2017] [Accepted: 02/20/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine and evaluate the pharmaceutical care needs and quality of life of patients with colorectal cancer. METHODS 36 Patients with colorectal cancer eligible for chemotherapy after surgery were included in the study. The patients were followed up during 3 courses of chemotherapy and individual pharmaceutical care plans were developed. The quality of life of patients was evaluated before and after the third course of chemotherapy. RESULTS The incidence of drug-related problems (DRPs) in chemotherapy-treated patients was reduced in the 3rd course as compared with 1st course (63.9% vs 75%, respectively; n=36; p>0.05). The clinical oncology pharmacist gave 147 recommendations to patients, which were followed in 98% (n=144) of cases. 91.7% (n=132) of the recommendations of clinical oncology pharmacists solved the drug-related problems; however, the remaining 8.3% (n=12) did not solve the problems and the patients were referred to a doctor for further investigations. The symptom-related quality of life of patients related to anaemia, diarrhoea and neurotoxicity was reduced after the third course of chemotherapy (p<0.05). CONCLUSIONS The pharmaceutical care provided by the clinical oncology pharmacist has an important role in the identification and resolution of DRPs. Evaluation of symptom-related quality of life is important for the monitoring of patients receiving chemotherapy.
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Affiliation(s)
- Songül Tezcan
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Marmara, Istanbul, Turkey
| | - Fikret Vehbi İzzettin
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Marmara, Istanbul, Turkey
| | - Mesut Sancar
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Marmara, Istanbul, Turkey
| | - Nazım Serdar Turhal
- Department of Internal Medicine, Division of Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Perran Fulden Yumuk
- Department of Internal Medicine, Division of Medical Oncology, Marmara University Medical School, Istanbul, Turkey
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Mestres C, Agustí A, Hernandez M, Puerta L, Llagostera B. Pharmacist Intervention Program at Different Rent Levels of Geriatric Healthcare. Pharmacy (Basel) 2017; 5:E27. [PMID: 28970439 PMCID: PMC5597152 DOI: 10.3390/pharmacy5020027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/22/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
As a pharmacy service giving pharmaceutical care at different levels of health care for elderly people, we needed a standardization procedure for recording and evaluating pharmacists' interventions. Our objective was to homogenize pharmacist interventions; to know physicians' acceptance of our recommendations, as well as the most prevalent drug related problems (DRP); and the impact of the pharmacists' interventions. To achieve this goal we conducted a one year prospective study at two levels of health care: 176 nursing homes (EAR) (8828 patients) and 2 long-term and subacute care hospitals (HSS) (268 beds). Pharmacists' interventions were recorded using the American Society of Health-System Pharmacists classification as the basis. Frequency of the different DRP and the level of response and acceptance on the part of physicians was determined. The Medication Appropriateness Index (MAI) was used to evaluate the impact of the interventions on the prescription quality. Patients' mean age was 84.2 (EAR) and 80.7 (HSS), and in both cases, polypharmacy ≥ 9 drugs was around 63-69%. There were 4073 interventions done in EAR and 2560 in HSS. Level of response: 44% (EAR), 79% (HSS); degree of acceptance of the recommendations: 84% (EAR), 72% (HSS). Most frequent DRP: inappropriate dose, length of therapy, omissions, and financial impact. Drugs for the nervous system are those with the most DRP. MAI values/medication improved from 4.4 to 2.7 (EAR) and 3.8 to 1.7 (HSS). A normalized way of managing pharmacists' interventions for different health care levels has been established. We are on the way to increasing collaborative work with physicians and we know which DRPs are most prevalent.
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Affiliation(s)
- Conxita Mestres
- School of Health Sciences Blanquerna, University Ramon Llull, Padilla 326, 08025 Barcelona, Spain.
| | - Anna Agustí
- Pharmacy Service, HSS Mutuam Girona, Avinguda de França 64, 17007 Girona, Spain.
| | - Marta Hernandez
- Pharmacy Service, EAR Grup Mutuam, Ausias March 39, 08010 Barcelona, Spain.
| | - Laura Puerta
- Pharmacy Service, HSS Mutuam Güell, Mare de Deu de la Salut 49, 08024 Barcelona, Spain.
| | - Blanca Llagostera
- Pharmacy Service, EAR Grup Mutuam, Ausias March 39, 08010 Barcelona, Spain.
