Effectiveness of a structured pharmacist-delivered intervention for patients post-acute coronary syndromes on all-cause hospitalizations and cardiac-related hospital readmissions: a prospective quasi-experimental study

Background: Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity in Qatar and globally. Aim: The primary objective of the study was to evaluate the effectiveness of a structured clinical pharmacist-delivered intervention on all-cause hospitalizations and cardiac-related readmissions in patients with ACS. Method: A prospective quasi-experimental study was conducted at Heart Hospital in Qatar. Discharged ACS patients were allocated to one of three study arms: (1) an intervention group (received a structured clinical pharmacist-delivered medication reconciliation and counselling at discharge, and two follow-up sessions at 4 weeks and 8 weeks post-discharge), (2) a usual care group (received the general usual care at discharge by clinical pharmacists) or, (3) a control group (discharged during weekends or after clinical pharmacists' working hours). Follow-up sessions for the intervention group were designed to re-educate and counsel patients about their medications, remind them about the importance of medication adherence, and answer any questions they may have. At the hospital, patients were allocated into one of the three groups based on intrinsic and natural allocation procedures. Recruitment of patients took place between March 2016 and December 2017. Data were analyzed based on intention-to-treat principles. Results: Three hundred seventy-three patients were enrolled in the study (intervention = 111, usual care = 120, control = 142). Unadjusted results showed that the odds of 6-month all-cause hospitalizations were significantly higher among the usual care (OR 2.034; 95% CI: 1.103–3.748, p = 0.023) and the control arms (OR 2.704; 95% CI: 1.456–5.022, p = 0.002) when compared to the intervention arm. Similarly, patients in the usual care arm (OR 2.304; 95% CI: 1.122–4.730, p = 0.023) and the control arm (OR 3.678; 95% CI: 1.802–7.506, p ≤ 0.001) had greater likelihood of cardiac-related readmissions at 6 months. After adjustment, these reductions were only significant for cardiac-related readmissions between control and intervention groups (OR 2.428; 95% CI: 1.116–5.282, p = 0.025). Conclusion: This study demonstrated the impact of a structured intervention by clinical pharmacists on cardiac-related readmissions at 6 months post-discharge in patients post-ACS. The impact of the intervention on all-cause hospitalization was not significant after adjustment for potential confounders. Large cost‐effective studies are required to determine the sustained impact of structured clinical pharmacist-provided interventions in ACS setting. Trial registration: Clinical Trials: NCT02648243 Registration date: January 7, 2016.This work was supported by an internal grant (Grant Number QUUG-CPH-CPH-14\15-2) from Qatar University Office of Research and Graduate Studies. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Qatar University

Health sciences students' and instructors' perceptions of the emergency switch to virtual internship amid the COVID-19 pandemic: A case from Qatar

In efforts to contain the COVID-19 pandemic, health colleges at Qatar University shifted their clinical training to virtual internships (VI) and project-based learning (PBL). The shift was new to students and faculty alike, and a major change that posed many challenges. This study aimed to explore the experience of changing to VIs during the pandemic from both the clinical instructors' and health sciences students' perspectives. A qualitative study was conducted based on the framework of readiness to change. It involved focus group discussions with students from the departments of Public Health and Human Nutrition and in-depth interviews with clinical instructors using appropriate online platforms. A total of 4 focus groups with 20 students and 4 interviews with instructors were conducted. Transcripts were analyzed following the inductive-deductive approach. The major themes that emerged from the analysis described students' and clinical instructors' perceptions of the necessity and efficiency of the switch to VI; the design of the VI and the extent of the clinical/field experience and skills that it offered; confidence in the ability to succeed in this type of internship and confidence about reaching expected goals; academic and moral support from clinical faculty and coordinators and the communication process with faculty and preceptors; and finally, the benefits gained and how employers would view this type of internship. Health sciences students' readiness for VI was generally low. Several student and faculty needs have to be addressed, specifically regarding the design of the program and the level of preceptors' communication with students. The findings would direct health programs, clinical instructors, and preceptors to better understand students' needs and efficiently plan for virtual internships during not only emergencies but also whenever there is a need to deliver online experiential learning courses.This study was funded by a Qatar University Emergency Response Grant (QUERG-CHS-2020-1)

