Polypharmacy and the occurrence of potential drug–drug interactions among geriatric patients at the outpatient pharmacy department of a regional hospital in Durban, South Africa

Background Polypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice. Little is known about this practice in South Africa. This study aimed to determine the level of polypharmacy and potential drug–drug interactions amongst the geriatric patient population in a facility in South Africa. Method A cross-sectional retrospective prescription chart review for 250 geriatric patients was conducted at the outpatient pharmacy department of a regional hospital. Variables extracted included demographic information, diagnosis, type of prescriber contact, and polypharmacy. Potential drug–drug interactions were determined with web-based multi-drug interaction checkers. Results The average (SD) number of diagnosed clinical problems was 3.54 ± 1.26, with hypertension, diabetes mellitus, and heart disease occurring most frequently. The level of polypharmacy was high with patients receiving an average (SD) of 12.13 ± 4.25 prescribed medicines from 3032 prescribed medicines. The level of polypharmacy was highest within the age categories, 60–64, and 70–74 years of age, respectively. The level of potential drug–drug interactions was also high with an average (SD) of 10.30 ± 7.48 from 2570 potential drug interactions. The majority of these interactions were moderate (72.5%) and pharmacodynamic (73.2%) by nature of the clinical severity of action and mechanism of action, respectively. Polypharmacy and type of prescriber contact were statistically significant contributors to the occurrence of potential drug–drug interactions, (F (2, 249) = 68.057, p < 0.05). However, in a multivariate analysis of variables to determine the strength of the association, polypharmacy was determined to be the strongest contributor to the occurrence of potential drug–drug interactions (p < 0.05) when compared with the type of prescriber contact (p value = 0.467). Therefore, irrespective of the type of prescriber contact, polypharmacy increases the potential for drug interactions among the sampled patient population. Conclusion A comprehensive consideration of disease management guidelines, patient factors, and rational medicine review could be measurable strategies towards improving medicine use. This would also limit the occurrence of significant drug interactions among the geriatric patient population. A national study is required to determine if differences occur across hospitals and regions.

The use of anti-hyperlipidemia in a private hospital in Yogyakarta during 2013-2019

Background: Lipid modifying agents have an important role in the primary and secondary prevention of cardiovascular diseases such as coronary heart disease and stroke. The use of lipid-modifying agents tends to increase along with the increasing prevalence of these diseases. Objectives: To determine the utilization of lipid modifying agents for hospitalized patients in a private hospital in Yogyakarta during the period of 2013 - 2019 in regard to the agents used and their quantity. Methods: The main data for this study were aggregate data on the use of lipid modifying agents for hospitalized patients during 2013-2019 obtained from the hospital pharmacy department. After identification of the names of lipid modifying agents, the quantities of these drugs were then calculated in units of defined daily dose (DDD) and the final quantity was expressed in DDD/100 bed days (BD). The R2 value from linear regression was used to determine the trend of use of individual agents over the period. Results: There were two pharmacological subgroups of lipid modifying agents used during the period of 2013 – 2019 with an average of total quantity of 14.81 DDD/100 BD. Utilization of statins was approximately 90% of the total use, and utilization of fibrates tended to decrease over the period. Individually, simvastatin use decreased significantly over the period (R2 = 0.885), but atorvastatin use continued to increase (R2 = 0.908) with 10-fold increase from 2013 to 2019. Conclusion: The lipid modifying agents used during the period 2013 - 2019 were predominantly statins, and the utilization of atorvastatin increased significantly during this period. Keywords: lipid modifying agents, ATC/DDD, fibrates, statins

Two-way Evaluation and Analysis of Student-centered Pharmacy Teaching

Student-centered teaching model is a very important concept in the education sector, which will be restricted and influenced by many factors in the process of implementation. This paper focuses on investigating and studying the influence of teachers, students and supporting management of teaching reform on this teaching mode. According to undergraduates in pharmacy department of our hospital, the whole class was divided into study group and control group. Two-way evaluation method was used in the study group, and traditional experimental teaching method was used in the control group. The experimental theory, skill test scores and experimental report scores of the two groups of students were compared and analyzed, and the evaluation of teachers' teaching methods and learning effects of the students in the study group were investigated. The results show that students' evaluation of the Two-way evaluation method and teaching effect are very good. Two-way evaluation can stimulate students' interest in learning, and help to cultivate students' awareness of inquiry, practical ability, innovative ability, ability to analyze and solve problems.

The Difference in Contributing Factors and Costs Associated with Outpatient Refusal to Accept Cardiovascular Medications or Analgesics During Dispensing Process.

