Journal of Pharmaceutical Policy and Practice最新文献

Background: This study aimed to assess medication adherence among Jordanian patients with dyslipidemia and evaluate the impact of health literacy, well-being, and doctor-patient communication on adherence in this population. Dyslipidemia is a prevalent condition that significantly increases the risk of cardiovascular diseases, and understanding the factors influencing medication adherence is crucial for improving patient outcomes.

Methods: An observational cross-sectional study was conducted from March to July 2023. A convenience sample of adult Jordanians diagnosed with dyslipidemia was surveyed in a tertiary hospital using validated scales: the Lebanese Medication Adherence Scale-14 (LMAS-14), the Doctor-Patient Communication Scale (DPC), the WHO well-being index, and the health literacy scale. Bivariate analysis and linear regression models were employed to analyze associations.

Results: Among 410 participants (mean age 58.62 ± 12.11 years), the mean scores were LMAS-14 (35.10), DPC (55.77), WHO well-being (47.53), and health literacy (38.96). Higher medication adherence was associated with older age (B = 0.093, p = 0.049), university education (B = 2.872, p = 0.017), prior surgery (B = 2.317, p = 0.021), medium income level (B = 3.605, p = 0.006), and better doctor-patient communication (B = 0.166, p = 0.003). Conversely, cigarette smoking (B = -3.854, p = 0.001) and health insurance (B = -2.146, p = 0.039) were linked to lower adherence.

Conclusion: The findings underscore the substantial interplay of socio-demographic and clinical factors affecting medication adherence. Enhanced public health interventions focusing on improving health literacy, communication quality, and addressing socio-economic conditions are vital for better adherence and patient outcomes in Jordan.

Background: Most patients with cancer have comorbid conditions that necessitate advanced medical treatment. Polypharmacy (PP) and potentially inappropriate medicine (PIM) use is common among older adult patients with cancer. Not much research has been conducted on PP and PIM use among older adult patients with cancer in Ethiopian oncology centers. Therefore, this study aimed to evaluate the prevalence and determinants of PP and PIM use among older adults with cancer in Northwest Ethiopia oncology centers using the American Geriatrics Society (AGS) 2019 updated Beers criteria.

Methods: This multicenter cross-sectional study was conducted among older adult patients with cancer from July 15-December 30, 2023 in Northwest Ethiopian oncology centers. The use of at least one drug included in the 2019 Beers criteria revisions was classified as potentially inappropriate medication use. To identify the factors influencing PP and PIM use, logistic regression analysis was performed.

Results: Of the 310 samples aproched, 305(98.4% response rate) participated in the study. The prevalence of PP and PIM use were 70.2% (95% CI 64.9-75.1) and 63.0% (95% CI 57.4-68.8) respectively. Being female AOR:3.6; 95% CI:1.7-7.8; p =  0. 001, advanced age [(70-74 years) AOR:3.9; 95% CI:1.2-6.7; p =  0.046 and ≥75 years AOR:3.8; 95% CI:1.7-8.4; p =  0.0028], abnormal body weight (underweight AOR:5.5; 95% CI:1.5-9.6; p =  0.019, overweight AOR:5.1; 95% CI:1.5-7.3; p = 0.01 and obese AOR:5.6; 95% CI:1.5-9.3; p = 0.021) and comorbidities AOR:3.5; 95% CI:1.7-8.3; p =  0.0032 were statistically significant factors for PP. Advanced age [(70-74 years) AOR:5.5; 95% CI:1.4-9.8; p =  0.015 and ≥75 years AOR:3.3; 95% CI:1.5-7.1; p = 0.002)] and polypharmacy; AOR:7; 95% CI:3.4-9.4; p = 0.001 were statistically significant factors for PIM use.

Conclusion: Polypharmacy and potentially inappropriate medicine use were prevalent among older adult patients with cancer. Ensuring safe medicines prescription practices for older patients with cancer requires understanding the issue, stopping unwarranted treatment, and replacing it with less toxic, age-appropriate medicines.

