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Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia.

ABSTRACT: ObjectivesPatients with diabetes are at high risk for polypharmacy (ie, use of multiple medications) for treatment of diabetes, associated comorbidities and other coexisting conditions. This study aims to estimate the prevalence of polypharmacy and factors associated with polypharmacy among adult patients with diabetes. METHODS:A cross-sectional retrospective observational study of adults with diabetes, who visited the outpatient clinic of a tertiary teaching hospital in Saudi Arabia, was conducted. Data were extracted from the Electronic Health Record database for a period of 12 months (January-December 2016). Polypharmacy was defined as the cumulative use of five or more medications. Polypharmacy among adults with diabetes was measured by calculating the average number of medications prescribed per patient. A multivariable logistic regression model was used to examine the factors associated with polypharmacy. RESULTS:A total of 8932 adults with diabetes were included in this study. Of these, nearly 78% had polypharmacy which was more likely among women as compared with men and more likely among older adults (age ≥60 years) as compared with the adults. Also, polypharmacy was two times as likely among patients with coexisting cardiovascular conditions (adjusted OR (AOR)=2.89; 95% CI 2.54 to 3.29), respiratory disease (AOR=2.42; 95% CI 1.92 to 3.03) and mental health conditions (AOR=2.19; 95% CI 1.74 to 2.76), and three times as likely among patients with coexisting musculoskeletal disease (AOR=3.16; 95% CI 2.31 to 4.30) as compared with those without these coexisting chronic conditions categories. CONCLUSIONS:Polypharmacy is common among patients with diabetes, with an even higher rate in older adults patients. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimens and minimising medications to enhance the outcome of diabetes care.

SUBMITTER: Alwhaibi M

PROVIDER: S-EPMC5988096 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesThe purpose of this study is to measure the adherence rates of oral antidiabetic drugs (OADs) in patients with type 2 diabetes mellitus (T2DM) and assess the relationship of glycaemic control and adherence to OADs after controlling for other associated factors.DesignCross-sectional retrospective study.SettingLarge tertiary hospital in the central region of Saudi Arabia.Participants5457patients aged 18 years and older diagnosed with T2DM during the period from 1 January 2016 to 31 December 2016.Primary and secondary outcome measuresThe modified medication possession ratio (mMPR) was calculated as a proxy measure for adherence of OADs. The factors associated with OADs non-adherence and medication oversupply were assessed using multinomial logistic regression models. The secondary outcomes were to measure the association between OADs adherence and glycaemic control.ResultsMajority of patients with T2DM were females (n=3400, 62.3%). The average glycated haemoglobin was 8.2±1.67. Among the study population, 48.6% had good adherence (mMPR >0.8) and 8.6% had a medication oversupply (mMPR >1.2). Good adherence was highest among those using repaglinide (71.0%) followed by pioglitazone (65.0%) and sitagliptin (59.0%). In the multivariate analysis, women with T2DM were more likely to have poor adherence (adjusted OR (AOR)=0.76, 95% CI=0.67, 0.86) compared with men. Also, medication oversupply was more likely among patients with hyperpolypharmacy (AOR=1.88, 95% CI=1.36, 2.63), comorbid osteoarthritis (AOR=1.72, 95% CI=1.20, 02.45) and non-Saudi patients (AOR=1.53, 95% CI=1.16, 2.01). However, no association was found between glycaemic control and adherence to OADs.ConclusionThe study findings support the growing concern of non-adherence to OADs among patients with T2DM in Saudi Arabia. Decision makers have to invest in behavioural interventions that will boost medication adherence rates. This is particularly important in patients with polypharmacy and high burden of comorbid conditions.

Project description:BackgroundAeromonas hydrophila can cause a wide range of diseases and is mainly found in patients with underlying diseases. Globally the data on Aeromonas infections is limited, and no studies have been published about the situation in Saudi Arabia. The aim of this study was to investigate the risk factors, clinical presentation, treatment, and outcomes of Aeromonas infections in Saudi Arabia.MethodsA retrospective study was performed at a tertiary university hospital with 1000 beds in Jeddah, Saudi Arabia. All patients 14 years and older with Aeromonas-positive cultures between January 1, 2015, and December 31, 2022 were included. Patient information was extracted from the electronic health records, including patient demographics, comorbidities, presenting symptoms, source of infection, human immunodeficiency virus status, culture results and antimicrobial susceptibility, use of immunosuppressive medication, and 30-day mortality.ResultsIn total 24 patients were identified with Aeromonas hydrophila-positive cultures, 22 of which were males (91.7%), and most (75%) had hospital-acquired infections. The 30-day mortality was 20.8%. All Aeromonas cultures were susceptible to gentamicin, cefepime, and ciprofloxacin, while the majority were resistant to ceftazidime (83.3%) and meropenem (62.5%). The most common disease presentation was skin and soft tissue infection (33.3%), the most common clinical sign was fever (58.3%), and the most common symptom was abdominal pain (37.5%). Comorbidities were very common (median 3, range 1-7). Pitt bacteremia score (p < 0.001), Charlson weighted comorbidity index (p < 0.02), international normalized ratio (p < 0.005), and the number of comorbidity factors (p < 0.05) were all associated with 30-day mortality due to Aeromonas infection. The number of comorbidities had the best predictive value (83.3%) of 30-day mortality (p < 0.05, Odds ratio 3.253, 95% confidence interval: 1.088-9.729).ConclusionsAeromonas hydrophila is an important pathogen to consider in nosocomial infections. The number of comorbidities had the best predictive value of 30-day mortality. The susceptibility pattern of this organism indicates that, in Saudi Arabia, when an Aeromonas infection is suspected, treatment with quinolone along with other broad-spectrum antibiotics should be started until the culture and susceptibility results are known.

