Journal of Pharmaceutical Policy and Practice最新文献

Introduction: Pharmacogenomics implementation in clinical practice is anticipated to improve our understanding of individual variations in drug response and optimise the safety and efficacy of drug therapy. We aimed to assess the knowledge, perceptions, and readiness of physicians, pharmacists, and nurses in Qatar regarding the implementation of clinical pharmacogenomics.

Methods: A mixed-method study with an explanatory sequential design was conducted. Phase I was the quantitative phase which involved sending an online survey to physicians, pharmacists, and nurses. Phase II was the qualitative phase which involved conducting focus group discussions.

Results: A total of 802 responses were collected, with a response rate of 20%. Only 15.4% of participants had previous pharmacogenomics-related training. The median knowledge score for healthcare professionals was 4 out of 10 denoting low level of knowledge. However, compared to other professions, pharmacists had a higher knowledge score (p-value <0.001) and Doctor of Pharmacy (PharmD) holders scored higher than BSc holders (p-value <0.001). Despite the low level of knowledge, perceptions of healthcare professionals were positive. In addition, the majority believed knowledge of pharmacogenomics is necessary and that counselling patients on pharmacogenomics requires specialised training pharmacogenomic principles in practice. The main themes extracted from the focus group discussions were knowledge, outcome expectations, preparedness, facilitators, barriers, public education, and implementation planning. Regarding readiness, most healthcare professionals reported that they are not currently confident in applying.

Conclusions: Healthcare providers have a low level of knowledge of pharmacogenomics. Despite this, the majority have positive perceptions towards its implementation in practice. Compared to other professionals, pharmacists with a PharmD degree scored higher in the knowledge assessment. Most healthcare providers report low confidence regarding the readiness for the implementation of pharmacogenomics and report a lack of knowledge, specialised training, and clinical guidelines as barriers.

Background: Gabapentin is increasingly recognised for its potential for abuse, raising concerns within healthcare communities. Community pharmacists are on the front lines in identifying and addressing instances of gabapentin abuse, making their insights invaluable. This study aims to assess community pharmacists' experiences and perceptions regarding gabapentin abuse in Jordan.

Methods: A cross-sectional study was conducted from April to June 2024 using a questionnaire-based approach. The questionnaire, developed in English, was uploaded to Google Forms and distributed through social networking platforms. It consisted of four sections: demographic information, pharmacists' experiences with gabapentin abusers, strategies to limit access to gabapentin, and perceptions of gabapentin abuse, which were assessed using a 5-point Likert scale. A Chi-square test was employed to analyze the association between categorical variables.

Results: The study included 209 pharmacists (median age 29.0 years, IQR 8.0 years). Concerning gabapentin, 72.7% of pharmacists received requests to sell it in the past 6 months. Of these, about 75.7% encountered suspected gabapentin abusers, noting behavioural changes (95.9%), frequent refill requests (90.4%), and inconsistent medical histories (87.8%) as key indicators. Most suspected abusers were male (81.7%) and aged 21-30 years (74.8%).Common reasons cited by suspected abusers for requesting gabapentin included neuropathic pain (93.0%), low back pain (89.6%), and mood instability (73.0%). Pharmacists perceived an increase in gabapentin abuse (74.5%) and expressed a need for additional training (83.3%). Additionally, 83.7% recognised their pivotal role in identifying and addressing gabapentin abuse. Finally, significant associations were found between working in chain pharmacies and receiving gabapentin requests (χ² = 9.159, p = 0.002).

Conclusion: Pharmacists have an important role in detecting gabapentin abuse which necessitates adequate education. Pharmacists have concerns regarding this issue and believe stricter regulations are needed.

Background: The integration of Artificial Intelligence (AI) tools like ChatGPT into medical education is expanding, offering benefits such as efficient information synthesis. However, concerns about the accuracy, reliability, and proper use of these tools persist. Understanding medical students' perceptions of ChatGPT is crucial for optimising its use in educational settings.

Objectives: To evaluate how medical students perceive ChatGPT for educational purposes and to assess its perceived advantages and disadvantages.

Methods: A cross-sectional study was carried out using a questionnaire with five main domains to explore Jordanian medical students' perceptions, practices, and concerns regarding the ChatGPT. This study was conducted from May to July, 2023, and the data were collected using the convenience sampling technique through Google Forms shared within medical students' Facebook groups. Descriptive statistics summarised participant demographics, while logistic regression identified factors influencing ChatGPT usage. Variables with a P-value ≤ 0.05 in multiple regression were considered statistically significant.

