Drug Therapy Problems Among Patients With Thyroid Disorders in Kenyatta National Hospital

Abstract

Background: The prevalence of thyroid dysfunction has been on the rise in sub-Saharan Africa. Patients with thyroid disorders are more likely to present with other comorbidities such as hypertension, diabetes, cardiomyopathies and auto immune diseases. These patients are likely to be on various categories of drugs including those with a narrow therapeutic index such as levothyroxine and others which affects thyroid function. In view of such interventions occurrence of drug therapy problems severely limits achievement of therapeutic goals. Information regarding drug therapy problems in this subset of patients is limited and only mentioned in few inconclusive studies. This study aimed to evaluate the various drug therapy problems that maybe encountered in such patients in Kenya Study Objectives: The aim of this study was to assess and characterize the various drug therapy problems which occur among patients presenting with thyroid disorders and are being followed up at the endocrinology clinic located within Kenyatta National Hospital. Methodology: The study adopted a cross-sectional design. A simple random sample of patients presenting with thyroid dysfunctions and who met the inclusion criteria was taken. All relevant patient data was extracted using a questionnaire modified from the Helper and Strand tool. The relevant laboratory reports and medication prescription data was extracted from the patient’s files. Assessment of drug therapy problems was done using the Helper and Strand tool. The data obtained was entered in Microsoft excel and analyzed using STATA. Descriptive summary statistics were presented as means with standard deviations for normally distributed data for continuous variables and medians and interquartile ranges for non-normally distributed data. Categorical variables were summarized using frequencies and percentage proportions. Results Among the 85 participants recruited, 71 (83%) were females and 14 (17%) were males. The male to female ratio was 1:5. The mean age of participants was 51.4(SD 14.8) with a range of 21-83 years. Hyperthyroidism was the most prevalent thyroid condition (47%) followed by hypothyroidism (25%). The major type of comorbidity was hypertension (36%) followed by both hypertension and diabetes (9%). Eighty seven percent of the participants had a DTP. The most xv prevalent type of DTP was noncompliance (38%) followed by dosage too low (25%) and need for additional drug therapy (16%). The most significant risk factors for noncompliance to thyroid medication were level of education (p -0.004), income (p -0.030) and type of drugs (p -0.026). Conclusion Hyperthyroidism is the most prevalent thyroid disease condition in KNH. The prevalence of drug therapy problems among thyroid disease patients in KNH is high (87%). Noncompliance to medication regimen is the major type of DTP in the study population. The patient’s level of education, income status and type of thyroid medication are the major risk factors for noncompliance to drug regimen. Recommendations Introduction of Medication therapy management (MTM) services at the endocrinology clinic would have a positive impact in addressing the high prevalence of DTPs in thyroid disease patients. Further interventional research is needed to access the impact of various solutions applied to solve DTPs. Further research should be done on the DTP related morbidity and mortality in patients with thyroid disease.