Health-related stakeholders' perceptions of clinical pharmacy services in Qatar.

Background: In Qatar, the National Vision 2030 and the National Health Strategy 2018-2022 articulate the need to improve healthcare delivery by better utilisation of the skilled workforce. In this regard, pharmacy practice is rapidly advancing and several extended pharmacy services are now available in institutionalised settings. Objective: This study aimed to determine health-related stakeholders’ perceptions of current clinical pharmacy services in Qatar, and the potential development and implementation of further patient-centred roles. Setting: All major organisations and institutions relating to the practice, education, regulation, and governance of pharmacy in Qatar. Method: Qualitative, face-to-face semi-structured interviews were conducted with individuals in key strategic positions of policy development and influence (i.e. health-related academic leaders, healthcare policy developers, directors of medicine/pharmacy/nursing, and patient safety leaders). Participants were recruited via a combination of purposeful and snowball sampling, until the point of data saturation was reached. The interview guide was grounded in the Consolidated Framework for Implementation Research domains of innovation characteristics, outer and inner setting, characteristics of individuals, and implementation process. The interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework approach. Main outcome measure: Perceptions of stakeholders regarding current and potential for future clinical pharmacy services in Qatar. Results: Thirty-seven interviews were conducted with stakeholders of policy influence in healthcare. The interviewees reported a variety of clinical pharmacy services available in Qatar, which they perceived as positively impacting patient care outcomes, pharmacists’ professional autonomy, and the healthcare system in general (innovation characteristics). However, they perceived that these services were mainly performed in hospitals and less in community pharmacy setting (inner setting) and were undervalued by patients and the public (outer setting). Expansion of pharmacists’ clinical activities was supported, with recognition of facilitators such as the skillset and training of pharmacists, potential time release due to automation and well-considered implementation processes (characteristics of individuals, inner setting, process). Conclusion: Health-related stakeholders in Qatar have positive perceptions of current clinical pharmacy services and support the expansion of pharmacist’s roles. However, service development needs to consider the issues of patient and public awareness and initially target institutionalised healthcare settings

A retrospective drug use evaluation of cabergoline for lactation inhibition at a tertiary care teaching hospital in Qatar.

Background: Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians. Objective: The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety. Method: A retrospective cross-sectional DUE study was conducted over a period of 4 months from September 1, 2013, till December 31, 2013, at the Women's Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10 days of delivery or abortion were included in the study. A descriptive data analysis was undertaken. Results: Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension. Conclusion: The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern can be further enhanced through informing health care providers regarding appropriate cabergoline dosage regimen and its safety in patients with uncontrolled hypertension

Key stakeholders' views on the potential implementation of pharmacist prescribing: a qualitative investigation.

Background: An accumulation of international evidence demonstrates that pharmacist prescribing is effective, safe and well-accepted. While there is potential for such development in the Middle East, the majority of published studies are largely reported from Western countries and the perspectives of individuals in strategic positions of policy and practice in the Middle East were unknown. Objective: To explore the views of key stakeholders in Qatar regarding the potential development and implementation of pharmacist prescribing. Methods: Qualitative, face-to-face semi-structured interviews were conducted with stakeholders in strategic positions of policy influence (i.e. medical, pharmacy and nursing department directors, health-related academics, patient safety and quality directors, professional regulators). Stakeholders were recruited via purposive and snowball sampling. The interview schedule was constructed from an extensive literature review and grounded in the Consolidated Framework for Implementation Research (CFIR) to ensure comprehensive exploration of potential facilitators and barriers. Interviews were conducted from April to August 2017, digitally recorded, transcribed, and independently analysed by two researchers using CFIR as a coding framework. Results: Thirty-seven interviews were conducted with directors of medicine (n=5), pharmacy (n=6) and nursing (n=5), healthcare policy developers (n=6), healthcare academics (n=9), and patient safety advocates (n=6). Interviewees were aware of pharmacist prescribing models internationally and generally supported development and implementation in Qatar due to perceived benefits of improved patient care, professional development and enhanced team working. While there were more facilitators than barriers, it was clear that there was a requirement to systematically plan the development and implementation of pharmacist prescribing, with reference to all five CFIR domains. The need for further training, demonstration of pharmacists’ prescribing competence, and extensive engagement of stakeholders were considered crucial. Conclusion: There is potential for pharmacist prescribing to be developed and implemented in Qatar. Further research is warranted to define the models of prescribing suitable for Qatar, and to highlight issues of education, training and accreditation

Knowledge, perception, attitude and experience of pharmacist in Qatar towards drug use in pregnancy: a cross-sectional study.

