Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

Thao H Nguyen; Vy T T Le; Dung N Quach; Han G Diep; Nguyet K Nguyen; Anh N Lam; Suol T Pham; Katja Taxis; Thang Nguyen; Phuong M Nguyen

doi:10.3390/healthcare9030327

Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

Healthcare (Basel). 2021 Mar 14;9(3):327. doi: 10.3390/healthcare9030327.

Authors

Affiliations

¹ Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
² Depatment of Pharmacy, Can Tho Children's Hospital, Can Tho City 900000, Vietnam.
³ Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam.
⁴ Department of Epidemiology, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam.
⁵ Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands.
⁶ Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam.

Abstract

Background: Our study was conducted to determine the prevalence of drug-related problems (DRPs) in outpatient prescriptions, the impact of DRPs on treatment efficacy, safety, and cost, and the determinants of DRPs in prescribing for pediatric outpatients in Vietnam.

Methods: A retrospective cross-sectional study was conducted on pediatric outpatients at a pediatric hospital in Can Tho, Vietnam. DRPs were classified according to the Pharmaceutical Care Network Europe classification (PCNE) of 2020. The study determined prevalence of DRPs and their impacts on efficacy, safety, and cost. Multivariate regression was used to identify the determinants of DRPs.

Results: The study included 4339 patients (mean age 4.3, 55.8% male), with a total of 3994 DRPs, averaging 0.92 DRP/prescription. The proportion of prescriptions with at least one DRP was 65.7%. DRPs included inappropriate drug selection (35.6%), wrong time of dosing relative to meals (35.6%), inappropriate dosage form (9.3%), inappropriate indication (7.1%), and drug-drug interactions (0.3%). The consensus of experts was average when evaluating each aspect of efficiency reduction, safety reduction, and treatment cost increase, with Fleiss' coefficients of 0.558, 0.511, and 0.541, respectively (p < 0.001). Regarding prescriptions, 50.1% were assessed as reducing safety. The figures for increased costs and decreased treatment effectiveness were 29.0% and 23.9%, respectively. Patients who were ≤2 years old were more likely to have DRPs than patients aged 2 to 6 years old (OR = 0.696; 95% CI = 0.599-0.809) and patients aged over 6 years old (OR = 0.801; 95% CI = 0.672-0.955). Patients who had respiratory system disease were more likely to have DRPs than patients suffering from other diseases (OR = 0.715; 95% CI = 0.607-0.843). Patients with comorbidities were less likely to have DRPs than patients with no comorbidities (OR = 1.421; 95% CI = 1.219-1.655). Patients prescribed ≥5 drugs were more likely to have DRPs than patients who took fewer drugs (OR = 3.677; 95% CI = 2.907-4.650).

Conclusion: The proportion of prescriptions in at least one DRP was quite high. Further studies should evaluate clinical significance and appropriate interventions, such as providing drug information and consulting doctors about DRPs.

Keywords: Vietnam; drug-related problems; outpatients; pediatric; prescribing.