Results: Nearly two-thirds (N = 136, 61.5%) claimed to have knowledge of AI but not in clinical settings. Most participants (88.5%, N = 216) were aware of ChatGPT, with 86.9% (N = 212) agreeing that 'Medical students can benefit from using ChatGPT.' Additionally, 83.2% (N = 203) felt that 'ChatGPT helps students quickly and easily summarize complex information.' Conversely, 78.3% (N = 191) expressed concerns about ChatGPT's potential inaccuracies, with accuracy and reliability cited as primary concerns. Multiple logistic regression showed that younger students (OR = 0.902, P = 0.025) and those with lower proficiency (OR = 0.487, P = 0.007) used ChatGPT more frequently than others.

Conclusion: Although the use of the ChatGPT could be more beneficial for aiding students in developing medical knowledge, evidence-based academic regulations should guide its use. Future research should be conducted to examine the enablers and barriers to ChatGPT use in medical education.

The Pakistani pharmaceutical industry cannot ignore the contribution of pharmaceutical multinational corporations (MNCs) in terms of innovation and access to advanced treatments. The sale of a pharmaceutical manufacturing plant by an MNC to a Pakistani company has again sparked a debate on why MNCs are closing manufacturing operations in the country. National firms are currently giving MNCs a tough time in Pakistan. Besides competition, MNCs face mergers and acquisitions that hinder the expansion of existing facilities. In the recent past, there has been a noticeable shift in the market shares of multinational corporations (MNCs) and local companies. The market share of national firms has gradually increased, reaching 74.51%, while the market share of MNCs has decreased, falling to 25.49%. These local companies have increasingly partnered with foreign companies through joint ventures, which has had a positive impact on their growth and market share. Nevertheless, the federal government recently deregulated prices for non-essential medicines, so it is expected that MNCs will show their commitment to Pakistan by investing in the country. Investing in new molecules and infrastructure is necessary for MNCs in order to maintain their position in the market. Infrastructure investment is crucial for the smooth operation of pharmaceutical firms. This includes the construction of state-of-the-art manufacturing facilities, the establishment of research and development centres, and the upgrading of technology.

Background: Anemia management in chronic kidney disease (CKD) is a significant challenge for healthcare professionals worldwide. The extensive management of CKD and its complications is directly linked with a substantial treatment burden, which impacts quality of life (QoL). This study aimed to assess the prevalence and management of anemia and to evaluate the treatment burden and its impact on the QoL of CKD and dialysis patients in Pakistan.

Methodology: A multicenter prospective observational study was conducted in three hospitals. A total of 170 patients were enrolled, with 156 available for follow-up after six months. Their prior consent was obtained. Each participant was interviewed in person and received a data collection form.

Results: At baseline, the prevalence of anemia among CKD (stage 3-5) and dialysis patients was 78.7% and 94.7%, respectively. Patients on dialysis used more erythropoietin stimulating agents (ESAs), with 38.6% at baseline and 40.8% by month six, compared to non-dialysis CKD patients. Oral iron was used by 6.2% of stage 3, 25% of stage 4, 20% of stage 5 patients, and 6.6% of dialysis patients at baseline. At the six-month follow-up, 42.8% of CKD and 33.8% of dialysis patients achieved the target hemoglobin level. Dialysis patients had a higher treatment burden compared to CKD at baseline (77.4±10.6 vs 59.3±13.3) and at six-month visit (79.3±11.1 vs 59.1±14.5). The multiple regression analysis showed that treatment burden had a significant association with age, disease duration, and comorbidity at baseline. There was a significant negative correlation between overall treatment burden and QoL, indicating that QoL decreases as treatment burden increases.

Conclusion: Anemia was prevalent, and its management was suboptimal in this study. The overall treatment burden score was high in dialysis patients, negatively affecting the QoL.

Background: Intravenous unfractionated heparin (IVUFH) and low molecular weight heparins (LMWH) are first line anticoagulants for the management of acutely unwell patients. The decision to prescribe either IVUFH or an LMWH is complex with minimal direction from clinical guidelines. The aim of this study was to explore individual prescribers' perceptions on prescribing IVUFH or LMWH in patients' acute management.

Methods: Semi-structured interviews were conducted with purposively selected senior medical officers who were from specialities including cardiology, cardiothoracic surgery, respiratory, emergency, vascular surgery, nephrology, neurology and general medicine, identified as those that routinely prescribe IVUFH or LMWH. An interview tool with seven questions and four hypothetical case scenarios guided interview discussions. Interviews were audio recorded, transcribed and inductively coded for thematic analysis.

