Kiptoo Joshua, Yadesa Tadele Mekuriya, Muzoora Conrad, Namugambe Juliet Sanyu, Tamukong Robert
Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.
World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda.
Open Access Emerg Med. 2021 Jun 29;13:279-290. doi: 10.2147/OAEM.S309508. eCollection 2021.
Medication-related emergency department admissions impose a huge and unnecessary burden on the healthcare system. We sought to determine the prevalence and predictors of medication-related emergency department admissions, among patients with cardiovascular diseases at Mbarara Regional Referral Hospital, Uganda.
Institutional research ethics approval was secured to conduct a cross-sectional study at the Mbarara Regional Referral Hospital emergency department, between February and September, 2020. All eligible and consenting patients were enrolled in a consecutive manner after a preliminary diagnosis was made by the attending physician. Structured questionnaire interview and comprehensive medication history reviews were used to identify medication therapy problems, in collaboration with a resident physician present on duty. We used sequential categorization for medication therapy problem(s). Descriptive and logistic regression analyses were used to determine prevalence and predictors of medication-related emergency department admissions.
Out of the 128 patients interviewed, 105 (82%) patient admissions were associated with a medication therapy problem: ineffectiveness of drug therapy (53.3%, 56), medication non-adherence (42.9%, 45), and adverse drug reactions (3.8%, 4). Out of a total of 90 incidences of medication non-adherence, 34.4% (31/90) were due to lack of understanding of patient medication regimen, and 27.8% (25/90) due to unaffordable cost of medicines. Female gender (AOR = 4.31 [1.43, 13.03 at 95% CI]; -value = 0.010]) and a history of tobacco use (AOR = 9.58 [1.14, 80.28 at 95% CI]; -value = 0.037) were statistically significant predictors of medication-related emergency department admissions in adjusted analysis.
Four in five emergency department admissions were associated with medication-related causes, majorly due to ineffectiveness of drug therapy. Knowledge gap on patient medication regimens was the most prevalent cause for medication non-adherence. Female gender and previous or current tobacco use was an independent risk factor for medication-related admissions.
与药物相关的急诊科入院给医疗系统带来了巨大且不必要的负担。我们试图确定乌干达姆巴拉拉地区转诊医院心血管疾病患者中与药物相关的急诊科入院的患病率及预测因素。
获得了机构研究伦理批准，于2020年2月至9月在姆巴拉拉地区转诊医院急诊科开展一项横断面研究。所有符合条件并同意参与的患者在主治医生做出初步诊断后按顺序入组。与值班住院医师合作，通过结构化问卷调查和全面的用药史回顾来识别药物治疗问题。我们对药物治疗问题进行了顺序分类。采用描述性分析和逻辑回归分析来确定与药物相关的急诊科入院的患病率及预测因素。
在接受访谈的128例患者中，105例（82%）患者入院与药物治疗问题相关：药物治疗无效（53.3%，56例）、用药依从性差（42.9%，45例）和药物不良反应（3.8%，4例）。在总共90例用药依从性差的情况中，34.4%（31/90）是由于患者对用药方案不了解，27.8%（25/90）是由于药品费用负担不起。在调整分析中，女性（优势比=4.31[95%置信区间为1.43, 13.03]；P值=0.010）和有吸烟史（优势比=9.58[95%置信区间为1.14, 80.28]；P值=0.037）是与药物相关的急诊科入院的统计学显著预测因素。
五分之四的急诊科入院与药物相关原因有关，主要是由于药物治疗无效。患者用药方案方面的知识差距是用药依从性差最普遍的原因。女性以及既往或当前吸烟是与药物相关入院的独立危险因素。
