A non-clinical randomised controlled trial to assess the impact of pharmaceutical care intervention on satisfaction level of newly diagnosed diabetes mellitus patients in a tertiary care teaching hospital in Nepal

Background Patient satisfaction is the ultimate goal of healthcare system which can be achieved from good patient-healthcare professional relationship and quality of healthcare services provided. Study was conducted to determine the baseline satisfaction level of newly diagnosed diabetics and to explore the impact of pharmaceutical care intervention on patients’ satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal. Methods An interventional, pre-post non-clinical randomised controlled study was designed among randomly distributed 162 [control group (n = 54), test 1 group (n = 54) and test 2 group (n = 54)] newly diagnosed diabetes mellitus patients by consecutive sampling method for 18 months. Diabetes Patient Satisfaction Questionnaire was used to evaluate patient’s satisfaction scores at baseline, three, six, nine and, twelve months’ follow-ups. Test groups patients were provided pharmaceutical care whereas control group patients only received their usual care from physician/nurses. The responses were entered in SPSS version 16. Data distribution was not normal on Kolmogorov-Smirnov test. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences among the groups before and after the intervention (p ≤0.05). Results There were significant (p < 0.001) improvements in patients’ satisfaction scores in the test groups on Friedman test. Mann-Whitney U test identified the significant differences in satisfaction scores between test 1 and test 2 groups, control and test 1 groups and, control and test 2 groups at 3-months (p = 0.008), (p < 0.001) and (p < 0.001), 6-months (p = 0.010), (p < 0.001) and (p < 0.001), 9-months (p < 0.001), (p < 0.001) and (p < 0.001) and, 12-months (p < 0.001), (p < 0.001) and (p < 0.001) follow-ups respectively. Conclusion Pharmaceutical care intervention significantly improved the satisfaction level of diabetics in the test groups compare to the control group. Diabetic kit demonstration strengthened the satisfaction level among the test 2 group patients. Therefore, pharmacist can act as a counsellor through pharmaceutical care program and assist the patients in managing their disease. This will not only modify the patients’ related outcomes and their level of satisfaction but also improve the healthcare system

Perception of community pharmacy personnel towards patient counseling and continuing pharmacy education programs in Aden, Yemen

© 2018, Journal of Clinical and Diagnostic Research. All rights reserved. Introduction: Patient counseling is a major component of pharmaceutical care, especially in community pharmacy settings. However, most community pharmacists still do not offer patient-oriented services. Despite the beneficial role of community pharmacists, research examining their roles and responsibilities in developing countries like Yemen is lacking. Aim: To assess the community pharmacy personnel’s perceptions towards patient counseling and to recognise the major barriers to successful counseling; and to assess their perception towards continuing pharmacy education programs in Aden. Materials and Methods: A descriptive, cross-sectional study was conducted among 200 community pharmacy personnel in Aden using a self-administered, structured questionnaire. Data were collected regarding community pharmacy personnel’s knowledge, attitude, and their perception about patients’ attitude concerning patient counseling and respondents’ attitude toward the continuing pharmacy education. Results: The majority of the respondents had a positive attitude towards patient counseling (85%) and continuing pharmacy education (94.0%); dose and frequency (43.0%), duration (34.0%) and indication (11.5%) were the major information mentioned while counseling their patients. Lack of patient interest (47.0%), lack of knowledge (20.0%) and lack of time (15.5%) were the major barriers towards counseling. Conclusion: The present study showed that most community pharmacy personnel in Aden, Yemen had a positive perception towords patient counseling and continuing pharmacy education program

Nurses’ perceptions of and satisfaction with the use of automated dispensing cabinets at the Heart and Cancer Centers in Qatar: a cross-sectional study

Background Automated dispensing cabinets (ADCs) were introduced in 2010 and 2012 at the Heart Hospital (HH) and National Center for Cancer Care and Research (NCCCR), both run by Hamad Medical Corporation in Qatar. These medication distribution systems provide computer-controlled storage, dispensing, and tracking of drugs at the point of care in patient care units. The purpose of this study was to assess nurses’ perceptions of and satisfaction with the use of ADCs at HH and NCCCR. Methods A cross-sectional study was conducted in the two institutions in May and November 2012 using a piloted, validated, online, and anonymous questionnaire. The questionnaire consisted of four parts: nurses’ sociodemographic and practice characteristics, 21 questions about their perceptions, one question about their overall satisfaction, and one about the system’s ease of use. The self-administered survey was distributed to 503 nurses working at HH and NCCCR over three weeks using Survey Monkey®. Results The survey response rate was 80 % (n = 403). No significant difference was found in perception scores between the two institutions (p = 0.06). Ninety-four percent (n = 378) of nurses agreed that the medication delivery system allowed them to do their job more safely, and 90 % (n = 363) nurses agreed that they now spent less time waiting for medication from the pharmacy than they did before the ADC system was introduced. Eighty seven percent (n = 349) nurses agreed that they were able to administer medication more efficiently with the ADC system. The overall satisfaction rate (either “very satisfied” or “satisfied”) for the two hospitals was 91 %. Conclusions The nurses’ perceptions of and levels of satisfaction with the ADC system were very good over the 6 months after complete implementation and integration at HH and NCCCR. ADCs appear to increase efficiency in the medication process and should therefore improve the quality of care

