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Shegena et al. | Journal of Clinical and Translational Research 2024; 10(3): 191-200 193
the data were collected after voluntary consent. The study aim (v) “Dosage too high” can be related to toxicity; the dosing
was explained on enrollment. frequency being too short for the patient; the duration
Questionnaire-based interviews were conducted among of drug therapy being too long for a patient; or a drug
eligible participants to obtain participants’ baseline socio- interaction that increases the bioavailability of the active
demographics, past medical history, medication use, social drug drug, resulting in toxicity in a patient [11].
use, and any known drug allergies. A data collection form was
used to obtain data from patients’ medical files. Patients’ vital 2.5. Data analysis
signs were taken daily and recorded. Laboratory and diagnostic All the statistical data analysis was performed using the
investigations and current medication use were recorded daily. Statistical Package for the Social Sciences (SPSS), version 21
Each drug therapy given during the hospital stay was (SPSS Inc., United States of America [USA]). The descriptive
evaluated for appropriateness, effectiveness, and safety based analysis of sociodemographic, clinical, and drug-related
on Ugandan Clinical Guidelines (UCG, 2016), Up-To-Date variables was presented as the median with the interquartile
(2019) version 3.12.0.44, and HF treatment guidelines. The range (IQR) or percentage (%).
main outcome measure refers to DTP, which was determined if The prevalence of cardiovascular agent-related DTPs among
any undesirable event was experienced by a patient that involves hospitalized HF patients was calculated as follows:
drug treatment, potentially interfering with achieving the
desired goals of therapy [11]. In addition, poly-pharmacy was Number of cardiovascular agent
determined when a patient consumes five or more medications Prevalence % − Related DTP patients × 100% (II)
( ) =
daily. Total number of patients
DTPs that were identified were categorized according to the
Cipolle et al. classification system [11]. When a patient had Univariate and multivariate logistic regressions were employed
more than one DTP during follow-up, each DTP was classified to determine the independent factors associated with DTPs.
and counted separately. Lexicomp software was used to detect Variables were included in the model based on their significant
potential drug–drug interaction (DDI), and it was recorded as association with DTP in previous studies. Multicollinearity
clinically significant when the interaction was rated as C, D, and between the independent variables was checked, indicating that
X as per the Lexicomp drug interaction checker. The primary there was no significant correlation between two the variables.
investigator (E.A.S.) classified the common drugs used according Variables with P < 0.25 from the univariate analysis were included
to the World Health Organization (WHO)-Anatomical Therapeutic in the multivariate logistic regression. In the multivariate model,
Chemical (ATC) classification method [27]. The above-mentioned p < 0.05 was considered statistically significant.
tools are standard to assess DTP and valid to use in our study based 3. Results
on previous studies in a similar setting. The Cipolle et al. DTP
classification system [11] is summarized as follows: 3.1. Recruitment and sociodemographic characteristics of
(i) “Unnecessary drug therapy” defines a situation where participants
drug therapy is unnecessary as the patient does not have
a clinical indication for drug therapy; the use of multiple During the study period, 123 patients were screened for
drug products for a condition that requires only a single eligibility. Among these, five patients were excluded: three
drug; when nondrug therapy is more appropriate; addiction were unwilling to consent and two were discharged before an
or recreational drug use; or treating avoidable adverse interview could be conducted; 118 HF patients were included
reactions [11]. in the final analysis. The median (IQR) age of the patients was
(ii) “Needs additional drug therapy” defines a situation where a 43 (20.75 – 69.25); 44 (37.3%) patients were elderly patients;
patient requires additional medication either for an untreated 72 (61%) patients were females (Table 1).
condition or to prevent a new medical condition [11]. 3.2. Clinical characteristics and medication use of patients
(iii) “Ineffective drug” defines a situation where a different drug
is needed after the patient is prescribed a drug that is not A total of 56 (47.5%) patients were newly diagnosed with
the most effective for the medical condition; the medical HF; 32 (27.1%) patients stayed in the hospital for more than
condition is refractory to the drug product; the dosage form 11 days; 93 (78.8%) of the patients had at least one comorbid
of the drug product is inappropriate; the drug product is condition; 75 (63.5%) of the patients were on poly-pharmacy;
contraindicated in this patient; or the drug is not indicated and 79 (66.9%) patients incurred a significant DDI among their
for the condition [11]. medications (Table 2).
(iv) “Dosage too low” defines a situation where the dosage is According to the ATC classification, anti-infective agents
too low to produce the desired response in the patient; the were used by 53 (44.9%) of the patients, followed by the use
dosage interval is too infrequent to produce the desired of alimentary tract and metabolism agents by 48 (40.6%)
response; incorrect administration; a drug interaction that patients (Figure 1). Hypertension was the most common
reduces the bioavailability of the active drug, resulting in lack comorbid condition (37 [31.4%]), followed by kidney disease
of effectiveness in this patient; or the duration of the drug (23 [19.5%]) (Figure 2). All patients were using at least one
therapy is too short to produce the desired response [11]. cardiovascular agent.

DOI: https://doi.org/10.36922/jctr.23.00137