Assessment of Drug Therapy Problems in Adult Patients With Both Cardiovascular Diseases and Type 2 Diabetes Mellitus at Kenyatta National Hospital

Abstract

ABSTRACT Background information: Patients with both cardiovascular disease and type 2 diabetes mellitus conditions take multiple medications prescribed to them thus are more predisposed to drug therapy problems. Drug Therapy problems arise at any stage of the treatment process, which can lead to unplanned and costlier hospital admissions. There is limited published literature on drug therapy problems among these patients in Sub-Saharan Africa. Study objective: The aim of this study was to characterize the types of drug therapy problems and their predictor factors in patients with both T2DM and CVD followed up at Kenyatta National Hospital (KNH). Methodology: A cross-sectional study was conducted at outpatient diabetes clinic of KNH. One hundred and eighty adult patients aged 18 years and above, with both CVD and T2DM, were recruited using simple random sampling. Patient information such as social demographics, laboratory results, and treatment were collected from the patient files using a predesigned data collection tool. Prescribed related drug therapy problems were assessed through comprehensive review of systems and patients interviews. The appropriateness of medical therapy such as indication, dosage and needs additional drugs were assessed using World Journal of Non-communicable. The data was entered into Microsoft Excel 2010 and analyzed using STATA version 13.0. Descriptive, binary and multi-variable logistic analyses were employed to describe the population and determine the strength of association between the predictor and outcome variables. The p-value of less than 0.05 was considered statistically significant to study the association between predictive variables and drug therapy problem. Results: There were 66.1% female patients and the mean age was 61.6±11.3 years. A total of 164 DTPs were identified. Among these patients, 91.1% had at least one DTP. Commonest problems were non-adherence, needs additional drug and low dosage. Nonadherence was associated with coercion to take medicines (AOR 0.28; 95% CI: 0.12, 0.67; P=<0.001), perception that one could stop taking medications when the condition was under control (AOR 6.99; 95% CI: 2.64, 18.51; P=<0.001) and expectations for a xix cure (AOR 0.24; 95% CI 0.11, 0.56; p=<0.001). In addition, Needs additional drug was associated with use of furosemide (4.71; 95% CI: 1.72, 12.89; P=0.003) and duration of T2DM of >72 months (AOR 0.39; 95% CI 0.19, 0.78; p=0.007). Furthermore, under-dosing was associated with 2-hour postprandial blood glucose test (AOR 4.57; 95% CI: 2.19, 9.52; P=<0.001) and poor blood pressure control (AOR 2.76; 95% CI: 1.26, 6.09; p=0.012) and lower income (AOR 0.64; 95% CI: 0.47, 0.89; p=0.007). Conclusion: Needs for an additional drug, dosage too low, and non-adherence were the most common types of Drug Therapy Problems identified among patients with both T2DM and CVD. Recommendation: We recommend establishment of medication therapy management services in hospitals where pharmacist would routinely identify, resolve, and prevent DTPs among patients with both T2DM and CVD.