|Year : 2019 | Volume
| Issue : 4 | Page : 328-332
A prospective study on hospitalization due to drug-related problems in a tertiary care hospital
Venkateswarlu Konuru, Bodanam Naveena, Edulakanti Sneha Reddy, Bandela Charles Vivek, Gyadari Shravani
Department of Pharmacy Practice/Pharm D, CMR College of Pharmacy, Hyderabad, Telangana, India
|Date of Web Publication||24-Sep-2019|
Dr. Venkateswarlu Konuru
Assistant Professor, Department of Pharmacy Practice/ Pharm D, CMR College of Pharmacy, Kandlakoya, Hyderabad 501401, Telangana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Drug-related problem (DRP) is any undesirable event experienced by the patient, which is suspected to involve drug therapy and interferes with a desired patient outcome. Most of these DRPs are avoidable with little vigilant effort. DRP admissions need high attention as DRP-related admissions on an average accounted for 8.36%, of which 50% are avoidable. The aim of the study was to identify the risk factors associated with DRPs in tertiary care hospital. Materials and Methods: One year prospective observational study was conducted in the departments of general medicine, dermatology, pediatrics, and gastroenterology of a tertiary care teaching hospital. A total of 148 cases, where a correlation between past medication history and current complaints was established, were included in the study. Exclusion criteria of the study were no correlation between past medication history and current complaints, social habits causing hospitalization, and herbal medication use history. Results and Discussion: In this study, nonadherence (50.94%) and adverse drug reaction (ADR) (38.36%) were predominant among the identified DRPs. Children and geriatrics showed the higher incidence of nonadherence to the prescribed therapy. ADRs were the DRP with the higher incidence among adults followed by nonadherence to the prescribed therapy. Lack of knowledge about the disease, its complications, and possible adverse reactions with self-medication was identified to be the high incidence risk factor. Higher incidence of DRPs was observed in patients having a past medical history of cardiovascular system and central nervous system diseases, which require long-term management. Conclusion: In this study, nonadherence to prescribed therapy was found to be the DRP causing hospitalization at a higher incidence. The most commonly involved risk factors were lack of knowledge about the disease, need of adherence to the therapy as prescribed, and outcomes of the treatment provided.
Keywords: Clinical pharmacist, drug-related problems, hospitalization, nonadherence, past medical history
|How to cite this article:|
Konuru V, Naveena B, Reddy ES, Vivek BC, Shravani G. A prospective study on hospitalization due to drug-related problems in a tertiary care hospital. J Pharm Bioall Sci 2019;11:328-32
|How to cite this URL:|
Konuru V, Naveena B, Reddy ES, Vivek BC, Shravani G. A prospective study on hospitalization due to drug-related problems in a tertiary care hospital. J Pharm Bioall Sci [serial online] 2019 [cited 2022 Jan 19];11:328-32. Available from: https://www.jpbsonline.org/text.asp?2019/11/4/328/267631
| Introduction|| |
Drug-related problem (DRP) can be defined as a circumstance related to the patient’s use of a drug that directly or indirectly prevents the patient from gaining the intended benefit of the drug. Identifying and addressing the DRPs are considered as the important tasks within the health-care system. Different DRP categorization systems exist but most of these systems target on the issues, which can be identified by reviewing the patient case sheets. Therefore, most commonly observed DRPs are adverse drug reaction (ADR), drug–drug interactions, subtherapeutic dose, nonadherence to the prescribed therapy, overuse of the medications, overdosage of the drug, wrong administration of the medication, drug use without an indication, and therapeutic duplication. DRPs may lead to reduced quality of life, hospital admission, and overall increase in health cost and even increase in the risk of morbidity and mortality.
Medical therapy has emerged to improve patient care to achieve optimal health outcome. However, DRPs represent a major issue leading to hospitalization. This significantly explains the need for assessment of majorly involved risk factors, disease conditions, drug classes, and severity. Most of the patients having chronic diseases are treated as outpatients and their management is challenging (there is a chance of improper medication use) as less time is available for outpatient evaluation. DRPs are common among individuals after hospital discharge is relevant as they threaten patient safety. Most efficient interventions to avoid hospitalization because of DRPs are focus on discharge planning and care transitions. Their effectiveness probably improves with home follow-up strategies. In 2004, the World Health Organization launched the World Alliance for Patient Safety. It is an initiative to assure medication accuracy at transitions of care by means of medication reconciliation. It could be a powerful strategy to reduce DRPs with patients moving through settings of care. Most of the studies were retrospective, multicenter studies carried out internationally. Limited research has been conducted in India to exemplify the impact of DRP that results in hospital admission.
