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Ferreira PD, Simoes JA, Velho DC. Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review. Cureus 2024; 16:e59532. [PMID: 38826951 PMCID: PMC11144025 DOI: 10.7759/cureus.59532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.
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Affiliation(s)
| | - Jose A Simoes
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, PRT
| | - Denise C Velho
- Family Medicine, ULS de Leiria, USF Santiago, Leiria, PRT
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Sales I, AlRuthia Y. Arabic translation and cultural adaptation of Hill-Bone compliance to high blood pressure therapy scale. Saudi Pharm J 2024; 32:102053. [PMID: 38590609 PMCID: PMC10999866 DOI: 10.1016/j.jsps.2024.102053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background Adherence to prescription medications is vital to the success of any treatment plan, especially for chronic health conditions, such as hypertension (HTN). Although there are different scales used in assessing adherence to prescription medications, most if not all, of those scales are not available in Arabic. The absence of essential assessment tools makes the appraisal of adherence to prescription medications very difficult for native Arabic speakers. Therefore, this study aimed to translate and validate the Hill-Bone Compliance to High Blood Pressure Therapy (CHBPT) scale, which is commonly used to assess adherence to antihypertensive medications, among a sample of Arabic-speaking patients with HTN. Methods This was a single-center cross-sectional study that took place at a university-affiliated hospital. It interviewed adult (≥18 years) patients with HTN who were visiting the primary care clinics between January and November 2020. Non-Arabic speakers, those under 18 years of age, individuals without a diagnosis of HTN, and patients without any previously filled prescription medications for HTN within the past three months were excluded. The forward-backward translation method was used after receiving permission from the originators of the questionnaire to translate their scale to Arabic. Test-retest and Cronbach alpha methods were used to assess the reliability. Principal component analysis with varimax rotation was used to examine the construct validity. Results One hundred and forty-one patients consented and participated in the study. Most of the patients were ≥ 50 years old (75 %), male (72 %), and had another chronic health condition besides HTN (99 %). The translated scale had good internal consistency (Cronbach alpha = 0.83) and reliability (intraclass correlation coefficient of 0.9). The Kaiser-Meyer-Oklin was 0.82 indicating adequate sampling to conduct factor analysis; hence, three factors (e.g., subscales) were extracted similar to the original scale. The mean scores for appointment keeping, medication taking, and reducing sodium intake subscales, as well as for the overall scale were 5.62 ± 1.39, 33.94 ± 3.87, 9.73 ± 2.1, and 49.29 ± 5.21, respectively. Conclusion The translated version of the Hill-Bone CHBPT scale has both good reliability and validity and will hopefully help healthcare providers assess and monitor HTN patients' adherence to their antihypertensive medication regimens. Multicenter studies should be conducted to verify the validity and reliability of the translated questionnaire among different Arabic-speaking patient populations with HTN.
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Affiliation(s)
- Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Rusu RN, Gavril RS, Ababei DC, Macadan I, Ciobîcă A, Nicolae C, Popescu RI, Bild W, Bild V. Validity and reliability of the Romanian version of the Hill-Bone compliance to high blood pressure therapy scale. Front Pharmacol 2024; 15:1256848. [PMID: 38515851 PMCID: PMC10955134 DOI: 10.3389/fphar.2024.1256848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Romania is considered a country with high cardiovascular risk, arterial hypertension and its complications accounting for about 60% of total deaths. The management of high blood pressure often involves a combination of both therapeutic regimens as well as lifestyle changes, to which patients have to be adherent. In order to assess patients adherence to professionals' recommendations, validated tools are needed. The aim of our study was to translate, culturally adapt and validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale into Romanian. The study included 215 participants from Iasi, North-Eastern Romania. The internal consistency of the instrument was measured with Cronbach's alpha coefficient, while the construct validity was determined using exploratory factor analysis and principal component extraction with promax rotation. Sampling adequacy and appropriateness of data for factor analysis was measured using Kaiser-Meyer-Olkin (KMO) statistics and Bartlett's test of sphericity. Our statistical analysis revealed a Cronbach's alpha coefficient of 0.733 (73.3%) and a Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy of 0.697. The chi square test demonstrated that the overall perfect adherence was not significantly associated with the number of medications taken per day variable (p = 0.721). The Romanian version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale demonstrated suitability for its use in evaluating adherence in the intended population.
