Home monitoring of blood pressure: patients’ perception and role of the pharmacist

Purpose: To explore the use of the blood pressure monitors by hypertensive patients in Jordanian homes and investigate their effect on emotional status and disease management, and the role of the pharmacist in this regard.Methods: This cross-sectional study was conducted over two months in 2012, in Amman, Jordan. Participants visiting cardiovascular clinics were approached and asked to answer a validated questionnaire. One hundred patients with doctor-diagnosed hypertension were recruited into the study. The questionnaire investigated the role of the pharmacist regarding the use of the blood pressure home measuring devices, patients’ emotional response to their blood pressure readings and actions taken in response. Completed questionnaires were encoded and the data were analyzed using SPSS (version 17).Results: A majority of the patients (82 %) use home measuring monitors to monitor their blood pressure at home. The pharmacist was reported as the health care professional mostly responsible for counseling patients on the proper use of blood pressure monitors (50 %) and delivering needed relevant education (56 %). A majority of participants suffer from anxiety (68 %) in response to high blood pressure readings. The main follow-up management performed by participants in response to elevated blood pressure was physical activity (40 %).Conclusion: Most hypertensive patients in Jordan use home blood pressure monitors; however, home self-measurement showing high blood pressure readings cause many patients to feel anxious. Pharmacists take the lead in educating patients in this regard.Keywords: Jordan, Hypertension, Blood pressure monitor, Pharmacis

Effect of Divergence in Patients’ Socioeconomic Background on their Perspective of the Role of the Community Pharmacist in Amman, Jordan

Purpose: To examine the effect of divergence in patients’ socioeconomic background on their perspective of the roles of the pharmacist in Amman, Jordan.Methods: This was a single-phase observational study conducted in two different socioeconomic areas: Western (WA) and Eastern Amman (EA, which is of a lower socioeconomic status than WA) in March to May of both 2009 and 2010. A validated questionnaire was completed by patients walking into community pharmacies. The source of advice (clinical specialist, general practitioner, pharmacist, nurse or herbalist) regarding patient's disease management and medication use, as well as patients’expectation of the pharmacist were investigated.Results: 2000 patients (mean age: 35.1 ± 13.7 years, 57.2 % males) visiting community pharmacies in Amman (1000 each from WA and EA) took part in the study. The majority of patients chose the pharmacist as the source of advice on medication use (WA, 50.8 %; EA, 53.6 %), followed by the clinical specialist (WA, 35.7 % vs EA, 26.9 %, p = 0.001). Other aspects of patient perspective and expectation of the pharmacist were also assessed; in several instances, more reliance on thepharmacist was observed in EA (lower socioeconomic status) than in WA.Conclusion: The findings of this study is important for future social pharmacy studies in the area, as it shows that socioeconomic status influences patient’s perception of the role of the community pharmacist in Amman, Jordan.Keywords: Socioeconomic status, Community pharmacist, Jordan, Patient perception, Counselin

Psychological Impact of Life as Refugees: A Pilot Study on a Syrian Camp in Jordan

Purpose: To investigate types and prevalence of psychological distresses endured by Syrian refugees at Alzatary Camp in Jordan.Methods: This observational study was conducted over a period of 2 months (November and December, 2012) at Alzatary Camp for Syrian refugees in Jordan. A validated questionnaire was filled by a field researcher to gather information on respondents’ living conditions, psychological distresses and perspectives of the medical care services provided.Results: The questionnaire was completed for 73 respondents with a mean age of 37.7 ± 11.2. A majority of refugees (63.3 %) lived in tents, and the rest in caravans. Some of the respondents (56 %) suffered from psychological distresses; 46 % believed that psychological therapy and support is needed, out of which 14.5 % reported receiving such therapy. Refugees staying in tents reported low satisfaction with the medical care  services provided (54.2 % vs. 23.8 %) and great need for psychological support (66.7 % vs. 31.3 %) when compared to refugees staying in caravans.Conclusion: Syrian refugees at Alzatary Camp suffer from psychological distress that requires urgent attention. Current medical support is not sufficient, especially for refugees staying in tents.Keywords: Syrian refugees, Jordan camps, Alzatary Camp, Psychological disorders, Mental healt

Perceptions, Experiences and Expectations of Physicians Regarding the Role of the Pharmacist in an Iraqi Hospital Setting

