bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of non-technical skills in community pharmacy practice: an exploratory review of the literature
Authors: Ashour Ahmed , Phipps Denham L , Ashcroft Darren M
Published: January 2021

Background

Non-technical skills (NTS) are the cognitive and social skills that complement technical skills in safe and efficient practice, and include leadership, teamwork, task management, decision-making and situation awareness. Other areas within healthcare have heavily invested in producing taxonomies to aid training and assessment of NTS within their disciplines, and have found them to be essential for improving patient safety. In pharmacy, no validated taxonomy has been produced, nor has the existing literature been appraised to aid the future development of a validated taxonomy.

Objective(s)

To examine the literature on NTS within a community pharmacy setting and establish the research conducted thus far on each NTS and how they are applied by community pharmacists.

Methods

A literature search of six electronic databases (EMBASE, PsychINFO, Medline, SCOPUS, CINAHL Plus and HMIC) using the generic list of NTS identified in previous studies. Only empirical studies were included. Examples of behaviours or skills were extracted and categorised within each NTS.

Key findings

Seventeen studies were identified that contained one or more examples of NTS specific to community pharmacy practice. Altogether, 16 elements were extracted. Four elements were identified within leadership and task management. A further three were identified within situation awareness and decision-making, and a final two within teamwork and communication.

Conclusion

A framework consisting of the skills and how they're applied has been presented which describe the NTS required by community pharmacists from the published literature. This framework can provide a foundation for further investigation into NTS use within pharmacy practice.
Pharmacy students’ attitude towards providing pharmaceutical care to patients with anxiety and their knowledge of psychotropic medicines in Jordan
Authors: Al Jomaa Esraa E , Abdel-Qader Derar H , Silverthorne Jennifer , Hamadi Salim , Al Meslamani Ahmad Z
Published: January 2021

Objectives

To describe pharmacy students’ attitude towards providing pharmaceutical care (PC) to patients with anxiety and their knowledge of psychotropic medicines (PM).

Methods

A cross-sectional emailed survey was sent to all 200 pharmacy students (fourth and fifth year) in one Jordanian university. Statistical analysis included descriptive statistics and chi-square test.

Key findings

A total of 134 responses were received (response rate 67%). About two-thirds of students (87, 64.9%) would like to give enough time to patients with anxiety to discuss their medications. Only half of students knew correctly that alprazolam (53.7%) and diazepam (50.0%) are categorized as anxiolytics. Undertaking a course in psychiatry was significantly associated with better students’ knowledge in PM (P < 0.05).

Conclusion

Despite positive attitudes towards providing PC to patients with anxiety, policy makers should include courses on psychiatric pharmacotherapy in pharmacy curricula to improve pharmacy students’ knowledge of PM.
The cardiology training needs of general practice-based pharmacists
Authors: Clarke Clodagh , Tennant Sheila , Greenlaw Nicola , Girvin Briegeen , Forsyth Paul
Published: January 2021

Objectives

As the role of the general practice clinical pharmacist (GPCP) evolves, there has been a shift towards patient-facing roles across multiple conditions. This study aimed to measure the self-reported cardiology training needs of GPCPs.

Methods

An online survey was developed. Participants were shown a list of statements on cardiac conditions and medication across seven sub-domains. Participants self-reported their knowledge against each statement using a Likert Scale. Participants were considered to require training in that topic where they had ‘disagreed’, ‘strongly disagreed’ or expressed a ‘neutral’ rating in ≥3/7 areas. Participants were shown a list of single statements around cardiology test result knowledge and clinical assessment skills. Respondents who ‘disagreed’, ‘strongly disagreed’ or declared a ‘neutral’ position with the statement were judged to need training in that topic.

Key findings

Seventy-three out of 135 (54%) GPCPs responded. Acute coronary syndrome had the highest training requirement (38/73, 52%) within conditions. Fifty-nine out of 73 (81%) required training on sacubitril/valsartan and 57/73 (78%) with ivabradine. Fifty-four out of 73 (74%) and 44/73 (60%) required training on how to interpret natriuretic peptides and troponin, respectively. Fifty-nine out of 73 (81%), 48/73 (66%) and 55/73 (75%) required training on interpreting ECG, echocardiogram and coronary angiography, respectively. Reduced length of experience in general practice (<2 years) was commonly associated with increased training needs.

Conclusions

There are areas of unmet cardiology training needs within GPCPs that require further support. As the GPCP role evolves, discussion is needed with national pharmacy stakeholders to decide how to incorporate this learning into routine training programmes.
The pharmacist informatician: providing an innovative model of care during the COVID-19 crisis
Authors: Falconer Nazanin , Monaghan Corey , Snoswell Centaine L
Published: January 2021

Objectives

The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic.

