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. © 2017 Al-Taani et al.
Bibliographical noteExport Date: 15 September 2018
Correspondence Address: Al-Taani, G.M.; Department of Pharmacy Practice, School of Pharmacy, Yarmouk University, PO Box 566, Shafeeq Irshedat Street, Jordan; email: email@example.com
Funding details: MHE&SR, Ministry of Higher Education and Scientific Research
Funding details: 104/2012
Funding text: This project was supported by the Scientific Research Funds (project number: 104/2012) at the Ministry of Higher Education and Scientific Research, Amman, Jordan.
References: Hepler, C.D., Strand, L.M., Opportunities and responsibilities in pharmaceutical care (1990) Am J Hosp Pharm, 47 (3), pp. 533-543; Johnson, J.A., Bootman, J.L., Drug-related morbidity and mortality. A cost-of-illness model (1995) Arch Intern Med, 155 (18), pp. 1949-1956; Ernst, F.R., Grizzle, A.J., Drug-related morbidity and mortality: Updating the cost-of-illness model (2001) J am Pharm Assoc (Wash), 41 (2), pp. 192-199; Hartholt, K.A., van Der Velde, N., Looman, C.W., Adverse drug reactions related hospital admissions in persons aged 60 years and over, The Netherlands, 1981-2007: Less rapid increase, different drugs (2010) Plos One, 5 (11); Sarkar, U., López, A., Maselli, J.H., Gonzales, R., Adverse drug events in U.S. adult ambulatory medical care (2011) Health Serv Res, 46 (5), pp. 1517-1533; Zaman Huri, H., Chai Ling, L., Drug-related problems in type 2 diabetes mellitus patients with dyslipidemia (2013) BMC Public Health, 13, p. 1192; Haugbølle, L.S., Sørensen, E.W., Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma-interviewing patients at home (2006) Pharm World Sci, 28 (4), pp. 239-247; Zaman Huri, H., Fun Wee, H., Drug related problems in type 2 diabetes patients with hypertension: A cross-sectional retrospective study (2013) BMC Endocr Disord, 13, p. 2; Kaufmann, C.P., Stämpfli, D., Hersberger, K.E., Lampert, M.L., Determination of risk factors for drug-related problems: A multidisciplinary triangulation process (2015) BMJ Open, 5 (3); Hanlon, J.T., Schmader, K.E., Samsa, G.P., A method for assessing drug therapy appropriateness (1992) J Clin Epidemiol, 45 (10), pp. 1045-1051; Aburuz, S.M., Bulatova, N.R., Yousef, A.M., Validation of a comprehensive classification tool for treatment-related problems (2006) Pharm World Sci, 28 (4), pp. 222-232; Aburuz, S., The case for evidence-based pharmaceutical care (2015) Res Social Adm Pharm, 11 (3), pp. e146-e147; Aburuz, S.M., Bulatova, N.R., Yousef, A.M., Al-Ghazawi, M.A., Alawwa, I.A., Al-Saleh, A., Comprehensive assessment of treatment related problems in hospitalized medicine patients in Jordan (2011) Int J Clin Pharm, 33 (3), pp. 501-511; Cipolle, R.J., Strand, L., Morley, P., (2004) Pharmaceutical Care Practice: the Clinician’s Guide, , 2nd ed. New York: McGraw-Hill; Ruopp, M.D., Perkins, N.J., Whitcomb, B.W., Schisterman, E.F., Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection (2008) Biom J, 50 (3), pp. 419-430; Billings, J., Blunt, I., Steventon, A., Georghiou, T., Lewis, G., Bardsley, M., Development of a predictive model to identify inpatients at risk of re-admission within 30 days of discharge (PARR-30) (2012) BMJ Open, 2 (4); Koh, Y., Kutty, F.B., Li, S.C., Drug-related problems in hospitalized patients on polypharmacy: The influence of age and gender (2005) Ther Clin Risk Manag, 1 (1), pp. 39-48; Bain, K.T., Weschules, D.J., Tillotson, P., Prevalence and predictors of medication-related problems (2006) Medicare Patient Management, 1, pp. 14-26; Viktil, K.K., Blix, H.S., Moger, T.A., Reikvam, A., Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems (2006) Br J Clin Pharmacol, 63 (2), pp. 187-195; Alkema, G.E., Wilber, K.H., Simmons, W.J., Enguidanos, S.M., Frey, D., Prevalence of potential medication problems among dually eligible older adults in Medicaid waiver services (2007) Ann Pharmacother, 41 (12), pp. 1971-1978; Rutledge, J.C., Ng, K.F., Aung, H.H., Wilson, D.W., Role of triglyceride-rich lipoproteins in diabetic nephropathy (2010) Nat Rev Nephrol, 6 (6), pp. 361-370; Khdour, M.R., Jarab, A.S., Adas, H.O., Samaro, E.Z., Mukattash, T.L., Hallak, H.O., Identification of drug-related problems: A prospective study in two general hospitals (2012) Curr Clin Pharmacol, 7 (4), pp. 276-281; Ahmad, A., Mast, M.R., Nijpels, G., Elders, P.J., Dekker, J.M., Hugtenburg, J.G., Identification of drug-related problems of elderly patients discharged from hospital (2014) Patient Prefer Adherence, 8, pp. 155-165; Snyder, M.E., Frail, C.K., Jaynes, H., Pater, K.S., Zillich, A.J., Predictors of medication-related problems among medicaid patients participating in a pharmacist-provided telephonic medication therapy management program (2014) Pharmacotherapy, 34 (10), pp. 1022-1032; Babwah, F., Baksh, S., Blake, L., The role of gender in compliance and attendance at an outpatient clinic for type 2 diabetes mellitus in Trinidad (2006) Rev Panam Salud Publica, 19 (2), pp. 79-84; Vlassoff, C., Gender differences in determinants and consequences of health and illness (2007) J Health Pop Nutr, 25 (1), pp. 47-61
- Drug-related problems
- Medication-related problems
- Pharmaceutical care