Zeleke Tirsit Ketsela, Bazezew Zegaye Agmassie, Abebe Rahel Belete
Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Hepat Med. 2023 Sep 25;15:129-140. doi: 10.2147/HMER.S423351. eCollection 2023.
Pathophysiological alterations in liver cirrhosis affect how medications are metabolized and eliminated. Therefore, when prescribing medicines for patients with cirrhosis, appropriate prescription of medication is an accepted standard of practice. Since patients with cirrhosis require a complex therapy plan, it necessitates regular reviews of medication utilization. However, no research was conducted in Ethiopia. The aim of this study was to figure out the predictors of inappropriate prescriptions and the pattern of prescription in patients with cirrhosis.
A cross-sectional study design was carried out at Felege-Hiwot, a specialized and comprehensive referral hospital, from June 30, 2022, to November 30, 2022, in 123 hospitalized patients with cirrhosis. Patients were recruited using a simple random sampling procedure, and data were collected using an interviewer-administered questionnaire. For the purpose of identifying determinants of inappropriate prescription, logistic regression analyses have been carried out and statistical significance was defined by a p-value of less than 0.05 and a 95% confidence range.
The burden of inappropriate prescriptions among patients with cirrhosis was 35.8%. An increased number of medications prescribed (AOR = 4.88 (1.05-22.68)), prescription by a general practitioner (AOR = 3.57 (95% CI 1.07-11.44)), increased level of bilirubin (AOR = 3.54 (95% CI 1.95-6.45)), and decreased level of albumin (AOR = 0.18 (95% CI 0.04-0.72)) were predictors for an inappropriate prescription.
It has been found that there were inappropriate prescriptions among patients with liver cirrhosis. Prescribers should pay close attention to patients who have prescribed with higher number of medications, increased level of bilirubin and decreased level of albumin. Moreover, educational level of prescribers needs to be upgraded in order to adopt evidence-based medication prescriptions and adhere to recommended practices.
肝硬化的病理生理改变会影响药物的代谢和消除。因此，为肝硬化患者开药时，合理用药是公认的标准做法。由于肝硬化患者需要复杂的治疗方案，所以有必要定期审查用药情况。然而，埃塞俄比亚尚未开展此类研究。本研究的目的是找出肝硬化患者不适当处方的预测因素以及处方模式。
于2022年6月30日至2022年11月30日在费莱格 - 希沃特专科医院（一家专业的综合性转诊医院）对123例住院肝硬化患者进行了横断面研究设计。采用简单随机抽样程序招募患者，并通过访谈员管理的问卷收集数据。为确定不适当处方的决定因素，进行了逻辑回归分析，统计学显著性定义为p值小于0.05且置信区间为95%。
肝硬化患者中不适当处方的负担为35.8%。开具药物数量增加（比值比[AOR]=4.88[1.05 - 22.68]）、由全科医生开具处方（AOR = 3.57[95%置信区间1.07 - 11.44]）、胆红素水平升高（AOR = 3.54[95%置信区间1.95 - 6.45]）以及白蛋白水平降低（AOR = 0.18[95%置信区间0.04 - 0.72]）是不适当处方的预测因素。
已发现肝硬化患者中存在不适当处方情况。开处方者应密切关注开具药物数量较多、胆红素水平升高和白蛋白水平降低的患者。此外，需要提高开处方者的教育水平，以采用循证药物处方并遵循推荐做法。