Introduction: Patient medicines helpline services (PMHS) can reduce harm and improve medicines adherence and patient satisfaction after hospital discharge. There is little evidence of which PMHS attributes are most important to patients. This would enable PMHS providers to prioritise their limited resources to maximise patient benefit.

Methods: Patient preferences for PMHS attributes were measured using a discrete choice experiment. Seven attributes were identified from past research, documentary analysis and stakeholder consultation. These were used to produce a D-efficient design with two blocks of ten choice sets incorporated into an online survey. Adults in the UK who took more than one medicine were eligible to complete the survey and were recruited via the Research for the Future database. Preferences were estimated using conditional logistic regression. Associations between participant characteristics and preferences were investigated with latent class models.

Results: 460 participants completed the survey. The most valued attributes were weekend opening (willingness-to-pay, WTP: £11.20), evening opening (WTP: £8.89), and receiving an answer on the same day (WTP: £9.27). Alternative contact methods, immediate contact with a pharmacist and helpline location were valued less. Female gender and full-time work were associated with variation in preferences. For one latent class containing 27% of participants, PMHS location at the patient's hospital was the most valued attribute.

Discussion: PMHS providers should prioritise extended opening hours and answering questions on the same day. Limitations include a non-representative sample in terms of ethnicity, education and geography, and the exclusion of people without internet access.

Background: There was a fluctuation in medication demand and supply during COVID-19 pandemic. This study aimed to assess the trend of drug utilisation in Malaysia in 2018-2022 and evaluate the impact of COVID-19 on drug utilisation rates.

Methods: We conducted a repeated cross-sectional study of pharmaceutical sales data from public and private sectors in Malaysia from 2018 to 2022. Drug utilisation rates for the period after the onset of COVID-19 (2020-2022) was compared with the earlier period (2018-2019). Interrupted time-series regression analyses evaluated level and slope changes compared to pre-COVID-19 pandemic level for quarterly rates of drugs utilisation in public and private sectors.

Results: There was an immediate reduction in the utilisation rates for all drugs after COVID-19 in public (-20.4%; p = 0.043) and private sectors (-22.4%; p = 0.003). In both sectors, significant level changes were observed for anti-infectives, musculoskeletal, neurological, respiratory, and sensory organs preparations following COVID-19 pandemic, followed by a sustained increase in trend from 2020 to 2022. Public sector had a 22.2% reduction in the utilisation of cardiovascular drugs (p = 0.002), particularly for renin-angiotensin system (RAS) agents (-47.4%, p = 0.019). Private sector had large changes for anti-infectives (-53.6%, p < 0.001) and neurological drugs (-51.4%, p < 0.001), driven by an immediate level reduction in antibacterials (-54.2%, p < 0.001) and cough and cold preparations (-59.2%, p < 0.001). Classes with agents used for COVID-19 treatment, such as systemic corticosteroids, antibiotics, and antivirals had an increasing trend between April 2020 and December 2022, although some slope changes were not statistically significant.

Conclusion: A significant reduction in the overall drug utilisation rates was observed in the public and private sectors in Malaysia as an immediate impact of the COVID-19 pandemic in 2020. The impacts varied by therapeutic class and health sector. This finding provides an understanding of the changing patterns of drug utilisation that were affected by disease outbreaks for future planning of pandemic preparedness.

Background: Prescribing errors (PEs) cause significant avoidable harm globally. In Malaysia, despite the prevalence of PEs in government healthcare facilities, there is limited research on how pharmacist staffing levels influence intervention frequency and effectiveness. This study aims to address this gap by analysing intervention trends and assessing their association with staffing levels, highlighting the correlation between increased pharmacist presence and the frequency of interventions.

Methods: This retrospective cross-sectional study analysed data from the Ministry of Health's Pharmacy Management Form and the Pharmacy Board Registry from 2017 to 2019. Multivariate regression and two-way ANOVA assessed the association between the number of pharmacists, total prescriptions, and interventions on PEs in Health Clinic Outpatient Pharmacy, Hospital Outpatient Pharmacy, and Hospital Inpatient Pharmacy settings.

