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Shirzad-Yazdi N, Taheri S, Vazin A, Shorafa E, Abootalebi SN, Hojabri K, Javanmardi F, Shafiekhani M. Drug-related problems among pediatric intensive care units: prevalence, risk factors, and clinical pharmacists' interventions. BMC Pediatr 2024; 24:714. [PMID: 39516792 PMCID: PMC11546217 DOI: 10.1186/s12887-024-05185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Drug-related problems (DRPs) are frequently observed in intensive care units, resulting in a higher occurrence of drug side effects and increased treatment expenses. This study aimed to assess the prevalence of DRPs in pediatric patients admitted to the most prominent surgical and medical pediatric intensive care units (PICUs) in southern Iran, given the susceptibility of children to the effects of DRPs. METHOD This cross-sectional study was conducted at Namazi Hospital, which is affiliated with Shiraz University of Medical Sciences in Shiraz, Iran, from June 2022 to March 2023. The research focused on identifying and detecting drug-related problems (DRPs) among pediatric patients during their hospital stays across three medical wards, two pediatric intensive care units, and a surgical intensive care unit. The identification process occurred concurrently with patient treatment and utilized the Pharmaceutical Care Network of Europe's data collection form for DRPs version 8.01. Before any documentation, all cases were thoroughly reviewed and validated by a professional focus group. The data gathered were then statistically analyzed using SPSS to evaluate the study's outcomes. RESULT During the study, 323 pediatric patients were involved, of whom 57% experienced at least one DRP. The primary issues identified during the study were suboptimal drug treatment, accounting for 41.13% of cases, followed by concerns related to treatment safety, which constituted 38.53% of cases. Drug-drug interactions were found to be the leading cause of DRPs, accounting for 36.26% of cases. Two significant factors associated with DRP occurrence were the number of prescribed drugs and the number of prescribed anticonvulsants. Out of all clinical pharmacist interventions, 97% were accepted. CONCLUSION Patients admitted to the PICUs experience a high occurrence of DRPs. It is essential to consider optimal dosage adjustment, particularly for pediatric patients with impaired kidney function.
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Affiliation(s)
- Nasrin Shirzad-Yazdi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajjad Taheri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsaneh Vazin
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Eslam Shorafa
- Department of Pediatrics, Division of Intensive Care Unit, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Narjes Abootalebi
- Department of Pediatrics, Division of Intensive Care Unit, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Biostatics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Katayoon Hojabri
- Department of Pediatrics, Division of Intensive Care Unit, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Javanmardi
- Biotechnology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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Gebremariam SN, Sema FD, Jara AG, Mekonnen GA. Medication-Related Hospital Admission Among Patients Admitted to the Emergency Ward at the University of Gondar, North West Ethiopia: A Cross Sectional Study. Drug Healthc Patient Saf 2024; 16:75-88. [PMID: 39050408 PMCID: PMC11268659 DOI: 10.2147/dhps.s455990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
Background Medication-related hospital admission (MRHA) is hospitalization due to drug-related problems. MRHAs have been reported to be on the rise in recent decades. Objective This study was aimed at determining the prevalence, patterns, and predictors of MRHA among patients visiting the emergency ward of the University of Gondar comprehensive specialized hospital, Ethiopia. Methods A cross-sectional study was conducted from June 1, 2022, to August 30, 2022 G.C. in the emergency ward at the University of Gondar Comprehensive Specialized Hospital. The AT-HARM 10 tool was used to collect data from participants who fulfilled the inclusion criteria. Data was entered into EpiData Manager 4.6.0.0 and was exported to Statistical Package for Social Sciences (SPSS) version 24 for analysis. Descriptive statistics were presented using frequency and percentage. Binary logistic regression was applied to identify factors associated with MRHAs with a 95% confidence level, and significance was declared at a p-value <0.05. Results The prevalence of MRHAs was 30.5% (95% CI = 27.7-36.4%). More than half (64.52%) of MRHAs were definitely preventable. The majority of MRHAs (48.39%) were severe. Non-compliance (41.12%), followed by untreated indication (26.61%) and adverse drug reaction (12.09%) were the most frequent causes of MRHAs. Renal impairment (AOR = 2.703, 95% CI: 1.29 to 5.663), chronic disease (AOR = 10.95, 95% CI: 4.691 to 25.559), history of traditional medication use (AOR = 2.089, 95% CI: 1.162 to 3.755), and history of hospitalization (AOR = 4.001, 95% CI: 1.98 to 8.089) were significantly associated with MRHAs. Conclusion MRHAs were substantially prevalent. Most of the MRHAs were definitely preventable. Renal impairment, chronic disease, history of traditional medication use, and history of hospitalization were predictors of MRHAs. At the university hospital, health care providers should strive to prevent and manage MRHAs appropriately.
