bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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 &lt;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

Abstract

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 &lt; 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

Abstract

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

AbstractBackgroundAlthough 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.MethodsThe 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 findingsThe 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.ConclusionsThe 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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.
Development and validation of medication storage and disposal questionnaire
Authors: Al-Qerem Walid , Hailat Mohammad Majed , Gassar Ezeddin Salem , Jarab Anan S 
Published: January 2021

AbstractObjectivesInappropriate medication storage and disposal is a global problem and has a negative impact on public health, economy and the environment. One of the main causes of this problem is the lack of knowledge among the population about medication storage and disposal. This study aimed to develop a tool to measure knowledge and practice about medication storage and disposal and measure it among the Jordanian population.MethodsThis web-based cross-sectional study developed a tool to evaluate medication storage and disposal knowledge attitude and practice. Exploratory factor analysis, analysis of variance and t-test were conducted to analyze the data.Key findings1132 responses were collected. The exploratory factor analysis suggested a three-factor model, the three models are knowledge-need, patient-related, and medication-related factors. Knowledge-need factor evaluates the participants’ perceptions of the need for awareness and regulations regarding medication storage and disposal. The patient-related factor evaluates medication discontinuation behaviours. Medication-related factor evaluates the handling of damaged or expired medication practices. The highest mean of all three factors was for the knowledge-need factor (mean = 4.13), while the lowest was for the patient-related factor (mean = 3.22). The education level was negatively associated with patient-related factor indicating good behaviours. The means of the three factors were significantly associated with the respondents reporting that they know the correct medication storage and disposal behaviours, and the respondents believing that there are consequences of keeping medication at home.ConclusionThe questionnaire was a valid and reliable tool to assess the knowledge and practice of medication storage and disposal. This study’s findings suggest that the lack of knowledge is the main reason behind the inappropriate medication storage and disposal practice. There is a need for awareness-improvement, which should involve healthcare awareness campaigns and governmental regulations.
Impact of drug utilization management policy on prescription opioid use in Georgia Medicaid
Authors: Wang Yu , Perri Matthew , Young Henry , Abraham Amanda , Jayawardhana Jayani 
Published: January 2021

Abstract

Objective
To examine the effectiveness of changes in opioid prescription policies on opioid prescribing and health services utilization rates in Georgia Medicaid.

Methods
This study used data from the Georgia Medicaid patient enrollment, medical and pharmacy claims database from 2009 to 2014.We performed an interrupted time series analysis to examine the effect of the policy changes. Outcome measures assessed the trends in the indicators of potential inappropriate prescribing practices, including overlapping prescriptions of opioid + opioid, opioid + benzodiazepine and opioids + buprenorphine/naloxone, as well as health services utilization, including hospitalization, mean length of stay, outpatient office and emergency room visits.

Key findings
A total of 712 342 opioid users aged 18–64 were included in the study. The policies were associated with significant decreasing trend of opioid + opioid (−0.0011; 95% CI = −0.0020, −0.0002) and opioid + benzodiazepines (−0.001; 95% CI = −0.0022, −0.0006) overlapping while associated with a significant immediate decrease in and opioids + buprenorphine/naloxone after the implementations (−0.0014; 95% CI = −0.0025, −0.0003). Significant immediate decrease in level of office visits and ER visits were seen with the policy implementation (office visit: −0.2939; 95% CI = −0.5528, −0.0350, ER visit: −0.0740, 95% CI = −0.1294, −0.0185). The policies were not shown to be significantly associated with hospitalization and the mean length of inpatient stay.

Conclusions
Our analysis suggests that Georgia Medicaid opioid policies were useful to contain inappropriate opioid use.