Integrated Pharmacy Research and Practice最新文献

Background: Medication reconciliation (MR) on admission has potential to reduce negative patient outcomes. The objectives of this prospective observational study were to 1) measure the impact a hospital-wide MR program has on home medication error identification at hospital admission, 2) demonstrate cost-effectiveness of this program, and 3) identify risk factors placing individual patients at higher risk for medication discrepancies.

Methods: Technicians obtained medication histories on adult patients admitted to the hospital that managed their own medications. Frequency and type of medication errors were recorded. Cost avoidance estimations were determined based on expected adverse drug event rates. Logistic regression analysis was used to test for associations between medication errors and patient characteristics. Results were considered significant when p-value was less than 0.05.

Results: The study included 817 patients. Technicians recorded a mean of 6.1 medication discrepancies per patient (SD ± 0.4) and took 28.5 minutes (SD ± 1.2 minutes) to complete a medication history. Omission, commission, and dosing/frequency errors occurred in 82%, 59%, and 50% of medication histories, respectively. We estimated cost avoidance of $210.33 per patient with this program. Female gender, age, and high alert/risk medication use were linked to an increase in the likelihood of occurrence of a medication discrepancy.

Conclusion: This study validated the ability of a pharmacy technician to identify errors, demonstrated economic cost-effectiveness, provided new data on time to obtain a BPMH, and further identified factors that contribute to the occurrence of medication discrepancies. Potentially harmful medication discrepancies were identified frequently on admission. With further research, it may be possible to identify those at highest risk for home medication discrepancies upon admission.

Background: Auditable pharmaceuticals service and transaction system (APTS) is unique in its systems strengthening approach. It is a data-driven package of interventions designed to establish accountable, transparent, and responsible pharmacy practice. The objective of this study was to assess the outcome performance of pharmaceuticals services among selected hospitals with and without the APTS system in SNNPR, Ethiopia.

Methods: A cross-sectional comparative facility-based study was conducted at public hospitals by using an intervention and control approach to estimate the significance of the difference between average performances of APTS and non-APTS hospitals. A case-to-control ratio was applied to decide the number of sites and a simple random lottery sampling technique was employed to select control sites. The sample size formula was used to determine the proposed population for patient care indicator assessment. Epidata version 3.1 and SPSS version 23 were used for analysis. The study was conducted from March 1 to 30, 2019.

Results: APTS implemented hospitals attained 92.3% patient satisfaction on the overall pharmacy services compared to 47.5% for non-APTS hospitals. They have improved essential drugs (EDs) availability, minimum stock-outs, and reduced wastage rates, unlike control groups. They undertook workload analysis to assess human power sufficiency; generate reliable information from accurate recording culture for decision making; practiced transparency and accountability through conducting physical inventory and daily sales tracking/management system; and made budget utilization rationale applying ABC analysis, VEN analysis, ABC/VEN reconciliation, and stock status analysis (SSA) that non-APTS hospitals did less/not.

Conclusion: In general, higher performances were observed in APTS implemented hospitals than non-APTS hospitals regarding patient knowledge, satisfaction, and medicine availability at stores. In all cases, it needs improvement to achieve target values.

Background: According to World Health Organization (WHO) drug use indicators manual, the patients' knowledge on dispensed medication is a crucial patient care indicator. There is a dearth of studies about patients' knowledge of dispensed medication at the primary health care facility. The objective of this study was to assess the knowledge of dispensed medication and associated factors among patients attending in the outpatient pharmacy of Chencha primary level hospital, Southwest Ethiopia.

Methods: A facility-based cross-sectional study was employed among 403 patients attending in the outpatient pharmacy of Chencha primary level hospital. The data collection techniques were observation of dispensing process and face-to-face interview by using WHO patient care indicators and a structured questionnaire, respectively. Descriptive statistics, univariable and multivariable logistic regression were determined using the SPSS version 20.

Results: A total of 403 patients participated which make the response rate 100%. Fifty-three (13.2%) patients had adequate knowledge on dispensed medication. The findings of multivariable logistic regression indicated that tertiary levels of education (AOR = 3.87; 95% CI [1.25, 11.96]), being private employee (AOR = 10.98; 95% CI [3.25, 37.04]), having severe perception of illness (AOR =3.77; 95% CI [1.43, 9.94]), having three or more visits (AOR =3.20; 95% CI [1.21, 8.44]) and being counseled by pharmacist (AOR = 10.02; 95% CI [4.45, 22.56]) significantly increased the odds of having a "adequate knowledge of medicines."

Conclusion: This study showed inadequate level of knowledge of dispensed medicine among patients attending in outpatient pharmacy of Chencha primary level hospital. Patient education, employment status, number of visits, perception of illness, dispenser qualification and experience were the factors for knowledge of dispensed medicine. Dispensers need into account patients' perception of their illness of illness and frequency of visits during counseling.

