KLİNİK ECZACILIK UZMANLIK PROGRAMI KAPSAMINDA İÇ HASTALIKLARI SERVİSLERİNDEKİ MÜDAHALELER: RETROSPEKTİF BİR ÇALIŞMA

Abstract

Amaç: İlaçla ilgili sorunlar, hastanede yatan hastalarda optimal hasta sonuçlarını etkileyen yaygın bir sağlık sorunudur. Çalışmanın amacı, klinik eczacılık asistanının rotasyonları sırasında hastanede yatan hastalarda tespit ettiği ilaçla ilgili sorunları sınıflandırmak ve sağlık ekibine yapılan girişimleri değerlendirmektir. Gereç ve Yöntem: Bu çalışma, Nisan-Kasım 2018 tarihleri arasında iç hastalıkları servislerinde yatan hastaların klinik eczacılık asistanının rotasyonları sürecinde ilaçla ilgili sorunlarının incelendiği retrospektif bir çalışmadır. Hastaların demografik bilgileri, reçete edilen ilaçlar, laboratuvar bulguları kaydedildi. İlaçla ilgili sorunlar, Avrupa Farmasötik Bakım Ağı Versiyon 9.1 sistemi ile sınıflandırıldı. Sonuç ve Tartışma: Çalışmaya 92 hasta dahil edilmiştir. Hastaların ortanca yaşı 60.5'tir ve %59.8'i kadındı. Hastaların çoğunda (%63) üç veya daha fazla ek eşlik eden hastalık vardır. En sık eşlik eden hastalıklar hipertansiyon (%21.70) ve diabetes mellitus'tur (%10.64). Hastaların 57'sinde (%62) 147 adet ilaçla ilgili sorun saptandı. Potansiyel ilaç-ilaç etkileşimleri (%55.78), doz zamanlama talimatlarındaki hatalar (%9.52) ve kılavuzlara göre uygunsuz ilaç kullanımı (%8.16) ilaçla ilgili sorunların en yaygın nedenleri olarak belirlenmiştir. İlaçla ilgili sorunların çözümüne yönelik önerilerin kabul oranı %65'tir. Bu çalışmada en yaygın karşılaşılan ilaçla ilgili sorunlar ilaç seçiminden kaynaklanmaktadır. İlaçla ilgili sorunlar için önerilerin kabul oranı literatüre kıyasla daha düşüktür. Ancak klinik eczacılık hizmetinin henüz kurulmadığı bir merkezde bu ilk kabul oranları başarılı olarak kabul edilebilir.

Keywords

• İç hastalıkları
• ilaçla ilgili
• klinik eczacılık

INTERVENTIONS IN INTERNAL MEDICINE WARDS WITH SCOPE OF CLINICAL PHARMACY RESIDENCY PROGRAM: A RETROSPECTIVE STUDY

Abstract

Objective: Drug-related problems are a common health problem in hospitalized patients, affecting optimal patient outcomes. The aim of the study is to classify the drug-related problems detected by clinical pharmacy resident in hospitalized patients during their rotations and evaluate their interventions to the healthcare team. Material and Method: This is a retrospective study in which the drug-related problems of the patients hospitalized in the internal medicine wards between April and November 2018 were examined during the rotations of the clinical pharmacy resident. Patients’ demographics, prescribed medicine, laboratory findings were recorded. Drug-related problems are classified with the Pharmaceutical Care Network Europe Version 9.1 system. Result and Discussion: Ninety-two patients were included in the study. The median age of patients was 60.5 years and 59.8% of them were female. Most of the patients (63%) had three or more comorbidities. The most frequent comorbidities were hypertension (21.70%) and diabetes mellitus (10.64%). One hundred forty-seven drug-related problems were detected in 57 patients (62%). Potential drug-drug interactions (55.78%), errors in dosing timing instructions (9.52%), and inappropriate drug use according to guidelines (8.16%) were the most common causes of drug-related problems. The acceptance rate of interventions for resolving drug-related problems was 65%. The most common drug-related problems in this study were due to drug selection. The acceptance rate of recommendations for drug-related problems was lower than in the literature. However, this initial acceptance rate can be considered successful in a center where clinical pharmacy services have not been established.

