Polypharmacy in elderly cancer patients : challenges and the way clinical pharmacists can contribute in resource-limited settings

The aim of this study was to address the problems associated with polypharmacy in elderly cancer patients and to highlight the role of pharmacists in such cases in resource‐limited settings. A narrative review of existing literature was performed to summarize the evidence regarding the impact of polypharmacy in elderly cancer patients and the pharmaceutical strategies to manage it. This review emphasizes the significance of polypharmacy, which is often ignored in real clinical practice. Polypharmacy in the elderly cancer population is mainly due to: chemotherapy with one or more neoplastic agents for cancer treatment, treatment for adverse drug reactions due to neoplastic agents, the patient's comorbid conditions, or drug interactions. The role of the clinical pharmacist in specialized oncology hospitals or oncology departments of tertiary care hospitals is well established; however, this is not the case in many developing countries. A clinical pharmacist can contribute to solving the problems associated with polypharmacy by identifying the risks associated with polypharmacy and its management in resource‐limited settings. As in many developed countries, the involvement of a clinical pharmacist in cancer care for elderly patients may play a vital role in the recognition and management of polypharmacy‐related problems. Further research can be conducted to support this role

A Study Assessing The Impact Of Academic Detailing Program On Childhood Diarrhoeamanagement Among The Primary Healthcare Providers In Banke Region, Nepal

Childhood diarrhoea is common in Nepal. Studies had reported poor knowledge and irrational prescribing practice among healthcare professionals for childhood diarrhoea management. Academic detailing had been used to promote rational prescribing in many developed countries, but uncommon in developing countries like Nepal. With this background, a prospective interventional study was conducted in Banke district of Nepal to evaluate the impact of academic detailing on childhood diarrhoea and its management to the randomly divided 235 primary healthcare providers. Data on knowledge, attitude and practice were collected with the help of validated semistructured questionnaire; and data on prescribing pattern was collected with the help of simulated clients. At baseline, Knowledge (K) score, Attitude (A) score, Practice (P) score and Total KAP score for the participants in control group were 7, 38, 26 and 71, respectively which was not significantly different than the participants of intervention group. K-score, A-score, P-score and KAP-score for the participants in intervention group were 7, 37, 25 and 70, respectively. However, it improved significantly in participants of intervention group during first and second follow up phases of the study

A Study Assessing The Impact Of Academic Detailing Program On Childhood Diarrhoea Management Among The Primary Healthcare Providers In Banke Region, Nepal

A prospective interventional study was conducted in Banke district of Nepal to evaluate the impact of academic detailing on childhood diarrhoea and its management to the randomly divided 235 primary healthcare providers. Satu kajian intervensi prospektif telah dijalankan di daerah Banke, Nepal untuk menilai kesan perincian akademik pada cirit-birit zaman kanak-kanak dan pengurusannya ke atas 235 pengamal penjagaan kesihatan primer yang telah dibahagikan secara rawak

Availability, price, and affordability of essential medicines to manage noncommunicable diseases : a national survey from Nepal

The aim of this study was to evaluate the availability, price, and affordability of essential noncommunicable disease (NCD) medicines in Nepal. A cross-sectional survey was conducted in Nepal in 2015 using World Health Organization/Health Action International (WHO/HAI) methodology. We collected data on the availability and price of 60 essential NCD medicines from medicine distribution outlets in both the public and private health care sectors in 6 regions. Essential NCD medicines were more available in the private sector (78%) than the public sector (60%). Furosemide tablets were the cheapest (NPR 0.6/10 tablets) and streptokinase injections were the most expensive (NPR 2200/vial) drugs. There was no significant difference (P > .05) in availability and affordability of essential NCD medicines across the 6 survey areas. Treating selected NCD conditions with medicines was generally affordable, with 1 month of treatment costing no more than a day’s wage of the lowest paid unskilled government worker. The lower availability of NCD medicines in the public sector limits the effectiveness of the government’s policy of providing free health services at public facilities. Although NCD medicines were generally affordable, future health policy should aim to ensure improved equitable access to NCD medicines, particularly in public facilities

Perception Of Nepalese Community Pharmacists Towards Patient Counseling And Continuing Pharmacy Education Program: A Multicentric Study

