Predictors of Medication-Related Emergency Department Admissions Among Patients with Cardiovascular Diseases at Mbarara Regional Referral Hospital, South-Western Uganda

Abstract

Background Medication-related emergency department admissions impose a huge and unnecessary burden on the healthcare system. We sought to determine the prevalence and predictors of medication-related emergency department admissions, among patients with cardiovascular diseases at Mbarara Regional Referral Hospital, Uganda. Methods Institutional research ethics approval was secured to conduct a cross-sectional study at the Mbarara Regional Referral Hospital emergency department, between February and September, 2020. All eligible and consenting patients were enrolled in a consecutive manner after a preliminary diagnosis was made by the attending physician. Structured questionnaire interview and comprehensive medication history reviews were used to identify medication therapy problems, in collaboration with a resident physician present on duty. We used sequential categorization for medication therapy problem(s). Descriptive and logistic regression analyses were used to determine prevalence and predictors of medication-related emergency department admissions. Results Out of the 128 patients interviewed, 105 (82%) patient admissions were associated with a medication therapy problem: ineffectiveness of drug therapy (53.3%, 56), medication non-adherence (42.9%, 45), and adverse drug reactions (3.8%, 4). Out of a total of 90 incidences of medication non-adherence, 34.4% (31/90) were due to lack of understanding of patient medication regimen, and 27.8% (25/90) due to unaffordable cost of medicines. Female gender (AOR = 4.31 [1.43, 13.03 at 95% CI]; P -value = 0.010]) and a history of tobacco use (AOR = 9.58 [1.14, 80.28 at 95% CI]; P -value = 0.037) were statistically significant predictors of medication-related emergency department admissions in adjusted analysis. Conclusion Four in five emergency department admissions were associated with medication-related causes, majorly due to ineffectiveness of drug therapy. Knowledge gap on patient medication regimens was the most prevalent cause for medication non-adherence. Female gender and previous or current tobacco use was an independent risk factor for medication-related admissions.

Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors

“…Other studies among admitted elderly patients have reported cardiovascular drugs, nervous system agents and anti-infective agents as the cause of ADRs. 11 , 12 A study in Uganda by Kiguba et al 17 reported herbal medicines to be linked to hospital-acquired ADRs. The Uganda treatment guidelines require that misoprostol is administered from a hospital setting; however, it is a common practice for patients to self-medicate with misoprostol to initiate abortion before seeking professional care which causes adverse events such as incomplete abortion, failed abortion, missed abortion, severe anaemia, haemorrhagic shock, sepsis, ectopic pregnancy and ruptured uterus 26 requiring hospital admissions.…”

“… 6 , 10 Recent studies in Uganda among the admitted elderly implicate cardiovascular drugs, nervous system agents and anti-infective agents as the common cause of ADRs. 11 , 12 Self-medication has been highlighted to be associated with ADR-related hospitalization in HIC 13 , 14 ; however, such data are scarce in Sub-Saharan Africa (SSA) where self-medication is rampant.…”

“…Being a woman, higher number of administered drugs, comorbidities and the use of antiretroviral therapy are associated with ADR-related hospital admissions in South Africa. 15 Studies conducted in Uganda have reported female gender and history of tobacco use as predictors of medication-related emergency admission among cardiovascular disease patients 12 ; being aged 19–59 years, herbal medicine use, polypharmacy and drug-drug interactions are associated with ADRs among heart failure patients 16 ; and preadmission use of herbal medicines and treatment with six or more conventional medicines during hospitalization are the common risk factors for hospital-acquired suspected ADRs. 17 These studies document the epidemiology of hospital-acquired ADRs and ADRs in the elderly who do not represent the general population.…”

“… 17 These studies document the epidemiology of hospital-acquired ADRs and ADRs in the elderly who do not represent the general population. 11 , 12 , 15 – 17 Thus, the burden and associated factors of ADRs linked to hospital admission are not well investigated among inpatients in SSA, particularly in Uganda, where the risk of ADR-related hospitalizations could be heightened by the colliding epidemics of infectious and non-infectious diseases. 18 This study sought to determine the burden, characteristics, contributing factors and patient outcomes of ADRs documented as the primary diagnosis linked to hospital admission among adult inpatients at a tertiary care hospital in Uganda.…”