Date Published: January 18, 2019
Publisher: Public Library of Science
Author(s): João Paulo Vilela Rodrigues, Fabiana Angelo Marques, Ana Maria Rosa Freato Gonçalves, Marília Silveira de Almeida Campos, Tiago Marques dos Reis, Manuela Roque Siani Morelo, Andrea Fontoura, Beatriz Maria Pereira Girolineto, Helen Palmira Miranda de Camargo Souza, Maurílio de Souza Cazarim, Lauro César da Silva Maduro, Leonardo Régis Leira Pereira, John Rovers.
It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist’s activity can enhance drug therapy’s effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student’s t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was “untreated condition”. From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to “drug introduction” (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.
Inappropriate use of medication constitutes a major public health issue that negatively affects treatment response and increases costs regarding the management of drug-related problems (DRPs). DRP refers to drug treatment events which may interfere its results, being a frequent cause of morbidities, hospitalizations and mortality. They can be associated to aspects, such as indication need, treatment effectiveness, safety, which includes detection and prevention of adverse drug reactions, and drug therapy adherence [1,2].
We carried out a single-arm trial at the adult Neurology Unit of the General Hospital of Medical School of Ribeirão Preto, University of São Paulo, Brazil (HCFMRP-USP). HCFMRP-USP is a tertiary teaching hospital focused on teaching, researching, and assisting Brazilian Public Health System patients. Inpatients medical prescriptions, as well as their clinical and laboratorial information were accessed through the hospital’s eletronic information system. Regarding Neurology Unit, there are 26 beds for the hospitalization of adults with previously diagnosed neurological disease or for diagnostic investigation.
A total of 409 adults admitted to the Neurology Unit of HCFMRP-USP were followed up, with a mean age of 49.1 years (SD 16.5). Regarding gender, men composed 51.1% of the sample. Among all patients, 222 (54.3%) presented at least one DRP during the hospitalization period; adding up to 516 DRPs, a mean of 2.3 (SD 2.1) per patient, and a minimum and maximum value of one and 14, respectively.
DRP related to indication need were the most common, particularly those classified as “untreated condition” (26.9%). Untreated health problems potentially aggravate patient’s clinical condition, which may extend the length of hospitalization, consequently increasing the costs to the health system . Vitamins comprised the class of drugs involved in most PIs (9.1%), from which vitamin B12 was the drug most commonly associated with “drug introduction” PI (68.4%). Vitamin B12 deficiency triggers neuronal damage and neurological disorders, such as dementia and neuropathic pain [28,29]. Yi et al. carried out a study in a neurology unit of a tertiary teaching hospital—similar reality of the present study—that corroborated this finding. The authors found that the most frequent DRPs were related to vitamin B12 deficiency that causes hyperhomocysteinemia . Its early detection and treatment can prevent irreversible damage to the central nervous system, and the role of clinical pharmacist in promoting the adequate use of this vitamin is critical to the pharmacotherapy success. Interventions related to the introduction of pharmacological therapy were supported by laboratory tests, such as vitamin B12 and fasting plasma glucose, by clinical parameters, such as blood pressure values and/or by signs/symptoms indicating some untreated clinical condition. Seizures in patients with epilepsy are an example of clinical sign that may result in a “drug introduction” PI.
DRPs were quite prevalent in patients admitted to the Neurology Unit of HCFMRP-USP, especially among elderly patients and in the presence of politherapy. However, monitoring the patients clinical evolution and the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that contributed to the optimization of pharmacotherapy and was well accepted by physicians.