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Affiliation(s)
- Saron Naji Gebremariam
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Faisel Dula Sema
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdisa Gemedi Jara
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizework Alemnew Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mulder MB, Doga B, Borgsteede SD, van den Burg AM, Metselaar HJ, den Hoed CM, Hunfeld NGM. Evaluation of medication-related problems in liver transplant recipients with and without an outpatient medication consultation by a clinical pharmacist: a cohort study. Int J Clin Pharm 2022; 44:1114-1122. [PMID: 36100818 PMCID: PMC9618499 DOI: 10.1007/s11096-022-01423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Background Transplant recipients undergo significant changes in their medication regimen during follow-up and are at an increased risk for medication-related problems (MRPs). Aim This study aimed to compare the prevalence and types of MRPs and interventions in liver transplant recipients with and without an outpatient medication consultation by a clinical pharmacist as well as the satisfaction with information about medicines and medication adherence. Method We performed a single-center, observational cohort study. A retro- and prospective cohort were used and subdivided in a group that did and did not receive a medication consultation. The prevalence and types of MRPs and interventions were identified and categorized. The satisfaction parameters were evaluated using validated questionnaires. Results Included were 291 patients. In total, 368 MRPs were identified in 197 patients in the non-medication consultation cohort (median 1; range 1–3 per patient) and 248 MRPs in 94 patients in the medication consultation cohort (median 2; range 1–4 per patient). In the medication consultation cohort, significantly fewer MRPs as unnecessary drugs (17.3% versus 58.7%, p < 0.001), suboptimal therapy (2.4% versus 9.5%, p < 0.001), untreated indication (2.8% versus 6.8%, p = 0.040) and underdosed drugs (0.4% versus 6.3%, p < 0.001) were identified. In the non-medication consultation cohort significantly more patients used unnecessary drugs (72.1% versus 39.4%, p < 0.001) compared to the medication consultation cohort. Patients in both cohorts are satisfied with the information about medicines and reported a high medication adherence. Conclusion Patients in the medication consultation cohort had significantly fewer MRPs and used significantly less unnecessary drugs. Including a clinical pharmacist to the post-transplant care has an added value. Supplementary information The online version contains supplementary material available at 10.1007/s11096-022-01423-6.
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Affiliation(s)
- Midas B Mulder
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3015 GD, Rotterdam, The Netherlands.