Evaluation of an intensive education program on the treatment of tobacco-use disorder for pharmacists: A study protocol for a randomized controlled trial

Background: Tobacco use is presently responsible for the death of over seven million people across the world. In Qatar, it is one of the main causes of premature deaths and preventable diseases. To reduce tobacco use, Qatar has ratified the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) and has implemented many tobacco-control initiatives. In spite of these measures, tobacco use is still considered a public health threat in Qatar. Pharmacists practicing in retail/community pharmacy settings are often the first port of call for individuals requiring general health advice. Evidence has proven that they have a pivotal role in health promotion and disease prevention including tobacco cessation. However, pharmacists in Qatar are not actively involved in tobacco control and many have not received any education or training about smoking cessation counseling in the past. In an effort to build the capacity of pharmacists towards tobacco control in Qatar, the aim of the proposed study is to design, implement, and evaluate an intensive education program on tobacco dependence treatment for pharmacists in Qatar. Methods/design: The study will be a prospective randomized controlled trial comparing an intensive tobacco-related education program versus non-tobacco-related training on pharmacists' tobacco-use-related knowledge, attitudes, self-efficacy, and skills. Community pharmacists practicing in Qatar will be eligible for participation in the study. A random sample of pharmacists will be selected for participation. Consenting participants will be randomly allocated to intervention or control groups. Participants in the intervention group will receive an intensive education program delivered by a multi-disciplinary group of educators, researchers, and clinicians with expertise in tobacco cessation. A short didactic session on a non-tobacco-related topic will be delivered to pharmacists in the control group. The study has two primary outcomes: post-intervention tobacco-related knowledge and post-intervention skills for tobacco cessation assessed using a multiple-choice-based evaluation instrument and an Objective Structured Clinical Examination (OSCE), respectively. The secondary study outcomes are post-intervention attitudes towards tobacco cessation and self-efficacy in tobacco-cessation interventions assessed using a survey instrument. An additional secondary study outcome is the post-intervention performance difference in relation to tobacco-cessation skills in the practice setting assessed using the simulated client approach. Discussion: If demonstrated to be effective, this education program will be considered as a model that Qatar and the Middle East region can apply to overcome the burden of tobacco-use disorder. Trial registration: ClinicalTrials.gov, ID: NCT03518476. Registered on 8 May 2018. Version 1/22 June 2018. 2019 The Author(s).ASHP: American Society of Health-System Pharmacists; ATTUD: Association for the Treatment of Tobacco use and Dependence; CE: Continuous education; CPG: Clinical practice guidelines; FCTC: Framework Convention on Tobacco Control; FIP: International Pharmaceutical Federation; GATS: Global Adult Tobacco Survey; GYTS: Global Youth Tobacco Survey; HMC: Hamad Medical Corporation; MCQ: Multiple choice question; ME: Middle East; NRT: Nicotine replacement therapy; OSCE: Objective Structured Clinical Examination; PBL: Problem-based learning; QCHP: Qatar Council for Healthcare Practitioners; QU: Qatar University; SPIRIT: Standard Protocol Items: Recommendations for Interventional Trials; SPSS: Statistical Package of Social Sciences; TTM: Transtheoretical model; WHO: World Health OrganizationScopu

