Overview of pharmacovigilance practices at the largest academic healthcare system in the State of Qatar.

Adverse Drug Reactions (ADRs) are major global concern, adversely impacting patient safety and health outcomes. ADRs cause significant morbidity and mortality among hospitalised patients, causing greater length of hospital stay, increased healthcare costs and patient dissatisfaction to the treatments. Pharmacovigilance (PV), a process of detecting, monitoring and preventing drug-related harm, plays a vital role to ensure patient safety. ADR reporting is the cornerstone of PV. PV practices in Qatar are relatively new and are evolving rapidly. The purpose of this article is to explore the medication safety practices (notably ADR reporting) at the largest academic healthcare center in Qatar. The article further provides evidence on how information related to ADRs are generated and interpreted. Furthermore, it describes how a designated center for monitoring medication safety activities was established at the largest healthcare provider in Qatar

Key stakeholders' views on the potential implementation of pharmacist prescribing: a qualitative investigation.

Background: An accumulation of international evidence demonstrates that pharmacist prescribing is effective, safe and well-accepted. While there is potential for such development in the Middle East, the majority of published studies are largely reported from Western countries and the perspectives of individuals in strategic positions of policy and practice in the Middle East were unknown. Objective: To explore the views of key stakeholders in Qatar regarding the potential development and implementation of pharmacist prescribing. Methods: Qualitative, face-to-face semi-structured interviews were conducted with stakeholders in strategic positions of policy influence (i.e. medical, pharmacy and nursing department directors, health-related academics, patient safety and quality directors, professional regulators). Stakeholders were recruited via purposive and snowball sampling. The interview schedule was constructed from an extensive literature review and grounded in the Consolidated Framework for Implementation Research (CFIR) to ensure comprehensive exploration of potential facilitators and barriers. Interviews were conducted from April to August 2017, digitally recorded, transcribed, and independently analysed by two researchers using CFIR as a coding framework. Results: Thirty-seven interviews were conducted with directors of medicine (n=5), pharmacy (n=6) and nursing (n=5), healthcare policy developers (n=6), healthcare academics (n=9), and patient safety advocates (n=6). Interviewees were aware of pharmacist prescribing models internationally and generally supported development and implementation in Qatar due to perceived benefits of improved patient care, professional development and enhanced team working. While there were more facilitators than barriers, it was clear that there was a requirement to systematically plan the development and implementation of pharmacist prescribing, with reference to all five CFIR domains. The need for further training, demonstration of pharmacists’ prescribing competence, and extensive engagement of stakeholders were considered crucial. Conclusion: There is potential for pharmacist prescribing to be developed and implemented in Qatar. Further research is warranted to define the models of prescribing suitable for Qatar, and to highlight issues of education, training and accreditation

Health-related stakeholders' perceptions of clinical pharmacy services in Qatar.

Background: In Qatar, the National Vision 2030 and the National Health Strategy 2018-2022 articulate the need to improve healthcare delivery by better utilisation of the skilled workforce. In this regard, pharmacy practice is rapidly advancing and several extended pharmacy services are now available in institutionalised settings. Objective: This study aimed to determine health-related stakeholders’ perceptions of current clinical pharmacy services in Qatar, and the potential development and implementation of further patient-centred roles. Setting: All major organisations and institutions relating to the practice, education, regulation, and governance of pharmacy in Qatar. Method: Qualitative, face-to-face semi-structured interviews were conducted with individuals in key strategic positions of policy development and influence (i.e. health-related academic leaders, healthcare policy developers, directors of medicine/pharmacy/nursing, and patient safety leaders). Participants were recruited via a combination of purposeful and snowball sampling, until the point of data saturation was reached. The interview guide was grounded in the Consolidated Framework for Implementation Research domains of innovation characteristics, outer and inner setting, characteristics of individuals, and implementation process. The interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework approach. Main outcome measure: Perceptions of stakeholders regarding current and potential for future clinical pharmacy services in Qatar. Results: Thirty-seven interviews were conducted with stakeholders of policy influence in healthcare. The interviewees reported a variety of clinical pharmacy services available in Qatar, which they perceived as positively impacting patient care outcomes, pharmacists’ professional autonomy, and the healthcare system in general (innovation characteristics). However, they perceived that these services were mainly performed in hospitals and less in community pharmacy setting (inner setting) and were undervalued by patients and the public (outer setting). Expansion of pharmacists’ clinical activities was supported, with recognition of facilitators such as the skillset and training of pharmacists, potential time release due to automation and well-considered implementation processes (characteristics of individuals, inner setting, process). Conclusion: Health-related stakeholders in Qatar have positive perceptions of current clinical pharmacy services and support the expansion of pharmacist’s roles. However, service development needs to consider the issues of patient and public awareness and initially target institutionalised healthcare settings

Views and perceptions of key stakeholders in Qatar on pharmacist prescribing.

