Determination of Drug-related Problems Among Type 2 Diabetes Outpatients in a Hospital in Vietnam: a Cross-sectional Study
Duong Thi Ly Huong, Nguyen Thanh Hang, Nguyen Khanh Ly, Nguyen Hong Nhat, Nguyen Thi Lan Huong, Le Thi Phuong Hue, Dang Thi Lan Anh, Bui Thi Kim Dung, Phung Minh Phuong, Luong Thuy Lan, Truong Thanh Tung, Nguyen Ngoc Hieu, Ngo Hai Ly
Abstract
Introduction
Drug-related problems (DRPs) are common in clinical practice and occur at all stages of the medication process. The major factor contributing to DRPs is prescription, although patients’ poor adherence to treatment is also a significant factor. This study evaluated type 2 diabetes outpatients in a hospital in Vietnam for drug-related problems (DRPs) and related variables.
Methods
A cross-sectional descriptive study was conducted on 495 outpatients who met the criteria and 157 people agreed to participate in the interview. Medication order review and medication adherence review were used to identify DRPs. The types of DRP were based on the Pharmaceutical Care Network Europe (PCNE) categories version 9.0. The identification and assessment DRPs were carried out by clinical pharmacists and get agreed upon by physicians who had not directly prescribed patients who participated in the study.
Introduction
A drug-related problem (DRP) is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes [1]. It has become a major challenge for healthcare systems due to their clinical and economic impact. The estimated annual cost of drug-related morbidity and mortality in the US was $528.4 billion, equivalent to 16% of total healthcare expenditures in 2016 [2]. Fortunately, half of them are potentially preventable [3]. Pharmacists play an important role in reducing DRPs by identifying and addressing them through a systematic medication review process. A study in Japan found that the potential cost savings from 2376 pharmaceutical interventions for 1678 drugs amounted to $2,657,820 with an average cost savings of $1511.0 per case of up to USD 2,657,820 [4]. The incidence of DRPs varied among studies, ranging from 8.54 to 99.16% and the average number of DRPs per patient ranged from 0.58 to 7.2 [5]. Treatment problems leading to DRP were mainly classified into two primary domains (effectiveness and safety), being treatment safety the most frequent problem [5]. The causes of DRPs were mainly in the prescribing section, including “drug selection” and “dose selection”, while patients’ poor adherence in the use section was also an important cause of DRPs [5]. Comorbidities and polypharmacy were considered as main factors associated with the occurrence of drug therapy problems [6–8].
Materials and methods
Study design, setting, and population
A cross-sectional analysis of patients receiving diabetes care at Thanh Nhan Hospital between December 12, 2022, and January 12, 2023, satisfied the following inclusion and exclusion criteria:
Inclusion criteria.
In order to participate in the study, participants must be at least 18 years old, have type 2 diabetes, be getting outpatient treatment, have fasting blood sugar (FBG) and glycated hemoglobin (HbA1C) tests, be taking diabetes medication, and have obtained consent.
Exclusion criteria.
Pregnant women and those who experienced an emergency requiring hospitalization are excluded.
All patients who satisfied the aforementioned requirements had their prescriptions gathered in templates. Patients who agreed to be interviewed would be questioned in accordance with a questionnaire that the study team had created.
Results
Demographic characteristics
A total of 495 T2DM patients fulfilled the inclusion and exclusion criteria for the study, while only 157 individuals (accounting for 31.72%) accepted the interview. The mean age of patients was 67.18 ± 9.88 years old, with the minimum and maximum years of age being 18 and 94, respectively. Most of the people (80%) were older than 60 years old. Females (57.2%) was higher than male (42.8%). The median time of diabetes was 10 years with a minimum and maximum year of 0 and 33, respectively. There was a new case of diabetes in this study. The majority of patients (97.7%) were diagnosed with both diabetes and hyperlipidemia, while 65.8% of patients had diabetes and hypertension concomitantly. The proportion of comorbidity in this study is rather high, with 89.3% of patients being diagnosed with three or more diseases and only two people got one disease. The average number of drug described among the population was 3.92±1.28 drugs. 148 patients (29.9%) received polypharmacy with five or more drugs concurrently per prescription (Table 2 and Fig 1).
Discussion
Unsafe medication use and medication errors are leading causes of injury and avoidable harm all over the world. Reducing the level of severe, avoidable medication-related harm by 50% over 5 years globally was the goal of the Global Patient Safety Challenge 2017 [22]. Among the various types of medication errors, prescription errors showed the highest number of cases (51%) [23]. A medication review is a systematic assessment of a patient’s medication management to optimize the quality of the use of medicines and minimize medication-related problems [21]. The Australian National Safety and Quality Health Service Standards describe three types of medication reviews: i) Prescription or medication order review: a review of individual medication orders and/or prescription validity; ii) Concordance or medication adherence review: a review of a patient’s medicine-taking behavior, iii) Clinical medication review: a comprehensive review of a patient’s medicines in the context of their clinical conditions [21]. This article conducted a prescription review and patient adherence review to determine drug-related problems in prescribing and patient administration procedures.
Conclusion
The study was conducted on 495 diabetes mellitus outpatients in Thanh Nhan hospital in Vietnam and identified 1174 DRPs in both prescribing orders and patients’ interviews. There was a close association between age, duration of diabetes, polypharmacy, cormobidity, lack of knowledge, and the occurrence of DRPs. “Inadequate knowledge” was a main patient-related factor associated with DRPs, especially related to occurring adverse drug events. Interventions aim to improve the knowledge of patients, which is the clinical pharmacist’s cornerstone mission in the next period.
Citation: Huong DTL, Hang NT, Ly NK, Nhat NH, Huong NTL, Hue LTP, et al. (2023) Determination of drug-related problems among type 2 diabetes outpatients in a hospital in Vietnam: A cross-sectional study. PLoS ONE 18(8): e0289825. https://doi.org/10.1371/journal.pone.0289825
Editor: Mohammad Nusair, Nova Southeastern University / Yarmouk University, UNITED STATES
Received: April 27, 2023; Accepted: July 25, 2023; Published: August 23, 2023
Copyright: © 2023 Huong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: This research is funded by Phenikaa University under grant number PU2022-1-D-02 (All authors). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Abbreviation: DRPs, Drug-related Problems; ADR, Adverse Drug Reaction; PCNE, Pharmaceutical Care Network Europe; OR, odd ratio; CI, Confidence interval; T2DM, type 2 diabetes mellitus; CVD, cardiovascular disease; SGLT2, Sodium-glucose Cotransporter-2; FBG, fasting blood glucose; CHO, (Cholesterol); LDL, (low-density lipoprotein); TG, (triglyceride); HDL, (high-density lipoprotein); eGFR, (estimated Glomerular Filtration Rate)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0289825#abstract0