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Affiliation(s)
- Răzvan-Nicolae Rusu
- Pharmacodynamics and Clinical Pharmacy Department, Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Sebastian Gavril
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Daniela Carmen Ababei
- Pharmacodynamics and Clinical Pharmacy Department, Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ioana Macadan
- Pharmacodynamics and Clinical Pharmacy Department, Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Andrei Ciobîcă
- Physiology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Camelia Nicolae
- Department of Internal Medicine and Cardiology, “Carol Davila” University of Medicine and Pharmacy, “Prof. Dr. Th. Burghelia” Hospital, Buchares, Romania
| | - Răducu Ionuț Popescu
- Physiology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Walther Bild
- Physiology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Center of Biomedical Research of the Romanian Academy, Iasi, Romania
| | - Veronica Bild
- Pharmacodynamics and Clinical Pharmacy Department, Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Center of Biomedical Research of the Romanian Academy, Iasi, Romania
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Commodore-Mensah Y, Delva S, Ogungbe O, Smulcer LA, Rives S, Dennison Himmelfarb CR, Kim MT, Bone L, Levine D, Hill MN. A Systematic Review of the Hill-Bone Compliance to Blood Pressure Therapy Scale. Patient Prefer Adherence 2023; 17:2401-2420. [PMID: 37790863 PMCID: PMC10544210 DOI: 10.2147/ppa.s412198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/05/2023] [Indexed: 10/05/2023] Open
Abstract
Background Poor medication adherence hampers hypertension control and increases the risk of adverse health outcomes. Medication adherence can be measured with direct and indirect methods. The Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale, one of the most popular adherence measures, indirectly assesses adherence to hypertension therapy in three behavioral domains: appointment keeping, diet and medication adherence. Aim To synthesize evidence on the use of the HBCHBPT Scale, including psychometric properties, utility in diverse patient populations, and directions for future clinical use and research. Methods We searched electronic databases, specifically CINAHL, PubMed, PsychInfo, Embase, and Web of Science. We included original studies that used the HBCHBPT Scale or its subscales to measure a health outcome, or methodological studies involving translations and validations of the scale. We extracted and synthesized data following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results Fifty studies were included in this review, 44 on hypertension, two on diabetes, and others on other chronic conditions. The scale was successfully translated into numerous languages and used in descriptive and intervention studies. The scale demonstrated sound psychometric properties (Cronbach's α coefficient 0.75) and sensitivity to capture intervention effects when used to evaluate the effectiveness of high blood pressure adherence interventions. The medication-taking subscale of HBCHBPT performs best and is widely used in diverse contexts to assess medication adherence for chronic conditions. Conclusion The HBCHBPT Scale has high versatility globally and has been used in various settings by various healthcare worker cadres and researchers. The scale has several strengths, including high adherence phenotyping capabilities, contributing to the paradigm shift toward personalized health care.
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Affiliation(s)
- Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabianca Delva
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sally Rives
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Cheryl R Dennison Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloombery School of Public Health, Baltimore, MD, USA
| | - Miyong T Kim
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Lee Bone
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David Levine
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martha N Hill
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Nakwafila O, Sartorius B, Shumba TW, Dzinamarira T, Mashamba-Thompson TP. Stakeholder's perspectives on acceptable interventions for promoting hypertension medication adherence in Namibia: nominal group technique. BMJ Open 2023; 13:e068238. [PMID: 37192796 DOI: 10.1136/bmjopen-2022-068238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE To determine the most acceptable hypertension intervention package to promote hypertension adherence based on stakeholders' perspectives. DESIGN We employed the nominal group technique method and purposively sampled and invited key stakeholders offering hypertension services and patients with hypertension. Phase 1 was focused on determining barriers to hypertension adherence, phase 2 on enablers and phase 3 on the strategies. We employed the ranking method based on a maximum of 60 scores to establish consensus regarding hypertension adherence barriers, enablers and proposed strategies. SETTING AND PARTICIPANTS 12 key stakeholders were identified and invited to participate in the workshop in Khomas region. Key stakeholders included subject matter experts in non-communicable diseases, family medicine and representatives of our target population (hypertensive patients). RESULTS The stakeholders reported 14 factors as barriers and enablers to hypertension adherence. The most important barriers were: lack of knowledge on hypertension (57 scores), unavailability of drugs (55 scores) and lack of social support (49 scores). Patient education emerged as the most important enabler (57 scores), availability of drugs emerged second (53 scores) and third having a support system (47 scores). Strategies were 17 and ranked as follows: continuous patient education as the most desirable (54 scores) strategy to help promote hypertension adherence, followed by developing a national dashboard to primarily monitor stock (52 scores) and community support groups for peer counselling (49 scores). CONCLUSIONS Multifaceted educational intervention package targeting patient and healthcare system factors may be considered in implementing Namibia's most acceptable hypertension package. These findings will offer an opportunity to promote adherence to hypertension therapy and reduce cardiovascular outcomes. We recommend a follow-up study to evaluate the proposed adherence package's feasibility.
