Drug-related problems vary with medication category and treatment duration in Taiwanese heart failure outpatients receiving case management

Hsu, Wei Hsuan; Shen, Li‐Jiuan; Lee, Chi-Ming

doi:10.1016/j.jfma.2015.11.014

Cited by 27 publications

(42 citation statements)

References 22 publications

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“…We have identified at least one DTP in 83.5% of study participants, which was in line to other studies [ 21 , 23 , 27 – 29 ]. The mean number of DTPs per patient was 2.60, which was lower than the mean reported in Taiwan, 5.90 DTPs per patient [ 30 ], but higher than that of Spanish study, 1.5 DTP/patient [ 21 ]. This might variation might be due to the differences in a study design, clinical characteristics, population demographics, medication therapy used and methods of DTP identification and classification.…”

Section: Discussionmentioning

confidence: 61%

Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia

et al. 2018

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BackgroundDrug therapy problem (DTP) is any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. Heart failure (HF) patients are more likely to experience DTP owing to multiple prescriptions and comorbidities. Despite the serious negative impact of DTP on treatment outcomes, there is a dearth of study on DTP among HF patients in Ethiopia.ObjectiveThe main aim of this study was to assess the prevalence and contributing factors of DTP among ambulatory HF patients in Jimma University Specialized Hospital, Ethiopia.MethodsA hospital based prospective observational study was conducted. Written informed consent was obtained from each patient after full explanation of the study. Data were collected through patient interview and expert review of medical, medication and laboratory records of one-year follow-up from May 2015 to April 2016. DTPs were identified using Cipolle’s method followed by consensus review with experts. Binary logistic regression was performed to identify factors contributing to DTP. A p<0.05 was considered statistically significant in all analyses.ResultOf 340 study participants; male to female ratio was equivalent, the mean (± SD = standard deviation) age was 50.5±15.6 years. Eight hundred eighty DTPs were identified equating 2.6 ±1.8 DTPs per patient. The frequently identified DTPs were dosage too low (27.8%), ineffective drug therapy (27.6%) and need additional drug therapy (27.4%). Most commonly implicated drugs were beta-blockers (34.4%), angiotensin converting enzyme inhibitors (24.8%), statins (16.5%) and antithrombotics (13.1%). Factors contributing to DTP were age >50 years (AOR [adjusted odd ratio] = 5.43, 95%CI [95% confidence interval] = 2.03–14.50); negative medication belief (AOR = 3.50, 95%CI = 1.22–10.05); poor involvement of patients in the therapeutic decision makings (AOR = 4.11, 95%CI = 1.91–8.88); number of co-morbidity≥2(AOR = 5.26, 95%CI = 2.38–11.65) and number of medications ≥5 (AOR = 3.68, 95%CI = 1.28–10.51).ConclusionDTPs are common among ambulatory care HF patients. Patients with older age, negative medication belief, polypharmacy, co-morbidities and those who were poorly involved in the therapeutic decision were more likely to experience DTP. Despite traditional prescription refilling, an integrated multidisciplinary approach involving patients and clinically trained pharmacists should be implemented in the patient care process at ambulatory care clinics in order to improve overall outcomes and reduce DTPs and associated burdens in HF patients.

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Section: Discussionmentioning

confidence: 61%

Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia

et al. 2018

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“…Therefore, it was recommended that clinical pharmacists could provide pharmaceutical care for ambulatory patients receiving long-term pharmacotherapy. 23 In our study, condition undertreated was the most common DRP subtype that was identified in patient interviews. A study by Tulner et al also reported that under-treatment usually occurred in elderly patients, with nearly one-third of them identified as being untreated.…”

Section: Discussionmentioning

confidence: 75%

Characterization of drug‐related problems and associated factors in ambulatory patients in China

Wang

Yang

et al. 2020

J Clin Pharm Ther

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Summary What is known and objective This study aimed to investigate the prevalence and the type of drug‐related problems (DRPs) in ambulatory patients and identify factors that may be associated with risk of DRPs. Methods Consecutive patients were enrolled from pharmacist outpatient clinics between January 2018 and June 2019. The pharmacists performed a comprehensive assessment of the patient's drug therapy. The DRPs and recommendations were evaluated using the DOCUMENT classification system. Results and discussion The study population consisted of 248 patients with a mean age of 72.55 ± 6.29. The patients had a mean of 7.55 ± 4.72 ongoing medications during patients’ routine clinic visits. A total of 1188 DRPs were identified during the study period. An average of 4.79 DRPs per patient was detected. Sixty‐two different traditional Chinese patent medicines (TCPMs) contributed to 102 DRPs. Drug selection (24.9%) was the most common DRP followed by under treated (24.2%) and monitoring needed (24.2%). The number of medications taken was the significant factor for DRPs. Pharmacists made 1092 recommendations to address the DRPs (an average 0.92 recommendations per DRP). A change in therapy was the most common recommendation (43.6%), followed by the category ‘monitoring’ (28.6%). The overall acceptance rate of clinical pharmacist recommendations was 88.7%. More than a half (51.6%) of all interventions were assigned a moderate level of clinical significance. What is new and conclusion Drug‐related problems were commonly observed among ambulatory Chinese patients. Clinical pharmacists had a valuable role to play in identifying and solving the DRPs.

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“…When inconsistency existed, a third pharmacist would re-investigate and re-classify. If results remained to be inconsistent, a consensus was reached through discussion [17].…”

Section: Pcne-drp Classificationmentioning

confidence: 99%

Drug-related problems among hospitalized patients with COPD in mainland China

Qin

et al. 2019

Int J Clin Pharm

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Background Data are lacking about the extent of drug-related problems in hospitalized patients with COPD in China. Objective Identify types and causes of drug-related problems and assess interventions performed by pharmacists. Setting Study was conducted in an academic teaching hospital in Shanghai, China. Method Between June 2017 and July 2018, 393 patients admitted to hospital for acute exacerbation of COPD hospitalized were enrolled. Patient demographics and clinical characteristics were collected. The drug-related problems and interventions were recorded and analyzed based on the Pharmaceutical Care Network Europe (PCNE)-DRP V 8.02 classification. Main outcome measures The number, types, causes, interventions, and outcomes of the problems were analyzed. Results A total of 640 DRPs, with 763 corresponding causes, were identified for 393 patients. "Treatment safety P2" was the most common type of problem (54.2%; 347/640), and the most common causes were "drug selection C1" (24.2%; 185/763), "dose selection C3" (21.5%; 164/763) and "treatment duration C4" (17.7%; 135/763). Antibiotics, corticosteroids, and proton pump inhibitors were the three primary medication classes associated with DRPs. Patients, hospitalized for more than eight days, taking ten or more drugs or having renal dysfunctions were more likely to have drug-related problems. Pharmacists totally proposed 1557 interventions to address the problems. Most interventions (91.0%; 1418/1557) were accepted, and 91.6% of the problems were solved. Conclusion The prevalence of drug-related problems among the studied COPD patients was high. Pharmacists can have an important role in addressing the problems and optimizing the safety and effectiveness of therapies for hospitalized COPD patients.

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Drug-related problems vary with medication category and treatment duration in Taiwanese heart failure outpatients receiving case management

Cited by 27 publications

References 22 publications

Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia

Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia

Characterization of drug‐related problems and associated factors in ambulatory patients in China

Drug-related problems among hospitalized patients with COPD in mainland China

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