Drug-Related Problems Identified at Patients’ Home: A Prospective Observational Study in a Rural Area of Thailand

Abstract

Objective The aim of the study was to examine the prevalence rates, nature, and predictors of drug-related problems (DRPs) experienced in participants living at home in a rural Thailand. Method A cross-sectional observational study was undertaken during December 2015 to January 2016. Drug-related problems were identified within a rural township having a population of 5256 by means of home visits by pharmacists. All suspected cases were then assessed for severity and preventability by clinical specialists. Drug-related problems were categorized according to Pharmaceutical Care Network Europe classification (revised 2010).v.6.2 Results From a systematically recruited cohort of 359 participants, suspected DRPs were identified in 160 participants. After detailed reviews by clinical specialists, 141 cases (39.3%) were deemed to have DRPs. Types of DRPs with prevalence rates were the following: problems of treatment effectiveness (3.7% of DPRs), adverse reactions (15.3%), treatment cost (28.4%), nonadherence to drugs (42.1%), and poor drug storage (10.5%). The most common drug to involve DRPs was those treating cardiovascular disease, especially simvastatin. Conclusions Nearly half of community living participants experienced DRPs, especially nonadherence to drugs, and has implications for other rural elderly persons of low education attainment for similar rural economies around the globe. Appropriate interventions should focus on reducing polypharmacy, providing outreach programs, and rigorous pharmacovigilance.

Effects of home drug delivery on drug-related problems: preliminary evidence for improved patient outcomes during the COVID-19 pandemic in Thailand

“…33 The risk of experiencing a DRP as a function of various predictors in the data set were evaluated using univariate logistic regression, and those results are expressed as odds ratios (ORs) and 95% CIs. Both variables with P < 0.05 in univariate analysis and those identified by previous studies 4,8,16,34 as predictors of DRPs were submitted to multivariate logistic regression to establish their independent association with DRPs while statistically controlling for other factors.…”

“…Considering that we observed a relatively low nonadherence prevalence (17.4%) than comparable results in Thailand (42%-45%), home drug delivery may already be a promising avenue for reduction of nonadherence problems. 8,9 It is likely that augmenting the drug-delivery program with other aspects of telepharmacy (e.g., video and text messaging with pharmacists) will reduce nonadherence even further. 24 Although the drug-delivery program described here was born out of the exigency of the COVID-19 crisis, we believe that it has been a positive forward step in the implementation of telepharmacy.…”

“…4,5 In Thailand, studies have estimated that between 39.3% and 52.62% of patients in rural areas have experienced DRPs. 8,9 In general, a DRP is defined as an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes in patients. 10e14 Common examples of DRPs include nonadherence to prescribed drug regimen, patients lacking understanding of how to take their medication or what dosage to take, patients experiencing unexpected adverse side effects or drug interactions, 5,8,15 changes of drug packaging or drug brands, 16 and, in extreme cases, patients experiencing unexpected medical emergencies resulting in hospitalization.…”

“…8,9 In general, a DRP is defined as an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes in patients. 10e14 Common examples of DRPs include nonadherence to prescribed drug regimen, patients lacking understanding of how to take their medication or what dosage to take, patients experiencing unexpected adverse side effects or drug interactions, 5,8,15 changes of drug packaging or drug brands, 16 and, in extreme cases, patients experiencing unexpected medical emergencies resulting in hospitalization. 1,7,8 The likelihood of DRPs is heightened in situations involving older patients, suboptimal prescribing (e.g., overuse, inappropriate use, or underuse of medications, and polypharmacy), medication errors (both dispensing and administration problems), and patient medication noncompliance (both intentional and unintentional).…”

Prevalence and Associated Factors of Drug-Related Problems Among Older People: A Cross-Sectional Study at King Chulalongkorn Memorial Hospital in Bangkok

“…There was a large difference globally in the prevalence of DRPs among older people, ranging from 14.1% (USA) to 95.9% (the Netherlands) [6][7][8][12][13][14]. The prevalence of DRPs in Thailand has been studied in the context of the specific disease-related inpatient settings or rural areas; these studies were not focused specifically on older people [15][16][17]. While the prevalence of DRPs in the general adult population has been documented in Thailand, much less is known about DRPs in older Thai people living in urban areas.…”