Perceptions of hospital pharmacists regarding roles in preventing and minimizing prescribing cascades: a mixed-method study

• Published in: Journal of infection in developing countries Vol. 19; no. 1; pp. 58 - 66
• Main Authors: Asad, Mahnoor, Ullah, Waseem, Gajdács, Márió, Madléna, Melinda, Shanmugham, Suresh, Veettil, Sajesh K, Jamshed, Shazia Q
• Format: Journal Article
• Language: English
• Published: Italy Journal of Infection in Developing Countries 31.01.2025; The Journal of Infection in Developing Countries
• Subjects: Adult; adverse drug reaction; Aged; Aged, 80 and over; Attitude of Health Personnel; Drug Prescriptions; Drug-Related Side Effects and Adverse Reactions - prevention & control; Female; healthcare professional; hospital pharmacists; Humans; Interviews as Topic; Male; Middle Aged; mixed-methods; Pakistan; Pharmacists; Pharmacists - psychology; Pharmacy Service, Hospital; Polypharmacy; prescribing cascade; Professional Role; Surveys and Questionnaires; Pakistan; mixed-methods; hospital pharmacists; healthcare professional; prescribing cascade; adverse drug reaction; polypharmacy
• ISSN: 1972-2680; 2036-6590; 1972-2680
• DOI: 10.3855/jidc.19554

Introduction: A prescribing cascade occurs when new medications are prescribed to address an adverse drug reaction (ADR) associated with the preceding use of a medication, which may be mistaken as the onset of a novel disease or condition. The aim of this study was to evaluate the perceptions of hospital pharmacists regarding roles in preventing and minimizing prescribing cascades. Methodology: A qualitative, semi-structured interview, followed by a quantitative, questionnaire-based study, was carried out at the Shifa International Hospital (SIH; Islamabad, Pakistan). Discharge summaries of patients aged ≥ 60 years were collected to assess the prevalence of polypharmacy at SIH. Results: Discharge summaries of n = 350 patients were collected; 60.2% (n = 211) had comorbid conditions, and the co-occurrence of diabetes and hypertension were the most common. 37.8% (n = 132) were taking 8 or more medications. Eight (n = 8) hospital pharmacists participated in the qualitative study, and 4 major themes were identified in their perceptions regarding prescribing cascades. Fifty-two (n = 52) pharmacists were recruited in the quantitative phase. 86.5% (n = 45) of the participants reported long standing illness/chronic conditions; 67.3% (n = 35) noted the presence of comorbidities as a high risk, while 90.3% (n = 47) noted multiple prescribers, and 75.0% (n = 39) identified the ageing population as important risks factors for polypharmacy. Conclusions: The current research may inform the role and responsibilities of hospital pharmacists in outpatient and inpatient departments, and in interprofessional care teams, in preventing and minimizing prescribing cascades.