Mothers beliefs and barriers about childhood diarrhea and its management in Morang district, Nepal

Background: In developing countries, mothers usually manage diarrhea at home with the pattern of management depending on perceived disease severity and beliefs. The study was carried out with the objective of determining mothers beliefs and barriers about diarrhea and its management. Methods. Qualitative methods involving two focus group discussions and eight in-depth interviews were used to collect the data. The study was conducted at the following places: Tankisinuwari, Kanchanbari and Pokhariya of Morang district, Nepal during the months of February and March 2010. Purposive sampling method was adopted to recruit twenty mothers based on the inclusion criteria. A semi-structured interview guide was used to conduct the interviews. Written informed consent was obtained from all of the participants before conducting the interviews. The interviews were moderated by the main researcher with the support of an expert observer from Nobel Medical College. The interviews were recorded with the permission of the participants and notes were written by a pre trained note-taker. The recordings were transcribed verbatim. All the transcribed data was categorized and analyzed using thematic content analysis. Results: Twenty mothers participated in the interviews and most (80%) of them were not educated. About 75% of the mothers had a monthly income of up to 5000 Nepalese rupees (US$ 60.92). Although a majority of mothers believed diarrhea to be due to natural causes, there were also beliefs about supernatural origin of diarrhea. Thin watery diarrhea was considered as the most serious. There was diversity in mothers beliefs about foods/fluids and diarrhea management approaches. Similarly, several barriers were noted regarding diarrhea prevention and/or management such as financial weakness, lack of awareness, absence of education, distance from healthcare facilities and senior family members at home. The elderly compelled the mothers to visit traditional healers. Conclusions: There were varied beliefs among the mothers about the types, causes and severity of diarrhea, classification of foods/fluids and beliefs and barriers about preventing or treating diarrhea.Scopu

Influences on interactions between physicians in the public and private sectors and medical representatives in Yemen

Objective This study aims to assess the relative importance of attitude and subjective norms as well as physicians' characteristics and practice-setting factors in predicting the outcome of physicians' interactions with MRs. Methods A cross-sectional survey was conducted among a convenience sample of 602 physicians in Sana'a, Yemen. The data were analysed using descriptive and inferential analyses. The t-test/Mann–Whitney test and ANOVA/Kruskal–Wallis test with post hoc analysis, principal component analysis, correlation analysis and regression analysis were applied at an a priori significance level of 0.05. Key findings The response rate was 76.5%. Results showed that physicians who see a greater number of MRs per week or have academic affiliations were significantly more likely to have received high/low-value promotional items than were those who saw fewer MRs or have no academic affiliations (P values < 0.001 and 0.021, respectively). Also male physicians and physicians who have private clinics were significantly more likely to have received high-value promotional items (P value < 0.001). Three out of five hypotheses were supported (physicians' belief in the appropriateness of accepting high/low-value pharmaceutical companies' promotional techniques relate positively and significantly to their behaviour of interactions with MRs, and physicians' attitudes towards pharmaceutical companies relates positively and significantly to their interactions with MRs). Conclusion Physicians in Yemen consider most of the promotional techniques as normal practice. The article provides empirical evidence for policymakers in developing countries in general, and Yemen specifically, to develop suitable policies and regulations for drug promotion.This work was supported by Yemeni Ministry of Health and Population. The authors acknowledge Dr Michael Steinman, Assistant Professor of Medicine in Geriatrics, San Francisco VA Medical Center and UCSF and Dr Douglas Ball, Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, for providing background support in terms of developing the questionnaire. We also thank all the physicians for their involvement in and cooperation during the study.Scopu

Problems and challenges faced in consumer reporting of adverse drug reactions in developing countries – A case study of Yemen, Nepal and Malaysia

Background: Pharmacovigilance is the “science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems”. The most commonly used adverse drug reaction (ADR) reporting system worldwide is spontaneous and voluntary reporting, which forms the backbone of reporting systems. Aims: To explore the current status of consumer involvement in the pharmacovigilance program in three developing countries, Yemen, Nepal and Malaysia. Method: An analysis was carried out for these three countries based on the current status of pharmacovigilance and involvement of consumers in their pharmacovigilance programs. Results: Malaysia has a good system for involving consumers in their national pharmacovigilance system, whereas Yemen still lacks the well-formed national drug policy. Lack of legislation and regulation which govern the import and distribution of drugs in Yemen is a limiting factor for development of consumer pharmacovigilance. Despite establishment of a pharmacovigilance centre, no reports have been released by the centre. The status of pharmacovigilance in Nepal is still in infancy. The regulatory body is assigned to be a national pharmacovigilance center, and coordinates with seven regional centers for pharmacovigilance activities. Nepal also lacks the involvement of consumers in the national pharmacovigilance program. Conclusion: Consumer reporting may be important for developing countries to implement a proper and effective pharmacovigilance program that can reduce morbidity and mortality rates, as well as reducing the economic burden of ADRs

