Magnitude and Correlates of Drug-Drug Interactions among Prescriptions for Patients Discharged from the Internal Medicine Departments of the Governmental Hospitals
Hanaa Younis Deeb Moussa
هناء يونس ديب موسى
With the increasing availability of complex therapeutic agents and widespread polypharmacy, the rate of drug-related problems and DDIs with medical and financial consequences have been enormously increasing. This study aims to assess the magnitude and factors that correlate with DDIs in prescriptions of patients discharged from the internal medicine departments of the Governmental Hospitals in the Gaza Strip. This study utilized a mixed-method, it involved collecting quantitative and qualitative data. The quantitative data were collected by two tools, first is the abstraction sheet of 600 discharged prescription sheets from the two hospitals were chosen by random sampling technique and the second is a semi-structured questionnaire to collect data from physicians of internal medicine departments and all pharmacists working in the two hopsitals, with a response rate of 75%. The qualitative data were collected through conducting 10 in-depth interviews with policymakers from the Ministry of Health. Quantitative data were analyzed by using the SPSS software and the qualitative data were analyzed using the open coding thematic technique. Findings revealed that the average age for participants (physicians and pharmacists) is 42.03 years. Only 16% of participants received training about DDIs. Most of the participants agree that the best sources of information for DDIs are online sources. The average score for participants in DDIs test of 10 pairs of drugs was 45%, the higher pair of drugs which answered correctly were Amoxicillin and Acetaminophen with an average score of 74.7%, however, the lowest score was for Digoxin and Clarithromycine with an average score 24%. Most of the participants had a positive attitude towards the importance of DDIs to manage and to the danger of DDIs for patient health. Few participants agree that the clinical pharmacist has fulfilled their role in the Gaza hospitals, also few agree that physicians actually consult a pharmacist before prescribing and physician trust of the pharmacist as a consultant of DDIs information. Only 51.3% of the participants had awareness regarding the availability of therapeutic protocols in Ministry of Health, 37.7% always adhere to the Ministry of Health protocols and most of the participants agree that the application of an electronic prescribing program will help in the detection of DDIs. About 54.8% of participants (patients) were female, the mean age is 51.66 years. The diseases most diagnosed are diseases of the circulatory system, which were diagnosed in 28.1% of prescriptions. The most prescribed drug was Acetylsalicylic acid (100 mg). The average number of drugs per prescription was 3.84 drugs. About 54.3% of prescriptions had 2 to 4 drugs and 34.3% had 5 and more drugs. The study also revealed that 22.3% of the prescriptions had minor DDIs, 56.5% had significant DDIs, 13% had serious DDIs and 60.8% had one type of DDIs at least. DDIs issue was statistically significantly associated with the setting, number of prescribed drugs, and age of the patient. The majority of healthcare providers working in the MOH hospitals are not knowledgeable enough about DDIs. There is a need for training and monitoring programs accompanied by supervision and incentives. Strengthening the role of the pharmacist. Prescription behavior requires further follow up and auditing. The necessity of a computerized prescribing alerting system.