Keywords

• Clinical pharmacy
• drug-related
• internal medicine

References

1. 1. Krähenbühl-Melcher, A., Schlienger, R., Lampert, M., Haschke, M., Drewe, J., Krähenbühl, S. (2007). Drug-related problems in hospitals: A review of the recent literature. Drug Safety, 30, 379-407. [CrossRef]
2. 2. Van Den Bemt, P.M.L.A., Egberts, T.C.G., De Jong-Van Den Berg, L.T.W., Brouwers, J.R.B.J. (2000). Drug-related problems in hospitalised patients. Drug Safety, 22(4), 321-333. [CrossRef]
3. 3. Kaboli, P.J., Hoth, A.B., McClimon, B.J., Schnipper, J.L. (2006). Clinical pharmacists and inpatient medical care: A systematic review. Archives of Internal Medicine, 166(9), 955-964. [CrossRef]
4. 4. Taylor, C.T., Church, C.O., Byrd, D.C. (2000). Documentation of clinical interventions by pharmacy faculty, residents, and students. The Annals of Pharmacotherapy, 34(7-8), 843-847. [CrossRef]
5. 5. Slaughter, R.L., Erickson, S.R., Thomson, P.A. (1994). Clinical interventions provided by doctor of pharmacy students. Annals of Pharmacotherapy, 28(5), 665-670. [CrossRef]
6. 6. Abunahlah, N., Elawaisi, A., Velibeyoglu, F.M., Sancar, M. (2018). Drug related problems identified by clinical pharmacist at the Internal Medicine Ward in Turkey. International Journal of Clinical Pharmacy, 40(2), 360-367. [CrossRef]
7. 7. Al-Hajje, A.H., Atoui, F., Awada, S., Rachidi, S., Zein, S., Salameh, P. (2012). Drug-related problems identified by clinical pharmacist’s students and pharmacist’s interventions. Annales Pharmaceutiques Francaises, 70(3), 169-176. [CrossRef]
8. 8. Vinluan, C.M., Jabalie, M.M., Navarrete, J.P., Padilla, M.E. (2018). Evaluating the Types of Pharmacy Student Interventions Made During an Interprofessional 6-Week Adult Internal Medicine Rotation. Journal of Pharmacy Practice, 31(3), 298-303. [CrossRef]

