Drug Therapy Problems Among Patients on Proton Pump Inhibitors in the Medical Wards of Kenyatta National Hospital

Abstract

Background: Drug therapy problems (DTPs) are major causes of morbidity, increased cost of health care, increased hospital stay and mortality. Proton Pump Inhibitor (PPI) use in hospitals has been increasing over time despite the myriad of side effects which compromise patient safety. Main Objective: The objective of the study was to identify and describe DTPs associated with PPI use by patients admitted at the medical wards of KNH. Methodology: A cross sectional study design was used targeting adult patients admitted in medical wards of KNH.A sample size of one hundred and seventy-six was consecutively selected. This was where all participants who met inclusion criteria were included until the desired sample size was attained. Data was collected through participant interviews and review of medical files. Descriptive statistics was summarized as means with standard deviation for normally distributed continuous variables and for non-normally distributed variables as median with interquartile range. Categorical variables at 95% significance level were presented as frequencies and percent proportions. Inferential statistics was used to evaluate association of patient- associated risk factors with occurrence of various types of DTPs. Chi-square test was used. Results: The overall prevalence of DTPs associated with PPI use among patients admitted in medical wards of KNH was 43.2%. The prevalence of various types DTPs present were; the dosage was too high (21.6%), adverse drug interaction (16.5%), unnecessary drugs (15.9%), low dosage (1.1%), non- adherence (1.1%), the need of a different drug (1.1%) and the need of additional drug therapy (0.6%). The multivariate analysis to assess the association between the DTPs and patient risk factors (comorbidities) was statistically insignificant, p value (0.104 to 0.860), at 95% confidence interval. Discussion: The mean age of the participants was 43.6 (SD 16.5) years, while the median age was 39.0 years. The majority of the participants were ma le (95, (54.0%) as compared to females (81, (46.0%), with the leading age bracket of 30 – 39 years (28.4%) and majority having a minimum level of secondary education (39.8%). Among the patient risk associated xv

factors, the top five leading were Anemia (52, 29.5%), followed by hypertension (50, 28.4%), cancer (35, 19.9%), HIV (29, 16.5%), and respiratory diseases (28, 15.9%). The high prevalence of the DTPs presence could be as a result of physicians’ prescribing patterns, lack of strict adherence to prescription guidelines, and failure to involve the clinical pharmacists in reviewing treatment sheets and monitoring PPI use. Conclusion: From the study findings, it is evident that the presence of DTPs associated with PPI use is very high, and this warrant extra caution in prescription of PPIs. This will improve patient therapeutic outcomes and safety. Recommendations: There is need for strict adherence to the guidelines during prescription, sensitization of healthcare workers on PPI use, and involvement of clinical pharmacists in reviewing treatments sheets and monitoring PPI use with view the of preventing occurrence of DTPs.