Assessment of treatment burden and its impact on quality of life in dialysis-dependent and pre-dialysis chronic kidney disease patients

Background The management of chronic kidney disease (CKD) and its complications places a significant burden on patients, resulting in impairment of their health-related quality of life (HR-QOL). Little is known about treatment-related burden in pre-dialysis and hemodialysis (HD) CKD patients. Objective This study aimed to investigate the magnitude of treatment-related burden and its impact on HR-QOL among patients with CKD. Methods This was a prospective, cross-sectional study to assess treatment-related burden and HR-QOL among patients with CKD in Qatar. Treatment-related burden and HR-QOL were assessed quantitatively using the Treatment Burden Questionnaire (TBQ) and the Kidney Disease Quality of Life (KDQOL™) questionnaire, respectively. The total TBQ score ranges from 0 to 150, with a higher score indicating higher treatment burden, while the range of total possible scores for the KDQOL™ are from 0 to 3600 with higher transformed score indicating better QOL. Pre-dialysis and hemodialysis (HD) CKD patients who had regular follow-up appointments at Fahad Bin Jassim Kidney Center in Qatar were enrolled. Data were analyzed descriptively and inferentially using SPSS version-24. Results Two hundred-eighty CKD patients (HD = 223 and pre-dialysis = 57) were included in the analyses (response rate 60.9%). Approximately 35% of the participants reported moderate to high treatment-related burden (TBQ global score 51–150). HD patients experienced significantly higher treatment burden compared to pre-dialysis patients with a median (IQR) score of 45 (36) versus 25 (33), respectively (p < 0.001). Medication burden and lifestyle changes burden were the highest perceived treatment-related burden. Overall, the perceived median (IQR) HR-QOL measured using the KDQOL-36™ among the participants was 2280.6 (1096.2) compared to the maximum global score of 3600. Similarly, the HD patients demonstrated significantly lower HR-QOL compared to the pre-dialysis patients [median (IQR) score of 2140 (1100) vs. 2930 (995), respectively; p < 0.001). There was a strong negative correlation between TBQ score and KDQOL-36™ score [rs (251) = −0.616, p < 0.001], signifying that HR-QOL decreases as treatment burden increases. Conclusions This study suggests that a considerable proportion of CKD patients suffered from treatment-related burden and deterioration in HR-QOL at a varying degree of seriousness. HD patients experienced significantly higher burden of treatment and lower HR-QOL compared to pre-dialysis patients and that HR-QOL declines as treatment burden increases. Therefore, treatment-related burden should be considered in CKD management and factors that increase it should be considered when designing healthcare interventions directed to CKD patients.This research was funded by Qatar University under Student Grant number QUST-CPH-SPR/2017-19 [Approved amount QAR 20,000.00 (~US$ 5,480)]. The funders had no role in the design, planning, and implementation of the study. The content is the sole responsibility of the authors.Scopu

RESEARCH ARTICLES Pharmacy Students&apos; Knowledge and Perceptions About Pharmacovigilance in Malaysian Public Universities

Objective. To assess senior pharmacy students&apos; knowledge of and perceptions about pharmacovigilance and reporting of adverse drug reactions (ADRs) at 5 public universities in Malaysia Methods. A cross-sectional study was conducted between December 1, 2010, and January 31, 2010, using a validated self-administered questionnaire delivered to a sample of 510 final-year (fourth-year) pharmacy students at 5 Malaysian public universities. Results. Four hundred twenty-one (84%) students responded to the survey. About 60% (n 5 240) indicated that they had taken courses on the concept of pharmacovigilance during their current pharmacy curriculum. The mean score for knowledge about pharmacovigilance and ADR reporting was 6.9 6 1.4. There was a significant difference in the mean scores for knowledge about pharmacovigilance across the 5 universities. The majority (82.3%) of respondents felt it was necessary to confirm the causal relationship between the drug and the ADR. About 57.8% (n 5 241) of the respondents believed that pharmacy students are competent and capable of reporting ADRs during their clerkships. The majority (87.0%) of respondents perceived that pharmacy students should be taught how to report ADRs. Conclusion. The results of this study demonstrate that the majority of final-year pharmacy students in Malaysian public universities have insufficient knowledge about pharmacovigilance and ADR reporting

The role of pharmacists in developing countries: the current scenario in Pakistan

During the past few years, the pharmacy profession has expanded significantly in terms of professional services delivery and now has been recognized as an important profession in the multidisciplinary provision of health care. In contrast to the situation in developed countries, pharmacists in developing countries are still underutilized and their role as health care professionals is not deemed important by either the community or other health care providers. The aim of this paper is to highlight the role of pharmacists in developing countries, particularly in Pakistan. The paper draws on the literature related to the socioeconomic and health status of Pakistan's population, along with background on the pharmacy profession in the country in the context of the current directions of health care