Abstract
Background Patients with ischemic stroke are often taking multiple medications and are at increased risk for drug-related problems (DRPs). However, the prevalence and nature of DRPs in these patients in China and the impact of pharmacist interventions to resolve DRPs in this population are unknown. Objective To investigate the prevalence and nature of DRPs in ischemic stroke patients. Setting A neurology ward at an academic teaching hospital in Shanghai, China. Methods This was a prospective observational study conducted from September to November 2017. A total of 274 ischemic stroke adult patients were included. Pharmacists provided pharmaceutical care activities in the multi-disciplinary team. DRPs were categorized by the Pharmaceutical Care Network Europe classification V8.0. Main outcome measure The number, types, and causes of DRPs. Results We identified 88 DRPs related to 89 causes, an average rate of 0.32 DRP per patient. The rates of DRPs were higher in patients with renal impairment (0.91), liver impairment (0.65), or patients younger than 60 years (0.39). The primary cause of the DRPs was drug selection (66.3%), and the most common problem was treatment safety (60.2%). Among the top medications associated with DRPs were proton pump inhibitors (17.2%) followed by cerebrovascular/nootropics (16.1%) and sedative-hypnotics (13.9%). The acceptance rate of pharmacists’ inventions reached 94.0%, and 90.0% of these accepted inventions were fully implemented (DRP status solved). Conclusion Drug-related problems are relatively common in hospitalized ischemic stroke patients in China, and treatment safety is the major DRP type. Pharmacist intervention can identify and resolve pertinent DRPs to optimize medication therapy.
References
Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;394(10204):1145–58.
Michaels AD, Spinler SA, Leeper B, Ohman EM, Alexander KP, Newby LK, et al. Medication errors in acute cardiovascular and stroke patients: a scientific statement from the American Heart Association. Circulation. 2010;121(14):1664–822.
Hohmann C, Neumann-Haefelin T, Klotz JM, Freidank A, Radziwill R. Drug-related problems in patients with ischemic stroke in hospital. Int J Clin Pharm. 2012;34(6):828–31.
Kanagala VS, Anusha A, Rao BS, Challa SR, Nalla KS, Gadde RS. A study of medication-related problems in stroke patients: a need for pharmaceutical care. J Res Pharm Pract. 2016;5(3):222–5.
Semcharoen K, Supornpun S, Nathisuwan S, Kongwatcharapong J. Characteristic of drug-related problems and pharmacists' interventions in a stroke unit in Thailand. Int J Clin Pharm. 2019;41(4):880–7.
Mechler K, Liantonio J. Palliative care approach to chronic diseases: end stages of heart failure, chronic obstructive pulmonary disease, liver failure, and renal failure. Prim Care. 2019;46(3):415–32.
Pharmaceutical Care Network Europe (PCNE) The PCNE classification. https://www.pcne.org/working-groups/2/drug-related-problem-classification Accessed 19 October 2019.
Qu C, Meng L, Wang N, Chen Y, Yang X, Wang J, et al. Identify and categorize drug-related problems in hospitalized surgical patients in China. Int J Clin Pharm. 2019;41(1):13–7.
Naess H, Waje-Andreassen U. Review of long-term mortality and vascular morbidity amongst young adults with cerebral infarction. Euro J Neurol. 2010;17(1):17–22.
Fick DM, Semla TP, Steinman M, Beizer J, Brandt N, Dombrowski R. American Geriatrics Society Beers Criteria® Update Expert P. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94.
Lin C-F, Shen L-J, Wu F-LL, Bai C-H, Gau C-S. Cardiovascular outcomes associated with concomitant use of clopidogrel and proton pump inhibitors in patients with acute coronary syndrome in Taiwan. Br J Clin Pharmacol. 2012;74(5):824–34.
Acknowledgements
None.
Funding
This study was supported by the 2018 Shanghai municipal health Commission Research Project (No. 201840079).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
All authors declare that they have no conflict of interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Chen, Q., Jin, Z., Zhang, P. et al. Characteristics of drug-related problems among hospitalized ischemic stroke patients in China. Int J Clin Pharm 42, 1237–1241 (2020). https://doi.org/10.1007/s11096-020-01081-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-020-01081-6