Results: Annually, pharmacists intervened in approximately 1.8% of total prescriptions, with the most common errors being wrong dose, wrong medication, and wrong dosing frequency. These interventions were consistent across all settings, highlighting the uniformity in pharmacists' approach to managing PEs. The regression analysis revealed a significant positive correlation between the number of pharmacists, total prescriptions, and interventions on PEs, with an adjusted R-squared value of 0.899. Both the number of pharmacists and total prescriptions received were positively significant (p < 0.05), indicating that increased pharmacist presence strongly correlates with intervention frequency. No statistically significant differences were observed in intervention rates across different settings and severity levels, suggesting that pharmacists consistently provide effective interventions irrespective of the clinical context.

Conclusion: In conclusion, this study confirms that increasing the number of pharmacists and total prescriptions received are critical predictors of interventions on PEs in Malaysia. It underscores the vital role of pharmacists in enhancing patient safety and healthcare quality, demonstrating their effectiveness in diverse settings and their adaptability to various patient needs and challenges.

Purpose: To provide an insight into the role of a clinical pharmacy initiative in a surgical urology unit through evaluating the nature, significance, associated medications, and acceptance rate of pharmacist interventions.

Methods: A cross-sectional study was carried out at the Ambulatory Care Center (ACC), Doha, Qatar. Data related to clinical pharmacist interventions and associated rationale were classified according to the nature of the intervention using an adapted classification system. The assessment of the severity followed the National Patient Safety Agency (NPSA) Risk Matrix. Linear regression, Kruskal-Wallis, and post-hoc analyses were performed to determine the association between patient-related and medication-related characteristics on pharmacist interventions.

Results: A total of 3284 interventions (on 1486 patients) were analysed. Most patients (n = 1105; 74.4%) had 1-2 interventions. Age and gender showed a positive linear correlation with the number of interventions per patient (p < 0.01). Majority of interventions were related to pharmacological strategy (n = 1858; 56.6%) and quantity of drug (n = 821; 25%). Additional drug therapy (n = 748; 22.78%) was the most common subcategory followed by optimum dose/frequency (n = 691; 21.04%) and discontinuation of medications (n = 352, 10.72%). Anti-infectives were the most identified drug category (n = 798, 55.1%). Most interventions (59.4%) were of moderate significance; patients with moderate interventions were found to be older compared to patients with minor interventions (p = 0.032). Prescribers' acceptance rate was high (>90%), with a notable increase of 6.6% from 2021 to 2023.

Conclusion: This study showed that the clinical pharmacy service in the urology surgical field was a fruitful initiative. The clinical pharmacist's role has expanded to include not only therapeutic optimisation while ensuring medication safety across the continuum of perioperative care but also the identification and management of untreated health problems. The dynamic and complexity of the urology patient population challenge clinical pharmacists; however, the practice concepts remain the same as in any other clinical setting.

Background: There is a global call for upscaling and optimising the role of community pharmacists (CPs) in the control of non-communicable diseases (NCDs). In the United Arab Emirates (UAE), where NCDs are classified as a public health pandemic, upscaling CPs contributions has become more critical. Several contextual, professional, and educational challenges constrain the role of CPs.

Objective: To synthesise the perspectives of key stakeholders in the UAE healthcare system and propose a roadmap for advancing the role of CP s in controlling NCDs in the UAE.

Methods: This research followed a qualitative design using the International Pharmaceutical Federation (FIP) framework for quality assurance of pharmacy profession development. Data were collected using semi-structured interviews with 28 experts and senior leaders, then analysed using the thematic analysis technique with the assistance of NVivo software.

Results: The analysis yielded three main themes that outlined the prospective roadmap: education, work environment, and policy. Some of the generated subthemes were establishing accredited NCD-specialised programmes, building a national framework for interprofessional education and collaboration, and upscaling the engagement of CPs in public health platforms and initiatives.

Conclusion: Improving the role of CPs in controlling the NCD pandemic in the UAE requires coherent and well-structured multidisciplinary endeavours from health policymakers, educational institutions, and all groups of healthcare professionals, including the CPs themselves.

