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Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort.

ABSTRACT: OBJECTIVES:To evaluate the incidence and types of drug-related problems (DRP) in a general teaching hospital and to evaluate the acceptability of pharmaceutical interventions by the medical team. DESIGN:Prospective cohort study during 2 years. SETTING:Conducted in a Brazilian University Hospital. PARTICIPANTS:The patient cohort consisted of 9303 patients with a total of 12?286 hospitalisation episodes. PRIMARY OUTCOME MEASURES:DRP detected by pharmacists' review of 100% medication orders using Pharmaceutical Care Network Europe 6.2 classification. RESULTS:Patients with a mean age of 52.6±17.7 years and 50.9% females. A total of 3373 DRP in 1903 hospital episodes were identified, corresponding to a cumulative incidence of 15.5%. 'Treatment ineffectiveness' (11.5%) and 'Treatment costs' (5.90%) were the most common DRP and 'Drug use process' (18.4%) and 'Treatment duration' (31.0%) the main causes of DRP. The medicines involved most often involved in DRP were anti-infectives (36.0%), mainly cephalosporins (20.2%), antiulcer (38.6%), analgesics/antipyretics (61.2%), propulsives (51.2%), opioids (38.5%) and antiemetics (57.4%). From 1939 pharmaceutical interventions, at least, 21.4% were not approved by the medical team. CONCLUSION:DRP detected by 100% medication order review by hospital pharmacists occur in a significant proportion of hospital episodes, the most frequent being related to treatment effectiveness and treatment costs. The medications mostly involved were cephalosporins, penicillins, antidyspeptics, analgesics, antipyretics, opioids and antiemetics. Pharmaceutical interventions had low acceptability by the medical staff.

SUBMITTER: Saldanha V

PROVIDER: S-EPMC7204863 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort.

Saldanha Valdjane V Randall Martins Rand R Lima Sara Iasmin Vieira Cunha SIVC Batista de Araujo Ivonete I Gouveia Oliveira Antonio A

BMJ open 20200423 4

<h4>Objectives</h4>To evaluate the incidence and types of drug-related problems (DRP) in a general teaching hospital and to evaluate the acceptability of pharmaceutical interventions by the medical team.<h4>Design</h4>Prospective cohort study during 2 years.<h4>Setting</h4>Conducted in a Brazilian University Hospital.<h4>Participants</h4>The patient cohort consisted of 9303 patients with a total of 12 286 hospitalisation episodes.<h4>Primary outcome measures</h4>DRP detected by pharmacists' revi ...[more]

PMID: 32332007

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Project description:OBJECTIVE:To identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients. METHODOLOGY:Prospective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample. RESULTS:The study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%. CONCLUSION:This study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice.

Project description:BackgroundNon-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements.MethodsWe systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality.ResultsOur review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness.ConclusionsOverall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base.

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Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort.

Publications

Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort.

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