The Use of Multiple Inhalation Devices for Chronic Obstructive Pulmonary Disease: A Study of Older Patients in Primary Care

Background Chronic obstructive pulmonary disease (COPD) is a long term condition characterised by progressive narrowing of the airways and premature ageing of the lungs. By 2020, it is estimated to be the third biggest cause of death in the UK, after heart disease and stroke. COPD imposes a large financial burden on health services and is among the most costly diseases in the UK. Inhalation therapies are central to the management of COPD; they include pressurised metered dose inhalers (pMDIs), dry powder inhalers (DPIs), and nebulisers. Although, findings from previous studies reveal suboptimal use and a wide range of problems with inhaler handling among COPD patients, very little is known about how and why problems arise. Therefore, the aim of this study was to examine how older patients made decisions regarding the use of inhalers especially when combination of inhalation devices were used at home, how those decision and difficulties contributed to suboptimal outcomes and treatment failures. Method A cross-sectional study design using semi-structured face to face interviews, observations of inhalation device users, with patients in their own homes, was conducted with 46 patients. Based on previous studies among patients with respiratory diseases, it was anticipated that the sample of 60 patients would enable us to achieve the study objectives and would be able to reach saturation level, additionally, this sample size was achievable within the time and resources of the study. Patients were recruited from Pinn Medical Centre and identified by the staff through patients’ medical notes. All COPD patients, registered at Pinn Medical Centre, and prescribed a combination of at least two different inhalation devices were invited to participate. The practice population includes patients of different ages, duration and experience of inhalation therapies, ethnicity and disease severity. The data were audio recorded for verbatim transcription. Qualitative and quantitative analysis were conducted using Nvivo and SPSS programme, respectively. The study was approved by Newcastle & North Tyneside 2 Research Ethics Proportionate Review Sub-Committee. Results 46 patients have been interviewed. Male (N=24) and female (N=22), the mean age was 77 years (63-100). Two-thirds of participants (N=31), 67%, used a combination of both pMDIs and DPIs, 10 participants (22%), used a combination of DPIs, three participants (7%) used three different kinds of inhalation devices (pMDIs, DPIs, and nebulisers), whereas the least used group was a combination of pMDIs with just two participants (4%). Differing expectations of treatment (e.g. regarding immediacy and extent of response), and preferences for different type of device were expressed. Treatment failures were of concern to patients who had experienced multiple episodes of exacerbation. The study identified factors which were potential contributors to treatment failures. These included adherence decisions which were influenced by their beliefs about inhalation therapies and concerns of side effects, especially with the long term such as steroids, and willingness to use devices in public. The study findings also revealed practical and technical issues in manipulation and cleaning the inhalation devices especially with the use of DPIs. Discussion and Conclusion Treatment failures are a major concern for COPD patients. Most patients experienced problems with inhalation devices used at home. To improve treatment, continuous education and follow up needs to be done for COPD patients in order to provide all the necessary assistance in the future tailored to each patient who is at high risk of treatment failures and/or experiencing problems

“You could lose when you misuse” – factors affecting over-the-counter sale of antibiotics in community pharmacies in Saudi Arabia: a qualitative study

Abstract Background The sale of antibiotics without a prescription poses a global public health concern. Antibiotics dispensed without a prescription are largely recognised as a cause of antibiotic misuse and overuse which may result in antibiotic resistance, recurrent infection, increased cost and adverse effects of treatment. There have been no qualitative studies to explore the reasons for over-the-counter (OTC) sale of antibiotics, despite the fact that non-prescription sale of antibiotics are increasing in Saudi Arabia. Methods Qualitative interviews were conducted with community pharmacists living in the Eastern Province of Saudi Arabia using face-to-face, open-ended questions. Interviews were audio-recorded and transcribed verbatim. The interview transcripts were analysed using thematic analysis and NVivo 10 software. Results All participants declared that antibiotics were frequently sold without a medical prescription on an OTC basis. The main reasons for OTC sale of antibiotics were found to be related to the ease of access to community pharmacies compared to other healthcare services, expertise and knowledge of pharmacists and patients’ trust, misconceptions and inappropriate practices of the public towards antibiotic use, customer pressure, pharmacists’ need to ensure business survival and weak regulatory enforcement mechanism. These are presented in more detail below by using illustrative quotes from participants’ transcripts. Conclusions The non-prescribed sale of antibiotics is still a common practice in Saudi Arabia, despite being a problem. The results of this study highlight the need to design interventions to promote rational use of antibiotics

Incidence and prevalence of prescribing errors in Saudi Arabia: A systematic study

Objective: The increased incidence of prescribing errors has become a major health problem and is a concern for healthcare authorities across the world due to its serious medical consequences for patients. However, very little is known about prescribing errors in Saudi Arabia. Therefore, this review aims to systematically review the studies that have assessed the incidence and prevalence of prescribing errors in Saudi Arabia.Methods: A systematic review of the literature related to prescribing errors among adults in Saudi Arabia was limited by the period from January 2005 up to April 2016, using the following databases: PubMed, Scopus and ISI Web of Science. The search strategy included studies conducted among adults 18 or over; in primary or secondary care in Saudi Arabia; that assessed handwritten prescriptions by junior or senior doctors; and that were published in the English language only. The quality of the included studies was assessed using a 13-item quality assessment tool adopted from two previous studies.Results: Six studies met the inclusion criteria. The overall quality of the included studies was variable. Error rates varied from 7.1% to 94% for prescribing. The median error rate interquartile range (IQR) was as high as 32% (7.1-49%). Duration of the studies ranged from one day to two years. The studies included data on 259,055 prescription orders, with a number of prescription orders assessed in the studies ranging from 1582 to 240,000. The most common types of prescribing errors reported were attributed to incorrect dosage followed by incorrect strength and incorrect duration of treatment.Conclusion: This review suggests the need to improve the prescribing skills and knowledge of prescribers in Saudi Arabia through the introduction of educational and training programmes with the aim of reducing prescribing errors