THE ROLE OF QATAR COMMUNITY PHARMACISTS IN DEPRESSION CARE: A SURVEY OF ATTITUDES, PRACTICES AND PERCEIVED BARRIERS

Background: Negative attitudes and stigma are considered to be major barriers to healthcare and quality of life around the world for patients with depression. Community pharmacists are one of the most accessible healthcare providers. They can enhance patients’ adherence to antidepressant regimens through counselling on depression and antidepressant medications, as well as the provision of adequate follow up and medication management. Aim: Our study aims to describe the current practices, attitudes and perceived barriers of Qatar community pharmacists in relation to the provision of depression care. Methods: This is a cross-sectional online survey targeting all practicing community pharmacists in Qatar using an adapted survey instrument. Responses were measured on a 5-point-Likert scale. Study outcomes were scores of attitudes to depression, scores of self-reported depression care practices and the number of perceived barriers. These scores were produced by summing the individual scores of a set of survey items under the domain used to assess each outcome. Descriptive analyses of pharmacists’ responses were done using means and standard deviations for continuous variables, and frequency tables for categorical variables. Bivariate and multivariate regression analyses were also employed to investigate how pharmacists’ characteristics and attitude affected their practice. Statistical analysis was conducted using STATA version 15.1 and assigned a p-value of 0.05 for statistical significance. Results: The survey had a response rate of 39%. Pharmacists’ attitudes to depression were moderately positive. Out of a possible score of 5, the mean score of attitudes was 3.41, with a standard deviation of 0.94. However, the extent of pharmacists’ involvement in depression care was very low. Out of a possible score of 5, pharmacists’ practices had a mean score of 2.64 and a standard deviation of 0.26. The top three reported barriers were the lack of access to patients' medical records (83.21%), lack of patients’ insight on major depression and the importance of treatment (81.85%) and the lack of needed knowledge and training on mental health (79.63%), respectively. Female pharmacists were significantly less involved in depression care compared to male pharmacists (p= 0.006). Depression practice score increased with an increasing score of attitudes (p =0.001), and decreased with the number of years since the last pharmacy degree graduation (p=0.02).The presence of a private area for counselling patients was associated with higher scores of practice (p=0.03). Pharmacists’ practice scores varied across types of pharmacy setting, where pharmacists who worked in pharmacies located in shopping malls and supermarkets showed the highest scores of practice compared to community pharmacies of private hospitals (p=0.05). Conclusion: Pharmacists’ moderately positive attitudes towards depression and its care were not reflected in their current practices. A set of perceived barriers against the provision of depression care were also identified in this study. Results from this study could serve as an evidence base for future longitudinal studies in Qatar, implying a need for the development of local depression care and training programs for pharmacists to improve their knowledge and improve their attitude towards depression care

The role of community pharmacists in depression management: a survey of attitudes, practices and perceived barriers

Background Community pharmacists play a significant role in depression care. Depression is a health priority in national health strategies around the world, including in Qatar. Objective To describe current practices, attitudes and perceived barriers of community pharmacists towards depression care, and to investigate factors associated with these practices. Setting Community pharmacies in Qatar. Method A cross-sectional online survey using an adapted survey instrument. Scores were measured on a five-point Likert scale. Descriptive univariate and bivariate analyses of study outcomes, followed by multivariate regression examining the association between pharmacists’ practices and their attitudes, socio-demographic and professional characteristics. Main outcome measure Pharmacists’ scores on self-reported attitudes towards depression and depression care practices and the number of perceived barriers for depression care. Result: 358 pharmacists (response rate 39%) completed the questionnaire. Pharmacists’ attitudes to depression were moderately positive (mean score = 3.41, SD = 0.26) but involvement in depression care was very low (mean score = 2.64, SD = 0.94). Three major barriers were lack of access to patients’ medical records (83.21%), lack of patients’ insight on depression and the importance of treatment (81.85%), and lack of knowledge and training on mental health (79.63%). Female pharmacists and those graduated more than 10 years prior were significantly less involved in depression care compared to their counterparts (practice scores (95% CI) −4.36 (−7.46 to −1.26) and -7.51 (−15.10 to −1.35), respectively), while those who had access to private counselling area were more involved (practice score 3.39 (0.20 to 6.59). Pharmacists’ depression practice score was positively associated with attitudes (p = 0.001). Conclusion Pharmacists’ moderately positive attitudes were not reflected in their suboptimal depression-care practices. Action from policymakers is needed to improve pharmacists’ practices and attitudes to depression.This study was partially funded by a Qatar University Post-Graduate Student Grant (QUST-2-CHS-2019-15)

