Analysis of the Association Between Drugs with Drug-Related Problems and Types of the Identified Problems in Cardiovascular Outpatients
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Abstract
Objective: To analyze the association between medications with drug-related problems (DRPs) and types of the DRPs among cardiovascular patients at outpatient unit. Methods: This retrospective analytic study collected data from pharmacists review of prescriptions in cardiovascular outpatient unit at Queen Sirikit Heart Center of the Northeast during October 2022 to September 2025. The study analyzed the associations between the medications with DRPs and the types of DRPs using Generalized Estimating Equations (GEE) and the results were reported as adjusted odds ratio (aOR) with 95% confidence interval (CI) and P-value. Results: A total of 3,349 patients were included, with a mean age of 64 ± 13.2 years. The study identified 4,191 events of DRPs. The most common DRP was untreated indication (1,161 events or 27.7%). The identified DRPs were more frequently associated with warfarin (1,119 events; 26.7% of the total DRPs) than with other drugs. The identified DRPs were more frequently associated with anticoagulant drugs (1,458 events, 34.8%) than with other drug classes. DRPs from warfarin were more likely to be those involving overdosing (aOR 3.57; 95% CI 2.92-4.37; P<0.001) and underdosing (aOR 4.78; 95% CI 3.84-5.94; P<0.001) than those from the other drugs. DRPs from atorvastatin were more likely to involve prescribing in patients with a history of allergy or previous adverse drug reactions (ADRs) than those from the other drugs (aOR 3.24; 95% CI 2.16–4.84; P<0.001). In addition, DRPs from metformin were more likely to involve inappropriate drug selection than those from the other drugs (aOR 3.32; 95% CI 2.23–4.93; P<0.001). Conclusion: The types of the identified DRPs differed significantly according to the medications with DRPs. For example, DRPs from warfarin were commonly related to overdosing and underdosing, whereas DRPs from atorvastatin were often associated with prescribing in patients with a history of allergy or previous ADRs. Analyzing the DRPs at the individual drug level can help identify patterns of DRPs. This study highlights the role of pharmacists in detecting and preventing DRPs. The findings may be applied to the development of clinical decision support systems to improve medication safety.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of hospitalization resulting from medication-related problems in adult patients. Br J Clin Pharmacol 2014; 78: 202-17.
Tamargo J, Kjeldsen KP, Delpón E, Semb AG, Cerbai E, Dobrev D, et al. Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. Eur Heart J Cardiovasc Phar macother 2022; 8: 406-19.
Maher RL, Hanlon J, Hajjar ER. Clinical consequen- ces of polypharmacy in elderly. Expert Opin Drug Saf 2014; 13: 57-65.
Paisansirikul A, Ketprayoon A, Ittiwattanakul W, Pet- chlorlian A. Prevalence and associated factors of drug-related problems among older people: a cross-sectional study at King Chulalongkorn Memorial Hospital in Bangkok. Drugs Real World Outcomes 2021; 8: 73-84.
Hospital Pharmacy Association. Prescription review. In: Fundamental framework of medication manage- ment systems. Bangkok: Hospital Pharmacy Association (Thailand); 2020.
Hepler CD, Strand LM. Opportunities and responsibili ties in pharmaceutical care. Am J Hosp Pharm 1990 ; 47: 533-43.
Pharmaceutical Care Network Europe (PCNE). Classi fication for drug-related problems V9.1 [online]. 2020 [cited Mar 10, 2026]. Available from: www.pcne.org
Deawjaroen K, Sillabutra J, Poolsup N, Stewart D, Suksomboon N. Characteristics of drug-related problems and pharmacists' interventions in hospitalized patients in Thailand: a prospective observational study. Sci Rep 2022;12:17107.
Guignard B, Bonnabry P, Perrier A, Dayer P, Desmeu les J, Samer CF. Drug-related problems identification in general internal medicine: the impact and role of the clinical pharmacist and pharmacologist. Eur J Intern Med 2015; 26: 399-406.
