Knowledge of health care workers on corticosteroid adverse drug events in rheumatologic, respiratory and dermatologic clinics in a teaching hospital in Nairobi, Kenya

Abstract

Background: Corticosteroids form the cornerstone of management for a myriad of rheumatological, dermatological and chronic respiratory tract diseases. Whereas these drugs are crucial in reducing morbidity and mortality, they are not without inherent grave risks. Health Care Workers (HCWs) providing care to patients on long term corticosteroids are required to be well versed with these Adverse Drug Events (ADEs). Kenyatta National Hospital, the teaching hospital of the University of Nairobi, has established rheumatology, respiratory and dermatology clinics. Corticosteroid prescribing and dispensing is provided by the doctors and pharmacy staff respectively with ADEs surveillance and patient education provided by these two cadres as well as the nurses as per standards of practice. As biologic agents are not yet available in these clinics, corticosteroids, as well as other immunosuppressant drugs remain vital in control of immunological diseases.

Materials and Methods: HCWs in these clinics were requested to complete a selfadministered questionnaire assessing their knowledge of corticosteroid ADEs. The questions were open ended and the answers given were first analysed into total number of correct answers. Further analysis was done by grouping the correct answers into categories as per the systems affected by corticosteroids. A cut-off point of 6 correct answers was deemed adequate knowledge of ADRs. Correct answers given were calculated as a proportion of all the answers provided by the respondent. Median (interquartile range- IQR) was used to provide the midpoint of correct responses and the spread of the second and third quartiles respectively.

Results: Sixty-two HCWs were recruited, comprising of nurses (21%), pharmacy staff (12.9%) and senior house officers (66.1%). Majority (79%) had been stationed for over 1 year in the study clinics with 45% of them having worked in more than one of the study clinics.

ADRs of corticosteroids: Median (IQR) number of correct responses was 6.0 (3.0-9.5). Only 61% identified >5 ADRs. Proportion of respondents who documented the various ADRs; Metabolic disorders 89%, cutaneous 61%, mineral bone disease 37%, GIT 36%, neuropsychiatric 32%, adrenal suppression 24%, ophthalmic 21%, myopathy 18%.

Drugs that potentiate the ADRs of corticosteroids: Median (IQR) number of correct responses was 1.0 (1.0-2.0). Proportion of respondents who identified the drugs; Cytotoxics 34%, NSAIDs 35%, anticoagulants 15%, others 10%.

Advice that should be given to patients on corticosteroids: Median (IQR) number of correct responses was 2.0 (2.0-3.0). Surveillance for ADRs- 53% , adherence to duration and dosage 48%, tapering of corticosteroids 32%, drug interactions 16%, drugs to counter corticosteroid ADRs 13%, steroid cards 7%.

Conclusion: Although HCWs routinely administer corticosteroids, the awareness of ADRs and potential drug interactions is low. This needs to be addressed in order to ensure adequate surveillance of ADRs.