Which drugs cause treatment-related problems? Analysis of 10,672 problems within the outpatient setting

Ghaith M Al-Taani,1 Sayer I Al-Azzam,2 Karem H Alzoubi,2 Mamoon A Aldeyab3 1Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan; 2Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 3School of Pharmacy and Pharmaceutical Science, University of Ulster, Coleraine, County Londonderry, UK Background: Treatment-related problems (TRPs) may pose risks for patients if unaddressed. With the increased complexity of health care, it is important to target pharmacists’ efforts to patients that are at high risk for TRPs. Objectives: The present study aimed to identify medications most commonly associated with TRPs. Setting: Outpatient departments of five public and teaching hospitals in Jordan. Method: TRPs and drugs most commonly implicated with TRPs were assessed for patients recruited from outpatient clinics in five major hospitals in Jordan using a standardized and validated pharmaceutical care manual. Main outcome measure: Drugs associated with different types of TRPs. Results: Ultimately, 2,747 patients, with a total of 10,672 TRPs, were included in the study. The medication groups most commonly associated with TRPs were cardiovascular (53.0%), endocrine (18.1%), and gastrointestinal (7.7%) drugs. The most common specific drugs associated with TRPs from any category were atorvastatin (12.5%), metformin (8.5%), simvastatin (6.2%), and enalapril (5.9%). Cardiovascular medications were the most common drugs implicated with multiple subtypes of TRPs – most commonly, allergic reaction or undesirable effect (88.5%), drug product not available (87.3%), safety interaction issues (81.8%), a need for additional or more frequent monitoring (78.0%), and more effective drugs available (77.2%). Hypertension, diabetes mellitus, and dyslipidemia were the most common diseases associated with different subtypes of TRPs. Conclusion: The present study identified high-risk drugs for TRPs, which can be used as identification of targeting approach TRPs. Such an approach would improve care provided to patients and can inform health care policies. Keywords: drug related problems, drug therapy problems, high alert medication, Jordan, pharmaceutical care, treatment related problem

Prediction of drug-related problems in diabetic outpatients in a number of hospitals, using a modeling approach

Ghaith M Al-Taani,1 Sayer I Al-Azzam,2 Karem H Alzoubi,2 Feras W Darwish Elhajji,3 Michael G Scott,4 Hamzah Alfahel,5 Mamoon A Aldeyab6 1Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, 2Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 3Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan; 4Medicines Optimisation Innovation Centre, Pharmacy and Medicines Management Centre, Northern Health and Social Care Trust, Ballymena, Northern Ireland, UK; 5General and Specialized Surgery Department, Faculty of Medicine, Hashemite University, Zarqa, Jordan; 6School of Pharmacy and Pharmaceutical Science, University of Ulster, Coleraine, County Londonderry, UK Objective: Drug-related problems (DRPs) are considered a serious, expensive, and important undesirable complication of health care. However, as current health care resources are limited, pharmacist DRP services cannot be provided to all patients. Using a modeling approach, we aimed to identify risk factors for DRPs so that patients for DRP-reduction services can be better identified. Methods: Patients with diabetes from outpatient clinics from five key university-affiliated and public hospitals in Jordan were assessed for DRPs (drug without an indication, untreated indication, and drug efficacy problems). Potential risk factors for DRPs were assessed. A logistic regression model was used to identify risk factors using a randomly selected, independent, nonoverlapping development (75%) subsample from full dataset. The remaining validation subsample (25%) was reserved to assess the discriminative ability of the model. Results: A total of 1,494 patients were recruited. Of them, 81.2% had at least one DRP. Using the development subsample (n=1,085), independent risk factors for DRPs identified were male gender, number of medications, prescribed gastrointestinal medication, and nonadherence to self-care and non-pharmacological recommendations. Validation results (n=403) showed an area under the receiver operating characteristic curve of 0.679 (95% confidence interval=0.629–0.720); the model sensitivity and specificity values were 65.4% and 63.0%, respectively.Conclusion: Within the outpatient setting, the results of this study predicted DRPs with acceptable accuracy and validity. Such an approach will help in identifying patients needing pharmacist DRP services, which is an important first step in appropriate intervention to address DRPs. Keywords: medication-related problems, drug-related problems, pharmaceutical care, outpatient, diabetes&nbsp