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

Abstract

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.

Implementation of medication management services at the primary healthcare level – a pilot study

“…This study is one of the first research to have determined the factors associated with the occurrence of DTPs at the primary care level (24), by employing the theoretical framework proposed by Cipolle et al Moreover, it appears to be the first study to have established DTP-associated factors among general ambulatory patients, by using the aforementioned methodology. In line with published evidence (24,28,29), polymedicated patients were more likely to have a higher number of DTPs. The second characteristic most strongly associated with the occurrence of three or more DTPs was type 2 diabetes.…”

“…In addition, various studies have demonstrated its effectiveness on clinical (14,15,(17)(18)(19)(20)(21)(22)(23)(24), economic (17,22,23,25) and humanistic outcomes (26,27). Other studies determined some factors associated with the occurrence of DTPs, such as polypharmacy, multimorbidity and age, yet employed methodology or clinical settings dissimilar to the present study (28)(29)(30)(31). However, to the best of authors' knowledge, until now, no study determined the associated factors of patients with chronic diseases at the primary care level as they receive CMM services that follow the theoretical framework proposed by Cipolle et al (9).…”

<p>Antimicrobial Drug Therapy Problems Among Patients in the Outpatient Department of Ataye Hospital, Northeast Ethiopia</p>

“…DTPs are usually classified as: unnecessary drug therapy, the need for additional drug therapy, ineffective drug therapy, too low dosage, too high dosage, adverse drug reaction (ADR), and non-compliance. 9,10 Antimicrobial drug therapy problems refers to incorrect and inappropriate utilization of antimicrobials which affect patient health outcomes and even result in bacterial resistance. 11 Literature reviews regarding DTPs indicated that a total of 199 DTPs were identified among patients receiving outpatient antimicrobial therapy in the USA.…”

Using the Delphi Technique to Determine Objectives and Topical Outline for a Pharmaceutical Care Course: An Experience from the Cuban Higher Education System

“…2,3 DTP is any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. 4 DTP is an important public health problem and has been heightened in recent years. 5 Relatively 28% of all emergency department visits and 5 to 10% of all hospital admissions are drug related.…”