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Falconer N, Liow D, Zeng I, Parsotam N, Seddon M, Nand S. Validation of the assessment of risk tool: patient prioritisation technology for clinical pharmacist interventions. Eur J Hosp Pharm 2017; 24:320-326. [PMID: 31157796 DOI: 10.1136/ejhpharm-2016-001165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022] Open
Abstract
Background Adverse drug events (ADEs) pose a heavy burden on health systems worldwide. The assessment of risk tool (ART) was developed to help prioritise hospitalised patients for interventions such as medication reconciliation (MR) and review, and to reduce potential ADEs from unintentional medication discrepancies and prescribing errors. Aim To validate ART, and to determine which of the selected 25 flags were significantly associated with risk of unintentional medication discrepancies and prescribing errors. Method This was a prospective observational study of 247 admissions to two medical teams in a New Zealand hospital. Study pharmacists undertook MR and review for all eligible admissions over 5 months. A Kruskal-Wallis test was used to determine differences in numbers of unintentional medication discrepancies and prescribing errors, followed by generalised linear modelling, to find the estimated ratio of the mean number of unintentional medication discrepancies between the three ART groups. In part 2 of the study, using multivariable logistic regression, combinations of flags significantly associated with risk were identified. Results Significant differences in the number of unintentional medication discrepancieswere found between the ART risk groups (p<0.0001, Kruskal-Wallis test). Patients in the high-risk group had a significantly greater number of unintentional medication discrepancies than those in the medium- and low-risk groups. There were no significant differences in prescribing errors between the ART risk groups (p=0.08, Kruskal-Wallis test). Flags significantly associated with risk, included 'more than eight admission medications', OR=3.7 (95% CI 2.2 to 6.4) and 'readmission within 30 days', OR=6.8 (95% CI 3.0 to 15.2), p<0.0001. Conclusion ART was effective for prioritising patients for interventions such as MR.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy (PACE), University of Queensland, Brisbane, Queensland, Australia.,Pharmacy Service, Middlemore Hospital, Auckland, New Zealand
| | - Doreen Liow
- Pharmacy Service, Middlemore Hospital, Auckland, New Zealand.,Pharmacy Service, Mercy Ascot Hospital, Auckland, New Zealand
| | - Irene Zeng
- Ko Awatea Health Intelligence and Informatics, Middelmore Hospital, Auckland, New Zealand
| | | | - Mary Seddon
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Sanjoy Nand
- Pharmacy Service, Middlemore Hospital, Auckland, New Zealand
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Madhu S G, James E, Venu RP. Appropriateness of antibiotic usage for gastrointestinal disorders in a tertiary care hospital. Eur J Hosp Pharm 2016; 23:283-287. [PMID: 31156866 DOI: 10.1136/ejhpharm-2015-000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/08/2016] [Accepted: 01/25/2016] [Indexed: 12/29/2022] Open
Abstract
Objective To assess antibiotic usage in gastrointestinal disorders with respect to appropriateness, pattern of resistance, and incidence of adverse drug reactions (ADRs). Methodology Antibiotic prescribing in the gastroenterology department of a tertiary care hospital was evaluated using the Gyssens criteria and also by assessing drug related problems (DRPs) using the Pharmaceutical Care Network Europe V.6.2. A total of 173 patients were studied prospectively by a team of clinical pharmacists. Antibiotic susceptibility was prospectively studied; in addition, retrospective data on culture and sensitivity reports of commonly isolated organisms from 1 October 2012 to 30 September 2014 were collected to determine the resistance pattern in previous years. ADRs were evaluated using the Naranjo scale. Results Antibiotic therapy was appropriate in 60% of patients and inappropriate in the remaining patients due to incorrect decision, choice, and use. A total of 184 DRPs and 30 ADRs of antibiotics were identified. In the study patients, the most commonly isolated organism was Escherichia coli (27.3%) followed by Klebsiella pneumoniae (16.7%). Both E coli and K pneumoniae exhibited 100% resistance towards cefotaxime. There was an increase in the resistance of E coli and K pneumoniae against various antibiotics tested in 2013-2014 as compared to the previous year. An empirical antibiotic policy was developed which was endorsed by the gastroenterology department. Conclusions Although antibiotic therapy was appropriate in the majority of patients, irrational use occurred due to incorrect choice, improper dosage, and improper duration of therapy. E coli and K pneumoniae isolates showed an increase in resistance towards various antibiotics tested.