Self-medication and self-prescription with antibiotics in the Middle East—do they really happen? A systematic review of the prevalence, possible reasons, and outcomes

Objectives: There has been no review on the prevalence, possible causes, and clinical outcomes of self-medication with antibiotics (SMA) in the Middle East. Methods: Databases were searched (January 2000 through June 2016) for articles on SMA among adults aged ≥18 years living in the Middle East. A hand search for relevant citations and key journals was also performed. Results: Twenty-two studies were found. The prevalence of SMA ranged from 19% to 82%. Age, sex, and educational and income levels were the main determinants of SMA. Socio-cultural, economic, and regulatory factors were the most commonly cited reasons for SMA. Penicillins were the antibiotics most commonly used; the antibiotics were obtained mainly via stored leftover drugs, pharmacies without prescriptions, and friends/relatives. SMA was mainly for upper respiratory tract problems. The primary sources of drug information included relatives/friends and previous successful experience. Inappropriate drug use such as wrong indication, short and long duration of treatment, sharing of antibiotics, and storing antibiotics at home for use at a later time were reported. Negative and positive outcomes of SMA were identified. Conclusions: It is important to understand the links between different factors promoting SMA and to assess the changing trends in order to derive strategies aimed at reducing drug-related health risks

Career Choices and Preferences of Saudi Pharmacy Undergraduates: A Cross Sectional Study

Background: Despite the increasing number of pharmacy schools and their graduates, the healthcare workforce shortage has increased in Saudi Arabia’s pharmacy sector, especially with the opening of new retail pharmacies, industries and pharmaceutical companies, which means that more pharmacist positions have been created with expanded working hours. However, very limited data are available regarding the views and preferences of pharmacy students regarding their future job choices in Saudi Arabia, which may create concerns for licensing organizations, employers and institutions and also gaps between what students want and the vacancies for pharmacists. Therefore, this study aims to identify pharmacy students’ career choices and examine the factors that influence their choices across different pharmacy schools in Saudi via a cross-sectional survey. Materials and methods: A cross-sectional survey was carried out of undergraduates at all education levels at different colleges of pharmacy across Saudi Arabia from October 2017 to March 2018. The questionnaire gathered students’ characteristics and covered the importance of general job considerations for students, their choices and the factors influencing their future career choices and finally the students’ opinions regarding different work settings. The data were analysed using the Statistical Package for the Social Sciences (SPSS). Results: Hospital pharmacies were the preferred area of practice (n = 212: 51.6%), followed by academia and research centres (n = 102: 24.8%), while the pharmaceutical industry and community pharmacies were the least preferred, at 7% and 2%, respectively. Based on the respondents’ characteristics and preferred future career, a multivariate logistic regression revealed that the pharmD students were 4 times more likely to prefer hospital pharmacy posts (odds ratio (OR) = 4.554, p = 0.033) compared with the B-pharm students. Among the factors that influenced the students’ choices were personal interest, in addition to training experience and organizational reputation. The most important job considerations, according to the students, was moving up the job ladder (n = 346; 84.2%), and job openings in a certain field (n = 341; 83%). The Kruskal-Wallis test for nonparametric ordinal data declared detected several significant differences among different pharmacy settings for each item measuring the pharmD and B-pharm students' attitudes and opinions. Conclusion: By identifying these gaps and pharmacy students' goals and needs, we aim to draw the government’s attention to these to ensure a future balance between supply and demand and effective pharmacy workforce planning, which is mandatory. Keywords: Pharmacy undergraduates, Education, Career choice, Saudi Arabi

近200年来关中地区干旱灾害时空变化研究

Adverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events.To update the previous assessment of pharmacist-led medication reconciliation by restricting the review to randomized controlled trials (RCTs) only.Six major online databases were sifted up to 30 December 2016, without inception date (Embase, Medline Ovid, PubMed, BioMed Central, Web of Science and Scopus) to assess the effect of pharmacist-led interventions on medication discrepancies, preventable adverse drug events, potential adverse drug events and healthcare utilization. The Cochrane tool was applied to evaluate the chances of bias. Meta-analysis was carried out using a random effects model.From 720 articles identified on initial searching, 18 RCTs (6,038 patients) were included. The quality of the included studies was variable. Pharmacists-led interventions led to an important decrease in favour of the intervention group, with a pooled risk ratio of 42% RR 0.58 (95% CI 0.49 to 0.67) P<0.00001 in medication discrepancy. Reductions in healthcare utilization by 22% RR 0.78 (95% CI 0.61 to 1.00) P = 0.05, potential ADEs by10% RR 0.90 (95% CI 0.78 to 1.03) P = 0.65 and preventable ADEs by 27% RR 0.73 (0.22 to 2.40) P = 0.60 were not considerable.Pharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization

Prisma flow diagram representing the selection process of articles included in the review.

<p>Prisma flow diagram representing the selection process of articles included in the review.</p

The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials - Fig 2

<p>(a) Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. 2 (b) Risk of bias summary: review authors' judgements about each risk of bias item for each included study.</p