ASSESSMENT OF DRUG DOSAGEADJUSTMENT PRACTICE AND ASSOCIATED FACTORS AMONG PATIENTS WITH RENAL IMPAIRMENT ADMITTED TO MEDICAL WARDS AT AMHARA REGION REFERRAL HOSPITALS: A MIXEDSTUDY APPROACH, 2020

Abstract

Abstract Background: Inappropriate dosageadjustment is one of the poor practices that affect the effectiveness of treatments in patients with renal impairment. However, there is a paucity of evidences in our country concerning the magnitude and factors of inappropriate dosageadjustment among those patients. Objective: This study aimed to assess medication dosage adjustment practice and associated factors among adult patients with renal impairment admitted to medical wards at Amhara region referral hospitals. Method: An institutional based mixed approach, cross-sectional study and key informant interview was conducted from March 28/2020 to August 30/2020.Asingle stage cluster sampling technique was employed. The quantitative data was collected by using a pretested interviewer administered structured questionnaire and the qualitative data was collected thorough key informant interview by using an interview guide. Data were entered into Epi-Data version 4.6 and transferred into SPSS version 25 for further data processing and analysis.Descriptive statistics such as frequencies and percentages were computed. Both bivariable and multivariable binary logistic regression analysis was fitted to identify factors associated with dosage adjustment practice. A 95% confidence interval and a p-value less than 0.05 were used to declare statistical significance. Moreover, thematic analysis was done for the qualitative data to identify key themes. Result: Among 815 medications which need dosage adjustment 398(48.8%) of them were adjusted appropriately, and the remaining 417 (51.2%) with 95% CI (44.7%,54.3%) were adjusted inappropriately. Number of medications, number of comorbidities and being unemployed were significantly associated with inappropriate dosageadjustment. Furthermore, four themes were identified in the qualitative data analysis. Conclusion: Our study revealed that there was a considerable rate of inappropriate dosage adjustment in patients with renal impairment. Trainings for health care providers, use of guidelines and communication with clinical pharmacist should be encouraged for good treatment outcome. Key words: Dosage Adjustment Practice, Renal Impairment, Amhara Referral Hospital, Ethiopia