Drug Therapy Problems Associated With Corticosteroid Use Among Patients Admitted in Medical Wards at Kenyatta National Hospital

Abstract

Background: Drug therapy problems (DTPs) are any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. These treatment goals include cure of disease, resolution or reduction of symptoms, slowing of disease progression and prevention of disease or symptoms. DTPs are major causes of morbidity, increased cost of health care, increased hospital stay, and mortality, hence medical practitioners need to identify prevent and resolve DTPs. Study objectives: The study aimed to determine the prevalence, describe drug related factors, and risk factors of drug therapy problems associated with corticosteroid use among patients admitted in medical wards at KNH. Methodology: A descriptive cross-sectional study was carried out where a simple random sample was used to recruit patients who used corticosteroids and met the inclusion criteria at medical wards at KNH. A questionnaire modified from the Helper and Strand tool was administered by the principal investigator and was also used to extract data from patients’ files. The data collected were entered into Microsoft Excel and analyzed using STATA version 13, the level of significance (alpha) was set at 0.05 and logistic regression analysis was used to determine the risk factors for DTPs. Categorical variables were summarized as frequencies and percentages and the continuous variables as median and IQR. Pearson’s, Chi, and Fisher’s exact tests were applied to determine the associations between the predictor and the outcome variables. Results: Among the 155 participants females were the majority (60%), and the median age was 39 [25.0-54.0] years, with a range of 18-80 years. The prevalence of DTPs was 71.1%. The most common DTP category was the adverse drug reaction (39.4%) followed by non-adherence (35.5%) and dosage too low (16.1%). In multivariate logistic analysis found the significant risk factors associated with DTPs were the primary level of education (95% Cl 1.1-10.0, p=0.032) and family history of diabetes (95% Cl 1.2-2.8,p=0.03)

Conclusion: The prevalence of drug therapy problems associated with corticosteroid use is high in KNH. Adverse drug reaction was the most prevalent type of DTP. Recommendations: To prevent DTPs principles of rational drug use such as appropriate dose calculation for the individual and the medical indication and screening for drug-drug interactions should be encouraged amongst the prescribers. Well-structured adherence counseling should be carried out to ensure that patients are compliant with their prescriptions