Epidemiology and potential risk factors of drug‐related problems in Hong Kong paediatric wards

Abstract

A drug-related problem (DRP) is 'an event or circumstance involving drug therapy that actually or potentially interferes with the desired health outcome'. The extent and characteristics of DRPs in children in Hong Kong are unknown. The aim of this study was to determine the epidemiology of and identify risk factors for DRPs in hospitalized children in Hong Kong. METHODSThis was a prospective cohort study in children aged 0-18 years who were admitted to a medical ward, paediatric intensive care unit or neonatal intensive care unit of seven Hong Kong hospitals, during a 3 month period. Patients' charts, medical records and laboratory data were reviewed daily to identify DRPs; their preventability and severity were assessed. Logistic regression was used to analyse potential risk factors associated with the incidence of DRPs. RESULTSThree hundred and twenty-nine children (median age, 2 years; interquartile range, 0 months to 9 years) were included. In total, 82 DRPs were experienced by 69 patients. The overall incidence of DRPs was 21.0% (95% confidence interval, 16.7-25.8%). The incidence was higher in neonatal and paediatric intensive care units than medical wards. Dosing problems were the most frequently reported DRPs (n = 35; 42.7%), followed by drug choice problems (n = 19; 23.2%) and adverse drug reactions (n = 11; 13.4%). Sixty-seven (81.7%) DRP cases were assessed as preventable, 42 (51.2%) as minor and 40 (48.8%) as moderate. The number of prescribed drugs and 'certain infectious and parasitic diseases' were potential risk factors for occurrence of DRPs. CONCLUSIONSDrug-related problems were common in hospitalized children in this study in Hong Kong; the most frequent were dosing and drug choice problems, and the majority of them were preventable. Polypharmacy and 'certain infectious and parasitic diseases' were potential risk factors. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• The incidence of drug-related problems (DRPs) in hospitalized paediatric patients from countries other than Hong Kong is as high as 45.2%.• Dosing and drug choice problems are the most frequent DRPs in children.• There is no published research regarding the incidence and nature of DRPs in Hong Kong hospitalized children. WHAT THIS STUDY ADDS• The incidence of DRPs is as high as 21.0% (95% confidence interval, 16.7-25.8%) in children hospitalized in Hong Kong.• Of the DRPs in hospitalized children in Hong Kong, 81.7% were deemed preventable.• The number of prescribed drugs per patient (five or more) and 'certain infectious and parasitic diseases' increased the risk of occurrence of DRPs.

Assessment of drug-related problems in pediatric ward of Zewditu Memorial Referral Hospital, Addis Ababa, Ethiopia

“…A higher incidence was reported in UK and the Kingdom of Saudi Arabia study with 45.2% incidence within the same population of pediatric patients [20]. From the total incidence identified in this study, the percentage of male patients with DRPs was higher than of female patients(54.4 vs. 45.6%), although the difference was not significant (COR 1.5, 95% CI 0.9, 2.6, P = 0.089), and this finding is in agreement with the Hong Kong study [19]. …”

“…The incidence of DRPs in this study was 31.57% notably higher than an incidence reported in a Hong Kong study of 21.0% [19]. This difference may be due to differences in hospital settings including composition of healthcare workers, training levels of prescribers, presence or absence of support system, and difference in the definition of DRPs.…”

“…Similarly, anti-infectives were the most common classes of drugs involved in DRPs in other studies from Hong Kong [19] and UK [20]. Anti-infectives are used in very high numbers in the pediatric ward of ZMRH as most of the admitted patients were diagnosed with infectious diseases, as presented in Fig.…”

“…However, in multivariate logistic regression both poly-pharmacy and number of disease conditions were found to be independent predictors of DRPs in the pediatric ward of ZMRH. Other published findings also report on the number of drugs (≥5) taken by a patient as an important risk factor for the occurrence of DRPs [6, 19, 20]. The more complex drug therapy leads to a higher risk of experiencing DRPs such as adverse effects, drug–drug interactions, medication errors, and non-adherence.…”

Clinical Outcomes of Drug-related Problems in Saudi Arabia: Patients’ and Healthcare Providers’ Perspective

“…That has included a visit the doctor at ambulatory care clinic or emergency visit, hospital admission, or critical care admission or death. [3][4][5][6][7][8][9][10][11] Most of the studies done retrospective or perspective with follow up. There's not involved the patient respective and view.…”