Evaluation of pharmaceutically compounded oral caffeine on the impact of medication adherence and risk of readmission among preterm neonates: A single-center quasi-experimental study

• Published in: PloS one 2022-11, Vol.17 (11), p.e0275655-e0275655
• Main Authors: Ambreen, Gul, Kumar, Manoj, Ali, Amin, Shah, Syed Akbar Ali, Saleem, Syed Muzafar, Tahir, Ayesha, Salat, Muhammad Sohail, Aslam, Muhammad Shahzad, Hussain, Kashif
• Format: Article
• Language: English
• Subjects: Apnea; Apnea neonatorum; Biology and Life Sciences; Caffeine; Care and treatment; Diagnosis; Dosage; Drug dosages; Drugs; Evaluation; Extubation; Gestational age; Health aspects; Health risks; Infants (Premature); Medication adherence; Medicine and Health Sciences; Multiple births; Multivariate analysis; Neonates; Newborn babies; Patient compliance; Pediatrics; People and Places; Pharmacists; Physical Sciences; Quality control; Quasi-experimental methods; Risk analysis; Risk factors; Services; Socioeconomic factors; Tertiary; Therapy; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0275655

Caffeine is available in an ampoule, used via parenteral and enteral routes in preterm neonates to treat apnea of prematurity (AOP) in neonates of gestational age [greater than or equal to] 35-40 weeks. A longer duration of therapy has a higher risk of medication non-adherence due to higher costs and inappropriate dosage forms. Pharmaceutically compounded oral caffeine (PCC) could be an appropriate alternate dosage form. The researchers aimed to determine the impact of PCC on medication-related factors influencing medication adherence (MA) and the frequency of hospital readmission with apnea (HRA) in preterm neonates. We conducted a single-center quasi-experimental study for this quality improvement project using PCC among the preterm neonates admitted in a tertiary care level-III NICU at the Aga Khan University Hospital Karachi, Pakistan, received caffeine therapy, and survived at discharge. The researchers compared pre-PCC data (April-December 2017) with post-PCC data (April-Dec 2018) each for nine months, with three months intervals (January-March 2018) of PCC formulation and implementation phase. The study was conducted according to the SQUIRE2.0 guidelines. The Data were collated on factors influencing MA, including the cost of therapy, medication refill rates, and parental complaints as primary outcome measures. The Risk factors of HRA were included as secondary outcomes. After PCC implementation cost of therapy was reduced significantly from Rs. 97000.0 (729.0 USD) to Rs. 24500.0 (185.0 USD) (p