The fact is that most of these DRPs are avoidable with little vigilant effort. As per various researches carried out, DRP admissions need high attention as DRP-related admissions on an average accounted for 8.36%, of which 50% of are avoidable.
| Need of the Study|| |
To explain the importance of patient education about disease, drug, and highly possible DRPs, which when neglected may result in severe complications and deterioration of patient’s quality of life. To explain the importance of care needed in prescribing drugs in high-risk patients such as elderly with multiple chronic condition and low immune individuals. To highlight the importance of resolving the risk factors causing DRPs. The main aim was to study DRPs resulting in hospitalization.
| Materials and Methods|| |
A prospective observational study was conducted in various departments of 1200-bed tertiary care teaching hospital for 1 year (March 2017 to March 2018). Before the initiation of study, ethical clearance was obtained from the Institutional Human Ethics Committee on June 26, 2017. Objectives of the study include identification of group of people (age, sex, and area) at higher risk, risk factors involved, type of drugs involved in the DRPs, assess the severity, and identify the person responsible for DRPs. Inclusion criteria of this study were an association between the admission and a DRP, patient or patient caretaker being adequately communicable, and patients who were hospitalized in general medicine, pediatrics, gastroenterology, and dermatology departments. Hospital admissions attributed to herbal medicine use, poisoning, and substance abuse or outpatients consulting for DRP were excluded from the study. Data of the patients (demographic details, past medical history, past medication history, laboratory investigations, provisional and conformational diagnosis, treatment, and interviewing patient and patient caretakers) with drug-related admissions to hospital during the study period were collected and analyzed. Case sheets of patients with a past medical history were assessed for the impact of medications used in the past on the current complaints. If a DRP was observed, the case was considered for further study by documenting necessary information in documentation forms (data collection form and DRP assessment form). On the basis of the information available, the type of DRP (based on Hepler–Strand classification) and the associated risk factors were identified. Severity was classified as following: mild (DRP requiring only change in the treatment of existing medical condition), moderate (DRP requiring additional treatment with a change/no change in the treatment of existing medical condition and resulting in no permanent disability), and severe (DRP that was life-threatening, caused organ damage, or resulted in permanent disability or death).
Data analysis: The categorical variables were represented in number and percentage. The data were analyzed using Statistical Software Analysis (SAS), Version 9.1.
| Results|| |
A total of 452 cases with a past medical history were reviewed, of which 148 cases were enrolled into the study based on the inclusion criteria. Among the 304 excluded cases, 110 patients had no relation between past medical history and current reasons for admission, 90 cases were herbal medicine–related, 70 cases were due to patient’s social habits that aggravated their medical condition, and 34 cases were due to trigger factors. Among the 148 cases, 159 DRPs were identified, which show the probability of multiple DRPs in a single patient. In this study, adults (80, 54.05%) were predominant over children (42, 28.38%) and geriatric (26, 17.57%) in terms of prevalence, whereas males had higher risk to develop DRPs. Regardless of sex, DRPs were significant in rural areas, remaining details are given in [Table 1]. In this study, the most commonly observed DRPs were nonadherence to the prescribed therapy (81, 50.94%) followed by ADR (61, 38.36%), and other details are given in [Table 2]. In this study, risk factors highly responsible for DRPs were patients not having necessary knowledge about the disease (89, 39.73%) followed by inappropriate medication use (35, 15.65%), and other details are represented in [Table 3]. Patients (75, 47.16%) found to be majorly involved in the development of DRPs and other details are given in [Table 4]. A total of 159 DRPs were distributed according to the age group of 148 patients considered for the study as shown in [Table 5]. Nonadherence was the major DRP in children (35, 22.01%) and geriatrics (14, 8.80%), whereas ADR (42, 26.41%) was the major DRP in adults. Distribution of DRPs based on past medical history is described in [Table 6]. Nonadherence was the most common DRP in patients with past medical history followed by central nervous system (CVS) disease (18, 11.32%), cardiovascular system (CNS) disease (21, 13.20%), skin disease (10, 6.30%), metabolic disease (12, 7.54%), renal disease (12, 7.54%), respiratory disease (2, 1.26%), and ADR was the most identified DRP in patients with immune disease (8, 5.03%) and other conditions (12, 7.54%) (having complaints such as joint pains, cold, fever, and body pains). ADRs were predominant with over-the-counter (OTC) drugs (17, 80.94%), whereas nonadherence was predominant with prescribed drugs (81, 63.78%), and other details are present in [Table 7]. A total of 159 DRPs were distributed based on their severity as given in [Table 8], among which 133 (71.07%) were assessed as moderate followed by 38 (23.90%) as mild and 8 (5.03%) as severe., , , , ,
