Impact of Clinical Pharmacist-Led Interventions on Drug-Related Problems Among Pediatric Cardiology Patients: First Palestinian Experience

Figures & data

Table 1 Demographic and Clinical Characteristics of the Study Cases

Characteristics	Value
Gender
Male (%)	51 (58.6)
Female (%)	36 (41.4)
Age
Mean age in years ± SD (range)	2.32 ± 2.46 (2 months-11 years)
Medications
Mean prescribed medications ± SD (range)	5.27 ± 2.27 (3–14)
5 medications (%) > 1 to	37 (42.5)
≥ 5 medications (%)	50 (57.5)

Table 2 Types of Drug-Related Problems According to the PCNE V9.1³⁷

Problem	Frequency
	n	(%)	Total (%)
P1 – Treatment effectiveness
P1.1 No effect of drug treatment/therapy failure	13	(4.2)	157 (50.8)
P1.2 Effect of drug treatment not optimal	112	(36.2)
P1.3 Untreated symptoms or indication	32	(10.4)
P2 – Treatment safety
P2.1 Adverse drug event (possibly) occurring	94	(30.4)	94 (30.4)
P3 – Others
P3.1 Unnecessary drug-treatment	27	(8.7)	58 (18.8)
P3.2 Unclear problem/complaint	31	(10.1)
Total			309 (100)

Note: Adapted from PCNE-Classification v9.1. Published Online 2020. Available online: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf (accessed 27 July 2022).

Table 3 Major Drugs Involved in Drug-Related Problems

N	Drug	Frequency
		n	%	Total (%)
1	Furosemide	53	17.1	238 (77.0)
2	Captopril	42	13.6
3	Spironolactone	31	10.0
4	Omeprazole	23	7.4
5	Sildenafil	19	6.2
6	Aspirin	15	4.9
6	Ceftriaxone	13	4.2
7	Dexamethasone	12	3.9
8	Metoclopramide	11	3.6
9	Acetylcysteine	10	3.2
10	Ipratropium	9	2.9
11	Others	71	23.0	71 (23.0)
Total				309 (100)

Table 4 Relationship Between Drug-Related Problems and Causes According to the PCNE V9.1³⁷

DRP	Cause		Frequency
			n	%	Total (%)
P1: Treatment effectiveness
	C1.1	Inappropriate drug according to guidelines/formulary	5	1.5	157 (47.7)
	C1.3	Inappropriate combination of drugs, or drugs and food	9	2.7
	C1.5	No or incomplete drug treatment in spite of existing indication	27	8.2
	C2.1	Inappropriate drug form	28	8.5
	C3.1	Drug dose too low	11	3.3
	C3.3	Dosage regimen not frequent enough	3	0.9
	C3.5	Dose timing instructions wrong, unclear or missing	31	9.4
	C4.1	Duration of treatment too short	2	0.6
	C5.1	Prescribed drug not available	12	3.7
	C5.2	Necessary information not provided or incorrect advice provided	5	1.5
	C7.7	Inappropriate timing or dosing intervals	15	4.6
	C9.2	Other causes	9	2.7
P2: Treatment safety
	C1.1	Inappropriate drug according to guidelines/formulary	5	1.5	118 (35.9)
	C1.3	Inappropriate combination of drugs, or drugs and food	45	13.7
	C3.2	Drug dose of a single active ingredient too high	9	2.7
	C3.4	Dosage regimen too frequent	6	1.8
	C3.5	Dose timing instructions wrong, unclear or missing	22	6.7
	C6.3	Drug over-administered by a health professional	19	5.8
	C7.2	Patient uses/takes more drug than prescribed	3	0.9
	C7.7	Inappropriate timing or dosing intervals	5	1.5
	C9.2	Other causes	4	1.2
P3: Others
	C1.2	No indication for drug	14	4.3	54 (16.4)
	C1.4	Inappropriate duplication of therapeutic group or active ingredient	4	1.2
	C2.1	Inappropriate drug form/formulation (for this patient)	10	3.1
	C3.5	Dose timing instructions wrong, unclear or missing	5	1.5
	C4.2	Duration of treatment too long	9	2.7
	C5.1	Prescribed drug not available	7	2.1
	C9.2	Other causes	5	1.5
Total					329 (100)

Note: Adapted from PCNE-Classification v9.1. Published Online 2020. Available online: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf (accessed 27 July 2022).

Figure 1 Level of interventions in drug-related problems according to the PCNE V9.1.

Table 5 Acceptance and Outcome of Clinical Pharmacist’s Intervention According to the PCNE V9.1³⁷

Acceptance of Intervention		Frequency
		n	%	Total (%)
1. Intervention accepted
A1.1 Intervention accepted and fully implemented		286	86.9	318 (96.7)
A1.2 Intervention accepted, partially implemented		19	5.8
A1.3 Intervention accepted but not implemented		13	4.0
2. Intervention not accepted
A2.2 Intervention not accepted: no agreement		5	1.5	11 (3.3)
A2.3 Intervention not accepted: other reason		6	1.8
Total				329 (100)
Outcome of Intervention		Frequency
		n	%	Total (%)
0. Unknown
O0.1 Problem status unknown		3	0.9	3 (0.9)
1. Solved
O1.1 Problem totally solved		303*	92.1	303 (92.1)
2. Partially solved
O2.1 Problem partially solved		11	3.4	11 (3.4)
3. Not solved
O3.1 Problem not solved, lack of cooperation of patient/caregivers		3	0.9	12 (3.6)
O3.2 Problem not solved lack of cooperation of prescriber		5	1.5
O3.4 No need or possibility to solve problem		4	1.2
Total				329 (100)

Note: *Include 17 of accepted and partially implemented interventions that led to this totally solved problems. Adapted from PCNE-Classification v9.1. Published Online 2020. Available online: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf (accessed 27 July 2022).

PCNE-Classification v9.1. Published Online 2020. Available from: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf. Accessed July 27, 2022.

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