Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study

Abstract title: Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study. Aim: Prevalence of diabetes in Belgium is 2 to 3 times higher among people from Turkish descent. Medication adherence, an essential element of the diabetic regimen, appears to be lower among nonwhite ethnic groups. This study identifies factors influencing medication adherence among Turkish type-2 diabetics living in Belgium. Methods: Since this topic hasn’t been studied before we conducted an explorative, qualitative study using semi-structured in-depth interviews with the aid of an interpreter. The topicslist was based on insights from the literature and conversations with Turkish diabetics and health care workers and was slightly adjusted after the first interviews. 21 Turkish type-2 diabetics living in Belgium were selected using theoretical sampling. Respondent’s most recent HbA1c-values were also collected. Interviews lasted between 2 and 5 hours, were audio-taped, fully transcribed and translated. Thematic analysis was conducted by the first two authors with different educational backgrounds (sociologist/pharmacist). The first phase was a detailed, thematic analysis of the individual cases, in the second phase an analysis across cases, distinguishing adherers from non-adherers, identified factors influencing medication adherence. NVivo 8 was used for managing, coding and analysing the qualitative data. Results: Factors influencing medication adherence among type-2 diabetics from Turkish descent include knowledge of and attitudes towards diabetes and antidiabetics, health and medication beliefs, social support from health care providers and family members, the nature of the patient-provider relationship, perceptions of health care worker’s expertise and social roles in daily life. A typology was constructed identifying different constellations of factors that distinguish adherers from non-adherers. Implications for clinical practice are discussed. Conclusion: This qualitative study identifies factors influencing medication adherence among type-2 Turkish diabetics living in Belgium and provides a typology, distinguishing adherers from non-adherers, that may guide clinical practice. Results from this qualitative study will be tested in a future, quantitative study

Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study

Abstract title: Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study. Aim: Prevalence of diabetes in Belgium is 2 to 3 times higher among people from Turkish descent. Medication adherence, an essential element of the diabetic regimen, appears to be lower among nonwhite ethnic groups. This study identifies factors influencing medication adherence among Turkish type-2 diabetics living in Belgium. Methods: Since this topic hasn’t been studied before we conducted an explorative, qualitative study using semi-structured in-depth interviews with the aid of an interpreter. The topicslist was based on insights from the literature and conversations with Turkish diabetics and health care workers and was slightly adjusted after the first interviews. 21 Turkish type-2 diabetics living in Belgium were selected using theoretical sampling. Respondent’s most recent HbA1c-values were also collected. Interviews lasted between 2 and 5 hours, were audio-taped, fully transcribed and translated. Thematic analysis was conducted by the first two authors with different educational backgrounds (sociologist/pharmacist). The first phase was a detailed, thematic analysis of the individual cases, in the second phase an analysis across cases, distinguishing adherers from non-adherers, identified factors influencing medication adherence. NVivo 8 was used for managing, coding and analysing the qualitative data. Results: Factors influencing medication adherence among type-2 diabetics from Turkish descent include knowledge of and attitudes towards diabetes and antidiabetics, health and medication beliefs, social support from health care providers and family members, the nature of the patient-provider relationship, perceptions of health care worker’s expertise and social roles in daily life. A typology was constructed identifying different constellations of factors that distinguish adherers from non-adherers. Implications for clinical practice are discussed. Conclusion: This qualitative study identifies factors influencing medication adherence among type-2 Turkish diabetics living in Belgium and provides a typology, distinguishing adherers from non-adherers, that may guide clinical practice. Results from this qualitative study will be tested in a future, quantitative study

Older patients' prescriptions screening in the community pharmacy: development of the Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S) tool

Background: Ageing of the population often leads to polypharmacy. Consequently, potentially inappropriate prescribing (PIP) becomes more frequent. Systematic screening for PIP in older patients in primary care could yield a large improvement in health outcomes, possibly an important task for community pharmacists. In this article, we develop an explicit screening tool to detect relevant PIP that can be used in the typical community pharmacy practice, adapted to the European market. Methods: Eleven panellists participated in a two-round RAND/UCLA (Research and Development/University of California, Los Angeles) process, including a round zero meeting, a literature review, a first written evaluation round, a second face-to-face evaluation round and, finally, a selection of those items that are applicable in the contemporary community pharmacy. Results: Eighteen published lists of PIP for older patients were retrieved from the literature, mentioning 398 different items. After the two-round RAND/UCLA process, 99 clinically relevant items were considered suitable to screen for in a community pharmacy practice. A panel of seven community pharmacists selected 83 items, feasible in the contemporary community pharmacy practice, defining the final GheOP3S tool. Conclusion: A novel explicit screening tool (GheOP3S) was developed to be used for PIP screening in the typical community pharmacy practice

Potentially inappropriate prescribing in nursing home residents detected with the community pharmacist specific GheOP3S-tool

