3 research outputs found
Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal
Objective: To study the impact of educational
intervention on the pattern and incidence of
potential drug-drug interactions (DDIs).
Method: All patients admitted to Internal Medicine
wards of Manipal Teaching Hospital during the
study period were included. Patient details were
collected using a patient profile form and the datum
from the filled forms was analyzed using
Micromedex electronic database. An intervention
was carried out through a presentation during
clinical meeting and personal discussion. The target
groups for the intervention included doctors and the
nurses.
Results: Altogether 435 patients during
preintervention and 445 during postintervention
were studied. The incidence of potential DDIs was
53% (preintervention) and 41% (postintervention)
[chi-square =11.27, p=0.001]. The average number
of drugs per patient was 8.53 (pre-intervention) and
7.32 (post-intervention) [t=3.493, p=0.001]. Sixtyfour
percent of the potential DDIs were of
�Moderate� type and 58% had a �Delayed� onset in
both the phases. Seventy percent of the potential
DDIs during the pre-intervention phase and 61%
during post-intervention phase had a �Good�
documentation status. Pharmacokinetic mechanism
accounted for 45% of the potential DDIs during preintervention
and 36% in the post-intervention phase.
Cardiovascular drugs accounted for 36% of the
potential DDIs during pre-intervention and 33.2%
during post-intervention phase. Furosemide was the
high risk drug responsible for DDIs in both phases.
The most common potential DDIs observed were
between amlodipine and atenolol (4.82%)
(preintervention) and frusemide and aspirin (5.20%)
(postintervention).
Conclusion: There was an association between
potential DDIs and age, sex, and polypharmacy.Objetivo: Estudiar el impacto de una intervención
educativa en el esquema y la incidencia de las
interacciones medicamentosas potenciales (DDI).
Método: Se incluyó a todos los pacientes que
visitaron el servicio de medicina interna del
Hospital Universitario de Manipal. Los detalles de
los pacientes se recogieron utilizando un formulario
de perfil de paciente y los datos fueron analizados
utilizando la base de datos electrónica Micromedex.
Se realizó una intervención mediante una reunión
clínica y discusión personal. El grupo diana eran
los médicos y los enfermeros.
Resultados: Se estudiaron 435 pacientes durante la
pre-intervención y 445 durante la post-intervención.
Las incidencia de DDI potenciales fue del 53%
(pre-intervención) y 41% (post-intervención) [chi
cuadrado=11,27, p=0,001]. La media de
medicamentos por paciente fue de 8,53 (preintervención)
y 7,32 (post-intervención) [t=3,493,
p=0,001]. El 64% de las DDI potenciales eran de
tipo �Moderadas� y el 58% tenía una iniciación
�Retrasada� en ambas fases. El 70% de las DDI
potenciales durante la fase de pre-intervención y el
61% en la post-intervención tenían un estado de
documentación �Bueno�. Mecanismos
farmacocinéticos contabilizaron el 45% de las DDI
potenciales durante la pre-intervención y el 36 en la
post-intervención. Los medicamentos
cardiovasculares sumaron el 36% de las DDI
potenciales durante la pre-intervención y el 33,2%
en la post-intervención. La furosemida fue el de
mayor riesgo de DDI en las dos fases. La DDI
potencial más comúnmente observada en la preintervención
fue entre amlodipino y atenolol
(4,82%), y en la post-intervención fue entre
furosemida y aspirina (5,29%).
Conclusión: Existía una asociación entre DDI
potencial y edad, sexo y polimedicación
Health system gaps in cardiovascular disease prevention and management in Nepal
BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal's health systems gaps to prevent and manage CVDs. METHODS: We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts' codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. RESULTS: National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. CONCLUSION: Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.</p