Magnitude and Predictors of Drug Therapy Problems Among Patients With Leukemia at Kenyatta National Hospital

Abstract

Background Drug therapy problems (DTP) are undesirable effects and experiences that occur to a patient during drug treatment and tend to alter the desired therapeutic outcomes. Patients with leukemia are susceptible to DTPs due to the use of multiple cytotoxic drugs. There is limited data on drug therapy problems among these patients in sub-Saharan Africa. Objectives To assess the magnitude and predictors of drug therapy problems among patients with leukemia at Kenyatta National Hospital. Methodology A cross-sectional study to assess the magnitude and predictors of drug therapy problems among a random sample of 89 patients with leukemia at inpatient oncology units at Kenyatta National Hospital. Approval to conduct the study was sought from Kenyatta National Hospital-University of Nairobi Ethics and Review Committee and permission from the management of the hospital prior to data collection. A structured questionnaire was the main data collecting tool. Patient’s sociodemographic features, leukemia type, disease state, comorbidity present, length of hospital stay, phase of treatment, treatment regimen and patients experience with medication were collected from interviews and medical records. Data was collected over a period of four months between March to August 2023 and coded, entered into an excel sheet and cleaned. The coded data was exported and analysed using a statistical software STATA version 13. A bivariate and multivariate logistic stepwise forward regression analysis was done to determine the significant predictors of drug therapy problems. Results The study had a total of 89 participants with the majority as females (53.9%).Most of study participants were aged between 1-12 years (53.9%) with a mean age of 22(±20)years. Of the participants,78.6% had normal body mass index,78.6% were unemployed while majority (88.8%) had an active health insurance cover. Acute lymphoblastic leukemia was the most common leukemia at 53.9% with 79.8% of patients still in the disease state as initially diagnosed. Fifty five percent of study participants were in the induction phase of treatment. Majority (88.8%) of study participants had no comorbidity. Majority (57.3%) of the study participants reported to have stayed in the hospital for a period of twenty days and less. xiv Prevalence of drug therapy problems was 91% with total a of 204 DTPs identified (average of 2.5 per patient). Adverse drug reaction (88.8%),non-compliance (58.4%) and need for additional therapy (37.1%) were the majority types of therapy problems identified. Factors significantly associated with drug therapy problems were age, employment status, phase of treatment and chemotherapy regimens used. Conclusion The prevalence of drug therapy problems among patients with leukemia at Kenyatta National Hospital was high. Age, employment status, phase of treatment and chemotherapy regimens used were the significant predictors of drug therapy problems. Recommendation To increase identification and earlier resolution of drug therapy problems ,pharmacists should advance patient centred pharmaceutical care services in the oncology units. Standardised drug therapy problem assesment tools should be incorporated as part of care for leukemia patients with factors shown to significantly predict occurrence added as baseline guide