| | - B Doga
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S D Borgsteede
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands
| | - A M van den Burg
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C M den Hoed
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - N G M Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Drug therapy-related problem management in Nigeria community pharmacy - process evaluation with simulated patient. BMC Health Serv Res 2022; 22:209. [PMID: 35172827 PMCID: PMC8848586 DOI: 10.1186/s12913-022-07535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unresolved drug therapy-related problems (DTRPs) have economic and clinical consequences and are common causes of patients' morbidity and mortality. This study evaluated the ability of community pharmacists to identify and resolve DTRPs and assessed the perceived barriers to DTRP identification and resolution. METHODS A cross-sectional study which employed the use of three simulated patients (SPs) visit to 36 selected community pharmacies in 11 local government areas in Ibadan, Nigeria. The SPs played the role of a patient with prescription for multiple ailments (23-year-old male), type 2 diabetes and hypertensive patient with medication packs (45-year-old male) and hypertensive patient with gastric ulcer with a prescription (37-year-old female). They re-enacted three rehearsed vignettes when they spoke with the pharmacists. A five-member panel of experts predetermined the DTRPs present in the vignettes (n = 11), actions to take to investigate the DTRPs (n = 9) and recommendations to resolve the DTRPs (n = 9). Pharmacists' perceived barriers to the identification and resolution of DTRPs were assessed with a self-administered questionnaire. The percentage ability to detect and resolve DTRPs was determined and classified as poor ability (≤30%), fair ability (> 30 - ≤50%), moderate ability (> 50 - ≤70%) and high ability (> 70%). RESULTS One hundred and eight visits were made by the three SPs to the pharmacies. In total, 4.42/11 (40.2%) DTRPs were identified, 3.50/9 (38.9%) actions were taken, and 3.94/9 (43.8%) recommendations were made to resolve the identified DTRPs. The percentage ability of the community pharmacists to detect and resolve DTRPs varied slightly from one vignette to another (vignette 1-49.3%, vignette 2-39.1%, vignette 3-38.8%). But overall, it was fair (40.9%). Pharmacists' perceived barriers to DTRP detection and resolution included lack of access to patient's/client's medical history and lack of software for DTRP detection. CONCLUSIONS The community pharmacists displayed fair ability in detecting and resolving DTRPs. Several barriers preventing the optimal performance of pharmacist in DTRP identification and resolution were identified including inaccessibility of patient's/client's medical history. The regulatory authority of pharmacy education and practice in Nigeria need to mount Continuing Education Program to address this deficit among community pharmacists.
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Abstract
PURPOSE OF REVIEW To provide a summary of complications of antimicrobials and opportunities for antimicrobial stewardship (AS) in solid organ transplant (SOT) patient care. RECENT FINDINGS Personalized, precision antimicrobial prescribing in SOT aiming to avoid negative consequences of antimicrobials is essential to improving patient outcomes. The positive impact AS efforts in transplant care has been recognized and bespoke activities tailored to special interests of transplant patients and providers are evolving. Strategies to optimize stewardship interventions targeting antibacterial, antiviral, and antifungal drug selection and dosing in the transplant population have been recently published though clinical integration using a 'handshake' stewardship model is an optimal starting point in transplant care. Other recent studies involving transplant recipients have identified opportunities to shorten duration or avoid antimicrobials for certain commonly encountered clinical syndromes. This literature, informing recent consensus clinical practice guidelines, may help support institutional practice guidelines and protocols. Proposals to track and report stewardship process and outcome measures as a routine facet of programmatic transplant quality reporting have been published. However, developing novel metrics accounting for nuances of transplant patients and programs is critical. Important studies are needed to evaluate organizational transplant prescribing cultures and optimal behavioral science-based interventions relevant to antimicrobial use in this population. SUMMARY Consequences of antimicrobial use, such as drug toxicities, and Clostridiodes difficile (CDI) and multidrug-resistant organisms colonization and infection disproportionately affect SOT recipients and are associated with poor allograft and patient outcomes. Stewardship programs encompassing transplant patients aim to personalize antimicrobial prescribing and optimize outcomes. Further studies are needed to better understand optimal intervention strategies in SOT.
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Affiliation(s)
- Jonathan M Hand
- Department of Infectious Diseases, Ochsner Health, The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana, USA
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Wallerstedt SM, Hoffmann M, Lönnbro J. Methodological issues in research on drug-related admissions: A meta-epidemiological review with focus on causality assessments. Br J Clin Pharmacol 2021; 88:541-550. [PMID: 34327734 DOI: 10.1111/bcp.15012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
AIM To investigate methodological aspects potentially related to the diverging scientific literature on the prevalence of drug-related hospitalisations, focusing on causality assessments. METHODS Original studies contributing data to a recent meta-analysis were reviewed. Methodological aspects, in particular those related to causality assessments, were extracted and compiled. RESULTS Thirteen studies provided data on the prevalence of drug-related admissions. Seven studies focused on adverse drug reactions (prevalences 1.3-10%), and six studies used the broader concept of drug-related problems (prevalences 4.5-41%). In 10 out of 13 studies, causality between the drug and the specified problem was assessed. One study required a probable causal relationship; the remaining studies merely required a possible causal relationship. Five studies assessed the association between the problem assumed to be related to drug therapy and the admission, at one end requiring the former to be demonstrated as the underlying cause and, at the other, merely requiring a temporal relationship between drug intake and admission. Three out of eight studies involving multiple assessors for all/some cases reported the inter-rater agreement, ranging from none to almost perfect. Physicians were involved in the assessments in five studies, reporting prevalences of 3.2% to 4.5%, while studies without such medical input reported prevalences of 8.8% to 41%. CONCLUSIONS This review illustrates that methodological issues contribute to the diverse literature on drug-related admissions. We provide suggestions for harmonisation of research, including explicitly assessing the drug-problem-admission relationships from a medical perspective, focusing on problems where the drug treatment is the probable culprit.
