Impact of pharmaceutical care on health outcomes in patients with COPD

Background Chronic obstructive pulmonary disease (COPD) treatment goals are often not achieved despite the availability of many effective treatments. Furthermore, clinical pharmacist interventions to improve clinical and humanistic outcomes in COPD patients have not yet been explored and few randomized controlled trials have been reported to evaluate the impact of pharmaceutical care on health outcomes in patients with COPD. Objective The aimof the present studywas to evaluate the impact of pharmaceutical care intervention,with a strong focus on self-management, on a range of clinical and humanistic outcomes in patients with COPD. Setting Outpatient COPD Clinic at the Royal Medical Services Hospital. Method In a randomised, controlled, prospective clinical trial, a total of 133 COPD patients were randomly assigned to intervention or control group. A structured education about COPD and management of its symptoms was delivered by the clinical pharmacist for patients in the intervention group. Patientswere followed up at 6 months during a scheduled visit. Effectiveness of the intervention was assessed in terms of improvement in health-related quality of life,medication adherence, disease knowledge and healthcare utilization. Data collected at baseline and at the 6 month assessment was coded and entered into SPSS software version 17 for statistical analysis. A P value of\0.05 was considered statistically significant. Main outcome measure The primary outcome measure was health-related quality of life improvement. All other data collected including healthcare utilization, COPD knowledge and medication adherence formed secondary outcome measures. Results A total of 66 patients were randomized to the intervention group and 67 patients were randomized to the control group. Although the current study failed to illustrate significant improvement in health-related quality of life parameters, the results indicated significant improvements in COPD knowledge (P\0.001), medication adherence (P\0.05), medication beliefs (P\ 0.01) and significant reduction in hospital admission rates (P\0.05) in intervention patients when compared with control group patients at the end of the study. Conclusion The enhanced patient outcomes as a result of the pharmaceutical care programme in the present study demonstrate the value of an enhanced clinical pharmacy service in achieving the desired health outcomes for patients with COPD

Social marketing, shock advertising and risky consumption behavior

Purpose The overall objective of this research is to “explore whether shock advertising has a long-lasting positive effect on the smoking cessation among smoking Jordanians in a country where smoking is a deep-rooted social norm.” Design/methodology/approach This research is an exploratory qualitative research. A purposeful sampling technique was used to select participants from a mall intercept and randomly divided into groups of seven. Each group was interviewed in two different focus group sessions (four weeks apart). All focus groups were audio-recorded, transcribed and analyzed using thematic analysis. Findings A total of 41 participants took part in the focus group session. Most participants were smokers or second-hand smokers. “Three overarching themes were generated from the focus groups: previous anti-smoking campaign experience, shock advertising (SA) impact and drawbacks of SA. All participants reported that they have never been exposed to shocking adverts, and the shock appeal has never been applied in any of the anti-smoking or health awareness campaigns in Jordan. This research revealed that incorporating images of children with a mixture of emotional and fear appeals is effective in targeting Jordanian parents' negative consumptive behaviors, which may harm other individuals, especially children. Moreover, most participants commented that the effects of shock adverts would be very short term and would not likely change behaviors”. Originality/value This research contributes both “theoretically and practically to the value and effectiveness of shock advertising. This research area is overlooked in MENA countries, particularly Jordan”

Assessment of the inhalation technique and adherence to therapy and their effect on disease control in outpatients with asthma

Objectives The objective of this study was to assess correct use of inhaler devices, adherence to inhaler corticosteroid treatment and their effects on asthma control. Methods This study was a prospective, single-centre, observational study conducted between July and February 2016 at Al-Makased Hospital, respiratory outpatient clinic. Inhaler technique of asthma patients using pressurized metered-dose inhalers or dry powder inhalers (Turbuhaler (TH) and Accuhaler DiskusTM (ACC)) were assessed against published inhaler technique checklists. Asthma control variables measured using Asthma Control Test (maximum 25, higher score corresponding to better asthma control) were assessed, and adherence to asthma medications was assessed by Morisky adherence scale. Key findings Two hundred and twenty patients were recruited in the study. The mean age was 42.3 15.2 years and 59.1% were male. One hundred and seventeen (53.2%) were using TH, 60 (27.3%) were using ACC and 43(19.5%) were using MDIs. Only 22 (10%) were smoker and only 48 (21.8%) patients were their asthma controlled (ACT score >20). The devices were used correctly by 79.1% of patients using MDI, 69% of ACC and 55.6% of TH users (P > 0.001). The most common improper step was ‘forceful inhalation’ (65.4%) made by the MDI users, ‘Not exhaling to residual volume’ (58.7%) made by ACC users and ‘Not inhaling deeply enough’ (52.2%) made by TH users. Multivariate analysis showed that the likelihood of having controlled asthma was significantly higher in those with correct inhaler techniques (OR 2.3; 95% CI: 1.08–4.77; P = 0.028), high adherence to medications (OR 2.37; 95% CI: 1.05–4.92; P = 0.03) and having a higher level of education (OR 2.58; 95% CI: 1.19–3.63; P = 0.018). Conclusions It was found that asthma control was better among correct users. Repetitive training about using devices may contribute improving inhaler technique.This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

