Fentie Wendie Teklehaimanot, Tarekegn Angamo Mulugeta
Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
Drug Healthc Patient Saf. 2020 Dec 22;12:281-291. doi: 10.2147/DHPS.S268923. eCollection 2020.
Heart-failure patients are at high risk of experiencing drug-therapy problems, owing to polypharmacy, comorbidities, and usually advanced age. Drug-therapy problems can lead to poor clinical outcomes, increased health-care costs and decreased quality of life, and thus strategies for identifying, resolving, and preventing them are urgently needed. Therefore, this study aimed at investigating the incidence and predictors of drug-therapy problems among hospitalized heart-failure patients.
This hospital-based prospective observational study was conducted from February 1 to May 31, 2014 at Jimma University Specialized Hospital. Patients of either sex aged 18 years and above with chronic heart failure and complete medical records were enrolled. Patients with high-output heart failure, <1 day of hospital stay, unwilling to give written informed consent, and unconscious without caregivers were excluded. Data were collected from medication charts, laboratory reports, patients/caregivers, morning multidisciplinary meetings, and ward rounds. Multivariate binary logistic regression analysis was done to identify independent predictors of drug-therapy problems.
A total of 104 heart-failure patients (mean age 51.20±15.66 years, females 51.9%) were consecutively enrolled, and 95 (91.3%) had experienced at least one drug-therapy problem (total 268, mean 2.82±1.39 encounters per patient). Of these problems, 45.5% were the need for additional drugs, followed by noncompliance (22.0%), inappropriate dosing (9.3%), unnecessary drugs (9.0%), ineffective drugs (8.2%), and adverse drug reactions (6.0%). None of the independent variables was found to be an independent predictor of having at least one drug-therapy problem. However, the number of clinical/pharmacological risk factors (AOR 7.93), female sex (AOR 3.24), and length of hospital stay (AOR 12.98) were predictors of noncompliance.
Patients suffered from a large number of drug-therapy problems. Drugs with survival benefit were underused. Noncompliance and the need for additional drug therapy were the most frequently identified drug-therapy problems. Numbers of clinical/pharmacological risk factors, length of hospital stay, and female sex were identified as predictors for noncompliance.
由于用药种类多、合并症以及患者通常年事已高，心力衰竭患者面临药物治疗问题的风险很高。药物治疗问题会导致临床结局不佳、医疗保健成本增加以及生活质量下降，因此迫切需要识别、解决和预防这些问题的策略。因此，本研究旨在调查住院心力衰竭患者药物治疗问题的发生率及其预测因素。
本基于医院的前瞻性观察性研究于2014年2月1日至5月31日在吉马大学专科医院进行。纳入年龄在18岁及以上、患有慢性心力衰竭且有完整病历的男女患者。排除高输出量心力衰竭患者、住院时间<1天、不愿签署书面知情同意书以及无意识且无护理人员的患者。数据收集自用药记录、实验室报告、患者/护理人员、晨间多学科会议以及病房查房。采用多变量二元逻辑回归分析来确定药物治疗问题的独立预测因素。
共连续纳入104例心力衰竭患者（平均年龄51.20±15.66岁，女性占51.9%），其中95例（91.3%）至少经历过一次药物治疗问题（共268次，平均每位患者2.82±1.39次）。在这些问题中，45.5%是需要增加药物，其次是用药依从性差（22.0%）、给药不当（9.3%）、不必要的药物（9.0%）、无效药物（8.2%）以及药物不良反应（6.0%）。未发现任何自变量是至少存在一个药物治疗问题的独立预测因素。然而，临床/药理学风险因素的数量（比值比7.93）、女性（比值比3.24）以及住院时间（比值比12.98）是用药依从性差的预测因素。
患者存在大量药物治疗问题。具有生存获益的药物使用不足。用药依从性差和需要额外药物治疗是最常发现的药物治疗问题。临床/药理学风险因素的数量、住院时间以及女性被确定为用药依从性差的预测因素。