Background: Study looking into cardiovascular disorders (CVD) medicines or analgesics cost-saving activities during dispensing process is lacking. Aim: To determine differences in factors and costs associated with refused CVD medicines or analgesics during dispensing process Method: This study was approved by Medical Research and Ethics Committee (MREC) (Registration number: NMRR-20-177-53153(IIR)). Participants receiving CVD medicines or analgesics during dispensing process were recruited via convenience sampling technique between February and March 2020 at the Specialist Pharmacy Department of Jerantut Hospital, Malaysia. Refusal to medications and its reasons were asked based on the questionnaire developed by the researchers. Results: Overall, 175 patients participated in this survey and CVD drugs contributed toward 58.9% of the refused medicines. Those who refused CVD drugs and analgesics were significantly different in terms of gender, medications dosing frequency, refusal reasons namely side effects, medications use, intentionally skipping dose and skipping the dose when feeling well. No associations were found between forgetfulness and age with refusal to CVD drugs or painkillers. Those who refused CVD medicines had a significantly higher total daily medicines, total daily pill burden, and total number of medicines refused per prescription compared to those who refused analgesics. Cost of CVD medicines refused per prescription was significantly higher compared to analgesics, median Ringgit Malaysia (RM) 10.50 (IQR, RM 15.00) versus median RM 6.00 (IQR, 15.00), P=0.01. Conclusion: Refusal to CVD medicines and analgesics was associated with several medication’s and patient’s factors. However, higher cost-saving was observed in those refusing CVD medicines. Keywords: cardiovascular disease, analgesics, dispensing, wastage

Silver nanoparticle based alcohol sensor manufacturing training for detection of halal drinks

Nowadays, halal drinks are one of the sectors that get the attention of various parties. Alcohol in beverages is important in determining the halalness of a beverage. Halal detection can be done using chemical sensors. In the Pharmacy Department, knowledge of analysis using sensors is rare. Therefore, this community service program was carried out to introduce qualitative methods of quick and simple alcohol analysis. The participants are students of the Pharmacy Department of STIKES Anwar Medika in Sidoarjo City. Participants are communities engaged in the health sector who have an interest in halal and how to make sensors for halal testing. This program is implemented by making a video on how to make a chemical sensor for alcohol detection. The chemical sensor is a paper-immobilized colloidal silver-based chemical sensor that is easy to apply in various conditions. Based on the results of the color change produced on the filter paper, from green to bluish which indicates that the food or beverage sample contains alcohol. Based on the questionnaire, participants expressed satisfaction with the increase in knowledge about additional tools that are easy and fast to detect alcohol.

Prescribing Practice of Third Generation Cephalosporins in Medical Wards at Hospital Queen Elizabeth II (HQEII)

Cephalosporins are amongst the most used antibiotics in hospital settings worldwide. The antibiotic report collated by the Pharmacy Department from Hospital Queen Elizabeth II(HQEII) in 2018 reflected high usage of third generation cephalosporins in medical wards, and indeed HQE II was one of the top users nationwide. This study aimed to evaluate the prescribing pattern of third-generation cephalosporins in medical wards as per National Antimicrobial Guidelines (NAG) 2019. A prospective, observational study was conducted in medical wards from June 2019 till January 2020. Patients who were started with third-generation cephalosporins (ceftazidime, ceftriaxone, cefotaxime, cefoperazone/sulbactam)were recruited, where 137 patients were enrolled with 60.6% were males. The mean age of patients was 53+16.8 years old. Antibiotics were initiated as per NAG recommendation. Cultures were taken before antibiotic initiation. Respiratory-related infections (n = 54, 39.4%) were the main indication and, antibiotics were continued as definite therapy in 38 patients (27.7%). The median duration of antibiotic treatment was 5 days (interquartile range = 3). Ceftazidime (n = 85, 62%) was most prescribed followed by ceftriaxone (n = 48, 35%)and cefotaxime (n = 4, 2.9%) respectively. It was worth noting that ceftazidime was primarilyused as empirical therapy for melioidosis (n = 64, 75.3%), particularly in patients with diabetes mellitus (n = 40, 62.5%), chronic kidney disease (n = 27, 42.2%), and/or occupational exposure (n = 4, 6.3%). The mean ceftazidime duration for empirical melioidosis was 3.2+1.6 days. Overall, third-generation cephalosporins were appropriately prescribed in medical wards as per NAG 2019. Further exploration of ceftazidime usage in empirical melioidosis is warranted.

Tingkat Efisiensi Penggunaan Resep Dokter Spesialis Menggunakan Metode K-Means Clustering

The National Formulary (Fornas) is a list of drugs stipulated in a Decree of the Minister of Health of the Republic of Indonesia, which is used as a guideline for hospitals in drug supply for participants of the National Health Insurance (JKN) program. Doctor's prescription is one indicator of the quality of hospital services. Prescribing drugs based on guidelines will provide efficiency in the supply of drugs. The purpose of this study was to facilitate controlling drug supplies, safe use of drugs and control costs and quality of treatment. K-Means Clustering is a method of grouping data into clusters using the K-Means algorithm. The data used in this study was a specialist doctor's prescription in December 2019 which was sourced from the Pharmacy department of the Meranti Islands District Hospital. The results of this research with the K-Means Clustering method consisted of 3 (three) clusters, namely cluster 0 obeying Fornas as many as 2 polyclinics, cluster 1 being less obedient to Fornas as many as 2 polyclinics and cluster 2 not obeying Fornas as many as 3 polyclinics. This research can be used as a reference and evaluation to hospital management on the efficiency level of using specialist doctor's prescriptions in improving the quality of hospital services.