Pharmaceutical care for adult asthma patients: A controlled intervention one‐year follow‐up study

Asthma is a clinical problem with social, psychological and economic burdens. To improve patient disease management, different education programmes have been developed. Challenges in asthma management may be partially attributed to nonadherence or improper use of inhalers. This study aimed to implement and assess hospital‐based pharmaceutical care services for asthmatic patients. A 12‐month, single‐ centre, randomized, controlled study was initiated in asthmatic adult patients who had been divided into either a control or intervention group. Patients in the control group received the usual care, and patients in the intervention group received patient counselling per study protocol that covered asthma knowledge, control, adherence to treatment and inhalation techniques. The main variables compared measurements at baseline with those at 6 and 12 months. A total of 192 patients completed the study protocol: 90 in the control group and 102 in the intervention group. The control group included 90 patients, and the intervention group included 102 patients. Over the course of the 12‐month follow‐up period, a significant difference was observed between intervention and control groups with respect to asthma control (38.2% vs 10.0%; P < .001), mean correct inhalation technique (confidence interval [CI]: 8.1, 7.8‐8.5 vs CI: 6.1; 5.6‐6.6; P = .01) and good medication adherence (60.7% vs 50.0%, P = .02). There were 34% and 25% decreases in emergency room visits and hospital admissions, respectively, in the intervention group compared to the control group. This study emphasizes the importance of patient counselling in asthma management and the significant contribution that the pharmacist's intervention can have on asthma control

Pharmaceutical Care in Children: Self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan

Objectives: Pharmacists require a baseline level of knowledge in paediatric pharmaceutical care in order to be able to adequately care for paediatric patients and counsel their families. This study aimed to explore the self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan regarding paediatric pharmaceutical care. Methods: This study took place in Jordan between November 2016 and May 2017. A 28-item questionnaire was designed and administered to 400 students from all pharmacy programmes in Jordan during their final year of training. Results: A total of 354 students agreed to take part in the study (response rate: 88.5%). Most respondents (95.2%) were aware of the term ‘paediatrics’. However, almost one-third of the respondents (30.5%) reported never having taken paediatric dose calculation courses and more than half (55.6%) were unfamiliar with the term ‘off-label medicines’. Moreover, most respondents (65.1%) had low knowledge scores (≤2 out of 5) when presented with realistic paediatric case scenarios. There were no significant differences in knowledge and attitudes between undergraduate and doctoral students or between those from public or private universities (P >0.05). Conclusion: The findings of this study highlight an alarming deficiency in paediatric pharmaceutical knowledge among final-year pharmacy students in Jordan. As such, paediatric-related content should be emphasised in the pharmacy curricula of Jordanian universities so that pharmacy students receive more formalised education and more extensive training in this area. Keywords: Pharmaceutical Care; Pediatrics; Pharmacy Students; Knowledge; Attitudes; Competency-Based Education; Jordan

Factors associated with lipid control in outpatients with heart failure

BackgroundDyslipidemia is common among patients with heart failure, and it negatively impacts clinical outcomes. Limited data regarding the factors associated with poor lipid control in patients with HF patients. Therefore, this study aimed to evaluate lipid control and to explore the factors associated with poor lipid control in patients with HF.MethodsThe current cross-sectional study was conducted at outpatient cardiology clinics at two major hospitals in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the validated 4-item Medication Adherence Scale. Binary logistic regression analysis was conducted to explore significant and independent predictors of poor lipid control among the study participants.ResultsA total of 428 HF patients participated in the study. Results showed that 78% of the participants had poor lipid control. The predictors that were associated with poor lipid control included uncontrolled BP (OR = 0.552; 95% CI: 0.330–0.923; P &lt; 0.05), higher Hb levels (OR = 1.178; 95% CI: 1.013–1.369; P &lt; 0.05), and higher WBC (OR = 1.133; 95% CI: 1.031–1.246; P &lt; 0.05).ConclusionsThis study revealed poor lipid control among patients with HF. Future intervention programs should focus on blood pressure control in order to improve health outcomes among HF patients with dyslipidemia