Background and Objective: Pharmacist prescribing has been implemented successfully in several countries around the world, with evidence of effectiveness, safety and acceptability. The Qatar Health Strategy provides the opportunity to advance further the clinical and prescribing role of the pharmacist. As part of considering this development, there was a need to gather the views and perceptions of key individuals in positions of strategic importance. The aim of this project is to explore the views and perceptions of stakeholders on the development and implementation of pharmacist prescribing in Qatar. Setting and Method: Qualitative, face-to-face interviews with indviduals in key strategic positions with policy influence (medical/pharmacy/nursing directors, hospital administrators, health academics, experts in patient safety as well as regulators and decision makers). Participants were recruited through purposive and snowballing sampling from different settings of: Ministry of Public Health, primary/secondary/tertiary health settings, community pharmacies and academic health institutions in Qatar. An interview schedule was drawn from an extensive search of the available literature, a systematic review being conducted by the investigators and the Consolidated Framework for Implementation Research (CFIR). The schedule was reviewed for credibility prior to piloting; interviews continued to the point of data saturation. Interviews were digitally recorded, transcribed verbatim and analysed thematically by two independent researchers using CFIR as a coding framework. Ethical approval was obtained prior to conducting fieldwork. Main outcome measures: Awareness, experiences and views of: non-medical prescribing; clinical roles and prescribing by pharmacists; facilitators, barriers and solutions to pharmacist prescribing development and implementation. Results: Data saturation and representation of stakeholder groups was achieved following 36 interviews. Emerging CFIR themes were: intervention characteristics (evidence of pharmacist prescribing models internationally, advantages of pharmacist prescribing in Qatar, adaptability of international models to Qatar); outer setting (better meeting patient needs, degree of networking with external organisations); inner setting (quality of communication processes within an organisation, engagement of key leaders in development and implementation); ideal characteristics of pharmacist prescribers in Qatar; and process of designing, implementing and evaluating the intervention. Conclusion: Stakeholders held positive views around the potential for pharmacist prescribing in Qatar. CFIR themes will facilitate the development of frameworks for pharmacist prescribing in Qatar

Knowledge, perception, attitude and experience of pharmacist in Qatar towards drug use in pregnancy: a cross-sectional study.

Pregnancy is a state of altered physiology and medication use during this period is remarkably challenging. Pharmacists are medication experts with great knowledge of pharmacology, pharmacokinetics and are trained to apply evidence based clinical knowledge. In a study done in the USA Mitchell et al found that use of medications, either prescribed or purchased over the counter (OTC), occurred in 88.8% of all pregnancies. Whereas, in Europe, prevalence estimates of prescribed medication use vary considerably across countries, ranging from 26% in Serbia to 93% in France. Given their central role to provide medication related advice to patients we conducted a questionnaire based survey to identify the knowledge, attitude, perception and experience of pharmacist in Qatar towards drug use in pregnancy

Behavioral determinants potentially influencing COVID-19 vaccine acceptance among pharmacy professionals in Qatar: a nationwide survey using the Theoretical Domains Framework

Background: There is a paucity of robust, theory-based research investigating vaccination behavior. 1 Using Theoretical Domains Framework (TDF), the study aimed to explore the key behavioral determinants influencing vaccine behavior among pharmacy professionals in Qatar. Methods: A cross-sectional online survey of pharmacy professionals was conducted in April 2021. Survey items included questions related to demographics, vaccination behavior, and behavioral ‘determinants’ influencing vaccination (Likert statements, TDF items). The draft questionnaire was reviewed for face and content validity with experts and piloted among 80 participants. The sample size was calculated (n = 353) using the Raosoft online calculator. Data were analyzed using descriptive and inferential statistics and Principal component analysis (PCA) of TDF items. 2,3 Results: The response rate was 37.40% (1,065/2,400). The majority expressed willingness to receive the COVID-19 vaccines. Participants who refused the influenza vaccine in the past were more likely to refuse the COVID-19 vaccines too (χ2(1) = 12.6, chi-square; p < 0.001). The mean (SD) overall percentage score of behavioral determinants influencing vaccine acceptance and advocacy were 31.2 ± 19.6 and 36.5 ± 28.2 (on a scale from -100 to 100). Vaccine acceptance was lower among those who refused any vaccines in the past (33.2 ± 18.9 vs 28.7 ± 20.1; p < 0.001) (Table 1). The main barriers to vaccine acceptance were safety, speed of development, and cultural influences. PCA identified ‘belief of consequence and emotions (fear and anxiety) as more negative determinant (-1.4 ± 42.1) potentially influencing vaccine acceptance behavior (Table 2). Although most participants considered it as their professional duty to advocate the use of vaccines, they were unsure if patients will accept their recommendations. Conclusion: Most participants expressed an interest to receive the COVID-19 vaccines and considered it as their professional duty to recommend the use of the vaccine. However, they were unsure if patients would accept their advice. Study findings will assist to develop behavior change interventions targeting individuals.qscienc

Safety of levetiracetam in pregnancy and lactation: a systematic review.