|Table 6: Distribution of drug-related problems based on past medical history|
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| Discussion|| |
In this study, 159 DRPs were identified among the 148 cases included. Various parameters in relation with the DRPs were evaluated and those are represented henceforth. From our study, it was observed that DRPs were predominant in the age group of 1–10 years. In terms of sex, males have high risk of DRPs when compared with the females. Similar findings were stated in the study conducted by Kumar et al. From our study, it was evident that both the urban and rural individuals have approximately equal risk for DRPs. In our study, nonadherence (50.94%) and ADR (38.36%) are predominant among the identified DRPs. Similar results were stated in the study conducted by Alghamdy et al., which showed higher incidence of noncompliance (44.3%) followed by ADR (39.3%). To prevent the avoidable ADRs, patients should be informed about the suspected and highly frequent ADRs, so that they can easily report and obtain immediate management. According to our study, children and geriatrics have higher incidence of nonadherence to the prescribed therapy, ultimately leading to further complications. ADRs have higher incidence among adults followed by nonadherence to the prescribed therapy. According to our study, higher incidence of DRPs is observed in patients having past medical history of CVS and CNS diseases, which requires long-term management. Similar results were reported in the study conducted by Hsu et al. To prevent DRPs in such patients, a regular follow-up plan is needed so as to change the therapy as per physician’s assessment toward patient’s need. From our study, risk factors responsible for the DRPs were identified as lack of knowledge about the disease, inappropriate medication use, hypersensitivity to the medications, self-medication with nonprescription medicines, drugs with narrow therapeutic index, presence of infectious and parasitic conditions, social habits, and economic status of the patient. In our study, DRPs were mostly associated with the prescribed medications. From our study, patients were found to be highly responsible for the DRPs. This may be due to inadequate awareness about consequences of improper medication use. Similar result was previously reported by Andreazza et al. In our study, it was observed that individuals with a past medical history are mostly admitted with moderate DRPs. Similar findings were reported in a previous study conducted by Singh et al.
| Conclusion|| |
In this study, nonadherence to prescribed therapy was found to be the DRP causing hospitalization at higher incidence followed by ADR. Most commonly identified risk factors in the patients having chronic diseases are lack of knowledge about disease, need of adherence to the therapy as prescribed, and outcomes of treatment provided. Severity of DRPs was majorly assessed to be moderate.
Limitations and future directions
Sample size being very small, certain risk factors could not be assessed adequately. Further study can allow us to elaborately assess the prevalence of DRPs and relative risk of causative factors.
We sincerely and wholeheartedly convey our regards to all doctors, nursing staff, and other medical staff of various departments who helped us in data collection and interpretation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kjeldsen LJ, Nielsen TRH, Olesen C Investigating the relative significance of drug-related problem categories. Pharmacy (Basel) 2017;5:31.
Adusumilli PK, Adepu R Drug related problems: an overview of various classification systems. Asian J Pharm Clin Res 2014;7:7-10.
Alghamdy MS, Randhawa MA, Al-Wahhas MH, Al-Jumaan MA Admissions for drug related problems at the emergency department of a university hospital in the Kingdom of Saudi Arabia. J Family Community Med 2015;22:44-8.
Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z A systematic review of hospitalization resulting from medicine-related problems in adult patients. Br J Clin Pharmacol 2014;78:202-17.
Hsu WT, Shen LJ, Lee CM Drug-related problems vary with medication category and treatment duration in Taiwanese heart failure outpatients receiving case management. J Formos Med Assoc 2016;115:335-42.
Garcio-Caballos M, Ramoz-Diaz F, Jimenez-Moleon JJ, Bueno-Cavanillas A Drug-related problems in older people after hospital discharge and interventions to reduce them. Age Ageing 2010;39:430-8.
Beijer HJ, de Blaey CJ Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 2002;24:46-54.
Barrins and Associates [internet]. Medication ordering and therapeutic duplication. [updated 2016 Sep 13; cited 2017 Dec 27]. 2016. Available from: http://barrins-assoc.com/resources/compliance-updates/medication-ordering-therapeutic-duplication-psychiatric-hospitals/. [Last accessed on 2017 Dec 27].
Kumar BPS, Dahal P, Venkataraman R, Fulori PC Assessment of clinical pharmacist intervention in tertiary care teaching hospital of Southern India. Asian J Pharm Clin Res 2013;6:258-61.
Andreazza RS, Silveira De Castro M, Sippel Koche P, Heineck I Causes of drug-related problems in the emergency room of a hospital in southern Brazil. Gac Sanit 2011;25:501-6.
Singh H, Kumar BN, Sinha T, Dulhani N The incidence and nature of drug-related hospital admission: a 6-month observational study in a tertiary health care hospital. J Pharmacol Pharmacother 2011;2:17-20.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]