Evaluation of Potential Drug-drug Interactions among Medications Prescribed in Primary Health-Care Centers for Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study From Palestine
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Date
2020-10-19
Authors
Athamneh, Sabrine
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Publisher
An-Najah National University
Abstract
Background
Nowadays, there is a global healthcare concern associated with the risk of high incidence medication errors, many of which are attributed to drug-drug interactions (DDIs). Co-morbid conditions such as; diabetes mellitus, hypertension, dyslipidemia, renal disease and peripheral artery diseases require complex therapy with multiple medications. Thus, administration of more than one medication concomitantly is a common practice to control their conditions and, for this reason, polypharmacy patients are more prone to DDIs. In our country there are no local studies concerned with the prevalence of potential DDIs among type 2 diabetes mellitus patients (T2DM), that is why the study was carried out.
Aim of the Study
The aim of this study is to evaluate the potential of DDIs among medication prescribed for T2DM patients and examine factors associated with these interactions, in primary healthcare centers.
Methods
The study is an observational survey employing a cross sectional design and encompassing all T2DM patients, whom visited the primary healthcare centers of the ministry of health (MOH) between July and September 2018. The sample size is comprised of 400 patients, all from the southern part of the West Bank; Hebron and Beitlehem. The patients were interviewed for their social demographic characteristics, their medical conditions, management and treatment by questionnaire-guided interviews. All their prescriptions of drugs were input to Lexi-Comp checker to find out the potential DDIs in their medications. Besides, the assessing the modalities of DDIs according to severity to contraindicated, major, moderate, or minor interaction.
Results
Among 400 patients, a little less than the half were over 60 years, the majority of them were female. The most common co-morbid conditions present in the diabetes mellitus (DM) patients were as follows; 77.3% had cardiovascular disease (CVD), 64.5% had dyslipidemia, and 12.0% had gout. Moreover, a total of 114 different medications were used, the most commonly prescribed medications were metformin being used by 85.5%, followed by atorvastatin 74.5%, and Acetyl salicylic acid (ASA) used by 74.0% patients. The most common interactions in 61.5 % patients were ASA with Metformin followed by Glimepiride with Metformin in 40.5 % cases. Out of participants 96% patients had at least one potential DDIs.
Overall 2627 interactions were identified, with an average of 6 interaction per prescription. According to the risk rating classification, 1.33% were A, 11.72% were B, 76.67% were C, 10.01%, and 0.27% were X risk rating. The number of potential DDIs that the patients had were also related to their age, educational level, comorbidities, number of medications prescribed and complication (p value < 0.05 for each one). However, there was no significant relationship with gender, material status or smoking (p value > 0.05).
Conclusions
The prevalence of DDIs among medications prescribed for T2DM was very common. This potentially is increasing parallel with increasing age, educational level, comorbidities, number of medications, in addition to the presence of complications. Updating data related to DDIs with good and effectively communicate among healthcare providers, especially prescribers and dispensers can play an important role in minimizing DDIs.