Methods

Fourteen expert informatics professionals involved in the provision of digital health in Queensland, Australia, were invited to participate in a brief semistructured interview. Transcripts were manually coded, through iterative readings of the text to identify participant responses related to opportunities for a pharmacist informatician to assist during COVID-19. Inductive thematic analysis as described by Braun and Clarke, was used to identify groups of text related to the provision of digital health, informatics and change of practice during a pandemic. The relevant codes were then grouped into themes to help answer the research question.

Key findings

Twelve experts agreed to participate, they included nine informatics pharmacists and three digital health experts from hospital and community. Two key themes and 13 codes related to enabling safer and more efficient workflow and use of data analytics to optimise care were identified. The first theme related to ‘social distancing without compromising care’ for example, by using the electronic capabilities of digital hospitals and telehealth services. The second theme related to the use of real-time data streaming to optimise patient flow and timely medication procurement and management. Examples of quotes from transcripts were used to provide context and answer the research question.

Conclusions

The experts interviewed identified areas where informatics pharmacists have the potential to assist with maintaining high quality patient care during this pandemic, and in future disasters. Improving awareness, training, and the integration about informatics roles as a result of this global pandemic will likely assist with future patient management in the event of future disasters.
The impact of computerised physician order entry on prescribing in general paediatric units in Hong Kong
Authors: Sin Conor Ming-Ho , Young Mei Wan , Lo Charles Cheuk Hang , Ma Po King , Chiu Wa Keung
Published: January 2021

Objectives

This study aimed to evaluate the effect of a closed-loop computerised physician order entry (CPOE) system on prescribing in a general paediatric unit in Hong Kong. We studied the effect of the CPOE system on medication prescribing error and the characteristics of these errors before and after the implementation of the system.

Methods

This was a single-site, prospective, observational study at a public hospital’s general paediatric unit in Hong Kong, conducted during the pre- and post-implementation of the system from March to April 2019 and 2020, respectively. Collected data included the number of medication orders processed, the number of prescribing errors identified, and the characteristics of errors, such as the severity, children’s age group, drug formulation, and drug class.

Key Findings

The prescribing error rate was significantly reduced from 6.7% to 3.9% after CPOE implementation. The causes of prescribing errors were found to be significantly different, as the implementation eradicated handwriting-related errors and reduced dosage selection-related errors. However, we found that CPOE increased other causes of error, such as missing entry of patient information that might affect the dispensing process, thus delaying patients in receiving their medications on time.

Conclusion

The CPOE system significantly reduced prescribing errors and altered some of the characteristics of these errors. Poor system design or inadequate user training could result in the creation of new causes of error.
Bushfires, COVID-19 and Australian community pharmacists: ongoing impact on mental health and wellbeing
Authors: McCallum Blake Andrew , Dunkley Kay , Hotham Elizabeth , Suppiah Vijayaprakash
Published: January 2021

Objectives

The nation was recovering from the aftermath of the catastrophic 2019–2020 bushfires when the first cases of the COVID-19 pandemic emerged in Australia. During the peak of the pandemic, Australia closed both its state and international borders to all travelers and interstate travel was very tightly regulated. Community pharmacists and pharmacy staff were one of the very few primary healthcare workers still serving their communities during these periods of strict lockdown. In this personal view article, the challenges and their toll on the mental health and wellbeing of these “essential workers” are described.

Key findings

Community pharmacists and pharmacy staff were under immense pressure to remain open and serve their communities amidst rapidly changing legislation and, at times, conflicting advice from the range of Australian health agencies. Rapid changes to workload and workflow were combined with the dilemma of balancing professional obligations with the personal duty of keeping themselves and their sometimes geographically distant families safe. Fluctuating demands and traumatic situations found community pharmacy staff often feeling distressed and underprepared.

Despite a global pandemic following a season of extraordinary bushfires, it has barely been acknowledged that community pharmacy staff are one of the highest risk groups for long-term psychological impacts. To our knowledge, very little research has addressed the toll of these cataclysmic events on this group of essential healthcare workers.
A scoping review of research on Canadian team-based primary care pharmacists
Authors: Miller Matthew J , Pammett Robert T
Published: January 2021

Objectives

An ageing population with an increasing prevalence of chronic disease and complex medication regimens has placed a strain on healthcare systems in Canada. A limited number of team-based primary care pharmacists are integrated into primary care clinics across the country, working alongside other members of the health care team to identify and resolve drug therapy problems and improve outcomes. While many studies have been completed in the area, the extent of research on integrated team-based primary care pharmacists in Canada is unknown. The objectives of this work were to describe the literature that exists surrounding pharmacists in a primary health care team setting in Canada. A scoping review of research focusing on pharmacists in team-based primary health care settings in Canada was performed. Thematic analysis was then performed to categorize the identified studies.

Key findings

The search identified 874 articles, of which 93 met inclusion criteria relevant to the objective. From these 93 studies, 4 themes and 23 subthemes were identified, with some studies having more than one theme or subtheme. Themes identified were the following: primary care pharmacist scope of practice (n = 79 studies), collaboration/communication within the primary care setting (n = 26), chronic disease management (n = 24) and ‘other’ (n = 15).

