ASSESSMENT OF THE FREQUENCY AND RATIONALITY OF PRESCRIBED MEDICINES IN PATIENTS WITH LIVER CIRRHOSIS

Keywords: liver cirrhosis, retrospective ABC frequency analysis, VEN analysis, real clinical practice

Abstract

The aim. Assessment of the dynamics of prescribing drugs to patients with liver cirrhosis (LC, K 74), in terms of real clinical practice by methods of clinical and economic analysis.

Materials and methods. 355 medical cards of inpatients with cirrhosis of the liver, which were divided into 4 groups depending on the period of stay of patients in the hospital. Methods: compatible retrospective ABC-frequency analysis, which ranked drugs consumed by patients in real clinical practice, according to the frequency of appointment using ABC-segmentation according to the Pareto principle (A – 80 % of drugs appointments: B – 15 %: C – 5 %); VEN-analysis, which divides the consumed drugs on a formal basis depending on the presence / absence of a particular drug in the regulations: vital (Vital or V), necessary (Essential or E) and secondary (Non-essential or N).

Results. Cirrhosis of the liver in recent years has been on the 10th - 11th place among the causes of death in the world. The analysis of prescribed drugs to patients with LC in real clinical practice in Ivano-Frankivsk region of Ukraine revealed that over the years doctors prescribed fewer drugs on average per patient (11.4 drugs → 8.8 drugs), which can be considered a positive fact. Among the prescribed drugs, drugs of group A – “Drugs that affect the digestive system and metabolism” prevailed, the share of which increased and was the highest in 2019 – 2020 (2007–2009 – 44.6 %; 2012–2013 – 46.6 %; 2015–2016 – 48.1 %; 2019–2020 – 48.55 %); the share of dietary supplements also increased from 1.65 % to 6.52 %.

Conclusions. Combined ABC-frequency and VEN-analyzes showed that the leaders in the years of hospital stay were the following drugs: Sodium chloride, Ademetionine, Pantoprazole, Spironolactone, Thioctic acid, Ornithine, Asparaginate K-Mg, Torasemide, Furosemide. However, the vital class V included only 9–11 % of drugs from the whole set of prescribed drugs, which requires systemic correction in accordance with European recommendations.

Downloads

Download data is not yet available.

Author Biographies

Iryna Fediak, Ivano-Frankivsk National Medical University

Department of Organization and Economics of Pharmacy and Drug Technology

Oleksandra Maksymenko, Ivano-Frankivsk National Medical University

Department of Organization and Economics of Pharmacy and Drug Technology

References

Sarin, S. K., Maiwall, R. Global burden Of liver disease: A true burden on health sciences and economies. e-WGN: e-WGN Expert Point of View Articles Collection. Available at: https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/global-burden-of-liver-disease-a-true-burden-on-health-sciences-and-economies

Sepanlou, S. G., Safiri, S., Bisignano, C., Ikuta, K. S., Merat, S., Saberifiroozi, M. et. al. (2020). The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 5 (3), 245–266. doi: http://doi.org/10.1016/s2468-1253(19)30349-8

Liver cirrhosis (15+), age-standardized death rates by country (2018). Global Health Observatory data repository. Available at: http://apps.who.int/gho/data/node.main.A1092#

World Total Deaths. Available at: https://www.worldlifeexpectancy.com/world-rankings-total-deaths

Guo, T., Chang, L., Xiao, Y., Liu, Q. (2015). S-Adenosyl-L-Methionine for the Treatment of Chronic Liver Disease: A Systematic Review and Meta-Analysis. PLOS ONE, 10 (3), e0122124. doi: http://doi.org/10.1371/journal.pone.0122124

Lewis, J. H., Stine, J. G. (2013). Review article: prescribing medications in patients with cirrhosis – a practical guide. Alimentary Pharmacology & Therapeutics, 37 (12), 1132–1156. doi: http://doi.org/10.1111/apt.12324

Angeli, P., Bernardi, M., Villanueva, C., Francoz, C., Mookerjee, R. P., Trebicka, J. et. al. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 69 (2), 406–460. doi: http://doi.org/10.1016/j.jhep.2018.03.024

Mellinger, J. L., Volk, M. L. (2013). Multidisciplinary Management of Patients With Cirrhosis: A Need for Care Coordination. Clinical Gastroenterology and Hepatology, 11 (3), 217–223. doi: http://doi.org/10.1016/j.cgh.2012.10.040

