Use of antihypertensive medications in patients with diabetes in Ajman, UAE

Optimal reduction in blood pressure with antihypertensive agents helps to prevent diabetic microvascular and macrovascular complications. The objective of the study was to evaluate the current utilization pattern of antihypertensive medications among patients with diabetes and co-existent hypertension as per the JNC 7th Report guidelines. A cross sectional survey was carried out among patients with diabetes attending the Outpatient Department of Internal Medicine at a tertiary care hospital in Ajman. Medical records of the patients were used to obtain diagnostic, demographic and drug use information. Unvariate analysis was performed using Chi square and t-test followed by logistic regression to compute independent predictors. Of 132 patients with diabetes, uncomplicated hypertension [HTN] was coexistent in 107 [81%] patients. Males constituted 49.5% of the total. The mean age of patients with HTN was [55.1 +/- 10.1], which was higher than that in those without HTN [49.6 +/- 9.9] [p<0.05]. 51.4% of patients with HTN were between 45-60 years of age. A higher number of patients with HTN had duration of diabetes < 5 years than those >5 years [p<0.05]. While adjusting the significant factors, only the duration of diabetes [adjusted OR 1.06; CI [1.003-1.116]] was statistically significant among patient with HTN. 68 [62.6%] prescriptions contained one antihypertensive drug, 29 [30%] two drugs and 8 [7.4%] no anti-hypertensive drug. Angiotensin converting enzyme inhibitors/ angiotensin receptor blockers [ACEI/ ARBs] followed by diuretics were commonly prescribed. ARBs with diuretics were the most frequent two drug combination. The antihypertensive utilization pattern was similar in both gender and age groups. The results represent the current prescribing trend for anti-hypertensive agents among patients with diabetes, which is in accordance with JNC-7 recommendations

dilemma of polypharmacy: nurses perceptions of health care professionals' contribution in polypharmacy in Ajman, UAE

Health care professionals do not pay sufficient attention to polypharmacy which is a slowly growing phenomenon. Physician-related factors which contribute to polypharmacy include the use of multiple medications in management of co-morbid illnesses, symptomatic treatment, and the treatment of the adverse effects of drugs. The present study aimed to identify nurses' perceptions of health care professionals' role in polypharmacy. This cross sectional study was conducted among nurses in Gulf Medical College Hospital and Research Centre, Ajman, United Arab Emirates from March to May 2011. A structured self-administered close-ended pilot-tested questionnaire was used as a study instrument. Association between socio-demographic characteristics and items were analyzed using Chi-square test and p<0.05 was considered statistically significant. A total of 92 female and 13 male nurses were included. The most common physician factors identified by nurses were prescribing medications for every symptom [78 [74%]], not conducting medication review [74 [70.5%]], not simplifying medication regimens [62 [59%]] and the influence of pharmaceutical companies 58 [55.2%]. Regarding the pharmacist related factors, nurses opined that inadequate pharmacist-doctor communication [71 [67.6%]] and lack of effective patient counseling [65 [61.9%]] influence polypharmacy. On comparing physician related factors between nurses of different years of experience and also between the genders, prescribing medications for every symptom, and not conducting a medication review with the patient scored the highest in all the groups. A higher number of male nurses [statistically significant at p<0.05] in comparison to female nurses opined that inadequate knowledge of clinical pharmacology [7 [53.8%]], and lack of time to review medications [6 [46%]] contributed to polypharmacy. Healthcare professionals need to be aware of the increase in polypharmacy. Regular assessment of prescribed medications should be carried out to avoid the administration of inappropriate drugs

Cardiovascular medications use among the critically ill patients of a tertiary care hospital: a drug utilization study