This research quantified and categorized 93 studies on pharmacists in interprofessional primary care teams in Canada. As this is an expanding role for pharmacists in Canada, understanding the current state of the literature is an important consideration when developing future team-based primary care roles.
Time to Revisit Classical Film Theory
Authors: Hunt Lester H
Published: January 2021

Film audiences are no longer in a position to know for certain which images, or features of images they see on the screen were created by photography and which were created in a computer. Yet they are reacting to the advent of computer graphics as if it is merely a technical improvement, not a change in the nature of film itself. This would mean that one of the most influential early theories of film—realism—is wrong. It held that film is by nature photographic and that its unique value is to afford the audience the physical connection with reality that photography, uniquely among pictorial media, brings. I argue that the audience is right about this. Even as applied to purely photographic films, realism was simply a mistake.
Science Fiction as a Genre
Authors: Terrone Enrico
Published: January 2021

Regardless of whether one agrees or disagrees with Stacie Friend’s claim that fiction is a genre, her notion of genre can be fruitfully applied to a paradigmatic genre such as science fiction. This article deploys Friend’s notion of genre in order to improve the influential characterization of science fiction proposed by Darko Suvin and to defend it from a criticism recently raised by Simon Evnine. According to Suvin, a work of science fiction must concern “a fictional ‘novum’ (novelty, innovation) validated by cognitive logic.” While Suvin conceives of his characterization as a necessary and sufficient condition for membership in the genre, I propose to cast the notions of “fictional novum” and “cognitive validation” as standard features of the genre, which works of science fiction should have but might lack. I argue that this amended version of Suvin’s characterization can better account for two basic properties of science fiction as a genre, namely its historicity and its relevance to appreciation. Lastly, I show that the amended version can shed some light on the affinity between works of science fiction and philosophical thought experiments.
Harlequin Resistance? Romance Novels as a Model for Resisting Objectification
Authors: Kolmes Sara , Hoffman Matthew A
Published: January 2021

Romance novels are primarily aimed at, written about, and written for women. They have been accused of being fantasies which feature sexually objectified heroines who are passive recipients of overwhelming masculine sexual energy. After shoring up these critiques of romance novels with A.W. Eaton’s account of how art can objectify its subjects, we examine a challenge to romance novels: does the sexual content in romance novels objectify its heroines? There is strong reason to think so. However, we argue that careful attention to the ways art can objectify its subject reveals that romance novels are structured to make it impossible for their heroines to be objectified. In many cases, individual signs of objectification are raised as possible outcomes and dismissed as part of the plot of a romance novel. Satisfying sex in a romance novel does not appear until it is impossible for the romantic heroine to be objectified. Understood in this way, romance novels serve as a model for one way that objectification could be avoided. The fantasy of a romance novel is not objectifying sex. It is sex free of objectification.
Fiction, Philosophy, and Television: The Case of Law and Order: Special Victims Unit
Authors: Vidmar Jovanović Iris
Published: January 2021

This article lies at the intersection of two problems: the one concerning the potential of fictional works to inform us about our social reality and foster our understanding of its various aspects, and the one concerning their potential to engage with philosophical issues. I bring these two together by analyzing the hit television series Law and Order: Special Victims Unit. According to my interpretation, the series is informative about our social world, and it raises philosophical concerns about it. This makes it well-equipped to fulfill the educative function attributed to mass art by Noël Carroll, and to stand out as an example of what he calls popular philosophy. To support this interpretation, I rely on contemporary views regarding the nature of our engagements with fictional narratives. I then explore how philosophical concerns are generated and I elaborate on the role they have in deepening one’s understanding of one’s social circumstances. I further show how the series provides innovative and independent philosophical knowledge by means specific to the medium of generic serialized fiction. The central part of my argument is an analysis of the narrative strategies which enable the informative and philosophical aspects of the series to generate the series’ educative function.
‘Beauty’ and the ‘Beautiful’: a Computational Analysis of the Company They Kept Across the Eighteenth-century Corpus
Authors: Regan John
Published: January 2021

This article is a computational enquiry into the different ways in which two words, assumed to be central to the eighteenth-century concept of aesthetics, were used across that century. Using word co-association measures designed specifically for this study, I show the markedly different lexis that surrounded the words ‘beauty’ and ‘beautiful’ in three decades of historical textual data from Eighteenth-Century Collections Online. Having demonstrated that these words were used in very different semantic contexts in the beginning, middle, and end of the century, the article presents semantic network diagrams which further demonstrate the distinctness of noun from adjective. I argue that while ‘beautiful’ is suspended in a semantic space that is recognizably aesthetic, ‘beauty’ is not. Furthermore, that which is deemed ‘beautiful,’ according to the evidence presented here, presents something of a challenge to received narratives of how the concept of aesthetics developed throughout the eighteenth century.
Seeing Through Photographs: Photography as a Transparent Visual Medium
Authors: Mizrahi Vivian
Published: January 2021

