Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions

Abstract

Drug-related problems (DRP) cause preventable negative health outcomes, especially during hospital admissions. The aim of our study was to examine the prevalence and characteristics of DRP in regular clinical pharmacy, as well as to determine those factors associated with a higher risk of DRP in the hospital setting. We analyzed data from a standardized registry database of regular pharmacy practice (2015- 2016). DRP were classified according to the Pharmaceutical Care Network Europe v6.2 classification. Cross-sectional data were obtained from 1602 adults admitted to medical wards. Crude and adjusted binary logistic regressions were performed to identify associations between potential risk factors and DRP. Overall DRP prevalence was high across medical specialties (45,1%), in a population characterized by advanced age, polypharmacy and multimorbidity. Problems leading to DRP were mainly classified into two domains (effectiveness and adverse reactions), being drug and dose selection the most frequent causes. Interventions were accepted and DRP were totally or partially solved in 74.1% and 4.81% of cases, respectively. In the adjusted model polypharmacy, allergies, BMI > 25 kg/m2 and clearance < 30 mL/min were associated with a higher risk of DRP. The participation of clinical pharmacists into multidisciplinary teams promotes the detection and solution of DRP. Polypharmacy, obesity, renal impairment and allergy are associated with a higher risk of DRP during admission.

Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial

“…This is consistent with the results of the previous studies that CKD severity and medication errors are associated with medication-related problems [30,31]. However, well-known risk factors for DRPs, such as polypharmacy and comorbidity, were not significantly associated with DRPs in this study, possibly owing to the relatively small sample size and the propensity of bias towards patients with CKD stage 5 with high medication burdens and complicated comorbidity conditions [32,33]. The present study demonstrated that clinical pharmacist interventions significantly reduced the number of DRPs at discharge compared with usual care.…”

“…Therefore, it is considered that the low incidence of new DRPs and resolution of potentially important DRPs during hospitalization in the intervention group might have contributed to the low acceptance rate of DRP interventions at discharge. DRPs have been associated with negative health outcomes, and it is anticipated that these pharmacist interventions and their high acceptance rates will improve clinical outcomes associated with anemia, diabetes, hyperlipidemia, hypertension, and secondary hyperparathyroidism in patients with CKD [10,32].…”

Clinical pharmacists’ interventions across German hospitals: results from a repetitive cross-sectional study

“…There are many studies about the impact of CPS, and especially for PI to reduce DRPs, ME or adverse drug events (ADE) [2,[17][18][19][20]. However, comparability is limited between these studies due to different definitions and methods and the lack of a standard denominator.…”

Pneumonia: Drug-Related Problems and Hospital Readmissions

“…In Ethiopia, the proportion of patients hospitalized for infectious diseases, and who also had DRPs, was 71.51% (123/172); of these, the unnecessary broad-spectrum antibiotic option ceftriaxone accounted for 44.77% [10]. Similarly, in a study in Spain, almost half (45.1%) of hospitalized patients suffered from DRPs [11]. Common DRPs associated with pneumonia include inappropriate antibiotic indications, prolonged antibiotic treatment, and overtreatment, which may lead to potential drug-drug interactions [12][13][14][15].…”