The Role of Qatar Community Pharmacists in Depression care: A Survey of Attitudes, Practices and Perceived Barriers

Background: Negative attitudes and stigma to mental health constitute major barriers to healthcare provision and access to treatment for patients with depression across the globe. Community pharmacists are among the most accessible healthcare providers who may play a significant role in depression care. This study aims to describe current practices, attitudes and perceived barriers of community pharmacists towards the provision of depression care, and investigates how pharmacists' attitudes, along with several sociodemographic and professional characteristics, are associated with these practices. Methods: A cross-sectional online survey targeting all practicing community pharmacists in Qatar using an adapted survey instrument. Responses were measured on a 5-point-Likert scale. Study outcomes were scores of attitudes towards depression, scores of self-reported depression care practices and perceived barriers for depression care. Descriptive univariate and bivariate analyses of study outcomes were conducted, along with a multivariate regression to investigate how pharmacists' characteristics and attitudes affect their practice. Results: Three hundred fifty-eight pharmacists answered the survey, making a response rate of 39%. Pharmacists' attitudes to depression were moderately positive (mean score=3.41, SD= 0.26). However, the extent of pharmacists' involvement in depression care was very low (mean score=2.64, SD= 0.94). Three major barriers were the lack of access to patients' medical records (83.21%), lack of patients' insight on major depression and the importance of treatment (81.85%) and the lack of needed knowledge and training on mental health (79.63%). Female pharmacists were significantly less involved in depression care compared to male pharmacists (p= 0.006). Depression practice score increased with an increasing score of attitudes (p =0.001) and decreased with the number of years since the last pharmacy degree graduation (p=0.02). The presence of a private area for counselling patients was associated with higher scores of practice (p=0.03). Conclusion: Pharmacists' moderately positive attitudes towards depression and its care were not reflected in their current practices. Findings from the study imply the need for actions and training programs for pharmacists to improve their attitudes and practices towards depression car

Effectiveness of a pharmacist-delivered smoking cessation program in the State of Qatar: a randomized controlled trial

Abstract Background Cigarette smoking is one of the major preventable causes of death and diseases in Qatar. The study objective was to test the effect of a structured smoking cessation program delivered by trained pharmacists on smoking cessation rates in Qatar. Methods A prospective randomized controlled trial was conducted in eight ambulatory pharmacies in Qatar. Eligible participants were smokers 18 years and older who smoked one or more cigarettes daily for 7 days, were motivated to quit, able to communicate in Arabic or English, and attend the program sessions. Intervention group participants met with the pharmacists four times at 2 to 4 week intervals. Participants in the control group received unstructured brief smoking cessation counseling. The primary study outcome was self-reported continuous abstinence at 12 months. Analysis was made utilizing data from only those who responded and also using intent-to-treat principle. A multinomial logistic regression model was fitted to assess the predictors of smoking at 12 months. Analysis was conducted using IBM-SPSS® version 23 and STATA® version 12. Results A total of 314 smokers were randomized into two groups: intervention (n = 167) and control (n = 147). Smoking cessation rates were higher in the intervention group at 12 months; however this difference was not statistically significant (23.9% vs. 16.9% p = 0.257). Similar results were observed but with smaller differences in the intent to treat analysis (12.6% vs. 9.5%, p = 0.391). Nevertheless, the daily number of cigarettes smoked for those who relapsed was significantly lower (by 4.7 and 5.6 cigarettes at 3 and 6 months respectively) in the intervention group as compared to the control group (p = 0.041 and p = 0.018 respectively). At 12 months, the difference was 3.2 cigarettes in favor of the intervention group but was not statistically significant (p = 0.246). Years of smoking and daily number of cigarettes were the only predictors of smoking as opposed to quitting at 12 months (p = 0.005; p = 0.027 respectively). Conclusions There was no statistically significant difference in the smoking cessation rate at 12 months between the groups. However, the smoking cessation program led to higher (albeit non-significant) smoking cessation rates compared with usual care. More research should be conducted to identify factors that might improve abstinence. Trial registration Clinical Trials NCT02123329 . Registration date 20 April 201