In the medical intensive care unit it is often necessary to utilize extensive pharmacologic interventions and multiple intravenous medications in order to stabilize a critically ill patient. In patients diagnosed with heart disease in the intensive care unit, pharmacotherapy is the primary line of management. We evaluated the utilization pattern of cardiovascular drugs among the inpatients in the intensive care unit. The study was carried out in medical intensive care unit of a tertiary care hospital in South India. The medical records of all inpatients of the ICU were reviewed over a period of twelve months. The demographic data, clinical data, and drug details were recorded. WHO Anatomic Therapeutic Chemical classification system was used to classify drugs. Descriptive statistical analysis was carried out, and values are expressed as percentage, mean +/- SD and range. A total of 1173 cardiovascular drugs prescribed among the 728 patients were included in the study. 337 [29%] drugs were anti-hypertensives and 836 constituted the other cardiovascular drugs. Noradrenaline [CO1CA03] 220 [30%], dopamine [C01CA04] 165 [22.5%], and atorvastatin [C10AA05] 109 [15%] were commonly utilized drugs. Polytherapy among ionotropes was noticed in 145 [20%] prescriptions. Among 337 anti-hypertensive drugs prescribed, calcium channel blockers 117 [34.7%], beta-blockers 90 [20.4%] and angiotensin converting enzyme inhibitors [ACEIs] 73 [16.6%] represented the major classes. Amlodipine [C08CA01] was the single most commonly prescribed anti-hypertensive drug 110 [32.6%]. Anti-hypertensive polytherapy was noticed in 295 [40.5%] prescriptions. A wide spectrum of cardiovascular drugs was utilized from various drug classes. Polytherapy of various drug classes was noticed. Overall, the scope for improving rational use of drugs exists

Critically ill patients and use of hormones and hormone-related medications

Critical illness can induce a number of neuroendocrine changes which often necessitates the use of hormones and related medications among the critically ill along with the other extensive pharmacologic interventions. The utilization pattern of hormonal therapy was determined among the inpatients of the intensive care unit in the present study. The study was carried out in medical intensive care unit of a tertiary care hospital in South India. The medical records of all inpatients of the ICU were reviewed over a period of twelve months. The demographic data, clinical data, and drug details were recorded. WHO-Anatomic Therapeutic Chemical classification system was used to classify drugs. Descriptive statistical analysis was carried out, and values are expressed as percentage, mean +/- SD and range. 728 [81%] consecutive patients who got hospitalized were included for the analysis. Male to female ratio was 1.9. The mean and standard deviation [SD] for age was 49.21 +/- 15.84 years with a range of 18-91 years. Sepsis 198 [27%] and acute renal failure 168 [23%] were the most common primary clinical diagnosis. 90% of prescriptions were by generic name. Prescription for insulin was noticed in 306 [42%] prescriptions and was the most commonly utilized hormone. Corticosteroid prescription was noticed in 280 patients [38.5%] and a total of 341 [46.8%] corticosteroids was utilized. Hydrocortisone [H02AB09] 182 [25%] was the preferred corticosteroid. Polytherapy among corticosteroids was noticed in 278 [38.2%] prescriptions. Thyroxine was utilized among 31 patients [4.3%]. Overall, rational use of hormones and hormonal drugs was noticed among the critically ill patients

Nurses' views on patient factors associated with polypharmacy in Ajman, UAE

The specter of polypharmacy is an ever-increasing problem faced by the healthcare professionals. Nurses need to be aware of the several patient related factors that contribute to polypharmacy. This study evaluated the views of nurses regarding patient-related factors associated with polypharmacy. Nurses working in Gulf Medical College Hospital and Research Centre in Ajman, United Arab Emirates participated in the study during March to May 2011. The fourteen item questionnaire regarding patient factors was used as the research tool. Association between socio-demographic characteristics and items were analysed using Chi-square test [p<0.05 considered statistically significant]. Of 105 nurses included, 92 were females and 13 males. The most commonly identified patient factors were lack of awareness of polypharmacy [94.3%], seeing multiple physicians [82.9%], use of self medications [79%], ordering of refills without follow up [78%], and not reporting all the medications they are currently on [78%]. On comparing male and female nurses, the lack of awareness of polypharmacy was the most commonly stated patient factors by both groups. Male nurses gave a higher ranking for increased awareness of treatment options among patients in comparison to female nurses. Nurses with 5-10 years of experience had given a high score for ineffective doctor-patient communication and increased awareness of treatment options among patients in comparison to other groups. Nurses are aware of the patient factors contributing to polypharmacy. They should be trained to implement this knowledge in reducing polypharmacy especially while counseling patient regarding medications

Reducing the burden of multiple medications: nurses' views on strategies to prevent polypharmacy in Ajman, UAE

