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Hospital Outpatient Visits Associated With Medication-Related Problems in Thailand: A Multicenter Prospective Observational Study

Dechanont, Supinya PharmD*; Jedsadayanmata, Arom PhD; Butthum, Bodin MD; Kongkaew, Chuenjid PhD

doi: 10.1097/PTS.0000000000000367
Original Article: PDF Only

Objectives The aims of the study were to investigate the prevalence of hospital visits associated with medication-related problems (MRPs, i.e., adverse drug events [ADEs], adverse drug reactions [ADRs], nonadherence [NA] to medication, and medication error) and to identify the medications involved in hospital visits associated with MRPs in outpatient departments (OPDs).

Methods A prospective observational study was carried out in OPD of 11 hospitals in the lower northern region of Thailand. Patients visiting OPDs were screened for suspected MRPs by clinical pharmacists using medical record review supplemented by patient interview. Three experts evaluated suspected MRPs using the following 3 criteria: causality, severity, and preventability.

Results Of the 3069 patients who visited the OPDs during the study period, 113 (3.7%) were deemed to have causal MRPs. Nearly half of the causal MRPs (n = 49, 43.4%) were preventable. The following 4 types of causal MRPs were identified: ADEs (n = 112, 3.7%), ADRs (n = 65, 2.1%), NA to medications (n = 48, 1.6%), and medication errors (n = 1, 0.03%). In nonelective patients (n = 764), 35 patients (4.6%) were judged to have causal MRPs. Of the nonelective patients who experienced causal MRPs, 25 (71.4%) were preventable. The medications commonly associated with ADEs and NA to medication were those targeting the cardiovascular system (especially enalapril, amlodipine, and hydrochlorothiazide), whereas the medications involving ADRs involved the cardiovascular and endocrine systems (especially, enalapril, amlodipine, and metformin).

Conclusions Outpatient department visits associated with MRPs, particularly in nonelective patients, were preventable. Effective strategies are needed for reducing visits to hospital OPD associated with preventable MRPs.

From the *Center for Safety and Quality in Health, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok; †Faculty of Pharmacy, Thammasat University, Pathum Thani; and ‡Faculty of Medicine, §Center of Excellence of Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand.

Correspondence: Chuenjid Kongkaew, Faculty of Pharmaceutical Sciences, Naresuan University, 99 Moo 9, Phitsanulok-Nakornsawan Road, Thapho, Muang, Phitsanulok 65000, Thailand (e-mail:;

The authors disclose no conflict of interest.

This study was supported by the National Research Council of Thailand. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article.

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