Hospital Outpatient Visits Associated With Medication-Related Problems in Thailand: A Multicenter Prospective Observational Study.

OBJECTIVES: The aims of the study were to investigate the prevalence of hospital visits associated with medication-related problems (MRPs, i.e., adverse drug events [ADEs], adverse drug reactions [ADRs], nonadherence [NA] to medication, and medication error) and to identify the medications involved in hospital visits associated with MRPs in outpatient departments (OPDs). METHODS: A prospective observational study was carried out in OPD of 11 hospitals in the lower northern region of Thailand. Patients visiting OPDs were screened for suspected MRPs by clinical pharmacists using medical record review supplemented by patient interview. Three experts evaluated suspected MRPs using the following 3 criteria: causality, severity, and preventability. RESULTS: Of the 3069 patients who visited the OPDs during the study period, 113 (3.7%) were deemed to have causal MRPs. Nearly half of the causal MRPs (n = 49, 43.4%) were preventable. The following 4 types of causal MRPs were identified: ADEs (n = 112, 3.7%), ADRs (n = 65, 2.1%), NA to medications (n = 48, 1.6%), and medication errors (n = 1, 0.03%). In nonelective patients (n = 764), 35 patients (4.6%) were judged to have causal MRPs. Of the nonelective patients who experienced causal MRPs, 25 (71.4%) were preventable. The medications commonly associated with ADEs and NA to medication were those targeting the cardiovascular system (especially enalapril, amlodipine, and hydrochlorothiazide), whereas the medications involving ADRs involved the cardiovascular and endocrine systems (especially, enalapril, amlodipine, and metformin). CONCLUSIONS: Outpatient department visits associated with MRPs, particularly in nonelective patients, were preventable. Effective strategies are needed for reducing visits to hospital OPD associated with preventable MRPs.

Drug-Related Problems Identified at Patients' Home: A Prospective Observational Study in a Rural Area of Thailand.

OBJECTIVE: The aim of the study was to examine the prevalence rates, nature, and predictors of drug-related problems (DRPs) experienced in participants living at home in a rural Thailand. METHOD: A cross-sectional observational study was undertaken during December 2015 to January 2016. Drug-related problems were identified within a rural township having a population of 5256 by means of home visits by pharmacists. All suspected cases were then assessed for severity and preventability by clinical specialists. Drug-related problems were categorized according to Pharmaceutical Care Network Europe classification (revised 2010).v.6.2. RESULTS: From a systematically recruited cohort of 359 participants, suspected DRPs were identified in 160 participants. After detailed reviews by clinical specialists, 141 cases (39.3%) were deemed to have DRPs. Types of DRPs with prevalence rates were the following: problems of treatment effectiveness (3.7% of DPRs), adverse reactions (15.3%), treatment cost (28.4%), nonadherence to drugs (42.1%), and poor drug storage (10.5%). The most common drug to involve DRPs was those treating cardiovascular disease, especially simvastatin. CONCLUSIONS: Nearly half of community living participants experienced DRPs, especially nonadherence to drugs, and has implications for other rural elderly persons of low education attainment for similar rural economies around the globe. Appropriate interventions should focus on reducing polypharmacy, providing outreach programs, and rigorous pharmacovigilance.

Hospital Admissions Associated With Medication-Related Problems in Thai Older Patients: A Multicenter Prospective Observational Study.

OBJECTIVE: The aim of the study was to estimate the prevalence rate and risk factors of medication-related problems (MRPs) leading to hospital admissions in Thai older patients. METHODS: A prospective observational study was carried out in nine hospitals in Lower Northern Thailand. Participants admitted to internal medicine units were screened for suspected MRPs by clinical pharmacists using medical record review and patient interview. Three experts evaluated suspected MRPs independently using the following four criteria: contribution of MRPs to hospital admissions, causality, severity, and preventability. RESULTS: Of 1776 patients admitted during the study period, 56 patients (3.2%) were deemed to have causal MRPs; 24 (42.9%) were judged as preventable. The medication groups most commonly associated with MRPs were those targeting the endocrine system, especially antidiabetic medications, such as metformin and glipizide. Preventable MRPs were usually manifest as hypoglycemia (n = 15, 62.5%). The variables that contributed to hospital admissions associated with MRPs were age (odds ratio = 1.92; 95% confidence interval [CI] = 1.06-3.47), starting a new drug within 1 week (odds ratio = 2.31; 95% CI = 1.08-4.95), or within 1 month (odds ratio = 2.17; 95% CI = 1.05-4.48). CONCLUSIONS: Hospital admissions associated with MRPs in Thai older patients continue to burden the Thai healthcare system of which nearly half were preventable. Further studies should consider analysis of costs and include hepatic and renal function status of participants.

