Patient Factors Associated with Pharmaceutical Interventions for Inpatients at a Brazilian Teaching Hospital.

BACKGROUND

Pharmaceutical interventions aim to correct or prevent a drug-related problem (DRP) that might lead to negative clinical consequences and increase health care costs.

OBJECTIVE

To identify variables associated with the provision of pharmaceutical interventions by clinical pharmacists during hospitalization.

METHODS

In this retrospective cohort study, adult inpatients of the medical ward of the University Hospital of the University of São Paulo in São Paulo, Brazil, were followed from admission to discharge. Logistic regression models were used to evaluate the association between occurrence of at least 1 pharmaceutical intervention and the following baseline characteristics: sex, age, Charlson comorbidity index, renal failure, electrolyte imbalance, hemoglobin, platelet count, and use of a nasoenteric tube, as well as the number, second-level Anatomical Therapeutic Chemical (ATC) code, and administration route of prescribed medications.

RESULTS

A total of 148 patients were included in the study, of whom 75 (50.7%) were men. The mean age was 62.8 (95% confidence interval [CI] 59.9-65.8) years, and the mean length of the hospital stay was 10.7 (95% CI 8.4-13.1) days. Analgesics (ATC code N02), the most common type of medication, were prescribed to 144 (97.3%) of the patients. Pharmaceutical interventions were performed for only 49 (33.1%) of the patients. One out of every 4 of these interventions was intended to obtain information not provided in the prescription, to allow the prescription to be completed and dispensing to proceed. According to the multivariate analysis, the odds ratio (OR) of occurrence of at least 1 pharmaceutical intervention increased for patients with electrolyte imbalance (OR 2.68, 95% CI 1.09-6.63; p = 0.033), patients using 5 to 8 medications (OR 8.73, 95% CI 1.07-71.36; p = 0.043), patients using 9 or more medications (OR 10.39, 95% CI 1.28-84.05; p = 0.028), and patients using at least 1 systemic antibacterial (ATC code J01; OR 2.76, 95% CI 1.30-5.84; p = 0.008).

CONCLUSIONS

The findings of this study could allow the identification, at the time of admission and possibly before the occurrence of a DRP, of patients at higher risk of requiring a pharmaceutical intervention later during their hospital stay. To optimize patient care, clinical pharmacists should closely follow inpatients with electrolyte imbalance, polypharmacy, and/or use of systemic antibacterials.