Magnitude and determinants of drug therapy problems among type 2 diabetes mellitus patients with hypertension in Ethiopia

Abstract

Introduction: Type 2 diabetes mellitus patients with hypertension are at high risk of drug therapy problems since they are subject to receive multiple drug therapies due to comorbidities. Objectives: To determine the magnitude of drug therapy problems and its determinants among Type 2 diabetes mellitus patients with hypertension. Methods: A cross-sectional study was employed among 423 randomly selected participants based on the inclusion criteria. A structured questionnaire and review of patients’ medical record were employed in the data collection. The classification system used by Cipolle was used to classify and evaluate drug therapy problems. Data were analyzed using Statistical Package for the social sciences version 25.0 software. Multivariate logistic regression analysis was used to identify determinants of drug therapy problems with a statistical significance of p ⩽ 0.05. Results: A total of 491 drug therapy problems with a mean of 1.86 ± 0.53 drug therapy problems per patient were identified, and 62.4% (264) of them experienced at least one drug therapy problem. Non-compliance (197, 40.1%), needs of additional drug therapy (119, 24.2%), and dosage too low (91, 18.5%) were the most frequently observed drug therapy problems in the study setting. Anti-diabetic medications (88.4%), statins (44.5%), and aspirin (33.5%) were the most commonly involved drugs in drug therapy problems. The determinants of drug therapy problems were very low family income (adjusted odds ratio = 4.64, p = 0.010), age (45–65 years old) (adjusted odds ratio = 2.55, p = 0.008), presence of comorbidity (adjusted odds ratio = 9.19, p < 0.001), and taking ⩾5 medications (adjusted odds ratio = 2.84, p = 0.001). Conclusion: Approximately three out of five patients had one or more drug therapy problems encountered. In this study, the most common types of drug therapy problems were non-compliance, needs additional drug therapy, and dosage too low. Family monthly income, age, comorbidities, and number of medications were the significant determinants of drug therapy problems. Therefore, patient education regarding medication adherence, routine medication review, and strengthening clinical pharmacy services should be promoted.

Prevalence and factors associated with drug therapy problems among hypertensive patients at hypertension clinic of Mbarara Regional Referral Hospital, Uganda: a |cross-sectional study

“…The study by Kefale et al . 26 had 100% patients having both hypertension and diabetes mellitus, whereas our study had only 32.5% having both conditions. The high proportion of ‘dosage too low’ in our setting could be attributed to prescribing an ineffective dose and too infrequent dosing.…”

“…The current prevalence of antihypertensive-related DTPs of 61.8% is comparable to other studies in Northwest, Ethiopia (62.4%), Eastern Ethiopia (60.5%), Northern Ethiopia (55.6%) and Indonesia (57%). 7 , 14 , 26 , 34 However, this finding is lower than 71.2% and 80.7% both in Eastern Ethiopia as well as 82% in Southwest Ethiopia. 15 , 19 , 25 In addition, studies conducted in Malaysia showed that 88.8% and 90.5% participants had at least one DTP.…”

“…16 However, this finding was different from 5.4% and 23.4% among adults above 65 years reported by Weldegebreal et al . 14 and Kefale et al 26 respectively.…”

“…35 , 37 , 38 Furthermore, the dosage too low in our study is also higher than 18.5% and 16.8% in two studies conducted in Ethiopia. 14 , 26 The discrepancy in findings could be due to variations in study population and medical practitioner’s expertise and experience. The study by Kefale et al .…”

The Impact of Insulin Staging in the Context of Pharmaceutical Care on Patients with Type 2 Diabetes Mellitus

“…These results are in contrast with previous studies in which most of the DTPs were ascribed to patients’ non-compliance towards medications. 25 Two points are emerging here, firstly, the lack of a unified insulin regimen, and secondly, underrating the problems related to indication and effectiveness categories hurdle the patients to achieving a desired therapeutic outcome.…”