Magnitude and determinants of drug-related problems among patients admitted to medical wards of southwestern Ethiopian hospitals: A multicenter prospective observational study

Abstract

Background Drug-related problem (DRP) is an event involving drugs that can impact the patient’s desired goal of therapy. In hospitalized patients, DRPs happen during the whole process of drug use such as during prescription, dispensing, administration, and follow-up of their treatment. Unrecognized and unresolved DRPs lead to significant drug-related morbidity and mortality. Several studies conducted in different hospitals and countries showed a high incidence of DRPs among hospitalized patients. Despite the available gaps, there were scanties of studies conducted on DRPs among patients admitted to medical wards in Ethiopia. Therefore, this study assessed the magnitude of drug-related problems and associated factors among patients admitted to the medical wards of selected Southwestern Ethiopian hospitals. Patients and methods A multicenter prospective observational study was conducted at medical wards of Mettu Karl Hospital, Bedele General Hospital and Darimu General Hospital. Adult patients greater than 18 years who were admitted to the non-intensive care unit (ICU) of medical wards and with more than 48 h of length of stay were included. Identified DRPs were recorded and classified using the pharmaceutical care network Europe foundation classification system and adverse drug reaction was assessed using the Naranjo algorithm of adverse drug reaction probability scale. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. Multivariable logistic regression was used to analyze the associations between the dependent variable and independent variables. Result Of the 313 study participants, 178 (56.9%) were males. The prevalence of actual or potential DRPs among study participants taking at least a single drug was 212 (67.7%). About 125 (36.63%) patients had one or more co-morbid disease and the average duration of hospital stay of 7.14 ± 4.731 days. A total of 331 DRPs were identified with an average 1.06 DRP per patient. The three-leading categories of DRPs were unnecessary prescription of drugs 92 (27.79%), non-adherence (17.22%) and dose too high (16.92%). The most common drugs associated with DRPs were ceftriaxone (28.37%), cimetidine (14.88%), and diclofenac (14.42%). The area of residence (AOR = 2.550, 95CI%: 1.238–5.253, p = 0.011), hospital stay more than 7 days (AOR = 9.785, 95CI%: 4.668–20.511, p≤0.001), poly pharmacy (AOR = 3.229, 95CI%: 1.433–7.278, p = 0.005) were predictors of drug-related problem in multivariable logistic regression analysis. Conclusion The magnitude of drug therapy problems among patients admitted to the medical wards of study settings was found to be high. Therefore, the clinical pharmacy services should be established in hospitals to tackle the DTPs in this area. Additionally, healthcare providers of hospitals also should create awareness for patients seeking care from health facilities of the importance of rational drug usage.

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

“…Patients with one or more medical conditions increased their risk of developing DRPs by 1.48 times when compared to those who did not have any comorbid conditions; this conclusion is consistent with research from the Netherlands [38], India [39], and Norway [40], but differs from a study 8 BioMed Research International conducted in Gondar hospital [41] and a multicenter study in southwestern Ethiopian hospitals [42], which is not statistically different. In fact, as comorbidities and the number of medications rise, patients are at a higher risk of getting DRPs.…”

“…Patients who stayed in the hospital for seven or more days were 2.3 times more likely to have DRPs; it is supported by a meta-analysis conducted in Ethiopia [ 45 ], a study in China [ 29 ], and a multicenter prospective study in southwestern Ethiopia [ 42 ]. The reason might be the likelihood of infection in patients who stayed in the hospital for a long time necessitates more management, which raises the expense of patient healthcare.…”

Management Practice and Drug Related Problems and Its Contributing Factors Among Cervical Cancer Patients at Oncologic Center in Ethiopia: A Hospital-Based Retrospective Study

“… 21 A multicenter prospective observational study done in Ethiopia among medical ward patients also showed a higher prevalence (67.7%) of DRPs among study participants. 45 The difference might be attributed to the existing practice variation, healthcare professionals’ teamwork level, and availability of medication in the settings.…”

“… 44 In a multicenter prospective observational study conducted in Ethiopia, polypharmacy was also reported as a predictor of DRPs. 45 Co-morbidities are associated with DRPs as individuals diagnosed with many clinical conditions will take many drugs that ultimately interact with one another. In a study conducted at Kenyatta National Hospital, advanced stage cervical cancer was also reported to be a predictor of DRPs.…”

Non-Adherence to Antiepileptic Drugs and Associated Factors among Epileptic Patients at Ambulatory Clinic of Southwestern Ethiopian Hospital: A Cross-Sectional Study

“…13 Poly-pharmacy: The daily consumption of 5 or more medications. 16 Co-morbidity: Patients diagnosed with two or more diseases. 16…”