Unmet Therapeutic Needs as Drivers of Drug Therapy Problems among Ethiopian Cardiovascular Outpatients: A Cross-Sectional Study

Abstract

Abstract Background Drug therapy problems (DTPs) defined as medication-related events compromising optimal health outcomes, present particular challenges for patients with cardiovascular disease (CVD) due to complex regimens for multiple comorbidities, often resulting in adverse clinical consequences. This hospital-based cross-sectional study assessed the prevalence and determinants of DTPs among adult ambulatory CVD patients at Wolaita Sodo University Comprehensive Specialized Hospital from May to July 2022. Methods We conducted an institution-based cross-sectional study of ambulatory cardiovascular disease (CVD) patients receiving chronic care at Wolaita Sodo University Comprehensive Specialized Hospital. Data were collected through structured patient interviews and comprehensive medical record reviews. Drug therapy problems (DTPs) were systematically identified and classified using Cipolle’s validated methodology, adapted for the local patient population. We employed binary logistic regression to assess individual associations between predictor variables and DTPs, followed by multiple logistic regression to control for potential confounders. Statistical significance was determined at p≤0.05, with 95% confidence intervals used to estimate precision of effect measures. Result Among 195 ambulatory CVD patients, hypertension (59.5%, n=116) and heart failure (47.2%, n=92) were the most prevalent conditions. The study identified drug therapy problems (DTPs) in 69.7% of patients (n=136), totalling 168 DTPs (mean 1.3 SD 0.461 per affected patient). Unmet therapeutic needs (41.0%) and medication non-adherence (24.4%) emerged as the most common DTP categories. ASCVD risk assessment classified 40% of evaluated patients as high-risk (10-year risk ≥20%). Significant predictors of DTPs included polypharmacy (AOR=3.48, 95%CI:1.47-8.24) and age (25-64 years: AOR=16.38), while comorbidities (AOR=0.15) and prior hospitalization (AOR=0.31) demonstrated protective effects. Conclusion and recommendation This study identifies unmet therapeutic needs and medication non-adherence as the predominant drug therapy problems among ambulatory CVD patients at Wolaita Sodo University Comprehensive Specialized Hospital, calling for systematic medication reviews, pharmacist-led interventions for high-risk groups, and enhanced adherence support programs to optimize treatment outcomes.