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Affiliation(s)
- Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,HTA-Centrum, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hoffmann
- The NEPI Foundation - Swedish Network for Pharmacoepidemiology, Linköping University, Linköping, Sweden
| | - Johan Lönnbro
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lönnbro J, Holmqvist L, Persson E, Thysell P, Åberg ND, Wallerstedt SM. Inter-rater reliability of assessments regarding the quality of drug treatment, and drug-related hospital admissions. Br J Clin Pharmacol 2021; 87:3825-3834. [PMID: 33609324 DOI: 10.1111/bcp.14790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS To investigate inter-rater agreement on the quality of drug treatment, and the relationship between the drug treatment and hospital admission. METHODS Three specialist physicians and two resident physicians determined, independently and in consensus, the quality of drug treatment from an overall medical perspective, and its association with admission, in 30 randomly selected patients (50% female, median age 72 years) admitted to Sahlgrenska University Hospital, Sweden, in April 2018. The inter-rater agreement was evaluated with Gwet's agreement coefficient (AC1 ). RESULTS In all, 200 (95%) out of 210 drugs at admission and 238 (97%) out of 245 drugs at discharge were assessed as reasonable drug treatment by all assessors. Conversely, none of the drugs at admission, and two at discharge, were assessed as unreasonable drug treatment by all assessors (AC1 : 0.88 and 0.94 [all], 0.86 and 0.95 [specialists], 0.92 and 0.92 [residents], respectively). The assessments regarding the association between the drug treatment and the hospital admission (not related or main/contributory reason) were consistent between the assessors for 16 out of 30 patients (AC1 : 0.67 [all], 0.74 [specialists], 0.54 [residents]). In none of the three cases where the hospital admission was considered possibly attributable to a prescribing error did the assessors make consistent assessments. CONCLUSIONS As the inter-rater agreement ranged between weak and almost perfect, the reliability of assessments of drug treatment quality, as well as adverse consequences, appears to be a methodological concern. To yield acceptably reliable results regarding both drug treatment aspects at issue, specialist physicians should be involved.
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Affiliation(s)
- Johan Lönnbro
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lina Holmqvist
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Persson
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Thysell
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - N David Åberg
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,HTA Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Darwich AS, Polasek TM, Aronson JK, Ogungbenro K, Wright DFB, Achour B, Reny JL, Daali Y, Eiermann B, Cook J, Lesko L, McLachlan AJ, Rostami-Hodjegan A. Model-Informed Precision Dosing: Background, Requirements, Validation, Implementation, and Forward Trajectory of Individualizing Drug Therapy. Annu Rev Pharmacol Toxicol 2020; 61:225-245. [PMID: 33035445 DOI: 10.1146/annurev-pharmtox-033020-113257] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Model-informed precision dosing (MIPD) has become synonymous with modern approaches for individualizing drug therapy, in which the characteristics of each patient are considered as opposed to applying a one-size-fits-all alternative. This review provides a brief account of the current knowledge, practices, and opinions on MIPD while defining an achievable vision for MIPD in clinical care based on available evidence. We begin with a historical perspective on variability in dose requirements and then discuss technical aspects of MIPD, including the need for clinical decision support tools, practical validation, and implementation of MIPD in health care. We also discuss novel ways to characterize patient variability beyond the common perceptions of genetic control. Finally, we address current debates on MIPD from the perspectives of the new drug development, health economics, and drug regulations.