The idea that looking at a photograph is akin to face-to-face perception and that photographs provide genuine perceptual access to the objects they depict was notoriously defended by Kendall Walton in “Transparent Pictures.” Walton’s main thesis is that photographs are transparent in the sense that we can see objects through them. The main goal of this article is to support Walton’s view by providing a full account of photographic transparency. I will argue that the transparency that characterizes photography is not metaphorical but in fact exhibits all the essential properties of transparent materials. To understand how a photograph can be transparent, one must understand the special type of causal connection between a photograph and what it shows. Building on Fritz Heider’s work, I will argue that photography is a visual medium, like air, water, glass, or mirrors, capable of transmitting the visual properties of distant objects to the perceiver.
The Argument from Extreme Difficulty in Video Games
Authors: Artis Aderemi
Published: January 2021

Many video games require complex, rapid sequences of skilled bodily movements in order to complete game-world tasks. It is not unreasonable to think that this might interfere with our ability to aesthetically appreciate such video games. I present two versions of this argument from extreme difficulty: a strong version and a weak version. While extant treatments of the aesthetics of video games can be used to rebut the strong version, the weak version remains recalcitrant. I develop a reply to the weak version, use it to clarify key features of reasons used by video-game critics to argue in favor of their critical judgments, and to illuminate the development of video games over time.
Discovery of novel secondary metabolites encoded in actinomycete genomes through coculture
Authors: Kim Ji Hun , Lee Namil , Hwang Soonkyu , Kim Woori , Lee Yongjae , Cho Suhyung , Palsson Bernhard O , Cho Byung-Kwan
Published: January 2021

Actinomycetes are a rich source of bioactive natural products important for novel drug leads. Recent genome mining approaches have revealed an enormous number of secondary metabolite biosynthetic gene clusters (smBGCs) in actinomycetes. However, under standard laboratory culture conditions, many smBGCs are silent or cryptic. To activate these dormant smBGCs, several approaches, including culture-based or genetic engineering-based strategies, have been developed. Above all, coculture is a promising approach to induce novel secondary metabolite production from actinomycetes by mimicking an ecological habitat where cryptic smBGCs may be activated. In this review, we introduce coculture studies that aim to expand the chemical diversity of actinomycetes, by categorizing the cases by the type of coculture partner. Furthermore, we discuss the current challenges that need to be overcome to support the elicitation of novel bioactive compounds from actinomycetes.
Strategies to reduce healthcare costs: what medical conditions are US seniors treating with Mexican pharmaceuticals?
Authors: Dalstrom Matthew , Chung Ryan , Castronovo Lynette M
Published: January 2021

Objectives

The high price of pharmaceuticals in USA has caused patients, health insurance plans and policy makers to explore the possibility of purchasing pharmaceuticals in Mexico. However, it is unclear if the practice would lower costs and whether US patients would be willing to purchase pharmaceuticals in Mexico. Focusing on seniors who spend the winter along the Texas/Mexico border, Winter Texans, the purpose of this study was to identify their most common health problems and whether they used Mexican pharmaceuticals to manage those problems.

Methods

Data for this cross-sectional pilot study were collected through sending an online survey to 1040 seniors on the Winter Texan Migrant Panel. A total of 311 completed the survey and the data were analysed.

Key findings

The most common medical conditions were pain (69%), high cholesterol (37%) and arthritis (32%). Half of the respondents purchased a total of 293 Mexican pharmaceuticals with 77.5% indicating that the lower cost influenced their decision. The most frequently treated conditions with Mexican pharmaceuticals were infections (37%), pain (28%) and acid reflux (24.4%).

Conclusions

Seniors did not treat their most common medical conditions with Mexican medication, except for pain. Instead, they used it for more minor and acute problems. This suggests that the decision of where to purchase a pharmaceutical is complex and not exclusively dependent on cost. Therefore, legislation and health insurance plans that encourage seniors to purchase pharmaceuticals abroad might be successful for lowering the cost of treatment for some medical conditions but not others.
Pharmacist-led heart failure patient focus group using mobile apps-based intervention mix
Authors: Hani Naira , Zachariah Seeba , Thomas Dixon , Cooper Jason C
Published: January 2021

Objectives

The impact of clinical pharmacists on inpatient heart failure (HF) care has been proven in many studies. Evidence regarding the use of mobile apps by pharmacists to achieve positive clinical outcomes in HF is limited. The purpose of this study is to examine the impact of a pharmacist-led HF patient focus group using mobile apps-based intervention mix.