Jirapermpun A, Pichayapaiboon S. Drug related problems in outpatients with congestive heart failure at Maharat Nakhon Ratchasima Hospital. Maharat Nakhon Ratchasima Hospital Journal 2024; 34: 33-40.
Somprasong T. Drug related problem of outpatients receiving warfarin who had the INR out of target in Sathingpra Hospital. Journal of MCU Nakhondhat 2024; 11: 78-86.
National Coordinating Council for Medication Error Reporting and Prevention. NCC MERP index for categorizing medication errors [online]. 2001 [cited Mar 10, 2026]. Available from: www.nccmerp.org
WHO Collaborating Centre for Drug Statistics Metho- dology. ATC/DDD Index 2026 [online]. 2026 [cited Mar 16, 2026]. Available from: www.whocc.no/atc_ ddd_index/
Jantharuechai S, Khonyai P, Senma W, Ariyapim N, Ungprasert C, Ungprasert P. Drug-related problems identified through routine prescription review in cardiovascular outpatients: A 3-year retrospective study. Srinagarind Medical Journal. In press; 2026
Putriana N, Rusdiana T, Rostinawati T, Akbar MR, Destiani DP. Evaluation of warfarin use in cardiac clinic outpatients. Pharmacol Clin Pharm Res 2022; 7: 40.
Holbrook AM, Pereira JA, Labiris R, McDonald H, Douketis JD, Crowther M, et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med 2005; 165: 1095-106.
Verdoorn S, Kwint HF, Hoogland P, Gussekloo J, Bouvy ML. Drug-related problems identified during medication review before and after the introduction of a clinical decision support system. J Clin Pharm Ther 2018; 43: 224-31.
IBM Micromedex. DRUGDEX System [online]. 2026 [cited Mar 19, 2026]. Available from: www.micro medexsolutions.com
Wannapongsatit P, Pudeethip I, Kanjanawat P, Pudpong K, Wongpakdee P, Tumsen T, et al. A study of drug dosing adjustment initiative in patients with renal impairment admitted to internal medicine wards. Isan Journal of Pharmaceutical Sciences 2017;13 (Suppl): 373-81.
Jamaluddin J, Mohamed-Yassin MS, Jamil SN, Mohamed Kamel MA, Yusof MY. Frequency and predictors of inappropriate medication dosages for cardiovascular disease prevention in chronic kidney disease patients: a retrospective cross-sectional study in a Malaysian primary care clinic. Heliyon 2023; 9: e14998.
Wang J, Chi CL, St Peter WL, Carlson A, Loth M, Pradhan PM, et al. A population-based study of simvastatin drug-drug interactions in cardiovascular disease patients. AMIA Jt Summits Transl Sci Proc 2020; 2020: 664-73.
Yimama M, Jarso H, Desse TA. Determinants of drug-related problems among ambulatory type 2 diabetes patients with hypertension comorbidity in Southwest Ethiopia: a prospective cross sectional study. BMC Res Notes 2018; 11: 679.
Al-Taani GM, Al-Azzam SI, Alzoubi KH, Aldeyab MA. Which drugs cause treatment-related problems? Analysis of 10,672 problems within the outpatient setting. Ther Clin Risk Manag 2018; 14: 2273-81.
Lekpittaya N, Kocharoen S, Angkanavisul J, Siriu- dompas T, Montakantikul P, Paiboonvong T. Drug-related problems identified by clinical pharmacists in an academic medical centre in Thailand. J Pharm Policy Pract 2023; 17: 2288603.
Sukngam P. Electronic prescribing in accordance with standard for clinical decision support. Siriraj Med J 2021; 73: 180-8.
Mohapatra AB, Sharma A. Effectiveness of clinical decision support systems in reducing medication errors across multiple specialties. Int J Healthc Qual Patient Saf 2025; 6: 10-9.