Purpose: To investigate the perceptions, expectations, and experiences of physicians regarding hospital-based pharmacists in some Iraqi government hospitals.Methods: A cross-sectional study was conducted at four government hospitals in Baghdad and Erbil, Iraq from March to July 2012. A validated, self-administered questionnaire was hand-delivered to a random sample of 200 physicians. The questionnaire comprised four sections that probed the physicians' demographic characteristics as well as their perceptions of, expectations of, and experiences with hospital pharmacists.Results: Most participants (69.4 %) reported rarely interacting with pharmacists and that enquiring about the availability of medications was the main purpose (74.9 %) of any interactions. Physicians reported being comfortable with pharmacists preventing prescription error, treating minor illness, and suggesting prescription medication to physicians of 74, 75 and 67 %, respectively, but only 47 % were comfortable with pharmacists providing patient education. The perspective of physicians in Erbil differed from that of physicians in Baghdad (p < 0.05).Conclusion: Interactions between Iraqi physicians and pharmacists are still not optimal. Physicians are much more comfortable with traditional pharmacist functions than with the extended, patient-oriented pharmacy services currently being promoted. Great efforts are needed to enhance the Iraqi physician's attitude regarding the clinical services provided by pharmacists which in turn would result in more collaboration among healthcare professionals.Keywords: Physician, Pharmacist, Perception, Experience, Expectation, Patient-oriented, Pharmacy servic

Blood Pressure Home Monitoring in Hypertensive Patients Attending a Tertiary Health Facility in Amman, Jordan: Effect on Disease Control and Adherence Rate

Purpose: To investigate the effect of home monitoring of blood pressure (HMBP) on adherence to antihypertensive medications and control of the disease among patients attending a tertiary health facility in Amman, Jordan.Methods: This cross-sectional correlation study was conducted in 2012 at the cardiovascular clinics of Jordan University Hospital. A questionnaire investigating participants' disease level of control, disease duration, frequency of HMBP use, type of measuring devices used, and effect of HMBP on adherence to antihypertensive medications and life style changes was used for the study. To minimize any bias that may have resulted from the involvement of pharmacists in data collection, we designed a clear stringent protocol that was strictly followed by the researcher with all patients. In addition to that, the researcher clearly introduced herself as an independent figure that cannot make any decisions or changes.Results: Two hundred and five hypertensive patients who practice HMBP were recruited into this study. Sixty percent of the patients were aged 50 - 69 years. About 45 % of the patients were diagnosed with hypertension for > 10 years. Almost half of the patients have been using digital devices for blood pressure monitoring. The mean rate of HMBP was 15 times per month but almost 80 % of the patients did not document their blood pressure readings. Around 55 % of the patients referred high readings to a healthcare professional. Patients with higher levels of education as well as patients with lower BP readings showed significantly higher rates of adherence to their antihypertensive medications. Patients with high BP readings reported that they exercise more and reduced their daily salt intake.Conclusion: Overall, the patients showed high adherence rates to antihypertensive medications and adoption of better life style. However, increasing patient’s awareness in respect to documenting and communicating BP readings to their physicians is needed.Keywords: Adherence, Hypertension, Compliance, Blood pressure monitoring, Salt intake,Antihypertensive, Jorda

Education on Correct Inhaler Technique in Pharmacy Schools: Barriers and Needs

Purpose: To investigate the effectiveness of a standard educational module on pharmacy students’ inhaler technique demonstration skills.Methods: This investigational study was conducted during the Clinical Pharmacy and Therapeutics tutorial classes in 2011. All fifth-year students were given placebo inhaler devices and information leaflets explaining the use of these devices. Students were then shown, by demonstration, the correct technique for each of the inhalers. All the students were assessed on the use of each of the inhalers two weeks following the tutorial. A validated questionnaire regarding the students’ barriers to demonstrate the correct inhaler technique was completed by all the students. The inhaler techniques  emonstratedwere Accuhaler (ACC), Turbuhaler (TH) and metered-dose inhaler (MDI).Results: Students scored significantly better with ACC with a score of 4.38 ± 1.81 (out of 9.00) than with TH (3.96 ± 1.75 out of 9.00); p = 0.004, and MDI (2.69 ± 1.76 out of 8.00); p < 0.001, based on Friedman test 2 weeks following training. The majority of students (78 %) believed that lack of practice with the devices was the primary barrier to correct inhaler use.Conclusion: Standard educational training may not be the most appropriate method of teaching students the correct use of inhalers. Clearly, there is a practice element missing which needs to be addressed in a feasible way.Keywords: Inhaler technique, Pharmacy education, Hands-on training, Training barrie

Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: the Easy Low Instruction Over Time (ELIOT) study

Background: Incorrect inhaler technique is a common cause of poor asthma control. This two-phase pragmatic study evaluated inhaler technique mastery and maintenance of mastery with DuoResp® (budesonide-formoterol [BF]) Spiromax® compared with Symbicort® (BF) Turbuhaler® in patients with asthma who were receiving inhaled corticosteroids/long-acting β2-agonists. Methods: In the initial cross-sectional phase, patients were randomized to a 6-step training protocol with empty Spiromax and Turbuhaler devices. Patients initially demonstrating ≥1 error with their current device, and then achieving mastery with both Spiromax and Turbuhaler (absence of healthcare professional [HCP]-observed errors), were eligible for the longitudinal phase. In the longitudinal phase, patients were randomized to BF Spiromax or BF Turbuhaler. Co-primary endpoints were the proportions of patients achieving device mastery after three training steps and maintaining device mastery (defined as the absence of HCP-observed errors after 12 weeks of use). Secondary endpoints included device preference, handling error frequency, asthma control, and safety. Exploratory endpoints included assessment of device mastery by an independent external expert reviewing video recordings of a subset of patients. Results: Four hundred ninety-three patients participated in the cross-sectional phase, and 395 patients in the longitudinal phase. In the cross-sectional phase, more patients achieved device mastery after three training steps with Spiromax (94%) versus Turbuhaler (87%) (odds ratio [OR] 3.77 [95% confidence interval (CI) 2.05–6.95], p < 0.001). Longitudinal phase data indicated that the odds of maintaining inhaler mastery at 12 weeks were not statistically significantly different (OR 1.26 [95% CI 0.80–1.98], p = 0.316). Asthma control improved in both groups with no significant difference between groups (OR 0.11 [95% CI -0.09–0.30]). An exploratory analysis indicated that the odds of maintaining independent expert-verified device mastery were significantly higher for patients using Spiromax versus Turbuhaler (OR 2.11 [95% CI 1.25–3.54]). Conclusions: In the cross-sectional phase, a significantly greater proportion of patients using Spiromax versus Turbuhaler achieved device mastery; in the longitudinal phase, the proportion of patients maintaining device mastery with Spiromax versus Turbuhaler was similar. An exploratory independent expert-verified analysis found Spiromax was associated with higher levels of device mastery after 12 weeks. Asthma control was improved by treatment with both BF Spiromax and BF Turbuhaler

Comparison of serious inhaler technique errors made by device-naïve patients using three different dry powder inhalers: a randomised, crossover, open-label study

Background: Serious inhaler technique errors can impair drug delivery to the lungs. This randomised, crossover, open-label study evaluated the proportion of patients making predefined serious errors with Pulmojet compared with Diskus and Turbohaler dry powder inhalers. Methods: Patients ≥18 years old with asthma and/or COPD who were current users of an inhaler but naïve to the study devices were assigned to inhaler technique assessment on Pulmojet and either Diskus or Turbohaler in a randomised order. Patients inhaled through empty devices after reading the patient information leaflet. If serious errors potentially affecting dose delivery were recorded, they repeated the inhalations after watching a training video. Inhaler technique was assessed by a trained nurse observer and an electronic inhalation profile recorder. Results: Baseline patient characteristics were similar between randomisation arms for the Pulmojet-Diskus (n = 277) and Pulmojet-Turbohaler (n = 144) comparisons. Non-inferiority in the proportions of patients recording no nurse-observed serious errors was demonstrated for both Pulmojet versus Diskus, and Pulmojet versus Turbohaler; therefore, superiority was tested. Patients were significantly less likely to make ≥1 nurse-observed serious errors using Pulmojet compared with Diskus (odds ratio, 0.31; 95 % CI, 0.19–0.51) or Pulmojet compared with Turbohaler (0.23; 0.12–0.44) after reading the patient information leaflet with additional video instruction, if required. Conclusions These results suggest Pulmojet is easier to learn to use correctly than the Turbohaler or Diskus for current inhaler users switching to a new dry powder inhaler