Economic Evaluation of Intravenous Immunoglobulin plus Corticosteroids for the Treatment of Steroid-Resistant Chronic Inflammatory Demyelinating Polyradiculoneuropathy in Thailand.

BACKGROUND AND OBJECTIVE: Intravenous immunoglobulin (IVIG) has been recommended for steroid-resistant chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The treatment, however, is very costly to healthcare system, and there remains no evidence of its economic justifiability. This study aimed to conduct an economic evaluation (EE) of IVIG plus corticosteroids in steroid-resistant CIDP in Thailand. METHODS: A Markov model was constructed to estimate the lifetime costs and outcomes for IVIG plus corticosteroids in comparison with immunosuppressants plus corticosteroids in steroid-resistant CIDP patients from a societal perspective. Efficacy and utility data were obtained from clinical literature, meta-analyses, medical record reviews, and patient interviews. Cost data were obtained from list prices, an electronic hospital database, published source, and patient interviews. All costs [in 2015 US dollars (US$)] and outcomes were discounted at 3 % annually. One-way and probabilistic sensitivity analyses were conducted. RESULTS: In the base-case, the incremental costs and quality-adjusted life years (QALYs) of IVIG plus corticosteroids versus immunosuppressants plus corticosteroids were US$2112.02 and 1.263 QALYs, respectively, resulting in an incremental cost-effectiveness ratio (ICER) of US$1672.71 per QALY gained. Sensitivity analyses revealed that the utility value of disabled patients was the greatest influence on ICER. At a societal willingness-to-pay threshold in Thailand of US$4672 per QALY gained, IVIG plus corticosteroids had a 92.1 % probability of being cost effective. CONCLUSIONS: At a threshold of US$4672 per QALY gained, IVIG plus corticosteroids is considered a cost-effective treatment for steroid-resistant CIDP patients in Thailand.

Hospital admissions/visits associated with drug-drug interactions: a systematic review and meta-analysis.

PURPOSE: To estimate prevalences of hospital admissions/visits associated with actual drug-drug interactions (DDIs) and examine the effect of study design (prospective vs. retrospective), population (all ages or adults), and method of detecting DDIs on reported prevalences. METHODS: PubMed, International Pharmaceutical Abstracts, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature plus, and the Cochrane Database of Systematic Reviews up to October 2013 were searched for observational studies examining actual DDIs, in any language. The outcomes in this study were DDI prevalence rates in total populations, DDI prevalence rates in total adverse drug reaction patients, and frequency (%) of each pair of DDIs. RESULTS: Thirteen studies met our inclusion criteria. The median DDI prevalence rate for hospital admissions was 1.1% (367 DDI cases/47 976 patients, interquartile range [IQR] 0.4-2.4%). The median DDI prevalence rate for hospital visits was 0.1% (20 DDI cases/23 607 patients, IQR 0.0-0.3%). In adverse drug reaction patients, the median DDI prevalence rate for hospital admissions (308 DDI cases/1683 patients) and hospital visits (8 DDI cases/90 patients) were 22.2% (IQR 16.6-36.0%) and 8.9%, respectively. Medical record, interview, drug interaction screening program, adverse reaction report, and electronic medical record were identified as methods used for detecting DDIs. Non-steroidal anti-inflammatory drugs were most commonly involved in hospital admission associated DDIs, whereas warfarin was frequently involved in DDIs detected at hospital visits as outpatients/emergencies. CONCLUSIONS: Drug-drug interactions are a significant cause of hospital admissions and hospital visits. Improved DDI information gathering could help to reduce such adverse effects from DDIs, especially for patients using non-steroidal anti-inflammatory drugs and warfarin.