Project description:BackgroundThis study aimed to determine the prevalence and associated factors of intestinal parasitic infections (IPIs) among patients referred from different primary healthcare centers (PHC) in Riyadh, Kingdom of Saudi Arabia.Material & methodsA cross-sectional retrospective study conducted at Riyadh Regional Laboratory (RRL). All stool samples that are requested for intestinal parasite detection by physicians from PHCs across the Riyadh Region during year 2020 are referred to the RRL. The data recorded included age, sex, nationality, PHC location, and the stool analysis result with the type of parasite detected.ResultsThe data of 1148 patients were collected and statistically analyzed. IPIs were present in 296 (25.8%) patients, among whom 40 were infected with more than one parasite. The rate of infection with intestinal protozoa (95.4%) was higher than that with intestinal helminths (4.6%). Sixty (17.4%) infections were caused by pathogenic intestinal parasites, including pathogenic protozoa and helminths. The most common pathogenic protozoa were Entamoeba histolytica/dispar, which represented 9.3% of all IPIs and 72.7% of infections caused by pathogenic protozoa. Saudi nationals were the predominant population infected with pathogenic protozoa (44.0%). Ascaris lumbricoides was the most common helminth infection (56.3%) among patients. Nonpathogenic IPIs were detected at a higher rate (82.6%) than pathogenic IPIs (17.4%), with the predominant protozoa being Blastocystis hominis (61.0%). A higher rate of IPIs was observed in expatriates than in Saudi nationals (229 [33.6%] vs. 67 [14.3%], respectively) (P = 0.0000).ConclusionsAmong the 12 different nationalities in our study cohort, the prevalence was the lowest in Saudi nationals (14.3%). The prevalence of B. hominis was high in all areas and nationalities, affecting all age groups among the patients referred for stool analysis. The implementation of preventive measures and awareness programs regarding sanitation and personal hygiene are needed.

Project description:ObjectivesDengue imposes substantial economic, societal and personal burden in terms of hospital stay, morbidity and mortality. Early identification of dengue cases with high propensity of increased hospital stay and death could be of value in isolating patients in need of early interventions. The current study was aimed to determine the significant factors associated with dengue-related prolonged hospitalisation and death.DesignCross-sectional retrospective study.SettingTertiary care teaching hospital.ParticipantsPatients with confirmed dengue diagnosis were stratified into two categories on the basis of prolonged hospitalisation (≤3 days and >3 days) and mortality (fatal cases and non-fatal cases). Clinico-laboratory characteristics between these categories were compared by using appropriate statistical methods.ResultsOf 667 patients enrolled, 328 (49.2%) had prolonged hospitalisation. The mean hospital stay was 4.88±2.74 days. Multivariate analysis showed that dengue haemorrhagic fever (OR 2.3), elevated alkaline phosphatase (ALP) (OR 2.3), prolonged prothrombin time (PT) (OR 1.7), activated partial thromboplastin time (aPTT) (OR 1.9) and multiple-organ dysfunctions (OR 2.1) were independently associated with prolonged hospitalisation. Overall case fatality rate was 1.1%. Factors associated with dengue mortality were age >40 years (p=0.004), secondary infection (p=0.040), comorbidities (p<0.05), acute kidney injury (p<0.001), prolonged PT (p=0.022), multiple-organ dysfunctions (p<0.001), haematocrit >20% (p=0.001), rhabdomyolosis (p<0.001) and respiratory failure (p=0.007). Approximately half of the fatal cases in our study had prolonged hospital stay of greater than three days.ConclusionsThe results underscore the high proportion of dengue patients with prolonged hospital stay. Early identification of factors relating to prolonged hospitalisation and death will have obvious advantages in terms of appropriate decisions about treatment and management in high dependency units.

Project description:BackgroundShift work and night shifts are very common in healthcare organisations worldwide. However, healthcare professionals doing shift work and night shifts are exposed to several stressors with psychological, social, physical and sleeping consequences. This study aimed to evaluate the effect of night shifts on the psychosocial, physical well-being and sleeping patterns of healthcare professionals in Saudi Arabia.MethodsWe conducted an observational cross-sectional study from July to September 2019 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Convenience sampling technique was used to recruit healthcare providers to participate in the study. The outcomes measured included the effect of working hours of healthcare workers on psychosocial and physical health, substance use, and sleep quality and patterns. Pearson's χ2 test was used to compare proportions, and Student's t-test/Analysis of variance (ANOVA) was used to examine the mean differences among different demographic groups.ResultsA total of 352 healthcare providers were involved in the study, of whom only 272 were night shift workers. The mean level of job satisfaction was higher among day shift workers than night shift workers: the mean scores were 3.82 (SD=0.93) and 3.48 (SD=1.04), respectively, p=0.007. Moreover, social life was more adversely affected among night shift workers compared with day shift workers: 3.95 (SD=1.11) and 3.61 (SD=1.25), respectively, p<0.030. Likewise, family life was more adversely affected among night shift workers than day shift workers, with a mean of 3.92 (SD=1.10) and 3.50 (SD=1.21), respectively, p<0.006. Around 71% of night shift workers reported having poor-quality sleep compared with 50% of day shift workers (p=0.001).ConclusionQuality of life is poor among night shift workers than day shift workers, particularly concerning sleep and social and physical outcomes. Further research is needed to investigate factors associated with the quality of sleep and the psychosocial and physical well-being of healthcare professionals working night shifts.

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Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia.

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