Results: Twelve doctors participated in interviews between February and October 2022. Mean interview duration was 24 min; data saturation was achieved. Most were senior doctors: one was a registrar and others were staff specialists. Three key themes emerged: (1) rationale for the choice of heparinoid, (2) patient safety considerations and (3) resources required. The themes and subthemes identified the complexity of issues to consider when choosing between IVUFH and LMWH. Multiple factors were considered by participants which were based on previous experiences and institutional capabilities rather than evidence-based medicine.

Conclusion: Future interventions should focus on highlighting LMWH as the preferred heparinoid in most clinical scenarios. The use of IVUFH should be reserved for specific patient cohorts where the benefit of IVUFH outweighs the additional risks.

Background: Nepal implemented a pilot of the Supervision, Performance Assessment, and Recognition Strategy (SPARS) program aimed to increase health workers' ability to manage medicines through on- the-job training and support from a new cadre of Medicines Management Supervisors (MMS). This study aims to assess the implementation costs.

Methods: Data from the SPARS central database and facilities was analysed to assess the total cost of the SPARS pilot including 293 public health facilities from 12 districts of 3 provinces, from May 2022 until July 2023. We estimated the number of health facilities to achieve a successful performance status, defined as a SPARS score ≥ 18.75 out of 25 (75%) and estimated the cost per facility to reach a successful score.

Results: In total, 293 facilities received 838 visits, performed by 48 MMS for an estimated total cost of $226,531. 124 facilities (44.3%) reached a score of 18.75 points after two or more visits. On average, it costs $1827 USD per facility to reach a successful SPARS score.

Conclusion: This study assesses the costs of implementing SPARS in 12 districts in Nepal. These findings can provide insights into further scaling up SPARS in Nepal or in other countries.

Background: Access to medicine is crucial for the effective functioning of healthcare systems. A robust regulatory framework is necessary to ensure the safety, effectiveness, and availability. However, weak regulatory frameworks persist in many low- and middle-income countries, leasing to the circulation of falsified and substandard medicines as well as anti-competitive restrictions on registering poor-quality medicines, which poses a significant public health threat. This study evaluated the evolution of Zanzibar's medicine regulatory system over the past two decades and identified the key factors contributing to its success by elaborating on the Zanzibar Food and Drug Agency, seeking the expertise of regional, continental, and global experts to assess its regulatory capacity and maturity level.

Methods: This study was conducted at the Zanzibar Food and Drug Agency (ZFDA) in Unguja, Zanzibar, using a retrospective cross-sectional review and qualitative approach. It thoroughly reviewed relevant regulatory documents, including Acts, policies, guidelines, and assessment reports. Data were collected using a standardised checklist and analysed to uncover patterns and insights regarding the evolution of Zanzibar's medicine regulatory system.

Results: This study revealed substantial legal provisions, organisational development, strategic planning, and resource allocation improvements. Notable achievements include establishing a structured organisational framework, developing a comprehensive strategic plan, and implementing a Quality Management System (ISO 9001:2015 certified). The ZFDA also addressed human resource limitations by creating job descriptions and a staff scheme of service, enhancing financial resources through revised fee regulations and government support, and improving infrastructure with new office and laboratory facilities.

Conclusion: Zanzibar's medicine regulations have evolved significantly, with marked regulatory capacity and infrastructure improvements. Future efforts should address the remaining challenges and foster collaboration with regional and international bodies to ensure the continued evolution and effectiveness of Zanzibar's medicine regulatory framework.

Background: Medicine shortages are a global problem. Prior studies have focused on hospitals, and staff views, with less information on community practice. This study aimed to estimate the prevalence of medicine shortages in community pharmacies and potential impact on patients.

Method: Four community pharmacies (two urban, two rural) in Ireland recorded details of prescription request shortages per items dispensed. Data were gathered one study day per month from February to April 2023. A prevalence across sites was estimated and trends examined using a Poisson regression.

Results: There were 76 medicine requests defined as shortages out of 3734 prescription item requests, giving a mean shortage prevalence of 2% (95% CI 1.6-2.5%). There was a non-significant, 17%, increase in shortage rate across the study period (p = 0.256). Higher rates were observed in the two urban pharmacies. In total, 61/76 (80%) of shortages were associated with a delay in patient treatment.

Conclusion: Shortages are prevalent in community pharmacy and cause delays in patient treatment and increase in workload of pharmacy staff. Regulatory initiatives to address the issue at a manufacturer level have been proposed, although workforce planning, resourcing and professional role expansion are also required to protect pharmacy staff and patient outcomes.