Clinical pharmacy in Kuwait: Services provided, perceptions and barriers

Introduction: Pharmacy practice has considerably evolved from a dispensing role to a patient-centered profession. Kuwait has minimal clinical pharmacy services established in its healthcare settings. Objectives: The objectives of this study were to document existing clinical pharmacy services in public hospitals, identify barriers to their implementation and assess perceptions regarding pharmacists providing clinical services. Material & Method: A cross sectional study using self-administered questionnaires among a total of 166 pharmacists and 284 physicians across 6 public hospitals in Kuwait was conducted. Results: Over half of pharmacists (54%) provided clinical services, with the most common service being education and drug information (86%). Forty percent (40%) of the pharmacists reported that clinical services offered were of their own initiative but most of them (71%) were not sure whether they would offer additional services in the future. The majority of physicians were receptive to an expanded patient-centered role of the pharmacist (97%), believed pharmacists add to patient clinical care (92%) and considered pharmacists members of the healthcare team (96%). Major barriers reported by pharmacists to implement clinical pharmacy services included lack of policy (49%), time (36%) and clinical skills (28%), which is similar to barriers reported by physicians. Conclusion: Although clinical pharmacy is in its infancy in Kuwait, it is well perceived and requested by physicians. Major barriers must be addressed and in this context, having a national framework for pharmacy practice from Ministry of Health, supported by cutting edge education and a pro-active professional association would be key assets to evolve the practice in Kuwait. Keywords: Clinical pharmacy, Implementation, Kuwait, Perceptions, Barriers, Service

White blood cell subpopulation changes and prevalence of neutropenia among Arab diabetic patients attending Dasman Diabetes Institute in Kuwait.

The effects of diabetes mellitus on the differential white blood cell count are not widely studied in the Arab populations. The objective of this cross-sectional, retrospective study is to assess the influence of chronic diabetes mellitus on white blood cell counts, absolute neutrophil (ANC) and lymphocyte counts (ALC) as well as the prevalence of benign ethnic neutropenia among Arabs attending the Dasman Diabetes Institute (DDI) in Kuwait.1,580 out of 5,200 patients registered in the DDI database qualified for our study. Age, gender, HbA1c and creatinine levels, estimated glomerular filtration rate as well as average WBC, ANC and ALC levels, presence of diabetes-associated complications and anti-diabetic medications were analyzed. Our results showed the mean value of the WBC was 7.6 ± 1.93 x 109/L (95% CI: 2.95-17.15). The mean ANC was 4.3 x 109/L (95% CI: 0.97-10.40) and mean ALC was 2.5 x 109/L (95% CI: 0.29-10.80). Neutropenia (ANC: <1.5 x 109/L) was detected in fifteen patients (0.94%). Six patients (0.4%) fulfilled the definition of lymphopenia (ALC < 1 x109/L). Patients with an HbA1c ≥ 7% and those taking at least 3 anti-diabetic medications showed higher values for ANC and ALC. Patients with diabetes-associated neuropathy or nephropathy displayed higher mean ANC values. Our study was limited by overrepresentation of patients over 50 years old compared to those under 50 as well as selection bias given its retrospective nature.Our study showed that patients with poorly controlled diabetes displayed higher ANC and ALC levels. In addition, patients with DM-associated complications showed higher ANC levels. This finding would suggest that DM exerts a pro-inflammatory influence on differential WBC counts. Our study also showed that the prevalence of benign ethnic neutropenia was lower than previously reported in other studies

Medications prescribed and mean ANC and mean ALC results among Arab diabetic patients attending DDI.

<p>Medications prescribed and mean ANC and mean ALC results among Arab diabetic patients attending DDI.</p

Medications prescribed and presence of polypharmacy among diabetic patients attending DDI.

<p>Medications prescribed and presence of polypharmacy among diabetic patients attending DDI.</p

Polypharmacy and mean ANC and mean ALC among Arab diabetic patients attending DDI.

<p>Polypharmacy and mean ANC and mean ALC among Arab diabetic patients attending DDI.</p

Demographic characteristics and laboratory findings, including mean ANC^* and mean ALC ^†, in Arab diabetic patients attending DDI (n = 1580).

<p>Demographic characteristics and laboratory findings, including mean ANC^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0193920#t001fn001" target="_blank">*</a>} and mean ALC ^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0193920#t001fn002" target="_blank">†</a>}, in Arab diabetic patients attending DDI (n = 1580).</p

Correlation between mean HBA1C values and mean ALC and ANC among Arab diabetic patients attending Dasman Diabetes Institute.

<p>Correlation between mean HBA1C values and mean ALC and ANC among Arab diabetic patients attending Dasman Diabetes Institute.</p

Differences in mean ANC and mean ALC values and patient demographics among Arab diabetic patients attending DDI.

<p>Differences in mean ANC and mean ALC values and patient demographics among Arab diabetic patients attending DDI.</p

Diabetes-associated complications and mean ANC and mean ALC in Arab diabetic patients attending DDI.

<p>Diabetes-associated complications and mean ANC and mean ALC in Arab diabetic patients attending DDI.</p