Anticholinergic burden and health-related quality of life among adult patients in a resource-limited setting: a cross-sectional study.

BACKGROUND: Anticholinergic medications are now widely acknowledged for their unfavorable risk-to-benefit profile owing to their adverse effects. Health-related quality of life (HRQoL) is commonly regarded as a crucial person-centered outcome. AIM: This study aimed to investigate the association between anticholinergic burden and HRQoL in hospitalized and ambulatory patients seen in Ethiopia. METHOD: This cross-sectional study utilized a questionnaire and medical records to collect data from a convenience sample of adult patients attending both inpatient wards and ambulatory clinic of University of Gondar Comprehensive Specialized Hospital between April and September 2022. Anticholinergic burden was measured by anticholinergic cognitive burdens scale (ACBS), while HRQoL was measured using EQ5D-index (Euroqol-5 dimensions-5-Levels index) and EQ5D-VAS (visual analogue scale). Linear regression was used to assess the influence of high anticholinergic burden (ACBS score ≥ 3) on EQ5D-index and EQ5D-VAS, with adjustments made for sociodemographic and clinical confounders. RESULTS: A total of 828 patients participated in this study (median (IQR) age was 45.0 (30, 60) and 55.9% were female). On multiple linear regression analysis, high anticholinergic burden was associated with a statistically significant decline in HRQoL, as evidenced by reductions in both EQ5D index (- 0.174 (- 0.250, - 0.098)) and EQ5D-VAS scores (- 9.4 (- 13.3, - 5.2)). CONCLUSION: A significant association between high anticholinergic burden and diminished HRQoL was found among a relatively younger cohort in a resource-limited setting, even after adjustment for important confounding variables. Clinicians should be cognizant of the cumulative impact of anticholinergic burden on HRQoL outcomes and strive to minimize anticholinergic burden.

Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia.

Background: Numerous studies report that anticholinergic burden (ACB) has been linked with several health consequences, including increased hospital admissions, prolonged hospitalization, and physical and cognitive impairment. However, low- and middle-income settings, as well as younger individuals, are underrepresented. Objectives: To assess the prevalence and determinants of ACB, and to assess the impact of ACB on in-hospital mortality among adult in-patients at University of Gondar Comprehensive Specialized Hospital (UOGCSH). Design: A cross-sectional study was conducted from June to August 2022 at UOGCSH among adult in-patients. Methods: A pre-tested questionnaire was utilized to collect data from patients and their corresponding medical charts. A consecutive sampling technique was used to select the participants. Descriptive statistics were used to summarize socio-demographic and clinical characteristics. Chi-squared, Fisher's exact, and Wilcoxon rank sum tests, as appropriate, were used to determine associations between independent variables and ACB. Kaplan-Meier survival curve and Cox proportional hazards regression test were used to assess the impact of ACB on in-hospital mortality. Results: A total of 420 adult in-patients, median (interquartile range) age of 38 (26, 55) years, participated in this study. Over half (58.3%) were exposed to anticholinergic medicines, with a high ACB (⩾3) seen in 11.2% of participants. High ACB was associated with higher median number of medicines per patient (p = 0.003) higher median hospital length of stay (p = 0.033), and having mental and behavioral disorders (p < 0.001). No significant association was found between ACB and in-hospital mortality (log-rank test p = 0.26, Cox regression adjusted hazard ratio: 1.47, 95% CI: 0.335-6.453, p = 0.61). Conclusion: Among adult in-patients, a significant majority (58.3%) were subjected to medications possessing anticholinergic properties, with a noteworthy 11.2% of the study subjects exhibiting a high ACB. Participants with higher median length of hospital stay were more likely to have high ACB even in this relatively younger adult patient population.

