Impact of community pharmacy-based educational intervention on patients with hypertension in Western Nepal

Background There is a paucity of data regarding the feasibility and impact of community pharmacy-based educational interventions on the management of chronic diseases in developing countries. AimsThe aim of this study was to establish the feasibility, and to investigate the impact, of community pharmacy-based educational intervention on knowledge, practice, and disease management of patients with hypertension in Western Nepal.MethodA single-cohort pre-/post-intervention study was conducted from August 2012 to April 2013. The participants included in the study were patients diagnosed with hypertension attending a pharmacist-led hypertension clinic. The educational intervention was conducted by pharmacists, was individualized, and consisted of three counseling sessions over a period of six months. The patients’ knowledge of hypertension, their practice of lifestyle modification and non-pharmacological approaches concerning hypertension management, and blood pressure were assessed at baseline and again after 9 months by using a pre-validated questionnaire. ResultsFifty patients met the inclusion criteria and were enrolled in the study. The median (IQR) knowledge score changed from 6 (4) to 13 (0) after the intervention (

Types and outcomes of pharmacist-managed travel health services: A systematic review

Background and aim: Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services. Methods: A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services. Results: Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94–100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%–94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted. Conclusion: Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations

Predictors of Multidrug-Resistant Tuberculosis (MDR-TB) in Sudan

Multidrug-resistant tuberculosis (MDR-TB) is a global public health threat and burden on the health system. This is especially the case in high tuberculosis (TB) prevalence countries, such as Sudan. Consequently, this study aimed to ascertain the predictors of MDR-TB in Sudan to provide future guidance. An unmatched case-control study to assess the predictors of MDR-TB infections among the Sudanese population was conducted from August 2017 to January 2018 at Abu-Anga referral hospital. Patients’ data was gathered from patients’ cards and via interviews. A structured pre-validated questionnaire was used to gather pertinent information, which included sociodemographic characteristics and other relevant clinical data. Univariate and multivariate logistic regression analysis was employed to determine the predictors of MDR-TB infection. 76 of the 183 patients interviewed (41.5%) had MDR-TB cases. The independent predictors for MDR-TB were living in rural areas [adjusted odds ratio (aOR) = 3.1 (95% confidence interval (CI): 1.2–8.2)], treatment failure [aOR = 56.9 (10.2–319.2)], and smoking [(aOR = 4 (1.2–13.2)], whereas other sociodemographic factors did not predict MDR-TB. In conclusion, the study showed that a history of smoking, living in rural areas, and a previous treatment failure were the predictors of MDR-TB in Sudan. The latter factors are most likely due to issues that are related to access and adherence to treatment and lifestyle. The existence of any of these factors among newly diagnosed TB patients should alert clinicians for the screening of MDR-TB. The implementation of directly observed treatment (DOT) and health education are crucial in stopping the spread of MDR-TB in Sudan

The experiences of implementing generic medicine policy in eight countries: A review and recommendations for a successful promotion of generic medicine use

Generic medicines are clinically interchangeable with original brand medicines and have the same quality, efficacy and safety profiles. They are, nevertheless, much cheaper in price. Thus, while providing the same therapeutic outcomes, generic medicines lead to substantial savings for healthcare systems. Therefore, the quality use of generic medicines is promoted in many countries. In this paper, we reviewed the role of generic medicines in healthcare systems and the experiences of promoting the use of generic medicines in eight selected countries, namely the United States (US), the United Kingdom (UK), Sweden, Finland, Australia, Japan, Malaysia and Thailand. The review showed that there are different main policies adopted to promote generic medicines such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland. To effectively and successfully implement the main policy, different complementary policies and initiatives were necessarily introduced. Barriers to generic medicine use varied between countries from negative perceptions about generic medicines to lack of a coherent generic medicine policy, while facilitators included availability of information about generic medicines to both healthcare professionals and patients, brand interchangeability guidelines, regulations that support generic substitution by pharmacists, and incentives to both healthcare professionals and patients.Scopu

Prescribing patterns for upper respiratory tract infections : a prescription-review of primary care practice in Kedah, Malaysia and the implications