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Affiliation(s)
- Gayathri Madhu S
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita VishwaVidyapeetham University, AIMS Health Sciences Campus, Kochi, Kerala, India
| | - Emmanuel James
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita VishwaVidyapeetham University, AIMS Health Sciences Campus, Kochi, Kerala, India
| | - Rama P Venu
- Department of Gastroenterology, Amrita Institute of Medical sciences, Amrita VishwaVidyapeetham University, AIMS Health Sciences Campus, Kochi, Kerala, India
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Abdela OA, Bhagavathula AS, Getachew H, Kelifa Y. Risk factors for developing drug-related problems in patients with cardiovascular diseases attending Gondar University Hospital, Ethiopia. J Pharm Bioallied Sci 2016; 8:289-295. [PMID: 28216952 PMCID: PMC5314827 DOI: 10.4103/0975-7406.199335] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cardiovascular diseases (CVDs) are often accompanied with comoribidities and complications leading to taking multiple drugs and thus are more liable to be exposed to drug-related problems (DRPs). DRPs can occur at any stages of medication process from prescription to follow-up treatment. However, a few studies have assessed the specific risk factors for occurrence of at least one potential DRP per patient with CVDs in sub-Saharan African region. Aim: We aim to assess the risk factors for developing potential DRPs in patients with CVDs attending Gondar University Referral Hospital (GUH). Methodology: This was a cross-sectional study. A structured systematic data review was designed focusing on patients with CVDs (both out and inpatients) with age >18 years of both genders attending GUH from April to June 2015. All DRPs were assessed using drugs.com and Medscape. The causes of DRPs were classified using Pharmaceutical Care Network Europe version 6.2. Risk factors that could cause DRPs were assessed using binary logistic regression showing odds ratio with 95% confidential interval. Statistical significance was set at P < 0.05. Results: A total of 227 patients with CVDs were reviewed with a mean age of 52.0 ± 1.7 years. Majority were females (143, 63%), outpatients (133, 58.6%), and diagnosed with heart failure (71, 31.3%). Diuretics (199, 29.5%) were the most commonly prescribed drugs. A total of 265 DRPs were identified, 63.4% of patients have at least one DRP (1.17 ± 1.1). The most common DRPs were found to be an inappropriate selection of drug (36.1%) and dose (24.8%). The most identified risk factors causing DRPs were: Need of additional drug therapy and lack of therapeutic monitoring. Conclusion: The most identified risk factors for developing DRPs were the need of additional drug therapy and lack of therapeutic monitoring. There is a need for clinical pharmacist interventions to monitor and prevent the risk of developing DRPs and contribute to improve the clinical outcome in patients with CVDs.
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Affiliation(s)
- Ousman Abubeker Abdela
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Henok Getachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Kelifa
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Willeboordse F, Hugtenburg JG, Schellevis FG, Elders PJM. Patient participation in medication reviews is desirable but not evidence-based: a systematic literature review. Br J Clin Pharmacol 2015; 78:1201-16. [PMID: 24698145 DOI: 10.1111/bcp.12398] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/28/2014] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this systematic literature review is to investigate which types of patient participation in medication reviews have been practiced and what is known about the effects of patient participation within the medication review process. METHODS A systematic literature review was performed in multiple databases using an extensive selection and quality assessment procedure. RESULTS In total, 37 articles were included and most were assessed with a weak or moderate quality. In all studies patient participation in medication reviews was limited to the level of information giving by the patient to the professional, mainly on actual drug use. Nine studies showed limited results of effects of patient participation on the identification of drug related problems. CONCLUSIONS The effects of patient participation are not frequently studied and poorly described in current literature. Nevertheless, involving patients can improve patients' knowledge, satisfaction and the identification of drug related problems. Patient involvement is now limited to information sharing. The profit of higher levels of patient communication and shared decision making is until now, not supported by evidence of its effectiveness.