Background: Anticholinergics refers to substances that block the action of the neurotransmitter acetylcholine in the body. Previous studies have shown that medicines exhibiting anticholinergic effects could lead to increased hospital admissions, longer hospital stays, and both physical and cognitive impairments. Objective: In this study, we aimed to assess how medicines exhibiting anticholinergic effects might affect patients in Ethiopian in-patient settings. Methods: We conducted a cross-sectional study from June to August 2022, collecting data from adult in-patients through a questionnaire and medical charts. We used a widely recognized tool called Anticholinergic Cognitive Burden Score to measure anticholinergic burden. We used statistical analyses to identify associations between the use of anticholinergic medicines and various factors, including the number of medicines per patient and the length of hospital stay. Additionally, we explored the impact of anticholinergic burden on in-hospital mortality. Results: Out of the 420 participants, 245 were exposed to medicines with anticholinergic properties. High anticholinergic burden was observed in 47 patients. Patients with mental and behavioral disorders were more likely to have high anticholinergic burden, while those with diseases of the digestive system were less likely. Moreover, a high anticholinergic burden was linked to a greater median number of medicines per patient and an extended median hospital length of stay. However, the study found no significant difference in in-hospital mortality between patients with high and low anticholinergic burden. Conclusion: The study highlights that a significant proportion of the participants were exposed to medicines with anticholinergic properties, and a notable percentage experienced a high anticholinergic burden. This burden was particularly associated with mental and behavioral disorders, the use of higher number of medicines, and longer hospital stay. Importantly, the research did not find a clear link between anticholinergic burden and in-hospital mortality after accounting for other factors.

Understanding the impact of medicines with anticholinergic properties on patients at University of Gondar Hospital.

Drug-related problems and associated factors among adult psychiatric inpatients in Northwest Ethiopia: Multicenter cross-sectional study.

Objective: To determine the prevalence of drug-related problems and the factors influencing them among adult psychiatric inpatients. Methods: A multi-centre cross-sectional observational study was conducted from April to July 2021 at five randomly selected hospitals in Northwest Ethiopia. A total of 325 consecutively sampled patients participated in the study. Clinical pharmacists assessed the drug-related problems based on clinical judgement supported by updated evidence-based disease guidelines. We used the Medscape drug-interactions checker to check drug-to-drug interactions. The results were summarised using descriptive statistics, including frequency, mean, and standard deviation. For each variable, an odds ratio with a 95% confidence interval was calculated, as well as the related p-value. The value of p ⩽ 0.05 was considered statistically significant. Results: From the total number of 325 study participants, more than half of them (52.9%) were females, and the mean age ± (standard deviation) was 30.8 ± 11.3 years. At least one drug-related problem was recorded by 60.9% to 95% confidence interval (55.7-65.8) of study participants, with a mean of 0.6 ± 0.49 per patient. Additional drug therapy was the most common drug-related problem (22.8%) followed by non-adherence to medicine (20.6%) and adverse drug reactions (11%), respectively. Factors independent associated with drug-related problems were rural residence (adjusted odds ratio = 1.96, 95% confidence interval: 1.01-2.84, p-value = 0.046), self-employed (adjusted odds ratio = 6.0, 95% confidence interval: 1.0-36.9, p-value = 0.035) and alcohol drinkers (adjusted odds ratio = 6.40, 95% confidence interval: 1.12-37.5, p-value = 0.034). Conclusion: The prevalence of drug-related problems among adult psychiatric patients admitted to psychiatric wards was high. Healthcare providers give more attention to tackling these problems. Being a rural resident, self-employed, and alcohol drinkers were associated with drug-related problems.

Medicine Dose Adjustment Practice and Associated Factors among Renally Impaired Patients in Amhara Regional State, Ethiopia.

