ABSTRACT

Drug related Problems in Type-2 Diabetes patients in geriatric patients of South India: Using PCNE classification tool 

Background:
Drug-related problems (DRPs) lead to substantial morbidity and mortality and are statistically related to the clinical outcomes, healthcare costs, and quality of life of diabetic patients.  Several studies have demonstrated that diabetic patients are at the risk for drug -related problems. Patients with Type-2 diabetes mellitus (T2DM) are known to be at risk of drug related problems since they often receive multiple medications due to co-morbidities associated with the condition. This study assessed the prevalence of drug related problems and related factors in a geriatric population of diabetic patients using PCNE classification tool in a tertiary hospital of south India.

Methods: A prospective analysis of selected geriatric patients of Type 2 diabetic was conducted from January 2016 to January 2017 in the Medicine ward of Rajah Muthiah Medical College and Hospital, Annamalai University. Data was collected and analyzed for demographics, clinical conditions (co-morbidity), types of medications used and medication complications. All collected data were scrutinized with the SPSS version 20 for data management and analyzes in the study. The Chi-square test was used for determination of the significant relationship between types of medications prescribed for geriatric patients and factors associated with the occurrence of DRPs. The P-value <0.05 was considered statistically significant.
 
Results: 520 patients with a total of 782 drug related problems were identified, averaging 2.1(± 1.4) problems per patient. The occurrence of DRPs was elevated in males (58.06%) as compared to females (41.93%). 782 DRPs were examined in this study and the common of the issues were associated to drug interaction of drugs (42.45%; n=332), followed by 33.75 % (n=264) drug choice problem, 12.40 %; (n=97) adverse drug reaction, 8.82%; n=69drug use problem and 2.55%; n=20 dosing problem.49(12.4%) of the patients experienced at least one episode of hypoglycaemia. Non-adherence was the most common DRP at 26.7% while polypharmacy was identified as a major factor that contributed to DRP among the patients. Poly pharmacy and the hospital stay are significantly associated with various DRPs. More interventions were provided to the patient level, compare with prescriber level. Patient medication counselling is the most intervention in the study. Interventions proposed by a clinical pharmacist to tackle or avert medication related issues are to a huge degree acknowledged and endorsed by the prescribers. Most of the interventions are of high clinical importance. 

Conclusion: Outcomes of interventions indicate that almost 87.45% of problems are totally solved, by pharmacist’s interventions in this study; it is expanding proof that support and intercession of clinical pharmacists in geriatric health care have a positive influence on clinical outcomes. These findings suggest significant incidence of DRPs in the health facility indicating the need for comprehensive medication management approach which requires the use of pharmacists to play more active roles in managing patients with diabetes.

Drug related problems in type-2 diabetes patients in geriatric patients of South India: using pcne classification tool