Drug Use Evaluation Among Elderly Patients With History of Falling in Geriatric Assessment Clinic, Ramathibodi Hospital

Background: Drug use evaluation as an intervention approach for fall prevention has an effect on most drug-related outcomes. Geriatric assessment clinic provides comprehensive care in elderly patients. All prescribed or non-prescribed medications were evaluated by pharmacists. Objective: To study the drug and drug-related problem among elderly patients with history of falling. Methods: This is a cross-sectional study of elderly patients with history of fallings. Demographic data, health information, history of falls, and drugs use evaluation were obtained from their medical records in year 2010 to 2020. Linear regression model was used to examine the multivariate correlates to number of fallings. Results: A total of 183 patients with history of falling were studied. Of this, 97 had recurrent falls. Most patients (77%) had more than 5 underlying diseases and over half (55%) had dementia. Drug-related problem were found 69.4%, 4 in 5 of patients used 5 types of the medications or more. The diabetes drugs were found to increase risk of recurrent falls significantly (OR [95% CI], 2.11 [1.03 - 4.33]; P < .05). Conclusions: Most elderly patient with history of falling have drug-related problem (69.4%) and multiple morbidities including dementia. The diabetes drugs were 2 times significantly increased risk of recurrent falls. This study highlights the important of drugs management in this vulnerable group of elderly patients.

Study of Drug Use Evaluation and Bleeding Risk of Anticoagulants by Has-Bled In Geriatrics

Anticoagulant therapy being the most conventional form of therapeutic intervention is the cornerstone for the treatment and prevention of various ailments including Atrial Fibrillation (AF), Acute Coronary Syndrome (ACS), Venous Thromboembolism (VTE) and patients undertaking cardiac procedures1. Bleeding is the principal complication of anticoagulants even though used within its therapeutic limit. An innovative tool HAS-BLED score come up with the assessment of bleeding risk among patients under anticoagulant therapy supporting the physicians in a better clinical decision making2,3. The objective is to evaluate drug use and bleeding risk of anticoagulant drugs using HAS-BLED Score among geriatric patients. A prospective observational study was conducted in a tertiary care hospital among hundred patients for a period of six months. It was found that 61% were males and 49% were females. Most of the patients were from the age group of 65-70 (53%), 71-75 (31%) and least less than 75 (16%). The most commonly prescribed dosage form was parenteral (79%) and drug was heparin (52%). The bleeding risk of twenty patients taking warfarin was assessed using HAS- BLED Score, the risk categories shows greater than or equal to 3 (60%) high risk and score between 1-2 (40%) moderate risk. Drug use pattern of anticoagulants needs uninterrupted and repeated surveillance not only to discern therapeutic efficacy but also to scrutinize potential adverse drug reaction. From the HAS-BLED score distribution of patients taking warfarin conveys the need to monitor the parameters especially INR before and after initiation of anticoagulant therapy. Keywords: Drug Use Evaluation, Anticoagulant Therapy, HAS-BLED Score, Atrial Fibrillation, Bleeding Risk, Warfarin

Drug use evaluation of vancomycin at medical ward of Yekatit 12, hospital medical college, Addis Ababa, Ethiopia, 2018

<p class="Default"><strong>Background:</strong> Drug use evaluation is an ongoing systematic process designed to maintain the appropriate medication during &amp; after dispensing in order to assure appropriate therapeutic decision making and positive patient outcome.</p><p><strong>Methods:</strong> An institutional based cross-sectional study design was conducted to analyze drug use of vancomycin by using medication charts and medical note of patients that were admitted in the medical ward of Yekatit 12 Hospital Medical College. Data was analyzed using SPSS version 20. Patients who were admitted from medical ward and whose age were ≥18 years were eligible provided that they take Vancomycin during the study period were included and Patients with medical records of insufficient or illegible information’s were excluded. Structured check list was used for data collection, and the sample size was 169. Convenience sampling technique was used.</p><p><strong> Results:</strong><strong> </strong>Among 169 patients 136 (80.5%) had empiric treatments, the remaining 33 (19.5%) had specific treatments. Among 169 patients 61 (36.1%) had Infection during his/her stay in hospital of which 47 (77%) were hospital acquired pneumonia, 169 patients 39 (23.08%) had Vancomycin indication for hospital acquired pneumonia followed by 21 (12.4%), 21 (12.4%), meningitis and PCP respectively. The finding indicated that only 135 (79.9%) were appropriate regarding frequency, 124 (73.4%) were appropriate regarding dose, 104 (61.6%) were appropriate regarding duration, and the appropriate indication were only 128 (75.7%).</p><p><strong>Conclusions:</strong><strong> </strong>Vancomycine was mostly indicated as empiric therapy and only 135 (79.9%) were appropriately prescribed with respect to frequency, 128 (75.7%) were appropriate regarding indication and 124 (73.4%) were appropriate regarding to dose, 104 (61.6%) were appropriate regarding to duration. All physicians should prescribe drugs according to the guidelines.</p>