BACKGROUND: Kidney disease affects absorption, distribution, metabolism, and excretion of medicines and their metabolites. Therefore, when prescribing medicines for patients with kidney disease, dose adjustment is an accepted standard of practice. OBJECTIVE: This study aimed to assess medicine dose adjustment practice and associated factors among adult patients with renal impairment admitted to medical wards at Amhara region referral hospitals. METHOD: Multicenter, institution-based, cross-sectional study was conducted from March 28, 2020, to August 30, 2020. The data was collected by using a pretested interviewer-administered structured questionnaire. Data were entered into Epi-Data version 4.6 and transferred into SPSS version 25 for further data processing and analysis. Descriptive statistics such as frequencies and percentages were computed. Both bivariable and multivariable binary logistic regression analyses were fitted to identify factors associated with dose adjustment practice. A 95% confidence interval and a p value less than 0.05 were used to declare statistical significance. RESULT: Among 815 medicines' prescriptions that needed dose adjustment, 417 (51.2%) of them were dosed inappropriately. Number of medicines, number of comorbidities, and being unemployed were significantly associated with inappropriate dose adjustment. CONCLUSION: Our study revealed that there was a considerable rate of inappropriate dose adjustment in patients with renal impairment. Training for health care providers, use of guidelines, and communication with clinical pharmacists should be encouraged for good prescription practice.

Medication-Related Needs and Humanistic Impact of Patient-Centered Pharmaceutical Care at University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia.

PURPOSE: To assess patients' medication-related needs and the humanistic impact of patient-centered pharmaceutical care. PATIENTS AND METHODS: A hospital-based cross-sectional study was conducted using self-administered structured questionnaires from February 4 to 28, 2019, on patients attending ambulatory care for chronic non-communicable diseases at the University of Gondar specialized teaching hospital, North-west Ethiopia. Data were entered to SPSS version 22 for analysis. Descriptive statistics was used to describe the socio-demographic characteristics and medication-related needs of study participants. Independent sample t-test and one-way ANOVA analysis were performed to check for possible associations between dependent and independent variables. RESULTS: Information about what to do if patients missed doses and the potential side-effects or abnormal conditions caused by the prescribed medicines were not explained for most of the 425 patients studied. The majority of the study participants reported that they felt worried about adverse medicine effects, drug interactions, and long-term medicine use. Patients who were older than 50 or those receiving two or more medications were less satisfied with the effect of their medicine as compared to younger ones and those on monotherapy, respectively. People who were illiterate or had attended only primary schools thought that they received less disease and medicine information from health professionals than people who attended tertiary education. CONCLUSION AND RECOMMENDATION: Most of the participants were particularly unhappy with the amount of information received about side-effects and what to do if doses were missed. Special emphasis should be given to patients with a low level of education as they were not satisfied with medicine and disease information obtained from health professionals, experienced more psychological impacts of medicine use, and had poor overall quality-of-life.

Chemotherapy-Related Adverse Drug Reaction and Associated Factors Among Hospitalized Paediatric Cancer Patients at Hospitals in North-West Ethiopia.

BACKGROUND: One of the prevalent treatment modalities for cancer is chemotherapy. Adverse drug reactions, however, are becoming the world's major public health problem. More than half (54.5 percent) of cancer patients need hospitalization for further management, in addition to the increased health-care costs of treatment. The aim of this study was to evaluate adverse drug reactions associated with chemotherapy and related factors in hospitalized paediatric cancer patients in Ethiopia's north-west hospitals. METHODS: From July 1, 2017, to August 13, 2019, a cross-sectional study was carried out among 311 paediatric cancer patients at Gondar Comprehensive University, Specialized Hospital and Felegehiwot referral hospital. The data were entered into Epi Info version 7 and exported for further analysis to Statistical Product and Service Solutions (SPSS). To identify associated variables, both the bi-variate and multi-variate logistic regression analyses were computed. Variables with a P-value of less than 0.05 were considered statistically significant in the multivariate logistic regression analysis. RESULTS: The overall adverse drug reaction in this study was 41.5 percent ((95% CI: 35.8-47.2%)). Patients who received concomitant medications were at higher risk of experiencing adverse drug reactions (AOR: 2.60 (95% CI: 1.54-4.40)), according to the multivariate logistic regression analysis. Similarly, there was a risk of developing adverse drug reactions in patients taking four or more chemotherapy agents (AOR: 2.67 (95% CI: 1.52-4.68)). In addition, regimens based on etoposide (AOR: 1.99 (95% CI: 0.93-4.27)), mercaptopurine (AOR: 3.91 (95% CI: 1.06-14.46)) and doxorubicin (AOR: 2.32 (95% CI: 1.30-4.15)) were at higher risk for adverse drug reactions in patients. CONCLUSION: Adverse drug reactions developed in a significant proportion of the study patients (2 out of 5 patients). Therefore, for pediatric cancer patients on concomitant medications and for patients on etoposide, mercaptopurine and doxorubicin drug regimens, efficient prevention and management of adverse drug reactions should be sought.