Social marketing, shock advertising and risky consumption behavior

The overall objective of this research is to “explore whether shock advertising has a long-lasting positive effect on the smoking cessation among smoking Jordanians in a country where smoking is a deep-rooted social norm.” Design/methodology/approach This research is an exploratory qualitative research. A purposeful sampling technique was used to select participants from a mall intercept and randomly divided into groups of seven. Each group was interviewed in two different focus group sessions (four weeks apart). All focus groups were audio-recorded, transcribed and analyzed using thematic analysis. Findings A total of 41 participants took part in the focus group session. Most participants were smokers or second-hand smokers. “Three overarching themes were generated from the focus groups: previous anti-smoking campaign experience, shock advertising (SA) impact and drawbacks of SA. All participants reported that they have never been exposed to shocking adverts, and the shock appeal has never been applied in any of the anti-smoking or health awareness campaigns in Jordan. This research revealed that incorporating images of children with a mixture of emotional and fear appeals is effective in targeting Jordanian parents' negative consumptive behaviors, which may harm other individuals, especially children. Moreover, most participants commented that the effects of shock adverts would be very short term and would not likely change behaviors”. Originality/value This research contributes both “theoretically and practically to the value and effectiveness of shock advertising. This research area is overlooked in MENA countries, particularly Jordan”

Community pharmacists’ willingness and barriers to provide vaccination during COVID-19 pandemic in Jordan

Providing vaccination in community pharmacies could increase the vaccination coverage rate as well as help reducing the workload of the healthcare system. The current study was conducted to evaluate community pharmacists’ willingness and barriers to provide vaccination in community pharmacy setting. A validated questionnaire which included eight items to evaluate willingness and eleven items to evaluate the barriers to provide vaccines was distributed online. Binary logistic regression was conducted to explore the factors that are significantly associated with willingness and barriers to provide the vaccine. Among the 201 participating pharmacists, 174 (86.6%) had a high willingness level. Lack of authorization (91.6%), lack of collaboration with other healthcare professionals (85.6%), and lack of space for storage (74.1%) were the most recognized barriers to vaccinate. Pharmacists with BSc degree demonstrated less willingness (OR = 0.18 (0.07–0.46), and increased barriers (OR = 4.86 (1.56–15.17) to provide the vaccine when compared with Pharm D and postgraduate pharmacists P < .01. Factors including male gender (OR: 6.10), working in chain pharmacy (OR: 8.98) and rural areas (OR: 4.31), moderate income (OR: 19.34) and less years of experience (OR:0.85) were significantly associated with increased barriers to provide the vaccine (P < .05). Despite the high willingness of the community pharmacists to vaccinate, several barriers were present. Enhancing pharmacists’ authorization and collaboration with other healthcare professionals and providing space for storage along with providing training courses and workshops should be considered to enhance pharmacist’s engagement in vaccination service

Pharmacists’ perception of their role during COVID-19: a qualitative content analysis of posts on Facebook pharmacy groups in Jordan

Objective: This study aimed to evaluate the content available on Facebook pharmacy groups in Jordan regarding the perception of the pharmacists’ role during the coronavirus pandemic in Jordan. Methods: Researchers identified Facebook pharmacy groups through the search engine on the Facebook website. The main search keywords were pharmacy, pharmacist, pharmacists, and Jordan using both Arabic and English. Two researchers analyzed the posts and discussion threads on local pharmacy Facebook groups in a period between March 20th and April 3rd. A total of 184 posts and threads were identified for the purpose of the study. Results: Identified threads and responses resulted in three overarching themes: pharmacists having a positive role during the pandemic, taking additional responsibilities and services, and having passive or negative roles. A positive role was seen in pharmacists acting as first-line healthcare providers, creating public’s awareness regarding COVID-19, and being responsible for chronic medication refill during the pandemic. Taking additional responsibilities was summarized in home deliveries and involvement in industrial and corporate efforts to deal with the pandemic. A passive/negative role was seen mostly among hospital pharmacists not being proactive during the pandemic and by pharmacists trying to maximize profits during pandemic time. Conclusions: Pharmacists perceived their role as a positive role during the coronavirus pandemic. Not only they took responsibilities for their daily services during the crises, but they took additional responsibilities to assure patient safety and satisfaction