Methods

In this pre–post-exploratory study, using an intervention mix of hospital discharge counselling, MyTherapy app, WhatsApp and occasional phone calls to improve clinical outcomes in HF. Patient medication adherence, health-related quality of life (HRQoL) and 30-day all-cause hospital readmission rate were assessed. The Wilcoxon Signed-Rank Test was used to find statistical significance of improvements in medication adherence and HRQoL using SPSS software version 26.

Key findings

The intervention mix of initial hospital-discharge counselling, MyTherapy app, follow-up with the WhatsApp group and occasional phone calls established an effective communication with patients. All 10 patients had improvements in their clinical outcomes. Significant improvements in medication adherence and HRQoL were found (Z-value −2.810 and Z-value −2.805, respectively; 95% confidence interval). No patients were readmitted in 30 days or within 3 months of study.

Conclusions

A pharmacist-led HF patient focus group using mobile apps-based intervention mix was found to be effective in improving clinical outcomes in HF patients. Further research should be performed on long-term effects of our approach.
Utility of information in package inserts by pharmacists and pharmacy clients in a metropolitan city in Southwest Nigeria
Authors: Segun Showande Johnson , Victor Babalola Olumuyiwa
Published: January 2021

Objective

Package inserts provide relevant information to patients and health care professionals on the safety and rational use of drugs. This study evaluated the utility of package inserts by pharmacy clients for information, and by pharmacists during consultation and counselling with patients.

Methods

This cross-sectional self-administered questionnaire-based study was conducted in Ibadan, Nigeria among 705 pharmacy clients and 344 community and hospital pharmacists. The questionnaire had a 12-item and a 14-item package insert utility scale for pharmacists and pharmacy clients, respectively. The level of utility and association between demographic variables and package insert utility scores were determined with Mann–Whitney U and Kruskal–Wallis tests at P < 0.05.

Key findings

The response rate was 88.2% for pharmacy clients and 67.2% for pharmacists. Most of the pharmacy clients, 459 (73.8%), check for package inserts in drug packs. The most assessed information in package inserts was dose 432 (69.5%). Some of the pharmacy clients, 276 (44.4%), considered information from health professionals more reliable than that in package inserts. The pharmacy clients’ level of education was associated with package insert utility score (P = 0.001). Most of the pharmacists, 137 (59.3%), read package inserts but only 36 (15.6%) consulted package inserts during counselling with patients. The pharmacists’ age and the number of years spent in practice were significantly associated with package insert utility scores (P < 0.05). The level of utility of the information in package inserts by the pharmacy clients and the pharmacists was moderate – 66.8 and 60.0%, respectively.

Conclusion

Both pharmacists and pharmacy clients use package insert content moderately. Pharmacy clients rely more on information provided by health professionals than the information in package inserts but pharmacists seldom consult package inserts during counselling process.
Medication adherence among Nigerian patients with rheumatoid arthritis: a two instruments survey
Authors: Ubaka Chukwuemeka M , Ibe Ozulonye G , Amorha Kosisochi C , Isah Abdulmuminu , Okonta Mathew J
Published: January 2021

Objectives

Medication adherence is still a significant problem in chronic diseases management and rheumatoid arthritis (RA) is not an exception. There is very little information regarding the level and influencing factors of medication adherence among Nigerian patients with RA. This study evaluated the level and determinants of medication adherence among patients with RA in a Nigerian referral hospital.

Methods

Using a questionnaire based cross sectional survey, 169 patients with RA were evaluated for their medication adherence using two validated instruments namely; five-item Medication Adherence Report Scale and five-item Compliance Questionnaire for Rheumatology. The two instruments were subjected to descriptive (mean and frequencies) and mean difference (chi-square, t-test, Pearson correlation) analysis, and their reliability (Cronbach alpha) in a Nigerian setting was also established.

Key findings

The level of non-adherence reported in this study was high and ranged from 48.5% for the CQR to 63.9% for the Medication Adherence Report Scale questionnaires respectively. Being of a male gender, of an older age, the higher number of pills taken, better education and the duration of the disease all significantly contributed to higher adherence measures among these RA patients (P <0.05 for all). Both questionnaires used were correlated and reliable for use among patients with rheumatoid arthritis in Nigeria.

Conclusion

Findings from this study show that non adherence to medications among RA patients were high and factors such age, gender, education, pill burden could have been responsible.
National standard treatment guidelines: their impact on medicine use indicators in a resource-limited setting
Authors: Kagoya Harriet Rachel , Mitonga Honoré , Kibuule Dan , Rennie Timothy
Published: January 2021

Objectives

Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treatment guidelines on medicine use indicators at the population-level in Namibia.

Methods

An interrupted time-series modeling of the impact of national standard treatment guidelines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, generic and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007– 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was reflected by level change while long term impact was determined by trends/quarterly change after standard treatment guideline implementation.

