Identification and Resolution of Drug-Related Problems among Childhood Cancer Patients in Ethiopia

Abstract

Background: Even though medications play a major role in the cure, palliation, and inhibition of disease, they also expose patients to drug-related problems. Drug-related problems are frequent and may result in reduced quality of life, morbidity, and mortality.

Objectives: The study was aimed to identify, characterize, and resolve drug-related problems in the Pediatric Hematology/Oncology ward of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Methods: A prospective observational study was conducted from 25 June to 25 October 2018 to assess DRPs on patients admitted at the pediatric hematology/oncology ward of Tikur Anbessa Specialized Hospital, which is the highest level governmental tertiary care hospital in Ethiopia. Data were obtained from patients' medical charts, physicians, patients/caregivers, pharmacists, and nurses. All the collected data were entered and analyzed using the Statistical Package for the Social Sciences version 25e. Descriptive statistics were used to represent the data.

Results: Among the total 156 participants, DRPs were identified in 68.6% of the study subjects. Dosing problems which include dosage too low and high were the top ranking (39.3%) of all DRPs followed by needs additional therapy (27.2%) and nonadherence (14.0%). Systemic anti-infectives were the most common class of drugs involved in DRPs. Trimethoprim-sulfamethoxazole, methotrexate, vincristine, ondansetron, and metoclopramide were frequently involved in DRPs. The addition of drugs and change in drug dose were the two most proposed intervention types. Among the proposed interventions, 223 (92.15%) were fully accepted, 9 (3.72%) partially accepted, and 10 (4.13%) not accepted.

Conclusion: DRPs are common among Pediatric Hematology/Oncology ward patients. The hospital should develop a pediatric dosing chart for the commonly prescribed medications to prevent drug-related morbidity and mortality. The integration of clinical pharmacists can mitigate risks associated with DRPs.

Figure 1

Types of cancer diagnosed at the pediatric hematology/oncology ward of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 25 June- 25 October 2018.

Figure 2

Percentage of drug-related problems according to the Anatomical Therapeutic Chemical classification of the drug. A: Drugs acting on alimentary tract and metabolism, B: Drugs acting on blood and blood forming organs, C: Drugs acting on cardiovascular system, D: Dermatologic drugs, G: Drugs acting on genitourinary system and sex hormones, H: Systemic hormonal preparations, excluding sex hormones and insulin, J: Anti-infectives for systemic use, L: Antineoplastic and immunomodulating agents, M: Drugs acting on musculoskeletal system, and N: Drugs acting on nervous system.

Figure 3

Type of intervention given and its outcome. Partially accepted: the recommended intervention is accepted and implemented with modification or not implemented.