A pharmacist-delivered smoking cessation program in Qatar: an exploration of pharmacists' and patients' perspectives of the program

Background Tobacco use is one of the major causes of morbidity and mortality. An intensive pharmacist-delivered smoking cessation program was implemented in eight primary care pharmacies in Qatar. Objective This study aimed to qualitatively explore the perspectives of pharmacists and patients regarding their experiences in the program and their recommendations for improving it. Setting Primary care in Doha, Qatar. Method This study used a qualitative case study approach with semi-structured interviews of a sample of patients and pharmacists who participated in the program. Interviews were conducted between October 2016 and June 2017, were audio-recorded and transcribed verbatim. A thematic approach for data analysis was used. Main outcome measures Perspectives of pharmacists and patients. Results Pharmacists who delivered the program (n = 17) and patients who completed the program's outcomes assessment (n = 68) were invited through telephone call or email. Eight pharmacists and 22 patients were interviewed. Seven themes emerged: (1) both pharmacists and patients had positive experiences and both considered pharmacists as among the most suitable healthcare providers to provide smoking cessation interventions (2) both pharmacist and patient participants indicated that the program provided successful services (3) pharmacists identified several challenges for implementing the program including difficulty in motivating and in following-up patients, workplace barriers, communication and cultural barriers, (4) both pharmacists and patients perceived several barriers for quitting including lack of motivation to quit or to commit to the plan, high nicotine dependence, stress and personal problems (5) both pharmacists and patients considered several patient-related facilitators for quitting including development of smoking related complications, religious beliefs and external support; (6) use of smoking cessation medications was considered a program-related facilitator for quitting by patients whereas behavioral therapy was perceived to be a facilitator by pharmacists (7) pharmacists and patients proposed strategies for program improvement including enhancing pharmacist training and patient recruitment. Conclusion The program was perceived to be beneficial in helping patients quit smoking, and it positively contributed to advancing pharmacist role. The study findings can guide future development of successful pharmacist' smoking cessation programs in Qatar. 2021, The Author(s).This publication is made possible by a student grant by Qatar University (QUST-CPH-SPR\2017-1).Scopu

Assessment of an intensive education program on the treatment of tobacco-use disorder for pharmacists using OSCE (Objective Structured Clinical Examination)

Introduction: Tobacco use is one of the main causes of morbidity and mortality in Qatar. The aim of this randomized controlled trial (RCT) is to design, implement, and evaluate an intensive education program on tobacco-use treatment for pharmacists in Qatar. The study objectives are to assess the effectiveness of the program on pharmacists' skills toward tobacco cessation. Methods: A random sample of community pharmacists in Qatar was selected for participation. Consenting participants were randomly allocated to intervention or control groups. Participants in the intervention group received an intensive education program on treatment of tobacco-use disorder. A short didactic session on a non-tobacco-related topic was delivered to pharmacists in the control group. The pharmacists' tobacco cessation skills were assessed using an Objective Structured Clinical Examination (OSCE). Six-station OSCE targeting core smoking cessation competencies and skills was completed by participants in both groups. Performance of participants was assessed using validated assessment checklists that comprised analytical and global assessment sections. Results: A total of 54 and 32 participants in the intervention and the control group respectively completed the OSCE. Overall, pharmacists in the intervention group performed better in the analytical and global assessment sections than those in the control group. For example, for case 1, mean scores for developing rapport, data gathering and management were 2.76 vs 0.97 (p-<0.001), 5 vs 2.81 (p <0.001), and 3.5 vs 2.25 (p=0.001) respectively for the intervention group compared to the control group. Mean total analytical scores were 12.06 vs 6.4 (p-<0.001) for intervention compared to the control group for case 1. Furthermore, mean global assessment scores for case 1 were 3.19 vs 2.41 (p=0.009) for the intervention compared to the control group. Conclusion: The study results suggest that provision of an intensive educational program on the treatment of tobacco use results in improved skills toward tobacco cessation