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

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 (ADRs). Materials and Methods: Kenyatta National Hospital, the teaching hospital of the University of Nairobi, has established rheumatology, respiratory and dermatology clinics. As biologic agents are not yet available in these clinics, corticosteroids, as well as other immunosuppressant drugs remain vital in control of immunological diseases. HCWs in these clinics were requested to complete a self-administered open ended questionnaire assessing their knowledge of corticosteroid ADRs. Results: Sixty-two HCWs were recruited, comprising of nurses (21%), pharmacy staff (12.9%) and senior house officers (66.1%). Majority (74%) had been stationed for over 1 year at the clinic. 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