Key findings

Data points from 522 Pharmaceutical Information System reports from 38 health facilities were included. The eight-year period estimates were, 2.9 ± 0.1 medicines prescribed per outpatient, 48.1 ± 2.5% of prescriptions had an antibiotic and 74.0 ± 4.2% of medicines were prescribed by generic name. Of the 13 regions, 61.3% and 53.8% had a decline in the average medicines per prescription and prescriptions with antibiotics respectively, as well as 53.8% of the regions had an increase in prescribing of generic medicines immediately after implementation of the standard treatment guidelines. Thereafter, quarterly trends in the three indicators did not significantly improve after the intervention at national and in all regions, except for generic prescribing in Oshikoto region, 4.5% (95% CI: 2.6 – 6.3%, P < 0.001).

Conclusion

Whilst national standard treatment guidelines immediately improved medicine use indicators, it is discouraging that the improvement over time was marginal across regions and was not sustained at the national level. Robust point of care interventions is needed for sustained and effective implementation of standard treatment guidelines.
Minimum content of medication counselling for outpatients in North-Western Nigeria—a modified e-Delphi study
Authors: Abdu-Aguye Samirah N , Labaran Kamilu S , Danjuma Nuhu M , Mohammed Shafiu
Published: January 2021

Objective

The main objective of this study was to conduct a modified e-Delphi study to achieve consensus on the minimum content of medication counselling required by majority of outpatients in North-Western Nigeria. A secondary objective was to collect feedback from the panel members.

Methods

A two round e-Delphi study was conducted between March and May 2020 with pharmacists working in hospital, community or academic settings in North-Western Nigeria. During the first round, panel members were asked to use a five point scale to rate how important they felt it was to provide information about 17 items during medication counselling. Consensus was defined as any item that 90% or more of respondents rated as ‘essential or important’. Items that did not reach this level of consensus were re-rated again during the second round, where respondents were also asked to rate their level of agreement with nine statements.

Key findings

Thirty-four panel members completed the first round, while 29 completed the second round. Majority of them (76.5%) had practiced for between 5–10 years. After the first round, eight items achieved consensus, and were retained. After the second round, three of the initially equivocal items also achieved consensus. Majority of respondents believed that a minimum medication counselling standard would be useful for both dispensers and patients.

Conclusions

Consensus was achieved for 11 of the 17 items rated by the panelists. Feedback received about the research process was also largely positive, with many of them agreeing that the study's proposed outcome would encourage better medication counselling.
Antibiotics use and appropriateness in two Jordanian children hospitals: a point prevalence study
Authors: Abdel-Qader Derar H , Ismael Najlaa Saadi , Albassam Abdullah , El-Shara’ Asma’ A , Aljamal Mohammed S , Ismail Rami , Abdel-Qader Hasan A , Hamadi Salim , Al Mazrouei Nadia , Ibrahim Osama Mohamed
Published: January 2021

Background

Although inappropriate antibiotics prescribing in hospitals is a key factor in accelerating antibiotic resistance, inadequate data are available about antibiotics prescribing rate and appropriateness. Our study aimed to measure antibiotics prescribing rate, indications, appropriateness and predictors.

Methods

The study was conducted in two public children hospitals (five wards) in Jordan using one-week point prevalence survey to prospectively collect the data. Appropriateness of antibiotics therapy was assessed by a multidisciplinary committee and predictors of inappropriate prescribing were studied through multivariate logistic regression.

Key findings

The overall antibiotics prescribing rate was 75.6% (n = 501/663), where the highest rate of antibiotics prescribing was in the Pediatrics ward (82.2%, n = 222/270). However, the lowest rate was in the Pediatric Intensive Care Unit (30.0%, 9/30). The most common antibiotics classes prescribed were: Beta-lactams (57.5%, n = 492/855). The most common underlying condition for antibiotics prescribing was upper respiratory tract infections (25.5%, n = 128/501) followed by pneumonia (20.6%, n = 103/501). Around half of antibiotics were prescribed upon appropriate decision (49.5%, n = 423/855). However, 22.0% (n = 188/855) of antibiotics were wrongly chosen, and 9.5% (n = 81/855) were wrongly applied. Initially inappropriate decision for prescription occurred in 15.3% (n = 131/855) of antibiotics. Ceftriaxone (OR 3.1; 95% CI 2.6–4.1; P = 0.03) and patients with ≥3 medication orders (OR 2.6; 95% CI 1.7–3.5; P = 0.001) significantly predicted inappropriate antibiotics prescribing.

Conclusions

The incidence of antibiotics prescribing in Jordanian children hospitals was high compared to other countries. Further multi-centric studies are required to enhance the generalisability of results and better develop effective and efficient antibiotic stewardship programmes.
Prevalence and patterns of self-medication with antibiotics among visitors of central polyclinic of Kabul, Afghanistan
Authors: Negarandeh Reza , Poortaghi Sarieh , Shayan Shah Jahan
Published: January 2021

Objectives

Self-medication with antibiotics is a common public health problem worldwide. It is the main driving factor for the development of microbial resistance. The world is facing the challenge of losing effective antibiotics. The study aim is to determine the prevalence and related factors of self-medication with antibiotics among visitors of a clinic in Kabul, Afghanistan.