Background: The Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP3S-)tool was recently developed to screen for potentially inappropriate prescribing (PIP). Objective: We aimed (1) to determine PIP prevalence in older nursing home (NH) residents with polypharmacy using the GheOP3S-tool and (2) to identify those PIPs that are most frequently detected. Method: A cross-sectional study was carried out between February and June 2014 in 10 NHs in Belgium, supplied by a community pharmacy chain. For each NH, 40 residents (>70 years, using >5 chronic drugs) were included. PIP prevalence was determined using the GheOP3S-tool. Results: 400 NH residents were included [mean age (±SD) 86.2 (±6.3) years; median number of drugs (±IQR) 10 (7–12)]. A total of 1728 PIPs were detected in 387 (97 %) participants (Median 4; IQR 2–6). The most prevalent items can be assigned to three categories: long-term use of central nervous system drugs (i.e. benzodiazepines, antidepressants and antipsychotics), use of anticholinergic drugs (mutual combinations and with underlying constipation/dementia) and underuse of osteoporosis prophylaxis. Conclusion: Screening for PIP by means of the GheOP3S-tool revealed a high prevalence of PIP among older NH residents with polypharmacy. This finding urges for initiatives on the patient-level, but also on a broader, institutional level

Transdermal evaluation of caffeine in different formulations and excipients

Background: The stratum corneum(SC) forms adifficultphysical barrier fordrugs to pass through the skin. Several strategieswere developed to overcome this barrier.Optimization of topical drug formulations by selected excipients may facilitate the penetration of drugs through the SC into the viable skin cells and ultimately into the systemic circulation. Methods: Here, both the influence of two formulations (a classic carbomer-based gel and a novel Pluronic® lecithin organo gel (PLO gel)) and selected excipients (ethanol, propylene glycol, diethylene glycol monoethyl ether, isopropyl myristate (IPM), and water) with or without the penetration enhancer miconazole nitrate on the transdermal penetration characteristics of caffeine were determined using an in vitro Franz diffusion cell setup. Results: Higher fluxes were observed for the carbomer-based gel compared to the PLO gel. Among the commonly used excipients, IPM showed the best penetration enhancing properties, while the presence of the penetration enhancer miconazole nitrate did not significantly alter the apparent skin permeation characteristics for caffeine. Conclusion: The high ethanol percentage in the carbomer-based gel could explain the results as supported by our excipient data.Moreover, IPMcould play a beneficial role in topical formulations as this excipient was responsible for a significant increase in the amount of caffeine penetrated through the skin. No overall statistical significant effect of the presence of miconazole nitrate as a penetration enhancer was observed

Self-medication with over-the-counter analgesics : a survey of patient characteristics and concerns about pain medication

Pain is a common reason for self-medication with over-the-counter (OTC) analgesics. However, this self-treating population has remained largely uncharacterized. This cross-sectional observational study investigated individuals who self-medicate their pain with OTC analgesics to elucidate their pain characteristics and medication use. In addition, presence of and risk factors for concerns about pain medication were examined. The clinical profile of the participants (n = 1,889) was worse than expected with long-standing pain complaints (median pain duration of 9 years), pain located at multiple body sites (median of 4, and 13% with ≥10 painful body areas), about one-third suffering from daily pain and about 40% experiencing substantial pain-related disability. Head (58.6% of sample), low back (43.6%), and neck (30.7%) were the most common pain locations. About 73% had a physician diagnosis, mainly migraine and osteoarthritis. Paracetamol (used by 68.6% of patients) and nonsteroidal anti-inflammatory drugs (46.8%) were the most frequently used pain medications. About 40% of our sample showed substantial concern about the perceived need for pain medication and the perceived potential for harmful effects (eg, fear for addiction). These findings highlight the importance for health professionals to systematically probe pain patients about their self-medication practices and explore attitudes about pain medication. Perspective: This study found that the clinical picture of people who self-medicate their pain with OTC analgesics looked worse than expected. We also identified substantial concerns about pain medication. Therefore, we recommend that health professionals systematically probe pain patients about their self-medication practices and explore concerns about pain medication. © 2018 the American Pain Societ

Qbd analytical development of calcitonin bioadhesive formulation

Calcitonin is a 32-amino acid polypeptide hormone ubiquitous in humans and animals. It acts i.a. to reduce blood calcium (Ca2+), opposing the effects of parathyroid hormone (PTH). Both human (hu) and salmon (sa) calcitonins are clinically effective and currently approved as active pharmaceutical ingredients (APIs). A new bioadhesive nasal formulation is currently under development, which contains low dose calcitonin in polymeric excipients (carbomer and starch). The analytical development is confronted with several challenges: the low dose of the peptide in the formulation, its inherent instability, the polymeric matrix interacting with the peptide influencing sample preparation and its undefined degradation impurity profile in this formulation. The aim of this investigation was to develop a suitable method to determine the concentration of sa-calcitonin in this formulation and to establish its degradation profile, using experimental designs which will also give us mechanistic information. Degradation profiling was developed towards the sensitive detection of all possible already-identified related compounds [1], using a selective gradient FA-based RP-HPLC with ESI/iontrap MS detection in the SIM mode The assay was developed using Onion and Plackett-Burman designs, evaluating and optimizing the sample treatment procedure. The chromatography method is based on a TFA-based gradient RP-HPLC with UV detection for quantification. Both methods are applied in short-term stability studies for the release of clinical trial material