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

Abstract

Background: Drug therapy in the elderly needs an emphasis on age-related changes in drug pharmacokinetics and pharmacodynamics profile. Hospitalized elderly patients are at risk of more than one disease and polypharmacy associated with these; they are at risk of drug-related problems. This study aimed to assess the role of clinical pharmacy on identifying and resolution of drug-related problems among elderly patients admitted to medical ward of Northwest Ethiopia comprehensive specialized hospitals. Methods: A multicenter prospective observational study was conducted. A systematic sampling technique was used. The identified drug-related problem was recorded and classified using Cipolle, and adverse drug reaction was assessed using Naranjo algorithm of adverse drug reaction probability scale, and Medscape was used for drug-drug interaction. Data were analyzed by using STATA software version 14.1. Logistic regression was used, and results were reported as odds ratios (ORs) with 95% Confidence intervals with P value < 0.05 statistically significant. Result: A total of 389 study participants were included in the study. About 266 (68.4%) of the participants had at least a single drug-related problem. About 503 drug-related problems were identified with a mean of 1.32 (CI: 1.27-1.36) drug-related problem per patient. The three-leading categories of drug-related problems were dose too high 108 (21.5%), nonadherence 105 (20.9%), and adverse drug reaction 96 (19.1%). Alcohol use ( AOR = 2.2 , 95CI%: 1.23-3.94), source of the drug ( AOR = 2.85 , 95CI%: 1.63-4.98), length of hospitalization ( AOR = 2.32 , 95CI%: 1.37-3.95), number of comorbidities ( AOR = 1.48 , 95CI%: 1.09-1.99), and polypharmacy ( AOR = 3.06 , 95CI%: 1.72-5.46) were important risk factors for drug-related problems. From the intervention provided, 84.7% were accepted by prescribers. Among the total drug-related problems 67.4% of the problem was totally solved. Conclusion: This study revealed that DRPs were high among elderly patients admitted to medical ward of Northwest Ethiopia. Comorbidity, length of hospitalization, ploy-pharmacy, payer, and alcohol drinker were more likely to developed drug-related problems. Treatment optimizations were also done by clinical pharmacists and interventions were well accepted by prescribers.

The performance of the clinical pharmacist in pharmaceutical care and intervention in cases of polymedicated elderly people: an integrative review

“…In a pre/post-intervention study by Samir Abdin et al, (2020), assistant physicians accepted 263 recommendations regarding these Drug-Related Problems (DRPs), representing 87.7% of all detected. In a recent (multicenter prospective observational) study by Dagnew et al, (2022), of the practiced intervention, 84.7% were accepted by the prescribers. Among all drug-related problems, 67.4% were completely resolved.…”

Pharmaceutical Intervention in the Pharmacological Therapy of Elderly Patients in San Luis-ECUADOR

“…26 While other investigations present different results, because the prevalence of interventions at the prescriber level turns out to be the most common. 1,27 The intervention conducted at the patient's level had an acceptance of 100%, compared to the one conducted at the prescriber's level (0%), the last intervention was not accepted due to lack of information with the doctor, besides, it is about patients of the community who visits the prescriber again when they complete the treatment or do not return because they notice an improvement in their ailments.…”

“… 26 While other investigations present different results, because the prevalence of interventions at the prescriber level turns out to be the most common. 1 , 27 …”

“…With the pass of the years, elder population have increased worldwide and with this phenomenon, the use of medication to treat several diseases that affected them has increased, 1 , 2 which cause the appearance of problems related to their use. Medication-related problems (MRP) are events or circumstances related to pharmacotherapy that potentially interfere with the expected health outcomes.…”

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

“…It was reported that polypharmacy occurred in 54.8% of older patients (≥65 years old) with elective noncardiac surgery [ 12 ]. Pharmaceutical interventions can significantly decrease DRPs and have an average cost savings of USD 1511 per case by identifying and resolving DRPs [ 13 , 14 ]. Therefore, in order to reduce DRPs, morbidity, and patient costs and promote the rapid recovery of surgical patients, there is a great need for the medication therapy management services of surgical pharmacy in the ERAS programs.…”