Methods

A cross-sectional questionnaire-based survey on a sample of 384 consecutively selected visitors of the Central Polyclinic of Kabul, Afghanistan, was conducted.

Key findings

Approximately 34.9% of the sample self-medicated with antibiotics in the past 12 months. Amoxicillin was the most common antibiotic used for self-medication. The sore throat was a common health problem, and previous experience was the source of recommendation for self-medication. The most common reasons for self-medication with antibiotics were cost-saving, previous experience and lack of time.

Conclusions

Self-medication with antibiotics was prevalent among visitors to the clinic. Patterns of self-medication with antibiotics indicate the inappropriate practice of medicines. Pharmacists, friends and family approve the self-medication with antibiotics.
Compliance to hypertensive prescribing guidelines and blood pressure control in elderly patients in Namibia: findings and implications
Authors: Mashozhera Shylet , Bamitale Samuel Kayode , Godman Brian , Kibuule Dan
Published: January 2021

Objective

Resources-limited countries in sub-Saharan Africa are facing a crisis of hypertensive-related morbidity, mainly due to poor blood pressure (BP) control. The study aimed to evaluate BP control and hypertensive prescribing for elderly patients in a resource-limited setting.

Methods

Hospital-based survey assessing hypertensive prescribing practices among elderly patients (age, ≥60years) at a leading ambulatory care clinic in Namibia. The primary and secondary outcomes were compliance with prescribing guidelines, prescribing patterns and BP control respectively. Data were collected using patient exit interviews and a review of their prescription records. Data were analyzed using descriptive statistics using SPSS v25.

Key findings

Of the 189 elderly patients recruited, 69.3% were females, mean age was 70.3 ± 8.5 years and 2.6% had HIV. 61.4% of the prescriptions complied with the prescribing guidelines in terms of treatment choice and 78.3% (n = 148) had a poor BP control. 61.4% had at least one comorbidity, mainly diabetes mellitus (32.2%) or cardiac disease (20%). On average, 4.5 medicines were prescribed per patient and 4.8% were out of stock. Prevalence of non-INN prescribing was 64%. Diuretics, renin-angiotensin inhibitors were the most prescribed antihypertensive, 73.9% (n = 138/189) and 51.9% (n = 98/189) respectively. 90% of patients with good BP control were on ≥3 medicines compared to 77% for patients with poor BP controlled.

Conclusion

Whilst compliance with prescribing guidelines is modest, the sub-optimal BP control, high prevalence of co-morbidities and over prescribing with non-INN products is discouraging. Pharmacist-led medication audits could improve hypertensive prescribing and BP control among elderly patients, and we will be following this up
Cost implications of patient spending on heart failure medications in the US Medicare program
Authors: McGee Blake Tyler , Parikh Rishika , Phillips Victoria
Published: January 2021

Objectives

The aim of this study was to model the associations between patient spending on heart failure (HF) medications and Medicare and all-payer expenditures on health care services for participants in the Medicare prescription drug (Part D) program.

Methods

Correlational analysis of pooled 2011–12 data from the Medicare Current Beneficiary Survey. Analysis was restricted to community-dwelling beneficiaries with self-reported HF at baseline, continuous Part D coverage, and no Low-Income Subsidy (LIS). The main predictor was mean patient expenditure on a HF-related prescription per 30-day supply. The outcomes were all-payer and Medicare-specific payments for inpatient and total health care services during the observation year.

Key findings

Mean patient drug expenditure was not statistically associated with Medicare or all-payer inpatient payments or (after covariate adjustment) with total health care payments. However, patient expenditure was statistically associated with total Medicare payments, eγ = 1.022, 95% CI [1.004 to 1.041]. Marginal effects analysis predicted an average rise in total Medicare payments of $190.32, 95% CI [$40.54 to $341.10], for each additional $1 of patient spending per prescription, P = 0.013. Given an average 2.4 HF-indicated drug classes per participant and assuming 12.2 copays per year, a hypothetical $1 increase in prescription copay predicted a net loss to Medicare of $160.90 per participant.

Conclusion

Prescription drug spending by Medicare beneficiaries with HF was not associated with higher inpatient or all-payer costs. A modest association between patient drug spending and total Medicare costs was observed, but longitudinal and cost-effectiveness analyses are needed to support causal inference.
Drug utilization pattern and cost-effectiveness analysis of five most common antibiotics used in Saudi Arabia
Authors: Ali Mohammad Daud , Patel Munfis , Banu Nuzhat , Ahmad Ayaz , Hassan Yousif Amin
Published: January 2021

Objectives

Inappropriate use of antibiotics is a matter of concern worldwide as that may lead to antimicrobial drug resistance. The objective of current study was to assess drug utilization pattern and cost-effectiveness. Studies are conducted to analyze the pattern of antibiotics prescribing their adherence to standard guidelines and economic impact on the patients in order to promote their rational use.

