RESEARCH: Drug related problems in admitted geriatric patients
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In developing countries including Ethiopia, life expectancy is increasing. This is partly as a result of increased healthcare seeking behavior in the society and increased access to health service [1, 2]. Related to this, population aging has resulted in an increased prevalence of chronic diseases and thus rise in hospitalisations and healthcare costs of older adults [3].
The geriatric population is at high risk of drug related problems (DRPs) due to the age-related pharmacokinetic and pharmacodynamic changes [4]. Furthermore, a higher incidence of drug related problems could result from age associated increased prevalence of multiple chronic diseases, which causes the use of complex therapeutic regimens [5]. According to pharmaceutical care network of Europe (PCNE), DRP is defined as, “an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes” [6]. DRPs are associated with increased healthcare costs and hospital admissions, prolonged hospital stays, reduced quality of life, and increased mortality [7, 8]. Therefore, drug prescribing and use in older patients needs special considerations including avoidance of inappropriate drugs, rational utilisation of indicated medications, side effects monitoring, prevention of drug-drug interactions, and evaluation of adherence and patient involvements [9].
The identification, resolution, and prevention of DRPs have been described as a core process of pharmaceutical care. Clinical pharmacists are suitably trained to carry out medication reviews in geriatric patients and have been found to improve the use of high-risk medications and improve the accuracy of medication regimens [10, 11]. In order to resolve DRPs, the cause should be identified and DRPs should be classified appropriately. For such purpose, the classification of DRPs is crucial. There are several classifications for DRPs. However, there is no single standardised classification in the world [12]. The PCNE classification system is commonly practiced and has better usability and internal consistency as it is updated and revised periodically. It is very important for the documentation of DRPs in the pharmaceutical care process [13].
Ethiopia is the second from the top six countries, in which life expectancy and the number of geriatric population is increasing [14] however, there is limited attention for these older patients. Most of the health sciences training programs didn’t include gerontology training in their curriculum and there is no guideline that focuses on geriatric medicine. At the hospital level, geriatric wards are not established for these special populations.
As with other health care services, geriatrics care requires health care professional team work including clinical pharmacists. Experience from developed nations has shown involving clinical pharmacist in patient care resulted in a reduction of DRPs as well as associated costs [15, 16]. Despite the good start up including patient-oriented pharmacy curriculum, clinical pharmacy service is still at the infant stage in Ethiopia. With poor involvement of clinical pharmacists on geriatric care, there is limited information on magnitude of DRPs, determinant factors and clinical pharmacist’s interventions among geriatric patients in hospital set up. Therefore, this study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimisation.
Background
Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs. This study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization.
Methods
A prospective interventional study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems.
Results
A total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identified and 670 interventions were provided. For the clinical pharmacist interventions, the prescriber acceptance rate was 91.7%. Significant determinants for drug related problems were polypharmacy (adjusted odds ratio [AOR] = 4.350, 95% C.I: 1.212–9.260, p = 0.020) and number of comorbidities (AOR = 1.588, 95% C.I: 1.029–2.450, p = 0.037).
Conclusions
Drug related problems were substantially high among geriatric inpatients. Patients with polypharmacy and co-morbidities had a much higher chance of developing DRPs. Hence, special attention is needed to prevent the occurrence of DRPs in these patients. Moreover, clinical pharmacists’ intervention was found to reduce DRPs in geriatric inpatients. The prescriber acceptance rate of clinical pharmacists’ intervention was also substantially high.
Hailu, B.Y., Berhe, D.F., Gudina, E.K. et al. Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions. BMC Geriatr 20, 13 (2020). https://doi.org/10.1186/s12877-020-1413-7