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Affiliation(s)
- Adam S Darwich
- Logistics and Informatics in Health Care, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), KTH Royal Institute of Technology, SE-141 57 Huddinge, Sweden
| | - Thomas M Polasek
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia.,Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria 3052, Australia.,Certara, Princeton, New Jersey 08540, USA
| | - Jeffrey K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Kayode Ogungbenro
- Centre for Applied Pharmacokinetic Research, The University of Manchester, Manchester M13 9PT, United Kingdom;
| | | | - Brahim Achour
- Centre for Applied Pharmacokinetic Research, The University of Manchester, Manchester M13 9PT, United Kingdom;
| | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
| | - Birgit Eiermann
- Inera AB, Swedish Association of Local Authorities and Regions, SE-118 93 Stockholm, Sweden
| | - Jack Cook
- Drug Safety Research & Development, Pfizer Inc., Groton, Connecticut 06340, USA
| | - Lawrence Lesko
- Center for Pharmacometrics and Systems Pharmacology, University of Florida, Orlando, Florida 32827, USA
| | - Andrew J McLachlan
- School of Pharmacy, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Amin Rostami-Hodjegan
- Certara, Princeton, New Jersey 08540, USA.,Centre for Applied Pharmacokinetic Research, The University of Manchester, Manchester M13 9PT, United Kingdom;
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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: 68] [Impact Index Per Article: 11.3] [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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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. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2016; 8:289-295. [PMID: 28216952 PMCID: PMC5314827 DOI: 10.4103/0975-7406.199335] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/05/2016] [Accepted: 05/24/2016] [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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Kim KS, Moon A, Kang HJ, Shin HY, Choi YH, Kim HS, Kim SG. Higher plasma bilirubin predicts veno-occlusive disease in early childhood undergoing hematopoietic stem cell transplantation with cyclosporine. World J Transplant 2016; 6:403-410. [PMID: 27358786 PMCID: PMC4919745 DOI: 10.5500/wjt.v6.i2.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 02/15/2016] [Accepted: 03/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To analyze the association between plasma bilirubin levels and veno-occlusive disease (VOD) in non-adult patients undergoing hematopoietic stem cell transplantation (HSCT) during cyclosporine therapy.
METHODS: A total of 123 patients taking cyclosporine were evaluated using an electronic medical system at the Seoul National University Children’s Hospital from the years 2004 through 2011. Patients were grouped by age and analyzed for incidence and type of adverse drug reactions (ADRs) including VOD.
RESULTS: The HSCT patients were divided into three age groups: G#1 ≥ 18; 9 ≤ G#2 ≤ 17; and G#3 ≤ 8 years of age). The majority of transplant donor types were cord blood transplantations. Most prevalent ADRs represented acute graft-vs-host disease (aGVHD) and VOD. Although the incidences of aGVHD did not vary among the groups, the higher frequency ratios of VOD in G#3 suggested that an age of 8 or younger is a risk factor for developing VOD in HSCT patients. After cyclosporine therapy, the trough plasma concentrations of cyclosporine were lower in G#3 than in G#1, indicative of its increased clearance. Moreover, in G#3 only, a maximal total bilirubin level (BILmax) of ≥ 1.4 mg/dL correlated with VOD incidence after cyclosporine therapy.
CONCLUSION: HSCT patients 8 years of age or younger are more at risk for developing VOD, diagnosed as hyperbilirubinemia, tender hepatomegaly, and ascites/weight gain after cyclosporine therapy, which may be represented by a criterion of plasma BILmax being ≥ 1.4 mg/dL, suggestive of more sensitive VOD indication in this age group.