Polypharmacy is often used to imply a negative situation involving unnecessary or inappropriate use of medications. Nurse can contribute significantly in reducing the number of medications prescribed. The study was planned to identify the nurses' opinions on different strategies that could be used to prevent polypharmacy. This cross section study was conducted during March to May 2011 among nurses who are working in a tertiary care hospital in Ajman, UAE. In addition to socio-demographic characteristics the pilot-tested self-administered, questionnaire contained 20 items to collect information. Chi-square test was used to compare percentages by socio-demographic characteristics using PSAW software. The significance level for all analyses was p

Age and gender-based utilization pattern of anti-diabetic drugs in Ajman, UAE

Diabetes is a chronic multi-system metabolic disease associated with morbidity and mortality and cost to the society. Pharmacotherapy is an integral part of the management of diabetes. Factors like age, gender, Body Mass Index [BMI] and coexisting illnesses determine the prescription. The objective of the study was to evaluate the drug usage pattern of anti-diabetic drugs in different age groups and gender. A cross sectional epidemiological survey of all prescriptions of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman was conducted for a duration of 3 months. The socio-demographic and drug information was obtained by researchers with the help of a questionnaire. 54.8% patients were males and 45.2% were females. The mean age of patients with diabetes was 54.09 +/- 10.24 years. 128 patients were type 2 diabetes. Metformin combinations were the commonly prescribed anti-diabetic drug. Insulin prescription was noted in 14 patients, the commonest being Human Insulin. Metformin combinations were commonly prescribed in both genders. For patients below 45 years and those between 45-60 years of age metformin combinations were the commonest prescribed, while among patients above 60 years of age sulfonylureas were the most commonly prescribed. The utilization pattern of anti diabetic drugs varied among different age groups and gender. Metformin combination with newer antidiabetic medications were commonly utilized

Patients' adherence to anti-diabetic medications and factors associated with adherence

Anti-diabetic drug therapy plays a pivotal role in the glycemic control patients with diabetes. Patient with chronic diseases such as diabetes often discontinue their medications for various reasons which could lead to ineffective control of blood glucose levels. The objective of the study was to assess the patient adherence of anti-diabetic drug therapy and explore the reasons for non-adherence. This was a cross sectional survey of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman carried out over a period of three months. Data on patient adherence, knowledge of anti-diabetic drugs and patient-provider relationship were collected with the help of a researcher-administered questionnaire. A total of 132 patients were included [63 males and 69 females]. The mean age of the subjects was 54.09 +/- 10.24 years. Patient adherence rate to anti-diabetic drugs was 84%. Adherence was similar among male and female patients. Based on the educational status, patients with schooling showed non-adherence. The most common reason for non-adherence was forgetfulness. Only 2.3% of the patients took self-medication and alternative therapies in addition to the medications prescribed. The majority of the patients had good patient-physician relationship. The patients had good knowledge of diabetes and anti-diabetic medications, received from their doctor or as self-learned. It is crucial that health providers assess adherence of patients to drug therapy in the event of poor glucose control and presumed failure of the prescribed therapeutic regimen. Additionally, the health care providers should practice patient counseling on medication adherence for effective management of diabetes

Acceptability and practice of complementary medicine among clinicians in Ajman, UAE; a pilot study

The acceptability and utilization of Complementary and Alternative Medicine [CAM] of healthcare professionals especially clinicians has been changing in the recent times. The present study assessed the acceptability, utilization pattern and reasons for opting for CAM among clinicians in a tertiary care centre in Ajman, UAE. A sample of thirty six clinicians, was drawn from the pool of clinicians working in Gulf Medical College Hospital and Research Centre, Ajman, UAE. The questionnaire included socio-demographic characteristics, practice and attitude towards CAM, reasons for self use and recommending CAM to their patients. Descriptive statistics and Chi-square test were performed using PASW 18 version, and a p value of <0.05 was considered statistically significant. The respondents were multinationals, their age ranging from 26-70 years, with a mean age of 41.3 +/- 9.8 years. The male to female ratio was 1:3. It was noted that 39% of the clinicians themselves used CAM. Joint pain was the most common clinical condition for its use. The common form of CAM practiced was Ayurveda and homeopathy [35.7% each], and the outcome of CAM use was good for the majority of the clinicians. Family history of CAM use was noted in 78.6% of the respondents. Based on their personal experience with CAM, 30.6% of the respondents recommended CAM to others. The chief reason for self-use and recommending CAM is its fewer side effects. Around 69% did not use or recommend CAM, and the reason quoted was CAM is not scientific. About 38.9% of clinicians felt CAM is scientifically sound, 55.6% opined that it had fewer side effects, and 38.9% felt that CAM had a long term effect. Clinicians practice and recommend CAM. The primary reason for practice and recommendation of CAM is fewer adverse effects while the lack of scientific evidence is the reason for others not to favori CAM