9. 9. Ceylan, C., Sancar, M., Beceren, A., Demir, A., Kuş, C., Omurtag, G.Z. (2022). Evaluation of clinical pharmacist interventions on drug-related problems in the gastroenterology ward. Journal of Research in Pharmacy, 26(3), 687-696. [CrossRef]
10. 10. Umar, R.M., Apikoglu-Rabus, S., Yumuk, P.F. (2020). Significance of a clinical pharmacist-led comprehensive medication management program for hospitalized oncology patients. International Journal of Clinical Pharmacy, 42(2), 652-661. [CrossRef]
11. 11. Ginzburg, R. (2014). Impact of pharmacy student interventions in an urban family medicine clinic. American Journal of Pharmaceutical Education, 78(5), 90. [CrossRef]
12. 12. Mersfelder, T.L., Bouthillier, M.J. (2012). Farmacia en prácticas para los centros en los que Éstas se realizan: Una Revisión de la literatura. Annals of Pharmacotherapy, 46, 541-548. [CrossRef]
13. 13. Brockmiller, H., Abel, S.R., Koh-Knox, C.P., Birk, C.W. (1999). Cost impact of Pharm. D. candidates’ drug therapy recommendations. American Journal of Health-System Pharmacy, 56(9), 882-884. [CrossRef]
14. 14. Pound, M.W., Miller, S.M. (2007). Written versus oral recommendations made by pharmacy students during internal medicine rotations. The Annals of Pharmacotherapy, 41(5), 772-776. [CrossRef]
15. 15. Shogbon, A.O., Lundquist, L.M. (2014). Student pharmacists’ clinical interventions in advanced pharmacy practice experiences at a community nonteaching hospital. American Journal of Pharmaceutical Education, 78(3), 50. [CrossRef]
16. 16. Pham, D.Q. (2006). Evaluating the impact of clinical interventions by PharmD students on internal medicine clerkships: The results of a 3 year study. Annals of Pharmacotherapy, 40(9), 1541-1545. [CrossRef]
17. 17. Kara, E., Kelleci Çakir, B., Sancar, M., Demirkan, K. (2021). Impact of clinical pharmacist-led interventions in Turkey. Turkish Journal of Pharmaceutical Sciences, 18, 517-526. Turkish Pharmacists Association. [CrossRef]
18. 18. Ayalew, M.B., Megersa, T.N., Mengistu, Y.T. (2015). Drug-related problems in medical wards of Tikur Anbessa specialized hospital, Ethiopia. Journal of Research in Pharmacy Practice, 4(4), 216. [CrossRef]
19. 19. Barber, N.D., Batty, R., Ridout, D.A. (1997). Predicting the rate of physician-accepted interventions by hospital pharmacists in the United Kingdom. AJHP, 54(4), 397-405. [CrossRef]
20. 20. Tecen-Yucel, K., Bayraktar-Ekincioğlu, A., Kilickap, S., Erman, M. (2018). Clinical pharmacy practices in oncology patients treated with tyrosine kinase inhibitors. Uluslararasi Hematoloji-Onkoloji Dergisi, 28(1), 53-60. [CrossRef]
21. 21. Bektay, M.Y., Sancar, M., Okyaltirik, F., Durdu, B., Izzettin, F.V. (2023). Investigation of drug-related problems in patients hospitalized in chest disease wards: A randomized controlled trial. Frontiers in Pharmacology, 13, 5078. [CrossRef]
22. 22. Blix, H.S., Viktil, K.K., Reikvam, Å., Moger, T.A., Hjemaas, B.J., Pretsch, P., Walseth, E.K. (2004). The majority of hospitalised patients have drug-related problems: Results from a prospective study in general hospitals. European Journal of Clinical Pharmacology, 60, 651-658. [CrossRef]
23. 23. Lenssen, R., Heidenreich, A., Schulz, J.B., Trautwein, C., Fitzner, C., Jaehde, U., Eisert, A. (2016). Analysis of drug-related problems in three departments of a German University hospital. International Journal of Clinical Pharmacy, 38(1), 119-126. [CrossRef]
24. 24. Chiarelli, M.T., Antoniazzi, S., Cortesi, L., Pasina, L., Novella, A., Venturini, F. Mannucci, P.M. (2021). Pharmacist-driven medication recognition/ reconciliation in older medical patients. European Journal of Internal Medicine, 83, 39-44. [CrossRef]
25. 25. Bedouch, P., Allenet, B., Grass, A., Labarère, J., Brudieu, E., Bosson, J.L., Calop, J. (2009). Drug-related problems in medical wards with a computerized physician order entry system. Journal of Clinical Pharmacy and Therapeutics, 34(2), 187-195. [CrossRef]
26. 26. Garin, N., Sole, N., Lucas, B., Matas, L., Moras, D., Rodrigo-Troyano, A., Fonts, N. (2021). Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions. Scientific Reports, 11(1), 883. [CrossRef]
27. 27. Bond, C.A., Raehl, C.L., Franke, T. (2002). Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals. Pharmacotherapy, 22(2), 134-147. [CrossRef]
28. 28. Leape, L.L., Cullen, D.J., Clapp, M.D., Burdick, E., Demonaco, H.J., Erickson, J.I., Bates, D.W. (1999). Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA, 282(3), 267-270. [CrossRef]
29. 29. De Rijdt, T., Willems, L., Simoens, S. (2008). Economic effects of clinical pharmacy interventions: A literature review. American Journal of Health-System Pharmacy, 65(12), 1161-1172. [CrossRef]
30. 30. MacLaren, R., Bond, C.A., Martin, S.J., Fike, D. (2008). Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections. Critical Care Medicine, 36(12), 3184-3189. [CrossRef]