Introduction and aims: It is necessary to ascertain current prescribing of antibiotics for upper respiratory tract infections (URTIs) to address potential overuse. A retrospective analysis was conducted of all prescriptions for URTIs among ten public primary healthcare centres in Kedah, Malaysia from 1st January to 31st March 2014. Results: A total of 123,524 prescriptions were screened and analysed. Of these, 7129 prescriptions were for URTI, with 31.8% (n=2269) containing antibiotics. Macrolides were the most commonly prescribed antibiotic constituting 61% (n=1403) of total antibiotics prescribed. There was a statistically significant association between different prescribers and diagnoses (p=0•001) and a weak positive trend suggesting family medicine specialists are more competent in antibiotic prescribing, followed by medical officers and assistant medical officers (τ=0•122).. Conclusions: Prescribing practices of some prescribers were inconsistent with current guidelines encouraging resistance development. National antimicrobial stewardship programmes and further educational initiatives are ongoing in Malaysia to improve antibiotic us

Structured pharmacist-led intervention programme to improve medication adherence in COPD patients : a randomized controlled study

Background: COPD, a progressive, partly reversible condition with airflow limitation particularly warrants the inclusion of pharmacists in the healthcare team. Extreme physician scarcity severely limits the implementation of quality healthcare in India. Pharmacist-led educational intervention achieves smoking cessation and improves medication adherence. Objective: This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital. Methods: In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0. Results: Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P<0.001). It increased from 49% at the baseline to 80% after 24 months (P<0.001). Carelessness about taking medicines was one of the main reasons for non-adherence in COPD patients, but was effectively reduced by the intervention. Conclusions: This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counseling

The impact of law enforcement on the dispensing antibiotics without prescription in Saudi Arabia : findings and implications

Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised in Saudi Arabia despite being illegal. This is a concern increasing AMR. In May 2018, the law and regulations were enforced including fines up to 100,000 SR (equivalent to US$26,666) and cancellation of licences. Consequently, we wanted to evaluate the impact. Methods: Mixed method study among 116 community pharmacies in two phases. Pre-law enforcement phase between December 2017 and March 2018 and post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM). In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI) with 3 levels: level 1 – SC asked for something to relieve the symptoms, level 2 – SC asked for something stronger if an antibiotic was not dispensed, level 3 – SC requested an antibiotic. In SCM for each phase, all 116 pharmacies were visited with at least one of the scenarios. Results: Before the law enforcement, 70.7% of community pharmacists reported DAwP was common. 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After law enforcement, only 12.9% of community pharmacists indicated that DAwP was common, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively and mostly after level 3. Conclusion: Law enforcement was effective. However, there is still further scope for improvement as community pharmacists are worried patients may go elsewhere if no antibiotic dispensed on request. This could include educational activities

Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia

Background Patients’ satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patients’ satisfaction may also predict health-related behaviours of patients such as adherence to treatment and recommendations. Aims The study aimed to assess patients’ level of satisfaction with public healthcare services and to determine the factors that may influence their satisfaction level. Method A cross-sectional study was conducted using self-administered questionnaires distributed to a convenience sample of the general public in Kedah, Malaysia. Results A total of 435 out of 500 people invited to participate in the study agreed to take part, giving a response rate of 87%. In this study, only approximately half of the participants (n=198, 45.5%) were fully satisfied with the current healthcare services. The majority of the participants agreed that doctors had given enough information about their state of health (n=222, 51%) and were competent and sympathetic (n=231, 53.1%). Almost half of the participants (n=215, 49.5%) agreed that the doctors took their problems seriously. Only 174 (40%) participants agreed that doctors had spent enough time on their consultation session. Some 266 (61.2%) respondents agreed that healthcare professionals in the public health sector were highly skilled. The majority of the respondents described amenities, accessibility and facilities available in the public healthcare sector as good or better. In this study, waiting time was significantly associated with patients’ satisfaction as the results showed that those who waited longer than two hours were less satisfied with the services than those who waited under two hours. Conclusion The study findings showed that approximately half of the respondents were fully satisfied with current healthcare services. In this study, waiting time was the main factor that affected the patients’ satisfaction level. Other factors that influenced the satisfaction level included the length of consultation sessions and the process of patient registration. Hence, improvement in the health services that leads to a shorter waiting time may increase the satisfaction level of patients