Use of complementary and alternative medicine among the health care consumers of modern medicine

Complementary and Alternative Medicine is popular across the world and is widely practiced. Utilization pattern and reasons for use and non-use among patients attending tertiary care centre is assessed in this study. One hundred and twenty six patients of different nationalities, above the age 18 years, visiting various outpatient departments of Gulf Medical College Hospital and Research Centre, Ajman, UAE were interviewed using an open ended structured questionnaire. In addition to socio-demographic characteristics, acceptability, utilization pattern, reasons for use and non-use were elicited from the participants after obtaining consent from them. PASW 18 version was used to perform Chi-square test and descriptive statistics. The 135 participants were 20-81 years old, with 49% being below 40 years of age. Among the Indians, who constituted 52% of the sample, 60% were males, 70% having university education, but non working in a medical field of the 29% who had 'ever used' CAM, 54% were females. Those from the Far East used CAM most [85.7%], the next highest homeopathy and the medical condition musculoskeletal problems. A greater percentage of users administered internal preparations. Physicians had advised 30% of the users whereas non-medical information was used as source by the others. A family history of CAM was observed in 13 [10%], the conditions for which it was used being gall stone, renal problems and musculoskeletal conditions and others. Around 70% reported a good outcome for themselves and family, although only 10% recommended it to others. Most of the users [75%] were not sure whether CAM was based on scientific evidence, while 18% felt it was; 46% opined it had fewer side effects, and 44% felt it had long term effect. Good previous experience and less treatment complications were the most common reasons for using CAM. Non-use was due to lack of knowledge or absence of a need

Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital

Patients admitted to the Intensive care unit receive multiple medications from a variety of pharmacological classes due to life threatening illnesses. This study was conducted to assess the patterns of antimicrobial agents and to suggest necessary modifications in prescribing practices to achieve rational therapeutic practices. The present study aims to study the prescribing patterns of drugs and rationality of antimicrobial drug use in the medical ICU of a tertiary care hospital. A prospective observational study was carried out at the 15 bedded medical ICU of St. John's Medical College Hospital, Bangalore from October 15[th] 2005 to September 15[th] 2006. The relevant data on drug prescription of each patient was collected from the inpatient case record. Drugs were classified into different groups based on WHO-ATC classification. The demographic data, disease data and the utilization of different classes of drugs as well as individual drugs were analyzed. Of the 902 patients admitted in the medical ICU during the study period, 728 [81%] consecutive patients were included for the analysis. Male to female ratio was 1.9. The mean age was 49.21 +/- 15.84 years. Sepsis 198 [27%] and acute renal failure 168 [23%] were the most common primary clinical diagnoses. Maximum number of co-morbid conditions found in a single patient was 15. The average number of drugs per patient [prescription] was 11.6 +/- 2.09. Anti-peptic ulcer drugs 709 [97.4%], antimicrobial agents 679 [93%], ionotropes 340 [46.5%] were the most commonly prescribed drugs. Cephalosporins 622 [37.3%] were the commonly prescribed antimicrobial drug class. Cefoperazone [JO 1DD12] 218 [30%] was the commonly prescribed antimicrobial drug class. A total of 228 perscriptions [31.3%] contained two antimicrobial prescription and [187] 25.7% contained 3 drugs. Cefoperazone + sulbactam [J01DD62] 224[62%] was the most common FDC noticed. A wide spectrum of disorders was noticed. Extensive poly-pharmacy and Poly-therapy of antimicrobial agents were noticed