Assessment of Quality of Life of Epileptic Patients in Ethiopia.

BACKGROUND: Patients with epilepsy are at an increased risk of poor quality of life. PURPOSE: We aimed at assessing the quality of life and its determinants among epileptic patients at University of Gondar Referral Hospital (UoGRH), Ethiopia. METHODS: Institution based cross-sectional study was conducted on epileptic patients on follow up at UoGRH from January 15 to April 15, 2017. Information including socio-demographic profile and diagnosis was extracted from medical records and patients. Quality Of Life In Epilepsy-10 (QOLIE-10) tool was used to measure the quality of life. Independent t-test and one-way analysis of variance were used to look for factors associated with quality of life. The level of statistical significance was declared at P-value ≤ 0.05. RESULTS: A total of 354 patients were included in the study and mean age was 29.1 ± 11.7 years. The mean QOLIE-10 score was 19.85. One hundred ninety-four (54.8%) of participants had a good quality of life. Being illiterate, unemployment, and presence of co-morbid medical condition were associated with poorer quality of life. CONCLUSION: Nearly half of the participants had a poor quality of life. Patients with co-morbidity, illiteracy, and unemployment should be given special emphasis in order to improve their quality of life.

Drug Related Hospital Admissions; A Systematic Review of the Recent Literatures.

OBJECTIVE: To derive findings from different studies done on drug related hospital admissions and comprehensively express the incidence and preventability of drug related hospital admissions; identify the common types of drug related problems that caused hospital admission, and identify factors associated with drug related hospital admission. METHODS: Literatures that assessed hospitalization due to drug related problems were searched online using Pub Med and Google Scholar databases. The relevant reference lists of retrieved articles were also searched manually on Google. Prospective and retrospective studies conducted anywhere in the world on drug related hospitalization, published from January 2012 to January 2017 as an original article and written in English language were included. RESULT: The prevalence of drug related hospital admission varies from 1.3% to 41.3% with the average rate of 15.4%. Among hospitalized patients 2.7% were died due to drug-related problems (DRPs). Drugs that were frequently reported as causing drug related admission were antithrombotic drugs, antihypertensive drugs, analgesics, anti-diabetics, antipsychotics, and anti-neoplastic drugs. Poly pharmacy, old age and female sex were mentioned as determinants for drug related hospitalization by a number of studies. About one third of drug related hospital admissions were definitely preventable and more than 40% were also potentially preventable. CONCLUSION: Drug related problems contribute for more than 15% of hospital admissions. Higher risk of admission due to DRPs was observed in patients who were on poly pharmacy and those who were old. As most of drug related hospital admissions were preventable an emphasis should be given for preventive strategies to avoid complications and costs associated with admission.

Patient Satisfaction with Psychiatric Outpatient Care at University of Gondar Specialized Hospital: A Cross-Sectional Survey.