Pregnancy is a state of altered physiology and medication use during this period is remarkably challenging. Pharmacists are medication experts with great knowledge of pharmacology, pharmacokinetics and are trained to apply evidence based clinical knowledge. In a study done in the USA Mitchell et al found that use of medications, either prescribed or purchased over the counter (OTC), occurred in 88.8% of all pregnancies. Whereas, in Europe, prevalence estimates of prescribed medication use vary considerably across countries, ranging from 26% in Serbia to 93% in France. Given their central role to provide medication related advice to patients we conducted a questionnaire based survey to identify the knowledge, attitude, perception and experience of pharmacist in Qatar towards drug use in pregnancy

Future perspectives on nonmedical prescribing.

Many countries have implemented nonmedical prescribing (NMP) and many others are scoping prescribing practices with a view to developing NMP. This paper provides a future perspective on NMP in light of findings of an umbrella review of aspects of NMP. This is followed by coverage of the Scottish Government strategy of pharmacist prescribing and finally, consideration of two key challenges. The review identified seven systematic reviews of influences on prescribing decision-making, processes of prescribing, and barriers and facilitators to implementation. Decision making was reported as complex with many, and often conflicting, influences. Facilitators of NMP included perceived improved patient care and professional autonomy, while barriers included lack of defined roles and resource pressures. Three systematic reviews explored patient outcomes that were noted to be equivalent or better to physician prescribing. In particular, a Cochrane review of 46 studies of clinical, patient-reported, and resource-use outcomes of NMP compared with medical prescribing showed positive intervention-group effects. Despite positive findings, authors highlighted high bias, poor definition and description of 'prescribing' and the 'prescribing process' and difficulty in separating NMP effects from the contributions of other healthcare team members. While evidence of benefit and safety is essential to inform practice, for NMP to be implemented and sustained on a large scale, there needs to be clear commitment at the highest level. The approach being taken by the Scottish Government to pharmacist prescribing implementation may inform developments in other professions and countries. The vision is that by 2023, all pharmacists providing pharmaceutical care will be pharmacist-independent prescribers. There are, however, challenges to implementing NMP into working practice; two key challenges are the need for sustainable models of care and evaluation research. These challenges could be met by considering the theoretical basis for implementation, and robust and rigorous evaluation

Safety of levetiracetam in pregnancy and lactation: a systematic review.

Most women with active seizures are often encouraged to continue their antiepileptic medications during pregnancy to avoid serious fetal or maternal complications. Levetiracetam (LEV) is a newer antiepileptic drug used as adjunctive therapy in patients with refractory partial seizures with or without secondary generalization. Because of its broad-spectrum activity, LEV is becoming increasingly used in women with epilepsy of childbearing potential, during pregnancy and thus also during lactation. First generation anti-epileptics are known to cause Major Congenital Malformations (MCM) and developmental problems. However, there is paucity of literature on information regarding safety of Levetiracetam (second generation), use in pregnancy and breastfeeding. The purpose of the present study was to summarize the scientific evidence behind use of LEV during pregnancy and lactation

Medication errors in hospitals in the Middle East : a systematic review of prevalence, nature, severity and contributory factors

Acknowledgements Open Access funding provided by the Qatar National Library. The authors would like to acknowledge the contribution of Doua Al Saad to quality assessment. Funding This systematic review was undertaken as part of the selffunded PhD at Robert Gordon University, UK.Peer reviewedPublisher PD

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol

Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. This systematic review has been registered and published with Prospero ( CRD42020172773 )

Exploring facilitators and barriers to medication error reporting among healthcare professionals in Qatar using the theoretical domains framework : A mixed-methods approach

This work was supported by the Qatar National Research Fund, NPRP-7-388-3-095.Peer reviewedPublisher PD

Views and experiences of decision-makers on organisational safety culture and medication errors

ACKNOWLEDGEMENTS The authors wish to acknowledge the contributions of all interviewees, as well as support departments at Hamad Medical Corporation, Doha, Qatar. This work was supported by NPRP grant NPRP 7‐388‐3‐095 from Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors.Peer reviewedPublisher PD