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      Extent of poly-pharmacy, occurrence and associated factors of drug-drug interaction and potential adverse drug reactions in Gondar Teaching Referral Hospital, North West Ethiopia

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          Abstract

          The aim of this study was to assess the extent of poly-pharmacy, occurrence, and associated factors for the occurrence of drug–drug interaction (DDI) and potential adverse drug reaction (ADR) in Gondar University Teaching Referral Hospital. Institutional-based retrospective cross-sectional study. This study was conducted on prescriptions of both in and out-patients for a period of 3 months at Gondar University Hospital. Both bivariate analysis and multivariate logistic regression were used to identify risk factors for the occurrence of DDI and possible ADRs. All the statistical calculations were performed using SPSS ® software. A total of 12,334 prescriptions were dispensed during the study period of which, 2,180 prescriptions were containing two or more drugs per prescription. A total of 21,210 drugs were prescribed and the average number of drugs per prescription was 1.72. Occurrences of DDI of all categories (Major, Moderate, and Minor) were analyzed and DDI were detected in 711 (32.6%) prescriptions. Sex was not found to be a risk factor for the occurrence of DDI and ADR, while age and number of medications per prescription were found to be significant risk factors for the occurrence of DDI and ADR. The mean number of drugs per prescription was 1.72 and hence with regard to the WHO limit of drugs per prescription, Gondar hospital was able to maintain the limit and prescriptions containing multiple drugs supposed to be taken systemically. Numbers of drugs per prescription as well as older age were found to be predisposing factors for the occurrence of DDI and potential ADRs while sex was not a risk factor.

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          Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems.

          To investigate whether polypharmacy defined as a definite number of drugs is a suitable indicator for describing the risk of occurrence of drug-related problems (DRPs) in a hospital setting. Patients admitted to six internal medicine and two rheumatology departments in five hospitals were consecutively included and followed during the hospital stay, with particular attention to medication and DRPs. Comparisons were made between patients admitted with five or more drugs and with less than five drugs. Clinical pharmacists assessed DRPs by reviewing medical records and by participating in multidisciplinary team discussions. Of a total of 827 patients, 391 (47%) used five or more drugs on admission. Patients admitted with five or more and less than five drugs were prescribed the same number of drugs after admission: 4.1 vs. 3.9 drugs [P = 0.4, 95% confidence interval (CI) - 0.57, 0.23], respectively. The proportion of drugs used on admission which was associated with DRPs was similar in the patient group admitted with five or more drugs and in those admitted with less than five drugs. The number of DRPs per patient increased approximately linearly with the increase in number of drugs used; one unit increase in number of drugs yielded a 8.6% increase in the number of DRPs (95% CI 1.07, 1.10). The number of DRPs per patient was linearly related to the number of drugs used on admission. To set a strict cut-off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value when assessing DRPs in a clinical setting.
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            The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.

            To assess the additional resource utilization associated with an adverse drug event (ADE). Nested case-control study within a prospective cohort study. The cohort included 4108 admissions to a stratified random sample of 11 medical and surgical units in 2 tertiary-care hospitals over a 6-month period. Cases were patients with an ADE, and the control for each case was the patient on the same unit as the case with the most similar pre-event length of stay. Postevent length of stay and total costs. Incidents were detected by self-report stimulated by nurses and pharmacists and by daily chart review, and were classified as to whether they represented ADEs. Information on length of stay and charges was obtained from billing data, and costs were estimated by multiplying components of charges times hospital-specific ratios of costs to charges. During the study period, there were 247 ADEs among 207 admissions. After outliers and multiple episodes were excluded, there were 190 ADEs, of which 60 were preventable. In paired regression analyses adjusting for multiple factors, including severity, comorbidity, and case mix, the additional length of stay associated with an ADE was 2.2 days (P=.04), and the increase in cost associated with an ADE was $3244 (P=.04). For preventable ADEs, the increases were 4.6 days in length of stay (P=.03) and $5857 in total cost (P=.07). After adjusting for our sampling strategy, the estimated postevent costs attributable to an ADE were $2595 for all ADEs and $4685 for preventable ADEs. Based on these costs and data about the incidence of ADEs, we estimate that the annual costs attributable to all ADEs and preventable ADEs for a 700-bed teaching hospital are $5.6 million and $2.8 million, respectively. The substantial costs of ADEs to hospitals justify investment in efforts to prevent these events. Moreover, these estimates are conservative because they do not include the costs of injuries to patients or malpractice costs.
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              Health outcomes and polypharmacy in elderly individuals: an integrated literature review.

              The purpose of this integrated literature review was to determine the extent of research available related to polypharmacy and its effect on the health outcomes of the elderly population. A search of the Cumulative Index of Nursing and Allied Health Literature and Medline was conducted for studies published between 1995 and 2003 that linked polypharmacy and outcomes in the elderly population. The 16 studies in this integrative literature review were conducted in the United States, Canada, Australia, and Europe. Polypharmacy was shown to be a statistically significant predictor of hospitalization, nursing home placement, death, hypoglycemia, fractures, impaired mobility, pneumonia, and malnutrition. The effect of polypharmacy on elderly individuals is significant as demonstrated by this literature review. Nurses are in a unique position to monitor and potentially eliminate adverse effects of a complex medication regimen. Nursing research on polypharmacy and its effects on nursing-sensitive outcomes will help define guidelines for prevention and intervention.
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                Author and article information

                Journal
                J Adv Pharm Technol Res
                J Adv Pharm Technol Res
                JAPTR
                Journal of Advanced Pharmaceutical Technology & Research
                Medknow Publications & Media Pvt Ltd (India )
                2231-4040
                0976-2094
                Oct-Dec 2013
                : 4
                : 4
                : 183-189
                Affiliations
                [1]Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, Ethiopia
                [1 ]Department of Health Informatics, College of Medicine and Health Sciences, University of Gondar, Ethiopia
                [2 ]Department of Pharmacology, College of Medicine, Bahir Dar University, Bahir Dar, Ethiopia
                [3 ]Department of Clinical Pharmacy Research, College of Medicine and Health Sciences, University of Gondar, Ethiopia
                Author notes
                Address for correspondence: Dr. B Akshaya Srikanth, Pharm.D., Department of Clinical Pharmacy Research, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. E-mail: akshaypharmd@ 123456gmail.com
                Article
                JAPTR-4-183
                10.4103/2231-4040.121412
                3853694
                24350048
                87e79f31-1800-42a4-96fa-b5ea224f5690
                Copyright: © Journal of Advanced Pharmaceutical Technology & Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Original Article

                Pharmacology & Pharmaceutical medicine
                ethiopia,drug-drug interactions,poly-pharmacy,prescription,adverse drug reactions,gondar

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