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Affiliation(s)
- Floor Willeboordse
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; NIVEL, (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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14
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Hohl CM, Wickham ME, Sobolev B, Perry JJ, Sivilotti MLA, Garrison S, Lang E, Brasher P, Doyle-Waters MM, Brar B, Rowe BH, Lexchin J, Holland R. The effect of early in-hospital medication review on health outcomes: a systematic review. Br J Clin Pharmacol 2015; 80:51-61. [PMID: 25581134 DOI: 10.1111/bcp.12585] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/20/2014] [Accepted: 01/04/2015] [Indexed: 11/28/2022] Open
Abstract
AIMS Adverse drug events are an important cause of emergency department visits, unplanned admissions and prolonged hospital stays. Our objective was to synthesize the evidence on the effect of early in-hospital pharmacist-led medication review on patient-oriented outcomes based on observed data. METHODS We systematically searched eight bibliographic reference databases, electronic grey literature, medical journals, conference proceedings, trial registries and bibliographies of relevant papers. We included studies that employed random or quasi-random methods to allocate subjects to pharmacist-led medication review or control. Medication review had to include, at a minimum, obtaining a best possible medication history and reviewing medications for appropriateness and adverse drug events. The intervention had to be initiated within 24 h of emergency department presentation or 72 h of admission. We extracted data in duplicate and pooled outcomes from clinically homogeneous studies of the same design using random effects meta-analysis. RESULTS We retrieved 4549 titles of which seven were included, reporting the outcomes of 3292 patients. We pooled data from studies of the same design, and found no significant differences in length of hospital admission (weighted mean difference [WMD] -0.04 days, 95% confidence interval [CI] -1.63, 1.55), mortality (odds ratio [OR] 1.09, 95% CI 0.69, 1.72), readmissions (OR 1.15, 95% CI 0.81, 1.63) or emergency department revisits at 3 months (OR 0.60, 95% CI 0.27, 1.32). Two large studies reporting reductions in readmissions could not be included in our pooled estimates due to differences in study design. CONCLUSIONS Wide confidence intervals suggest that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient-oriented outcomes. This systematic review failed to identify an effect of pharmacist-led medication review on health outcomes.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Maeve E Wickham
- Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Boris Sobolev
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.,School of Population and Public Health, The University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z9
| | - Jeff J Perry
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Ave., E-Main Room EM-206, Box 227, Ottawa, Ontario, K1Y 4E9.,Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON, K1Y 4E9
| | - Marco L A Sivilotti
- Departments of Emergency Medicine, and of Biomedical & Molecular Sciences, Queen's University, c/o 76 Stuart Street, Kingston, ON, K7L 2 V7
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, 8215-112 Street NW, Room 1706 College Plaza, Edmonton, Alberta
| | - Eddy Lang
- Department of Emergency Medicine, Faculty of Medicine, University of Calgary, Rockyview General Hospital, HCAC building, 7007 14th St. SW, Calgary, AB, T2V 1P9
| | - Penny Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.,Department of Statistics, The University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Baljeet Brar
- Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, 1G1.42 Walter Mackenzie Building, Edmonton, AB, T6G 2B7
| | - Joel Lexchin
- School of Health Policy and Management, York University, 4700 Keele St., Toronto, ON, M3J 1P3.,Emergency Department, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4
| | - Richard Holland
- Public Health Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
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Fiß T, Thyrian JR, Wucherer D, Aßmann G, Kilimann I, Teipel SJ, Hoffmann W. Medication management for people with dementia in primary care: description of implementation in the DelpHi study. BMC Geriatr 2013; 13:121. [PMID: 24225205 PMCID: PMC3840668 DOI: 10.1186/1471-2318-13-121] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 11/01/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As the population ages, the relative and absolute number of age-associated diseases such as dementia will increase. Evaluation of the suitability and intake of medication and pharmacological treatment is an important aspect of care for people with dementia, especially if they live at home. Regular medication reviews and systematic cooperation between