Nguyen Thao H, Le Vy T T, Quach Dung N, Diep Han G, Nguyen Nguyet K, Lam Anh N, Pham Suol T, Taxis Katja, Nguyen Thang, Nguyen Phuong M
Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
Depatment of Pharmacy, Can Tho Children's Hospital, Can Tho City 900000, Vietnam.
Healthcare (Basel). 2021 Mar 14;9(3):327. doi: 10.3390/healthcare9030327.
Our study was conducted to determine the prevalence of drug-related problems (DRPs) in outpatient prescriptions, the impact of DRPs on treatment efficacy, safety, and cost, and the determinants of DRPs in prescribing for pediatric outpatients in Vietnam.
A retrospective cross-sectional study was conducted on pediatric outpatients at a pediatric hospital in Can Tho, Vietnam. DRPs were classified according to the Pharmaceutical Care Network Europe classification (PCNE) of 2020. The study determined prevalence of DRPs and their impacts on efficacy, safety, and cost. Multivariate regression was used to identify the determinants of DRPs.
The study included 4339 patients (mean age 4.3, 55.8% male), with a total of 3994 DRPs, averaging 0.92 DRP/prescription. The proportion of prescriptions with at least one DRP was 65.7%. DRPs included inappropriate drug selection (35.6%), wrong time of dosing relative to meals (35.6%), inappropriate dosage form (9.3%), inappropriate indication (7.1%), and drug-drug interactions (0.3%). The consensus of experts was average when evaluating each aspect of efficiency reduction, safety reduction, and treatment cost increase, with Fleiss' coefficients of 0.558, 0.511, and 0.541, respectively ( < 0.001). Regarding prescriptions, 50.1% were assessed as reducing safety. The figures for increased costs and decreased treatment effectiveness were 29.0% and 23.9%, respectively. Patients who were ≤2 years old were more likely to have DRPs than patients aged 2 to 6 years old (OR = 0.696; 95% CI = 0.599-0.809) and patients aged over 6 years old (OR = 0.801; 95% CI = 0.672-0.955). Patients who had respiratory system disease were more likely to have DRPs than patients suffering from other diseases (OR = 0.715; 95% CI = 0.607-0.843). Patients with comorbidities were less likely to have DRPs than patients with no comorbidities (OR = 1.421; 95% CI = 1.219-1.655). Patients prescribed ≥5 drugs were more likely to have DRPs than patients who took fewer drugs (OR = 3.677; 95% CI = 2.907-4.650).
The proportion of prescriptions in at least one DRP was quite high. Further studies should evaluate clinical significance and appropriate interventions, such as providing drug information and consulting doctors about DRPs.
我们开展这项研究是为了确定越南儿科门诊处方中药物相关问题（DRP）的患病率、DRP对治疗效果、安全性和成本的影响，以及儿科门诊处方中DRP的决定因素。
对越南芹苴市一家儿科医院的儿科门诊患者进行了一项回顾性横断面研究。DRP根据2020年欧洲药学保健网络分类（PCNE）进行分类。该研究确定了DRP的患病率及其对疗效、安全性和成本的影响。采用多变量回归来确定DRP的决定因素。
该研究纳入了4339名患者（平均年龄4.3岁，55.8%为男性），共有3994个DRP，平均每个处方有0.92个DRP。至少有一个DRP的处方比例为65.7%。DRP包括药物选择不当（35.6%）、给药时间与进餐时间错误相关（35.6%）、剂型不当（9.3%）、适应症不当（7.1%）和药物相互作用（0.3%）。在评估效率降低、安全性降低和治疗成本增加的各个方面时，专家的共识为中等，Fleiss系数分别为0.558、0.511和0.541（<0.001）。关于处方，50.1%被评估为降低了安全性。成本增加和治疗效果降低的数字分别为29.0%和23.9%。2岁及以下的患者比2至6岁的患者（OR = 0.696；95%CI = 0.599 - 0.809）和6岁以上的患者（OR = 0.801；95%CI = 0.672 - 0.955）更有可能出现DRP。患有呼吸系统疾病的患者比患有其他疾病的患者更有可能出现DRP（OR = 0.715；95%CI = 0.607 - 0.843）。患有合并症的患者比没有合并症的患者出现DRP的可能性更小（OR = 1.421；95%CI = 1.219 - 1.655）。开具≥5种药物的患者比服用药物较少的患者更有可能出现DRP（OR = 3.677；95%CI = 2.907 - 4.650）。
至少有一个DRP的处方比例相当高。进一步的研究应评估临床意义和适当的干预措施，如提供药物信息和就DRP咨询医生。