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Value of solid organ transplant-trained pharmacists in transplant infectious diseases. Curr Infect Dis Rep 2015; 17:475. [PMID: 25870143 DOI: 10.1007/s11908-015-0475-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in organ transplantation have led to improved graft and patient survival. Transplant pharmacist's education and training uniquely position them to contribute knowledge and skills to the management of these highly complex patients. In 2004, the United Network for Organ Sharing bylaws added requirements that all transplant programs identify one or more pharmacists with experience in transplant pharmacotherapy to be responsible for providing pharmaceutical care to solid organ transplant recipients. These bylaws also delineated the transplant pharmacist's roles and responsibilities. To further support these efforts, in 2007 the Centers for Medicare and Medicaid Services accreditation standards for transplant centers also mandated that a center have a designated, qualified expert in transplant pharmacology as a multidisciplinary team member. The transplant pharmacist is a consistent member of the transplant team that can add value to the multidisciplinary approach of prevention and treatment of transplant infectious diseases through all phases of transplant care.
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Urbina O, Ferrández O, Luque S, Grau S, Mojal S, Pellicer R, Riu M, Salas E, Comin-Colet J. Patient risk factors for developing a drug-related problem in a cardiology ward. Ther Clin Risk Manag 2014; 11:9-15. [PMID: 25565852 PMCID: PMC4275111 DOI: 10.2147/tcrm.s71749] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Because of the high incidence of drug-related problems (DRPs) among hospitalized patients with cardiovascular diseases and their potential impact on morbidity and mortality, it is important to identify the most susceptible patients, who therefore require closer monitoring of drug therapy. Purpose To identify the profile of patients at higher risk of developing at least one DRP during hospitalization in a cardiology ward. Method We consecutively included all patients hospitalized in the cardiology ward of a teaching hospital in 2009. DRPs were identified through a computerized warning system designed by the pharmacy department and integrated into the electronic medical record. Results A total of 964 admissions were included, and at least one DRP was detected in 29.8%. The variables associated with a higher risk of these events were polypharmacy (odds ratio [OR]=1.228; 95% confidence interval [CI]=1.153–1.308), female sex (OR=1.496; 95% CI=1.026–2.180), and first admission (OR=1.494; 95% CI=1.005–2.221). Conclusion Monitoring patients through a computerized warning system allowed the detection of at least one DRP in one-third of the patients. Knowledge of the risk factors for developing these problems in patients admitted to hospital for cardiovascular problems helps in identifying the most susceptible patients.
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Affiliation(s)
- Olatz Urbina
- Pharmacy Department, Hospital Universitari del Mar, Barcelona, Spain
| | - Olivia Ferrández
- Pharmacy Department, Hospital Universitari del Mar, Barcelona, Spain
| | - Sònia Luque
- Pharmacy Department, Hospital Universitari del Mar, Barcelona, Spain
| | - Santiago Grau
- Pharmacy Department, Hospital Universitari del Mar, Barcelona, Spain ; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Mojal
- Department of Statistics, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Rosa Pellicer
- Pharmacy Department, Hospital Universitari del Mar, Barcelona, Spain
| | - Marta Riu
- Department of Epidemiology and Health Services Evaluation, CIBER de Epidemiología y Salud Pública (CIBERESP), Hospital Universitari del Mar, Barcelona, Spain
| | - Esther Salas
- Pharmacy Department, Hospital Universitari del Mar, Barcelona, Spain
| | - Josep Comin-Colet
- Heart Failure Unit, Cardiology Department, Hospital Universitari del Mar, Barcelona, Spain
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Otero MJ, Moreno-Gómez AM, Santos-Ramos B, Agra Y. Developing a list of high-alert medications for patients with chronic diseases. Eur J Intern Med 2014; 25:900-8. [PMID: 25468740 DOI: 10.1016/j.ejim.2014.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients with chronic diseases often receive multiple medications and are associated with increased vulnerability to medication errors. Identifying high-alert medications for them would help to prioritize the interventions with greatest impact for improving medication safety. The aim of this study was to develop a list of high-alert medications for patients with chronic illnesses (HAMC list) that would prove useful to the Spanish National Health Service strategies on chronicity. METHODS The RAND/UCLA appropriateness method was used. Drug classes/drugs candidates to be included on the HAMC list were identified from a literature search in MedLine, bulletins issued by patient safety organizations, incidents recorded in Spanish incident reporting systems, and previous lists. Eighteen experts in patient/medication safety or in chronic diseases scored candidate drugs for appropriateness according to three criteria (evidence, benefit and feasibility of implementing safety practices). Additionally they rated their priority of inclusion on a Likert scale. RESULTS The final HAMC list includes 14 drug classes (oral anticoagulants, narrow therapeutic range antiepileptics, antiplatelets - including aspirin -, antipsychotics, β-blockers, benzodiazepines and analogues, corticosteroids long-term use, oral cytostatics, oral hypoglycemic drugs, immunosuppressants, insulins, loop diuretics, nonsteroidal anti-inflammatory drugs, and opioid analgesics), and 4 drugs or pairs of drugs (amiodarone/ dronedarone, digoxin, oral methotrexate and spironolactone/eplerenone). CONCLUSIONS An initial list of high-alert medications for patients with chronic diseases has been developed, which can be built into the medication management strategies for chronicity to guide the implementation of efficient safety strategies and to identify those patients at greater risk for preventable adverse drug events.
