EVALUATION OF DRUG THERAPY PROBLEMS IN ASTHMA PATIENTS RECEIVING CARE IN TWO HOSPITALS IN SOUTH-EASTERN NIGERIA
Objective: To evaluate drug therapy problems in asthma patients visiting a secondary and tertiary hospital in South-Eastern Nigeria.
Methods: This study was a retrospective, cross-sectional analyses of the medical records of adult asthmatic patients receiving care in two hospitals in Enugu State, within a 15-year period. The Pharmaceutical Network Care Europe (PCNE) tool version 6.2 was used to assess drug therapy problems. The IBM Statistical Product for Services Solution (SPSS) version 20.0 was used for analysis. For all results, P â‰¤ 0.05 was considered statistically significant.
Results: Majority of the patients were below 60 y old (81.2%); female (68.8%) and were on more than two drugs (95.3%). Majority of the identified drug therapy problems (DTPs) were adverse reactions (65.7%). The inappropriate drug combination was the major cause of DTPs (65.6%). Only about 23.4% of the intervention outcomes were known. University of Nigeria Teaching Hospital (UNTH) had more interventions (35.9%) than Medical Centre (8.0%) (Ï‡2 = 6.323; df = 1; **P = 0.012); and more of the outcomes of their interventions known (38.5%) compared to Medical Centre (0.0%) (Ï‡2 = 12.559; df = 1; **P Ë‚ 0.001).
Conclusion: Adverse reactions and inappropriate drug selection were the major identified DTPs and major cause of DTPs, respectively. Most DTPs had no interventions. The documented interventions included stopping of the drugs, change of drugs or dosage, change of instructions for use and starting of new drugs. Most interventions had unknown outcomes. UNTH had more interventions with known outcomes than the University of Nigeria Medical Centre.
2. Global Initiative for Asthma. Pocket guide for Physician and Nurses 2014. Based on Global Strategy for Asthma Management and Prevention; 2014. Available from: http://www.ginasthma.org. [Last accessed on 12 Aug 2017]
3. Centres for Disease Control and Preventions (CDC), National Asthma Control Programs, Asthma Fast Facts; 2016. Available from: http://www.cdc.gov/asthma//asthma-fast-fact. [Last accessed 09 Mar 2017]
4. Global Asthma Network (GAN). The Global Asthma Report: Asthma in Lowâ€“and Middleâ€“Income Countries; 2014. Available from: http://www.globalasthmareport.org/ [Last accessed 07 Mar 2017]
5. Roti. At least 15 million Nigerians are suffering from Chest related Diseases-Expert. Information Nigeria; 2012. Available from: https://www.informationng.com/2012/12/at-least-15-million-Nigerians-are suffering-from-chest-relted-diseases-expert.html. [Last accessed on 19 Apr 2017]
6. Robert JC, Linda MS, Peter CM. Chapter 5: Drug Therapy Problems. Available from: http://accesspharmacy. mhmedical.com/book.aspx?bookid=491. [Last accessed on 24 Apr 2017]
7. Pharmaceutical Care Network Europe Foundation. PCNE Classification for Drug-Related (revised 14-01-10 vm) V6.2; 2010. Available from: http://www.pcne.org/workinggroups/ 2/drug-related-problems. [Last accessed on 25 Apr 2016]
8. Khan AU, Ali I, Zafar R, Khalil A. Identification of drug-related problems and pharmacistâ€™s interventions in asthmatic patients at a private tertiary care facility-Pakistan. J Res Pharm Pract 2015;6:33-7.
9. Nascimento YA, Carvalho WS, Acurcio FA. Drug-related problems observed in a pharmaceutical care service, problems observed in a pharmaceutical care service, Belo Horizonte, Brazil. Braz J Pharm Sci 2009;45:321-30.
10. Root R, Phelps P, Brummel A, Else C. Implementing a pharmacist-led medication management pilot to improve care transitions. Innovations Pharm 2012;3:2.
11. Ganiyu KA, Akinleye MO, Fola TA. Study of the effect of ascorbic acid on the antiplasmodial activity of artemether in plasmodium Berghei infected mice. J Appl Pharm Sci 2012;2:96-100.
12. Casella S, Giudice E, Giannetto C, Marafioti S, Piccione G. Effects of hydrocortisone and aminophylline on the aggregation of equine platelets in vitro. J Vet Sci 2011;12:215-9.
13. Vervolet D, Durham S. Adverse reactions to drugs. Br Med J 1998;16:1511-4.
14. Cokaric M, Popovic SG, Bacic VV. Asthma therapy-related problems in adult mediterranean croatian patients. World J Pharm Sci 2015;2:2321-3310.
15. Rina A, Eff Y. The incidence of hypertension in asthma patients who treated with beta-2 agonists bronchodilators. Int J Pharm Pharm Sci 2017;9:181-4.
16. Rahmawati F, Pramantara DP, Rohmah W, Sulaiman SAS. Polypharmacy and unnecessary drug therapy on geriatric hospitalized patients in yogyakarta hospitals, Indonesia. Int J Pharm Pharm Sci 2009;1:6-11.
17. Muthukumar A, Sundara GR. A prospective clinical study on disease knowledge and medication adherence pattern among asthmatic patients in tertiary care hospital in a tirupur population. Asian J Pharm Clin Res 2017;10:388-91.
18. Sari CP, Hakim L, P Putu DI. Role of pharmacist in counselling asthma to improve patient adherence in Yogyakarta. ICPPS; 2017. p. 16-20.
19. Odili VU, Egiebor BO, Oparah AC. Identification of drug therapy problems in patients with diabetes treated in a secondary care facility in Benin city. Nig J Pharm Res 2011;9:72-81.
20. Blix HS, Viktil KK, Reikvam S, Moger TA, Hjemaas BJ, Pretsch P, et al. Walseth the majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol 2004;60:651-8.
21. Suleiman IA, Eniojukan JF, Eze I. Evaluating pharmaceutical care documentation among pharmacists in Nigeria. West Afr J Pharm 2012;23:69-76.
22. Lewis C, Humphreys E, Chisholm A, Carter V, Price D. Evidence of poor prescribing in asthma care. Respiratory Effectiveness Group Asia-Pacific summit, Singapore. Analysis conducted by Asthma UK using an Optimum Patience Care Research Database (www.optimumpatientcare.org), supplied through the Respiratory Effectiveness Group (www.effectiveness evaluation.org) initiative; 2015.
23. Richards M, Espitalier-Noel D, Stacey H, Thomerson J, Butt T. Poor drug history documentation in admission medical notes: clerking prompts and junior doctor education alone do not significantly reduce errors. Acute Med 2015;14:104-10.
24. Yusuff KB, Tayo F, Aina BA. Pharmacistsâ€™ participation in the documentation of medication history in a developing setting: an exploratory assessment with new criteria. J Pharm Pract 2010;8:139-45.