Objective: To study the perception of community pharmacists towards patient counseling and continuing pharmacy education programs. Methods: A semi structured questionnaire was developed by the researchers. The research was carried out in six major cities in Nepal, namely Kathmandu, Pokhara, Biratanagar, Birgunj, Nepalgunj and Bhairahawa. The filled questionnaires were analyzed as per the study objectives. Results: Altogether, 60 community pharmacists were included. Among them, 88.33% (n=53) were male. More than 50 patients visit most of the community pharmacies [36.67% (n=22)] daily. Most of the dispensers [56.67% (n=34)] took 1-5 minutes for dispensing a prescription. In most of the pharmacies [56.67% (n=34)], there were 2-5 dispensers and the qualification of a majority of dispensers were orientation training. Most of them [56.67% (n=340] believed that counseling was necessary as it was their own duty, but however, 48.33% (n=29) said that it was necessary to increase patient compliance. Our finding suggests that 83.33% (n=50) of retailers were facing some problems during patient counseling. All participants were interested in the continuing pharmacy education program. Conclusion: On the whole, the community pharmacists had a positive response towards patient counseling. Our findings suggest the need for continuing pharmacy education programs in Nepal to strengthen the concept of patient counseling.</p

Medicines prescribing for homeless persons:analysis of prescription data from specialist homelessness general practices

Background Specialist homelessness practices remain the main primary care access point for many persons experiencing homelessness. Prescribing practices are poorly understood in this population. Objective This study aims to investigate prescribing of medicines to homeless persons who present to specialist homelessness primary care practices and compares the data with the general population. Setting Analyses of publicly available prescribing and demographics data pertaining to primary care in England. Methods Prescribing data from 15 specialist homelessness practices in England were extracted for the period 04/2019-03/2020 and compared with data from (a) general populations, (b) the most deprived populations, and (c) the least deprived populations in England. Main outcome measure Prescribing rates, measured as the number of items/1000 population in key disease areas. Results Data corresponding to 20,572 homeless persons was included. Marked disparity were observed in regards to prescribing rates of drugs for Central Nervous System disorders. For example, prescribing rates were 83-fold (mean (SD) 1296.7(1447.6) vs. 15.7(9.2) p = 0.033) items), and 12-fold (p = 0.018) higher amongst homeless populations for opioid dependence and psychosis disorders respectively compared to the general populations. Differences with populations in the least deprived populations were even higher. Prescribing medicines for other long-term conditions other than mental health and substance misuse was lower in the homeless than in the general population. Conclusions Most of the prescribing activities in the homeless population relate to mental health conditions and substance misuse. It is possible that other long-term conditions that overlap with homelessness are under-diagnosed and under-managed. Wide variations in data across practices needs investigation. Impact of findings on practice statements The majority of prescribing activities focused on homeless populations relates to mental health conditions and substance misuse. Our findings suggest potential under-diagnoses and under-treatment of other long-term health conditions such as cardiovascular and respiratory conditions in homeless populations. Improving access to prevention and treatment of wider long term health conditions that overlap with homelessness and promoting medicines optimisation and adherence to prescribed treatments are key to improving the health of homeless populations

Impact of educational outreach visits by pharmacists on treatment of childhood diarrhoea-initial findings from Banke district, Nepal

Diarrhoea is one of the most common causes of mortality and morbidity in children in developing countries. Oral rehydration salts (ORS) and zinc are the primary tools used to fight diarrhoea in children. Educational outreach visits or academic detailing has been practiced over a period of time to improve prescribing behaviour in the developed countries. However, educational outreach programmes are very uncommon in Nepal. We conducted a pilot study to see the impact of educational outreach visits on the management of diarrhoea in children among 10 prescribers in the Banke district of Nepal. Initial findings suggest that there is a marked improvement on the prescribing of ORS and zinc by the prescribers after our intervention. Therefore it is planned to conduct the same study among a large number of prescribers in the Banke district of Nepal

Academic detailing as a possible source of drug information in the context of Nepal: a short review

The source of unbiased drug information is an integral part of evidence based practice. The status of evidence based practice in Nepal is very poor. One of the major factors associated with it, is the limited availability of new literature, and poor documentation and dissemination of the little available information. Academic detailing is an educational outreach program in which a trained health professional visits clinicians in their offices to provide evidence based information. So, there is a huge scope for academic detailing as a means to disseminate the available information in the context of Nepal. Research done worldwide has already shown improvement in the clinicians’ knowledge, their attitude and practice, improvement in their prescribing patterns and an increase in their adherence to clinical guidelines, following academic detailing. In Nepal, there are many topics which can be selected for academic detailing. Topics covering the information regarding newer drugs, diarrhoea treatment guidelines, the rational use of antimicrobials, the rationality of fixed dose combinations, nonsteroidal antinflammatory drugs (NSAIDs) and specialized devices for the administration of drugs, will be more relevant. Lack of local health statistics, lack of awareness about evidence based practice, challenges from pharmaceutical representatives and a lack of financing capability may be the major limitations for academic detailing in Nepal