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Affiliation(s)
- María José Otero
- ISMP-España, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain.
| | - Ana María Moreno-Gómez
- ISMP-España, Servicio de Farmacia, Hospital Santos Reyes, Aranda de Duero, Burgos, Spain.
| | | | - Yolanda Agra
- Dirección General de Salud Pública, Calidad e Innovación, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain.
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Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of hospitalization resulting from medicine-related problems in adult patients. Br J Clin Pharmacol 2014; 78:202-17. [PMID: 24283967 PMCID: PMC4137816 DOI: 10.1111/bcp.12293] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/13/2013] [Indexed: 12/23/2022] Open
Abstract
AIMS Medicine-related problems (MRPs) represent a major issue leading to hospitalization, especially in adult and elderly patients. The aims of this review are to investigate the prevalence, causes and major risk factors for MRPs leading to hospitalization in adult patients and to identify the main medicine classes involved. METHODS Studies were identified through electronic searches of Medline, Embase, Scopus and International Pharmaceutical Abstracts between January 2000 and May 2013. A systematic review was conducted of both retrospective and prospective studies. Studies included were those involving hospitalization resulting from MRPs in adults (≥18 years old), whereas studies excluded were those investigating drug misuse and abuse and studies investigating MRPs in hospitalized patients. Data analysis was performed using SPSS version 20. RESULTS Forty-five studies were identified, including 21 that investigated hospitalization resulting from adverse drug reactions, six studies that investigated hospitalization due to adverse drug events and 18 studies that investigated hospitalization due to MRPs. The median prevalence rates of hospitalization resulting from adverse drug reactions, adverse drug events and MRPs were 7% (interquartile range, 2.4-14.9%), 4.6% (interquartile range, 2.85-16.6%) and 12.1% (interquartile range, 6.43-22.2%), respectively. The major causes contributing to MRPs were adverse drug reactions and noncompliance. In addition, the major risk factors associated with MRPs were old age, polypharmacy and comorbidities. Moreover, the main classes of medicines implicated were medicines used to treat cardiovascular diseases and diabetes. CONCLUSIONS Hospitalization due to MRPs had a high prevalence, in the range of 4.6-12.1%. Most MRPs encountered were prevalent among adult patients taking medicines for cardiovascular diseases and diabetes.
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Affiliation(s)
- Abdullah Al Hamid
- Department of Pharmacy, School of Life and Medical Sciences, University of HertfordshireHatfield, UK
| | - Maisoon Ghaleb
- Department of Pharmacy, School of Life and Medical Sciences, University of HertfordshireHatfield, UK
| | - Hisham Aljadhey
- College of Pharmacy, King Saud UniversityRiyadh, Saudi Arabia
| | - Zoe Aslanpour
- Department of Pharmacy, School of Life and Medical Sciences, University of HertfordshireHatfield, UK
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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. [PMID: 24789053 DOI: 10.1007/s00228-014-1686-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [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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