Ibrahim, N; (2014) Drug-related Problems (DRPs) in Children with Kidney Disease. Doctoral thesis , UCL (University College London).

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Abstract

Introduction: Medicines are used with the intention of benefitting from their effect. The effects of medicines can also be undesirable and potentially lead to harm. A drug-related problem (DRP) is a term used to describe problem(s) that exist in the use of medicines. There remains a distinct paucity of data on the epidemiology of DRPs in children with kidney disease. Aim: To investigate the epidemiology of DRPs in children with kidney disease in clinical practice at tertiary Paediatric Nephrology units. Methods: Study 1: Prospective observational study on the characteristics of DRPs in hospitalised children with kidney disease. Study 2: Randomised control trial on clinical pharmacist (CP) interventions in resolving DRPs on the renal outpatient clinic. Results: Study 1: A total of 127 patients were recruited and a total of 203 DRPs were identified. The incidence of DRP was 51.2% (95% CI 43.2-60.6%) of patients reviewed by the CPs. The number of medicines prescribed per child was the only significant risk factor for the occurrence of DRPs (OR 1.06, 95% CI 1.02-1.10, p=0.002). The majority of DRPs were minor in clinical significance (68%, n=138/203). The predominant DRPs were sub-optimal drug effect. These DRPs were associated with drug selections and dosage errors. Study 2: A total of 100 patients were recruited (Control n=53, Intervention n=47). The trial showed no effect of intervention in the resolution of active DRPs (p=0.96) between the Control and Intervention arms. Conclusion: DRPs are common in children with kidney disease and necessitate a comprehensive approach to their identification and resolution. Their characteristics in both settings are different even though the majority of them shared a similar level of clinical significance. Further research is required to evaluate the effectiveness of pharmacists’ intervention in resolving DRPs at the outpatient clinics.

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