Analysis of prevalence, risk factors, and potential costs of unnecessary drug therapy in patients with chronic diseases at the outpatient setting

ABSTRACT

Background

Patients with chronic diseases require long-term use of medications and are at risk for prescription of unnecessary drugs.

Objective

To determine the prevalence, risk factors, and costs associated with unnecessary drugs in patients with chronic diseases at outpatient settings.

Methods

Clinical and demographic data, unnecessary drug therapy and prices of drugs were obtained from 2,677 patients from the outpatient setting of six major hospitals in Jordan. Multivariate logistic regression was used to determine risk factors associated with unnecessary drug therapy.

Results

A total of 936 unncessary medications were identified with an average of one unnecessary medication per every three patients. Monthly costs of unnecessary medications, at the national level, were estimated to range between JD 438,930.24 [(618,821.41 USD) (payer’s perspective)] and JD 744,765.5 [(1,050,000.19 USD) (patient’s perspective)]. Unnecessary drug was associated with cardiac catheterization (adjusted odds ratio [AOR] = 1.29, 95% CI: 1.01–1.71, p = 0.041), increased number of medications (AOR = 3.11, 95% CI: 2.51–3.86, p < 0.001), and inadequate knowledge/understanding of drug use (AOR = 2.4, 95% CI: 1.24–4.64, p = 0.009).

Conclusion

Unnecessary drug therapy is common in the outpatient setting. Identified risk factors should be specifically targeted to reduce its burden.

KEYWORDS:

• Prevalence
• risk factors
• cost
• unnecessary drug therapy
• chronic diseases
• outpatient settings

Article highlights

• Prescribing unnecessary medications is common in the outpatient settings of public hospitals.

• Proton Pump Inhibitors specifically lansoprazole and omeprazole are the most commonly prescribed unnecessary medications.

• Unnecessary medications endure a considerable cost to the healthcare system.

• Significant predictors of unnecessary medications are polypharmacy, cardiac catheterization, and poor knowledge/understanding of important information about drug use.

• Recommended strategies to reduce unnecessary prescribing include: patient and provider education, deprescribing plans, medication management systems, and clinical pharmacy services.

Author Contribution statement

R.M. Arabyat, S. Al-Azzam, and M. Nusiar conceived the idea. K. Al-Zoubi and S. Al-Azzam developed the protocol for the study and data collection. R.M. Arabyat performed the statistical analyses and drafted the manuscript. M. Nusair S.Al-Azzam and K. Al-Zoubi provided critical feedback and commented on the manuscript. All authors discuss the results, reviewed, and approved the final manuscript. The study was reviewed and approved by the Institutional Review Boards (IRB) of the Ministry of Health (MOH) of Jordan, University of Jordan, and King Abdullah University Hospital.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This project was supported by the Scientific Research Funds (project number: 104/2012) at the Ministry of Higher Education and Scientific Research Support Fund, Amman, Jordan.