physicians and pharmacists are not common in routine care. Medication management (MM), based on such a comprehensive home medication review could help to reduce drug-related problems and costs. The present article presents a medication management specifically for the application in the ambulatory setting and describes its implementation as part of a larger trial. METHODS/DESIGN A home medication review (HMR) and MM is implemented as part of the DelpHi study, a population based prospective, cluster-randomized controlled intervention study to test the efficacy and efficiency of the implementation of a collaborative care model in primary care. PARTICIPANTS people with dementia (PWD) and their caregivers are recruited by the patient's general practitioner. Inclusion criteria are a positive screening result for dementia, living at home and regular intake of drugs. PWD are asked to specify their regular pharmacy which is asked to participate in the study, too. INTERVENTION a comprehensive HMR is conducted as computer-assisted personal interview by specifically qualified Dementia Care Manager (DCM) at the people's home. It includes detailed information about drugs taken, their storage, administration, adherence and adverse events. The MM is conducted in cooperation between DCM, pharmacist and general practitioner and consists of a pharmaceutical evaluation, pharmaceutical recommendations and their application. Pharmacists are trained and provided with regularly updated information. The MM is designed to give information and recommendations concerning antidementia drugs, occurrence of drug related problems, intake of anticholinergic drugs, potentially clinically relevant drug-drug-interactions, adverse drug events and medication adherence. DISCUSSION The DelpHi-approach for medication management employs comprehensive instruments and procedures in the primary care setting under routine care conditions, and this approach should be useful in improving pharmacotherapy as part of the comprehensive treatment and care for people with dementia. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, number NCT01401582.
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Affiliation(s)
- Thomas Fiß
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Ellernholzstr 1-2, 17489 Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Grit Aßmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, University Hospital Rostock, Gehlsheimer Straße 28, 18147 Rostock, Germany
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, University Hospital Rostock, Gehlsheimer Straße 28, 18147 Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Ellernholzstr 1-2, 17489 Greifswald, Germany
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16
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Rama M, Viswanathan G, Acharya LD, Attur RP, Reddy PN, Raghavan SV. Assessment of Drug-Drug Interactions among Renal Failure Patients of Nephrology Ward in a South Indian Tertiary Care Hospital. Indian J Pharm Sci 2012. [PMID: 23204624 PMCID: PMC3507347 DOI: 10.4103/0250-474x.102545] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polypharmacy is common in drug prescriptions of chronic kidney disease patients. A study of the prescription patterns of drugs with potential interactions would be of interest to prevent drug related adverse events. A prospective observational study of six months (Dec 2009-May 2010) was carried out among the chronic kidney disease patients admitted to the nephrology ward of a South Indian tertiary care hospital. The pattern and rates of drug-drug interactions seen in the prescriptions of these patients was studied. Among the 205 prescriptions included, a total of 474 interactions were reported, making 2.7 interactions per prescription with incidence rates of 76.09%. Around 19.62% of interactions were of major severity. Most common interactions were found between ascorbic acid and cyanocobalamine (12.45%), clonidine and metoprolol (3.80%) respectively. Hypo or hypertension (31.65%), decreased drug efficacy (29.11%) and hypo or hyperglycemia (14.14%), were the most commonly reported clinical outcomes of the drug interactions. Cardiovascular drugs (calcium channel blockers and beta blockers; 52%) constitute the major class of drugs involved in interactions. As most of the interactions had a delayed onset, long term follow-up is essential to predict the clinically significant outcomes of these interactions. Hence, drug interactions are commonly seen in the prescriptions of chronic kidney disease patients which can lead to serious adverse events if not detected early. Need for collaboration with a clinical pharmacist and electronic surveillance, which are absent in developing countries like India, is emphatic.
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Affiliation(s)
- Mylapuram Rama
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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