Methods

The study was designed as a single-centred, cross-sectional retrospective pharmacy database study of prescribing patterns and cost-utility analysis of five most common antibiotics used in Saudi Arabia. Data for the period from 1 January 2019 to 31 December 2019 were used in the study. Demographic characteristics were demonstrated as frequencies and percentages (with Wilson 95% confidence intervals for proportions). The chi-square test (for P-value calculation) was used to compare the adherence of National Antimicrobial Guidelines for prescribing antibiotics in Saudi Arabia.

Key findings

The maximum number of patients was recorded from the age group of 18–35 years (35.97%) and minimum from 72 to 88 years (1.82%). The number of units prescribed was highest for amoxicillin, clavulanic acid (22487) to 42.93% of patients and was lowest for ciprofloxacin (4215) with 8.04%. The longest duration of therapy was for Cefdenir (7.23 days) and lowest for azithromycin (3.58 days). The cost was highest for Cefdenir 38.66SR (10.31USD), and lowest cost was estimated for Cefuroxime 12.43SR (3.31USD).

Conclusions

Our study declared that (amoxicillin with clavulanic acid) was used the most as first-line agents in treating bacterial infections due to their broad coverage against different microbes. Conducting laboratory tests to identify the type of microbe before prescribing could prevent the development of drug resistance and save the antibiotic for future. The cost-to-benefit analysis studies of antibiotics must be conducted for each indication that may promote their rational use.
An adapted two-step floating catchment area method accounting for urban–rural differences in spatial access to pharmacies
Authors: Zhou Yuhong , Beyer Kirsten M M , Laud Purushottam W , Winn Aaron N , Pezzin Liliana E , Nattinger Ann B , Neuner Joan
Published: January 2021

Objective

To adapt the two-step floating catchment area approach to account for urban–rural differences in pharmacy access in the United States.

Methods

The urban–rural two-step floating catchment area method was described mathematically. To calculate urban–rural-two-step floating catchment area measure, census tracts and pharmacies within the study area (Southeastern Wisconsin) were classified as urban, suburban or rural, and then different catchment area sizes (2, 5 and 15 miles) were applied, based on the Centers for Medicare & Medicaid Services (CMS)’ criteria for Medicare Part D service access within urban, suburban and rural areas. The urban–rural-two-step floating catchment area measures were compared to traditional two-step floating catchment area measures computed using three fixed catchment area sizes (2, 5, and 15 miles) by visually examining their spatial distributions. Associations between the four pharmacy accessibility measures and selected socio-demographics are calculated using Spearman’s rank-order correlation and further compared.

Key findings

The urban–rural two-step floating catchment area measure outperforms all the fixed catchment size measures and has the strongest Spearman correlations with the selected census variables. It also reduces the number of census tracts characterized as ‘no access’ when compared to the original measures. The spatial distribution of urban–rural two-step floating catchment area pharmacy access exhibits a more granular variation across the study area.

Conclusions

The results support our hypothesis that spatial access to pharmacies should account for urbanicity/rurality patterns within a region.
A retrospective study on drug utilization pattern and cost utility analysis of antifungal drugs
Authors: Ali Mohammad Daud , Patel Munfis , Banu Nuzhat , Ahmad Ayaz , Hassan Yousif Amin
Published: January 2021

Objectives

Fungal infections in humans are superficial or systemic and are found to be life threatening. They are common among the middle age group and particularly in females and immunocompromised patients.

Methods

This study was conducted to evaluate the prescription pattern of antifungal drugs and their economic burden on patients. The study was designed as a single centered, cross-sectional retrospective pharmacy database study of utilization of antifungal drug therapy and their cost analysis. Data for the period from 1 January 2019 to 31 December 2019 were retrieved from the inpatients and outpatient electronic pharmacy records along with the unit dose prices of antifungal drug in the study hospital.

Key ﬁndings

Antifungals use was more among females (67.05%) compared with males (34.91%). The use was predominant among middle age group (31–45) with Clotrimazole being the most utilized lower cost topical drug and fluconazole the next preferred systemic drug with least toxicity. Variconazole is a novel drug utilized the least among all age groups due to its adverse effects and higher cost. Clotrimazole is the drug of choice topically due to low cost and lesser absorption orally. Fluconazole is the next preferred drug that can be given systemically and its use remain unchanged due to lower cost and least toxicity in immunocompromised patients.

Conclusions

Variconazole although have adverse effects and used rarely it is the drug preferred in invasive treatments when benefit outweighs the risk. Variconazole is highly expensive drug used in invasive treatments and its adverse drug reactions, and cost need to be monitored.