BACKGROUND: Patient satisfaction is an imperative and commonly used indicator for measuring the quality of healthcare. Patient satisfaction with psychiatry services is an important construct, which influences multiple areas including treatment adherence and outcome. The aim of the present study was to assess the level of patient satisfaction and determine associated factors with psychiatric outpatient care. METHOD: An institution-based cross-sectional study was conducted from April 15 to May 15, 2017. A total of 250 psychiatric patients visiting psychiatric outpatient care in University of Gondar Specialized Hospital during the study period were included in the study. Data were collected using structured questionnaires and entered to and analyzed using Statistical Packages for Social Sciences (SPSS) version 20. Descriptive statistics and one-way ANOVA with post hoc test were used to determine the characteristics of the participants and examine the difference among different variables. P value<0.05 and confidence interval (CI) of 95% were used as cut-off points for determining statistical significance. RESULTS: During the one-month data collection period, 250 participants (92.593% response rate) were included in the analysis. Majority (133 (53.2%)) of them were males and cannot read and write (107 (42.8%)). Majority (194 (77.6%)) of study participants were satisfied with the outpatient care. The overall level of satisfaction among participants was good with a mean satisfaction score of 3.87. Majority (173 (69.2%)) of the participants claimed that health professionals working in outpatient care did not provide adequate information about payment for services. Statistically significant satisfaction difference with respect to the psychiatric outpatient care was found in the type of mental illness (t=2.224, P=0.043) and the participants' employment status (t=2.981, P=0.003). CONCLUSION: In general, the overall participants' satisfaction towards outpatient care was high. Statistically significant satisfaction difference with respect to the psychiatric outpatient care was found in the type of mental illness and the participants' employment status. Regular service evaluation is important to improve patient satisfaction and further research is needed to investigate why satisfaction difference exists among different types of mental illnesses.

Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients' point of view.

BACKGROUND: Nowadays, heart failure (HF) related morbidity and mortality rate is increasing globally. Younger populations happen to be more affected by HF in sub- Saharan African than the western countries. Even though medications, low sodium diet, regular exercise, and weight monitoring are essential to control heart failure symptoms and its exacerbation, poor adherence to these self-care recommendations is contributing to an increased in hospitalization, morbidity, and mortality. Therefore, this study aimed to assess heart failure patients' adherence to self-care recommendations and its associated factors. METHODS: A hospital-based cross-sectional study was conducted on 310 adult heart failure patients attending Gondar University referral hospital from February to May 2017. The participants were selected by systematic random sampling technique. Data were collected through face to face interview and from the patients' medical records. The data were analyzed using SPSS version 20. A binary logistic regression model was used to check the effect of different factors on the patients' adherence level. RESULTS: Of 310 study participants only 22.3% (95% CI, 17.4%-26.8%) of heart failure patients reported good adherence to their self-care recommendations. Adherence to self-care recommendation was positively associated with being male in gender (AOR = 2.34, 95% CI: 1.18-4.62), good level of heart failure knowledge (AOR = 2.49, 95% CI: 1.276-4.856) and free from chronic comorbid diseases (AOR = 2.57, 95% CI: 1.28-5.14). CONCLUSION: Overall, heart failure patients' adherence to self-care recommendations is poor and selective. Being male in gender, had no chronic comorbidity, and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations. It is therefore strategic to plan improving heart failure patients' knowledge about heart failure signs, symptoms and its management approaches, to improve the patients' adherence level.

Challenges and opportunities of clinical pharmacy services in Ethiopia: a qualitative study from healthcare practitioners' perspective

Background: Currently, clinical pharmacists have in-depth therapeutic knowledge and scientific skills to act as drug therapy experts in healthcare settings. Objective:The aim of this study was to assess the opportunities and challenges of clinical pharmacy services from the health practitioners’ perspective in University of Gondar (UOG) hospital Ethiopia. Methods: A qualitative study was performed using face-to-face in-depth interviews with health practitioners who were directly involvedin clinical pharmacy services (clinical pharmacists, physicians, and nurses) in UOG hospital. Results: A total of 15 health professionals from various specialties were interviewed to express their views towards clinical pharmacists’ competencies and identified challenges and opportunities regarding their clinical services. Based on inter-viewees report,the opportunities for clinical pharmacists includes acceptance of their clinical services among health specialties, new government policy and high patient load in hospital. However, inadequacy of service promotions, lack of continuity of clinical pharmacy services in wards, poor drug information services, lack of commitment, lack of confidence among clinical pharmacists, conflict of interest due to unclear scope of practice, and absence of cooperation with health workers were some of the challenges identified by the interviewees. Conclusion: We identified health professionals working in UOG hospital are receptive towards clinical pharmacy services, but identified some of the potential challenges that needed to be focused to strengthen and promote clinical pharmacy services. Further, the opportunities at hand also need to be utilized astutely to boost the services (AU)

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Ethiopian health care professionals' knowledge, attitude, and interests toward pharmacogenomics.