Background: Nasal sprays are used to deliver the medications locally to the nasal cavity. The majority of patients have been observed to perform nasal spray use techniques inadequately. This study was conducted to evaluate the impact of the intervention on nasal spray use technique.

Methods: This was a prospective pre- and post-interventional study to evaluate the nasal spray use technique among the subjects with the help of nasal spray checklist. A standardized WHO nasal spray checklist was used on the study conducted in Manipal Teaching Hospital, Pokhara, Nepal from July to October 2019. Subjects were asked to demonstrate the technique and a scoring system was applied before and after the intervention by the researcher. The total score of the intervention technique ranges from 0 to 11. After evaluation of the technique at the first visit, subjects were provided with an informative leaflet having all the steps to be followed to use the spray and the technique was re-evaluated after 10 days.

Results: A total of 81 subjects (51.9% male and 48.1% female) participated in the study. The average duration of nasal drug use was 15 days. The overall mean±SD score was 4.31±1.625 before intervention and 9.84±1.699 after intervention. After the intervention, the percentage of subjects using the nasal spray correctly increased by 50.27%. Wilcoxon signedrank test showed intervention on nasal spray use technique was effective (p=0.0001).

Conclusion: The nasal spray use technique was poor among the subjects before the intervention. The intervention was substantially effective in improving the technique to use the nasal spray. Regular assessment and reinforcement of correct technique by health professionals will improve the proper use technique of nasal spray, hence increasing the effectiveness of the therapy.

Background: Self-medication with over-the-counter (OTC) medications is common among medicine and health science students. For safe use of OTC medications, students are expected to have proper knowledge, attitude, and practice (KAP) towards OTC medications and subsequent adverse drug reactions (ADRs).

Objective: The aim of this study was to assess KAP of OTC medications use and related factors among medical and pharmacy students at the University of Gondar, Gondar, Northwest Ethiopia.

Methods: A cross-sectional study was conducted. Data were collected using a self-administered questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) version 24. Chi-square analysis was conducted and multivariable logistic regression analysis was used to determine the association between KAP and OTC use and its related adverse effects. A P value of less than 0.05 was used to declare statistical significance.

Results: A total of 380 students (229 medical students and 151 pharmacy students) participated in the study. The majority of the respondents 303 (79.7%) reported that they have the practice of self-medication. Fever 69 (80.2%), headache 21 (24.4%), and abdominal cramp 20 (23.3%) were the most common conditions for which the students go for self-medication while paracetamol 51 (59.3%) followed by non-steroidal anti-inflammatory drugs (NSAIDs) 44 (51.2%) were the most commonly used classes of drugs. An intention for time-saving caused by the waiting time due to crowds in medical consultation rooms 212 (77.4%) and a desire for quick relief 171 (62.4%) were the main reasons for the self-medication practice with OTC medications.

Conclusion: Self-medication is widely practiced among medical and pharmacy students. Significant problems and malpractices were identified, such as sharing of OTC medications, the use of expired medicines, doubling the dose of medications when they were ineffective, storage of OTC medications, and not reading labels and expiry dates.

Background: Medication errors in pediatric patients are grossly underreported. Pediatric patients are quite susceptible to medication errors. Potential injury by medication error is higher in young children and infants. It results in serious morbidity and mortality. Thus, this study aimed to assess medication error and its contributing factors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center.

Methods: A prospective observational study was conducted among pediatric patients with infectious diseases admitted from April 1 to June 30, 2018. The patient's written informed consent was obtained after explaining the purpose of the study. The data were collected by structured questionnaire. Data were entered into EpiData version 4.0.2 and then exported to SPSS version 21.0 for analysis. To identify the predictors of medication error, backward logistic regression analysis was done.

Results: From a total of the 325 study participants, 136 (41.8%) patients had at least one medication error during their hospital stay. A total of 273 medication errors were identified among 136 patients. Medication errors frequently occurred at prescribing stage 94 (34.4%). The most common types of medication errors were wrong dosing 72 (26.4%) and wrong frequency 47 (17.2%). Presence of disease comorbidity (AOR=1.64, 95%CI=1.01-2.67), being male (AOR=1.79, 95%CI:1.13-2.86) and presence of two infectious diseases (AOR=1.96, 95%CI: 1.20-3.23) and more than three infectious diseases (AOR=2.04, 95%CI: 1.03-4.01) were independent predictors of medication error occurrence.

Conclusion and recommendation: Medication errors were common in pediatric patients with infectious diseases in the study area. Presence of comorbidities, being male and the number of infectious diseases were associated with the occurrence of medication errors. Therefore, to reduce medication errors in the study setting, e-prescribing, computerized provider order entry, medication reconciliation, and collaboration of clinical pharmacists with other health professionals are needed.

Background: Tuberculosis is said to be one of the prevalent opportunistic infections and the leading cause of death among people living with human immunodeficiency virus. Although isoniazid preventive therapy (IPT) is thought to reduce the incidence of TB in HIV patients, its implementation has faced many obstacles. This study was concerned with the assessment of the outcome of IPT among people living with HIV who were on follow-up at Dessie referral Hospital (DRH), Northeast, Ethiopia.