Background: Good Manufacturing Practices (GMP) is the bedrock of quality assurance in the pharmaceutical industry that ensures that products are consistently produced and controlled according to quality standards. This study compared the GMP conformance of pharmaceutical facilities across two fiscal years, 2018/2019 and 2019/2020, using the East African GMP Compendium on Good Manufacturing Practices, 2014, as a benchmark.

Methods: We analyzed the proportion of conformance of foreign pharmaceutical industries to GMP standards and reported the aggregated data over a two-year period.

Results: Inspected facilities had notable non-conformances, most commonly related to laboratory quality control and premises. We noted a downward trend in conformance in 2019/2020 compared with 2018/2019, with only 32.9% of facilities adhering to EAC GMP requirements, down from 50% in the previous year. The COVID-19 pandemic has affected the ability to conduct on-site inspections, and may have contributed to the lower conformance rate.

Conclusions: These findings underscore the crucial need to continue GMP inspections and the importance of taking corrective actions to ensure adherence to the quality standards for products marketed in Tanzania. The study further revealed the significance of desk reviews in assisting regulatory authorities in facing unforeseen challenges such as pandemics.

Introduction: Deprescribing serves as a pivotal measure to mitigate the drug-related problem due to polypharmacy. This study aimed to map the factors influencing healthcare providers' deprescribing decision using the Behaviour Change Wheel framework and develop an innovative conceptual model to support deprescribing practice.

Methods: A cross-sectional online survey targeting doctors and pharmacists was conducted to assess the influence of various factors on healthcare providers' comfort in recommending deprescribing. The conceptual model was formulated, based on the existing deprescribing framework and the Behaviour Change Wheel. The model's robustness was scrutinised through Partial Least Squares Structural Equation Modeling (PLS-SEM), and model-fitting indices were employed to obtain the best-fit model.

Results: A total of 736 responses were analysed with the final best-fit model consisting of 24 items in 5 constructs (R ²: 0.163; SRMR: 0.064; rho_c: 0.750-0.862; AVE: 0.509-0.627) and three independent factors. Based on the results, we proposed that deprescribing could be promoted through strategies aimed at enhancing healthcare providers internal capabilities such as knowledge levels, when patients' condition deteriorated and previous experiences with adverse events of drugs. Organisational support in providing such educational opportunities is important, with the empowerment of patient and healthcare providers through policy enhancements, guideline development, and effective communication.

Conclusion: The deprescribing behaviours of healthcare professionals are influenced by an intricate interplay of patient, prescriber, and system factors. Enhancing deprescribing practices necessitates a comprehensive strategy that encompasses providers and patients' education, the development of structured deprescribing guidelines, the implementation of deprescribing support tools, and the enhancement of communication between healthcare providers.

Background: This study aimed to determine the association of Torsade de Pointes (TdP) with anxiolytic drugs and present a detailed overview of anxiolytic-induced cases of TdP reported to the Food and Drug Administration Adverse Event Reporting System (FAERS).

Methods: All cases of anxiolytic-induced TdP (n = 260) between 1990 and 2020 were retrieved from the FAERS database using the Preferred Term 'Torsade de Pointes, code: 10044066' from the Medical Dictionary for Regulatory Activities (MedDRA version 22). Four data-mining algorithms were used for disproportionality analysis: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Empirical Bayes Geometric Mean (EBGM), and Information Content (IC). Anxiolytics with ≥3 TdP cases were included.

Results: Of a total of eight drugs, this study identified seven signals of TdP, of which six signals were new, namely for alprazolam, bromazepam, lorazepam, meprobamate, midazolam, and oxazepam. Based on disproportionality analysis, among new signals, the highest risk of TdP was observed with bromazepam and midazolam. Alprazolam showed the lowest risk for TdP, while diazepam did not reach significant disproportionality.

Conclusions: This study identified six new signals of TdP among anxiolytic drugs, so warranting stringent clinical studies to ascertain the actual risk of TdP and ensure patient safety.

Clinical trial registration: This study is registered at ClinicalTrials.gov (NCT.gov ID: NCT04293432).