Nusrat, S., Khan, M. S., Fazili, J., Madhoun, M. F. (2014). Cirrhosis and its complications: Evidence based treatment. World Journal of Gastroenterology, 20 (18), 5442–5460. doi: http://doi.org/10.3748/wjg.v20.i18.5442

Benmassaoud, A., Freeman, S. C., Roccarina, D., Plaz Torres MCorina, Sutton, A. J., Cooper, N. J. et. al. (2019). Treatments for ascites in people with advanced liver disease. Available at: https://www.cochrane.org/CD013123/LIVER_treatments-ascites-people-advanced-liver-disease

Best, L. M., Freeman, S. C., Sutton, A. J., Cooper, N. J., Tng, E.-L., Csenar, M. et. al. (2019). Treatment for hepatorenal syndrome in people with decompensated liver cirrhosis: a network meta-analysis. Cochrane Database of Systematic Reviews. doi: http://doi.org/10.1002/14651858.cd013103.pub2

Martín-Llahí, M., Pépin, M., Guevara, M., Díaz, F., Torre, A., Monescillo, A. et. al. (2008). Terlipressin and Albumin vs Albumin in Patients With Cirrhosis and Hepatorenal Syndrome: A Randomized Study. Gastroenterology, 134 (5), 1352–1359. doi: http://doi.org/10.1053/j.gastro.2008.02.024

Sharma, P., Sharma, B. C., Agrawal, A., Sarin, S. K. (2012). Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: An open labeled randomized controlled trial of lactulose versus no lactulose. Journal of Gastroenterology and Hepatology, 27 (8), 1329–1335. doi: http://doi.org/10.1111/j.1440-1746.2012.07186.x

Mittal, V. V., Sharma, B. C., Sharma, P., Sarin, S. K. (2011). A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy. European Journal of Gastroenterology & Hepatology, 23 (8), 725–732. doi: http://doi.org/10.1097/meg.0b013e32834696f5

Vilstrup, H., Amodio, P., Bajaj, J., Cordoba, J., Ferenci, P., Mullen, K. D. et. al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver. Hepatology, 60 (2), 715–735. doi: http://doi.org/10.1002/hep.27210

Gluud, L. L., Dam, G., Borre, M., Les, I., Cordoba, J., Marchesini, G. et. al. (2012). Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: what is the evidence? Metabolic Brain Disease, 28 (2), 221–225. doi: http://doi.org/10.1007/s11011-012-9372-0

Ndraha, S., Hasan, I., Simadibrata, M. (2011). The effect of L-ornithine L-aspartate and branch chain amino acids on encephalopathy and nutritional status in liver cirrhosis with malnutrition. Acta Med Indones, 43, 18–22.

Goh, E. T., Stokes, C. S., Sidhu, S. S., Vilstrup, H., Gluud, L. L., Morgan, M. Y. (2018). L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database of Systematic Reviews. doi: http://doi.org/10.1002/14651858.cd012410.pub2

Ricart, E., Soriano, G., Novella, M. T., Ortiz, J., Sàbat, M., Kolle, L. et. al. (2000). Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients. Journal of Hepatology, 32 (4), 596–602. doi: http://doi.org/10.1016/s0168-8278(00)80221-4

Fernández, J., del Arbol, L. R., Gómez, C., Durandez, R., Serradilla, R., Guarner, C. et. al. (2006). Norfloxacin vs Ceftriaxone in the Prophylaxis of Infections in Patients With Advanced Cirrhosis and Hemorrhage. Gastroenterology, 131 (4), 1049–1056. doi: http://doi.org/10.1053/j.gastro.2006.07.010

Iogna Prat, L., Wilson, P., Freeman, S. C., Sutton, A. J., Cooper, N. J., Roccarina, D. et. al. (2019). Antibiotic treatment for spontaneous bacterial peritonitis in people with decompensated liver cirrhosis: a network meta-analysis. Cochrane Database of Systematic Reviews. doi: http://doi.org/10.1002/14651858.cd013120.pub2


👁 175
⬇ 231
Published
2021-01-30
How to Cite
Fediak, I., & Maksymenko, O. (2021). ASSESSMENT OF THE FREQUENCY AND RATIONALITY OF PRESCRIBED MEDICINES IN PATIENTS WITH LIVER CIRRHOSIS. EUREKA: Health Sciences, (1), 86-93. https://doi.org/10.21303/2504-5679.2021.001599
Section
Pharmacology, Toxicology and Pharmaceutical Science