Most women with active seizures are often encouraged to continue their antiepileptic medications during pregnancy to avoid serious fetal or maternal complications. Levetiracetam (LEV) is a newer antiepileptic drug used as adjunctive therapy in patients with refractory partial seizures with or without secondary generalization. Because of its broad-spectrum activity, LEV is becoming increasingly used in women with epilepsy of childbearing potential, during pregnancy and thus also during lactation. First generation anti-epileptics are known to cause Major Congenital Malformations (MCM) and developmental problems. However, there is paucity of literature on information regarding safety of Levetiracetam (second generation), use in pregnancy and breastfeeding. The purpose of the present study was to summarize the scientific evidence behind use of LEV during pregnancy and lactation

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol

Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. This systematic review has been registered and published with Prospero ( CRD42020172773 )

Exploring determinants of antimicrobial prescribing behaviour using the theoretical domains framework.

Few theoretically-based, qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals. Understanding these can promote successful development and implementation of behaviour change interventions (BCIs). To use the Theoretical Domains Framework (TDF) to explore determinants of clinicians' antimicrobial prescribing behaviour, identifying barriers (i.e., impediments) and facilitators to appropriate antimicrobial practice. Semi-structured interviews with purposively-sampled doctors and pharmacists with a wide range of specialties and expertise in Hamad Medical Corporation hospitals in Qatar. Interviews based on previous quantitative research and the TDF were audio-recorded, transcribed and independently analysed by two researchers using the TDF as an initial coding framework. Data saturation was achieved after interviewing eight doctors and eight pharmacists. Inter-related determinants of antimicrobial prescribing behaviour linked to ten TDF domains were identified as barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. The main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources); knowledge gaps relating to guidelines and appropriate prescribing (knowledge); restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity); challenging antimicrobial prescribing decisions (memory, attention and decision processes); and professional hierarchies and poor multidisciplinary teamworking (social influences). Key facilitators included guidelines compliance (goals and intentions), and participants’ beliefs about the consequences of appropriate or inappropriate prescribing. Further education and training, and some changes to guidelines including their accessibility were also considered essential. Antimicrobial prescribing behaviour in hospitals is a complex process influenced by a broad range of determinants including specific barriers and facilitators. The in-depth understanding of this complexity provided by this work may support the development of an effective BCI to promote appropriate antimicrobial stewardship

Cost-effectiveness analysis of dapagliflozin in addition to standard therapy in heart failure with reduced ejection fraction: A Qatari healthcare perspective

Background: Dapagliflozin has been shown to reduce the risk of heart failure hospitalization and cardiovascular mortality in patients with heart failure with reduced ejection fraction (HFrEF). 1,2 This work aims to determine the cost-effectiveness of dapagliflozin added to standard therapy versus standard therapy alone in patients with HFrEF, regardless of the presence or absence of type 2 diabetes mellitus (T2DM). Methods: A lifetime Markov model was constructed to compare the health outcomes and costs of dapagliflozin added to standard therapy versus standard therapy alone from a Qatari public healthcare perspective (Figure 1). 2 The cohort is comprised of HFrEF patients with left ventricular ejection fraction (LVEF) ? 40%, and New York Heart Association (NYHA) class II-IV with an average age of 65 years, based on Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure (DAPA-HF) trial (Table 1). 1,2 The model consisted of three health states: 'stable', 'hospitalization for heart failure', and 'dead'. Clinical inputs were derived from the results of DAPA-HF trial and costs, and utilities were estimated from published sources as well as publicly available sources in Qatar. 3 The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained (QALY). All outcomes and costs were discounted at a rate of 3% annually. Sensitivity analyses were conducted to confirm the robustness of the results. The study was based on published data; therefore ethics approval was not required. Results: Dapagliflozin added to standard care prevented 112 heart failure hospitalization and resulted in an additional cost of QAR 33,890 (USD 9,309). This equated to an ICER of QAR 101,763 (USD 27,951) per QALY gained, below the US willingness-to-pay threshold of USD 150,000 per QALY gained. Sensitivity analyses showed the findings to be robust. Conclusion: Dapagliflozin in addition to standard care appears to be a cost-effective strategy for patients with HFrEF, regardless of the presence or absence of T2DM.qscienc