Methods: A retrospective study of medical records of 220 patients, who were enrolled at Dessie Referral Hospital from January 10/2016 to December 11/2018, were conducted from March 23/2019 to April 6/2019. A systematic random sampling method was used to select the samples for the study, and a data abstraction format was used to capture the data. All data were entered, cleared and analyzed using SPSS version 21. Chi-square test was used to identify the association of outcome between the two IPT groups, and P-value <0.05 was considered as statistical significance.

Results: The total TB prevalence in this study was 25 (11.36%). The occurrence of TB in the IPT group was 9(4.09%) and 16 (7.27%) for the non-IPT group but not statistically significant (p=0.137). From the study, about 40.9% of patients developed opportunistic infections. Of these, 62.81% and 37.18% of opportunistic infections were developed among patients in the non-IPT and the IPT groups, respectively (p=0.002), which were statistically significant, and the IPT completion rate was 61.81%.

Conclusion: Although the current study showed that the IPT had not significantly reduced the prevalence of TB between IPT and the non-IPT group, the IPT has shown to significantly reduce the prevalence of opportunistic infections.

Introduction: Inventory management is a complex process that accelerates the probability of stock-out and overstocking if not tracked properly. Classification of drugs based on their criticality, cost burden, and in combination is important to make inventory decisions and optimize the quality use of scarce resources. This study analyzed the pharmaceutical inventory management systems of Dessie Referral Hospital using the ABC-VEN matrix for the years 2013 to 2017.

Methodology: Cross-sectional study design was used to review logistic data retrospectively from health commodity management information system and manual records. Data were collected from January 1-20, 2018 in Dessie Referral Hospital.

Results: In the five-year ABC-VEN analysis, 310 (17%), 368 (20.18%), and 1146 (62.83%) items were class A, B, and C, while 610 (34.56%), 1125 (63.74%), and 30 (1.7%) of pharmaceuticals were V, E, and N, respectively. Among these, 139 (7.88%) and 339 (19.21%) of AV and CV pharmaceuticals utilized 43.52% and 2.89% of annual drug expenditures, respectively. Category I, II, and III pharmaceuticals also accounted for 43.68%, 54.79%, and 1.53% of items with their respective USD drug expenditure of 2,268,405.64 (84.49%), 411,961.18 (15.34%), and 4483.97 (0.17%). The pharmaceutical inventory cost projected to be 1,619,351.79 USD in 2025 and total cost (β= 10.68, p = 0.001), class A (β= 8.68, p = 0.001), class B (β= 1.27, p = 0.007), class C (β= 0.72, p = 0.03), and E items (β= 6.08, p = 0.01) were statistically significant with inventory cost.

Conclusion: A huge amount of budget is invested in class A and category I, which pinpoints the need for strict inventory control to prevent wastage and accumulation of capital in buffer stocks. ABC-VEN analysis should be routinely performed before initiation of any new procurement for efficient use of scarce resources.

Purpose: This study was launched to assess COVID-19-related knowledge, attitude and practice among hospital and community pharmacists in Addis Ababa, Ethiopia.

Methods: Self-administered questionnaire was distributed to pharmacists working in hospitals and community pharmacies by physically delivering the questionnaire to study subjects. Data collected were entered into and analyzed by IBM SPSS Statistics^® Version 25. Binary logistic analysis was used to determine the association between independent and outcome variables.

Results: All 295 participants who completed the survey stated that they had heard about COVID-19. Almost all of the participants were aware of the causative agent, the clinical manifestations and the ways of transmission of COVID-19. Most participants (92.2%) identified elderly individuals as one of the high-risk groups for severe complications and death while 89.5% identified supportive therapy and life support as recommended management options to date. More than half (53.2%) of the respondents were found to have adequate knowledge about COVID-19. Among respondents, 89.8% had a positive attitude on the importance of following WHO recommendations in reducing the transmission of COVID-19. Only 9.8% had confidence in the capacity of healthcare facilities in the country to properly handle potential COVID-19 pandemic. Inadequate protective measures were taken to protect the staff from COVID-19 in the institutions of 70.2% of the participants. Among the WHO recommended prevention measures, hand washing was exercised by 97.3% of the study participants.

Conclusion: The study findings confirmed that there is a high level of knowledge on each specific aspect of COVID-19 among the study participants. However, only about half of the participants had adequate knowledge about the disease. The pharmacists showed a predominantly positive attitude towards the importance of WHO recommendations and predominantly negative attitude towards the country's capacity to deal with the pandemic. The practice related to COVID-19 was inadequate at institutional level. Nevertheless, most of the pharmacists individually exercised self-protective measures against COVID-19. All stakeholders should work on ensuring the adequate supply of materials and services that aid in controlling the pandemic.