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Individualised support for drug therapy is required for bariatric patients

More support is needed on an individual level with drug therapy for patients who have undergone bariatric surgery and is especially true for patients who reported significant difficulties in medication administration, according to researchers from Leipzig University Hospital and University of Leipzig, Leipzig, Germany. They emphasised the importance of integrating the patients' perspective into the follow-up care of patients who have undergone bariatric surgery to provide safe drug therapy for the individual patient.

For their study, they investigated patients' perspective on their drug therapy to better support patients and their healthcare professionals with drug therapy after surgery. The study was conducted via telephone-based interviews focusing on general aspects of the current drug therapy, such as difficulties in drug administration, changes after bariatric surgery and adverse events. The interview guide consisted of three parts: (i) current drug therapy, (ii) changes after bariatric surgery and (iii) adverse events.


Outcomes

The study included 105 enrolled patients who were taking a median of 10 (range: 3–30) drugs. The most frequently prescribed drugs were anti-anaemic drugs (105 participants; 100%), minerals (100; 95%), and vitamins (98; 93%). Cardiovascular diseases were the most frequent co-diagnoses (85 out of 105 participants; 81%).


In 623 of 1080 drugs (58%), the patients evaluated their expectations in terms of effectiveness as met, in 394 (37%) as rather met. In 32 (3%) and drugs, patients' expectations in terms of effectiveness were rather not or not met.


Of the 105 patients, 28 (27%) reported having difficulties in drug administration. The most frequent reason was the drug size being too large (16 patients, 15%). Regarding adherence-related aspects, 46 participants (44%) sometimes forgot to take at least one of their drugs and 21 (20%) took at least one of their drugs differently than prescribed by their physicians.


Ninety-two out of 105 patients (88%) reported that at least one drug was discontinued after bariatric surgery. Thirty-four patients (32%) had to take additional drugs temporarily after surgery, while 23 (22%) still had to take additional drugs that were initiated after surgery at the time of the interview. Furthermore, 56 patients (53%) reported dose changes, of which 50 patients (48%) reported dose reduction, and two patients (2%) reported changes in the administration form.


Changes occurred mostly in drugs for diabetes (113 of 490 reported changes; 23%), agents acting on the renin-angiotensin system (49; 10%), beta-blocking agents (31; 6%), diuretics (29; 6%) and drugs for acid-related disorders (27; 6%). In addition, 17 patients (16%) reported 21 self-observed changes in effectiveness and tolerability during the course of bariatric surgery treatment. Of these, ten changes referred to drug effectiveness and included, for example, a stronger effect of antihypertensive drugs (four reports). The remaining 11 changes observed by the patients referred to the tolerability of drugs. Out of the 21 reports, 13 were seen in the context of bariatric surgery and 9 in the context of weight loss (multiple categories possible).


Seventy-eight (74%) participants reported at least one adverse event with a median number of 2 (Q25/Q75: 0/4; min–max: 4–16) per patient. Patients observed a total of 304 adverse events, of which 271 (89%) were perceived as (rather) impairing. The three most frequently mentioned categories of adverse events were gastrointestinal disorders (91 of 304 reports, 30%), nervous system disorders (66 reports, 22%) and metabolism and nutrition disorders (64 reports, 21%).


In gastrointestinal disorders, 57 (63% of 91) and in nervous system disorders, 39 (59% of 66) adverse events occurred only after but not before surgery. In metabolism and nutrition disorders, 48 (75% of 64) adverse events were experienced only before surgery. The ten drugs which were most frequently suspected to cause adverse events by the patients themselves were drugs used for diabetes (43; 14% of 304 adverse events), analgesic drugs (30; 10%), psychoanaleptics (28; 9%), vitamins (28; 9%), psycholeptics (20; 7%), antibacterial drugs (15; 5%), unspecified antihypertensive drugs (14; 5%), beta-blocking agents (13; 4%), agents acting on the renin-angiotensin system (12; 4%) and antiepileptics (10; 3%).


“Overall, our findings emphasise the importance of integrating the patients' perspective into the follow-up care of patients who have undergone bariatric surgery to provide safe drug therapy for the individual patient,” they concluded.


The findings were reported in the paper, ‘Patients' perspective on their drug therapy after bariatric surgery: A quantitative, cross-sectional interview study’, published in Clinical Obesity. To access this paper, please click here

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