Optimising medicines use by South Asian and Middle Eastern groups in a primary care setting in the UK: validation of a tool to identify medicine-related problems

The ethnic minority groups (EMGs) are perceived to be more prone to medicine-related problems (MRPs) than the general population in United Kingdom. There is, therefore, a need for improved detection and prevention of MRPs in EMGs, such as South Asians (SA) and Middle Eastern (ME) populations, to avoid unnecessary GP visits and potential hospital admissions. In this cross-sectional study, the data were collected in 80 face-to-face semi-structured interviews using Gordon’s MRPs tool from seven pharmacies in London. The study involved patients aged over 18 from SA/ME origins who were prescribed three or more medicines. Interviews were audiotaped, transcribed verbatim and analysed thematically using Gordon’s coding frame and Nvivo 10. All issues under each of the main themes were explored and compared in an attempt to systematically adapt the Gordon’s MRPs tool for SA/ME populations. Some modifications were made to the original Gordon’s MRPs questionnaire to capture patients’ views regarding the use of medicines and the access to services. This also helped in identifying MRPs specific to SA/ME populations and proposing recommendations to address them. This included targeted medication use reviews (MURs), and tailored interventions to patients’ needs in improving medication use and access to services

“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

“Antibiotics kill things very quickly” - consumers’ perspectives on non-prescribed antibiotic use in Saudi Arabia

Abstract Background In recent decades, the Kingdom of Saudi Arabia has seen an exponentially growing antibiotic resistance, which is exacerbated by the use of antibiotics without a prescription and other various factors. However, no published data are available on factors influencing non-prescription use of antibiotics among the general public in Saudi Arabia using an in-depth interview technique. Methods Semi-structured interviews were carried out with 40 Saudi participants from the Eastern Province of Saudi Arabia, selected via snowball sampling technique. Participants were enrolled based on the following inclusion criteria: 18 years of age or older and had self-medicated themselves with antibiotics in the past two years. Data collection was continued until data saturation was attained. Interviews were audiotaped, transcribed verbatim and analysed using NVivo 10 software. Results Participants (80% female) had a mean (SD) age of 30 years (10.2). Self-medication with antibiotics was associated with various inappropriate antibiotic use behaviours and negative outcomes such as antibiotic resistance, treatment failures and adverse events. Interviews revealed that different reasons contribute to the rise of self-medication with antibiotics, ranging from difficulty accessing healthcare services, participant’s cultural beliefs and practices, lack of knowledge about antibiotics and antibiotic resistance, and weak regulatory enforcement. Conclusions The findings of the present study will aid in generating data that may provide an insight when designing future interventions to promote public health awareness regarding safe and effective 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

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

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

Medication use and medicine-related problems (MRPs) in South Asian and Middle Eastern patients with chronic diseases in the UK

Non peer reviewe

South Asian and Middle Eastern patients' perspectives on medicine-related problems in the United Kingdom

There has been little research which specifically examines medicine use among South Asian (SA) and Middle Eastern (ME) groups, although evidence suggests that medicine-related needs may be poorly met for these groups. To describe medicine-related problems (MRPs) experienced by SA and ME patients from their perspectives and identify possible contributory factors that may be specific to their cultures. The data were collected in seven pharmacies in London, United Kingdom (UK). The study was a qualitative study. Patients were from SA and ME origins, aged over 18 and prescribed three or more regular medicines. Patients were identified when presenting with a prescription. The data were collected in 80 face-to-face semi-structured interviews using Gordon's MRPs tool. Interviews were audiotaped, transcribed verbatim and analysed thematically using Gordon's coding frame and Nvivo 10 software. Main outcome measure Describing MRPs experienced by SA and ME patients from their perspectives and identifying possible contributory factors that may be specific to their cultures. Results Eighty participants (61 % male) had mean (SD) age 58 (13.4) years and a mean (SD) of 8 (4) medicines. Interviews revealed that several factors contributed to the development of MRPs; some appeared to be specific to SA and ME cultures and others were similar to the general population. The factors that were reported to be specific to SA and ME groups comprised religious practices and beliefs, use of non-prescription medicines, extent of family support, and travelling abroad-to patient's homeland or to take religious journeys. Illiteracy, language and communication barriers, lack of translated resources, perceptions of healthcare providers, and difficulty consulting a doctor of the same gender may also contribute to the problems. Many of these factors could be expected to influence patient's safety, adherence, and informed decision-making. This study demonstrated that SA and ME patients have their own problems and needs regarding both medicine use and service access. By uncovering particular problems experienced by these groups, the study can inform healthcare professionals to support SA and ME patients in the use of their medicinesPeer reviewe