BACKGROUND: Pharmacogenomics is a field of science which studies the impact of inheritance on individual variation in medication therapy response. AIM: We assessed healthcare professionals' knowledge, attitude, and interest toward pharmacogenomics. METHODS: A cross-sectional survey was conducted using a 32-item questionnaire among physicians, nurses, and pharmacists who were working at the University of Gondar Referral and Teaching Hospital in northwest Ethiopia. Descriptive statistics was applied, and the categorical variables were summarized as frequency and percentages. An analysis of variance (ANOVA) test was performed to compare mean scores among health professionals. A p-value of <0.05 was considered as statistically significant. RESULTS: Of 292 health professionals who responded, the majority were male (60%) and the mean age of study participants was 27.00 (±4.85 SD) years. The mean knowledge scores of all participants, pharmacists, physicians, and nurses were 2.343±1.109, 2.671±1.059, 2.375±1.093, and 2.173±1.110, respectively. Based on the ANOVA test, a statistically significant difference was noted in mean knowledge score between pharmacists and nurses (p=0.002). More than two-thirds (67.33%) of nurses, 42.86% of pharmacists, and 40.27% of physicians who participated did not know that genetic variations can account for as much as 95% of the variability in drug disposition and effects. The ability to accurately apply their knowledge to drug therapy selection, dosing, or monitoring parameter was reported by 35.3% of the participants. More than two-thirds (69.2%) of participants thought that pharmacogenomic testing will allow the identification of the right drug with less side effects. Most of the participants (83.2%) also requested to have training on pharmacogenomics. CONCLUSION: Participants showed limited knowledge, but they had positive attitude toward pharmacogenomics. Educational programs focusing on pharmacogenomic testing and its clinical application need to be emphasized.

Risk factors for developing drug-related problems in patients with cardiovascular diseases attending Gondar University Hospital, Ethiopia.

BACKGROUND: Cardiovascular diseases (CVDs) are often accompanied with comoribidities and complications leading to taking multiple drugs and thus are more liable to be exposed to drug-related problems (DRPs). DRPs can occur at any stages of medication process from prescription to follow-up treatment. However, a few studies have assessed the specific risk factors for occurrence of at least one potential DRP per patient with CVDs in sub-Saharan African region. AIM: We aim to assess the risk factors for developing potential DRPs in patients with CVDs attending Gondar University Referral Hospital (GUH). METHODOLOGY: This was a cross-sectional study. A structured systematic data review was designed focusing on patients with CVDs (both out and inpatients) with age >18 years of both genders attending GUH from April to June 2015. All DRPs were assessed using drugs.com and Medscape. The causes of DRPs were classified using Pharmaceutical Care Network Europe version 6.2. Risk factors that could cause DRPs were assessed using binary logistic regression showing odds ratio with 95% confidential interval. Statistical significance was set at P < 0.05. RESULTS: A total of 227 patients with CVDs were reviewed with a mean age of 52.0 ± 1.7 years. Majority were females (143, 63%), outpatients (133, 58.6%), and diagnosed with heart failure (71, 31.3%). Diuretics (199, 29.5%) were the most commonly prescribed drugs. A total of 265 DRPs were identified, 63.4% of patients have at least one DRP (1.17 ± 1.1). The most common DRPs were found to be an inappropriate selection of drug (36.1%) and dose (24.8%). The most identified risk factors causing DRPs were: Need of additional drug therapy and lack of therapeutic monitoring. CONCLUSION: The most identified risk factors for developing DRPs were the need of additional drug therapy and lack of therapeutic monitoring. There is a need for clinical pharmacist interventions to monitor and prevent the risk of developing DRPs and contribute to improve the clinical outcome in patients with CVDs.