Impact of hospital pharmacist-delivered individualised pharmaceutical service intervention on clinical and patient-reported outcomes in patients with hypertension: a randomised controlled trial.

OBJECTIVES: Patients with hypertension in Nepal are often known to have poor medication adherence and quality of life. This randomised controlled trial aimed to evaluate the impact of a hospital pharmacist-delivered individualised pharmaceutical service (P-DIPS) intervention on blood pressure, medication adherence and health-related quality of life (HRQoL) among patients with hypertension in a hospital setting in Nepal. METHODS: In an open trial, 56 adult patients with hypertension who had been receiving antihypertensive medication for ≥6 months were randomly allocated to a control group (n=28) which received the usual care and an intervention group (n=28) which received a P-DIPS along with the usual care. The difference in blood pressure, medication adherence and HRQoL between the two groups at baseline, 2 and 4 months was compared using the Mann-Whitney U test, independent t-test or χ2 tests. RESULTS: Participants were mostly ≥40 years (86%) and female (57%). There were no significant differences in the baseline characteristics between the control (C) and intervention (I) groups. At 2 months, the two groups had a significant improvement in the median (IQR) Morisky-Green-Levine (MGL) Medication Adherence Score (I=1 (2) vs C=2 (2); p<0.001) and the median (IQR) mental component of HRQoL (I=43.6 (9.5) vs C=37.5 (8.6); p=0.013). At 4 months, there were significant differences in the median (IQR) values of all the outcome measures between the groups (systolic blood pressure: I=125 (10) mmHg vs C=130 (15) mmHg, p=0.008; diastolic blood pressure: 80 (14) mmHg vs 90 (10) mmHg, p=0.012; MGL score: I=1 (1) vs C=2 (1), p<0.001; physical component of HRQoL: 45.0 (9.0) vs 40.3 (8.2), p=0.046; and mental component of HRQoL: 47.1 (11.1) vs 38.8 (8.5), p=0.003). CONCLUSIONS: The findings suggest that a P-DIPS intervention in the hospital setting of Nepal has a significant potential to improve blood pressure, medication adherence and HRQoL in patients with hypertension.

Antibiotic utilization, sensitivity, and cost in the medical intensive care unit of a tertiary care teaching hospital in Nepal.

BACKGROUND: High utilization and irrational use of antibiotics in an intensive care unit increases microbial resistance, morbidity, mortality, and costs. OBJECTIVE: This study aimed to evaluate the utilization, sensitivity and cost analysis of antibiotics used in the medical intensive care unit of a tertiary care teaching hospital of Nepal. METHODS: A prospective cohort study was conducted on patients admitted to the medical intensive care unit at a tertiary care teaching hospital in central Nepal from July to September 2016. Antibiotic utilization, defined daily dose per 100 bed-days and the cost of antibiotics per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. RESULTS: A total of 365 antibiotics were prescribed in 157 patients during the study period, with an average of 2.34 prescriptions per patient. Total antibiotic utilization in terms of defined daily dose per 100 bed-days was 49.5. Piperacillin/tazobactam (45.2%) was the most commonly prescribed antibiotic, and meropenem was the most expensive antibiotics (US$4440.70). The median (interquartile range) cost of antibiotics used per patient was US$47.67 (US$63.73). Escherichia coli, Acinetobacter, and Pseudomonas sp. were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. CONCLUSION: This study suggests that the utilization and cost of antibiotics are high in medical intensive care unit of the hospital and E. coli was resistant to multiple antibiotics. The findings highlight an urgent need for the implementation of antibiotic stewardship program in order to improve antibiotic utilization in such hospital settings.