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Affiliation(s)
- Olivia Nakwafila
- Discipline of Public Health Medicine,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health,Department of Public Health, University of Namibia, Oshakati campus, Namibia
| | - Benn Sartorius
- Discipline of Public Health Medicine,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for Tropical Medicine and Global Health,Nuffield Department of medicine, University of Oxford, Oxford, UK
| | - Tonderai Washington Shumba
- School of Allied Health Sciences, Department of Occupational therapy and Physiotherapy, University of Namibia, Hage Geingob Campus, Namibia
| | - Tafadzwa Dzinamarira
- School of Health Systems&Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Tivani Phosa Mashamba-Thompson
- Discipline of Public Health Medicine,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Sharma JR, Dludla PV, Dwivedi G, Johnson R. Measurement Tools and Utility of Hair Analysis for Screening Adherence to Antihypertensive Medication. Glob Heart 2023; 18:17. [PMID: 36968302 PMCID: PMC10038111 DOI: 10.5334/gh.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Poor adherence to the prescribed antihypertensive therapy is an understated public health problem and is one of the main causes of the high prevalence of uncontrolled hypertension in sub-Saharan Africa. Medication adherence is vital for the effectiveness of antihypertensive treatment and is key to ameliorating the clinical outcomes in hypertensive patients. However, it has often been ignored because the current methods used to assess medication adherence are not reliable, limiting their utilization in clinical practice. Therefore, the identification of the most accurate and clinically feasible method for measuring medication adherence is critical for tailoring effective strategies to improve medication adherence and consequently achieve blood pressure goals. This review not only explores various available methods for estimating medication adherence but also proposes therapeutic drug monitoring in hair for the measurement of medication adherence to the antihypertensive medication period.
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Affiliation(s)
- Jyoti R. Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Phiwayinkosi V. Dludla
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Girish Dwivedi
- Medical School, University of Western Australia, Harry Perkins Institute of Medical Sciences, Fiona Stanley Hospital, Verdun Street, Nedlands WA, 6009, Australia
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
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Family support and medication adherence among residents with hypertension in informal settlements of Nairobi, Kenya: a mixed-method study. J Hum Hypertens 2023; 37:74-79. [PMID: 35046496 DOI: 10.1038/s41371-022-00656-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 01/31/2023]
Abstract
Suboptimal medication adherence is a major barrier to hypertension control in Kenya, especially among informal urban settlement areas (sometimes referred to as "slums"). The few studies that have specifically explored medication adherence among this population have received discordant results, implying that additional factors which influence medication adherence merit further investigation. This study explores the relationship between family support and medication adherence among people with hypertension in informal settlements in Nairobi, Kenya. We conducted a quantitative survey followed up by semi-structured qualitative interviews. The sampling frame comprised two health facilities in informal settlement areas of the Korogocho neighborhood and participants were recruited via convenience sampling. We performed multiple logistic regressions for quantitative data and thematic analysis for qualitative data. A total of 93 people participated in the survey (mean age: 57 ± 14.7, 66% female). Most participants reported high family support (82%, n = 76) and suboptimal medication adherence (43% by the Morisky Scale; 76% by the Hill-Bone Scale), with no significant associations between family support and medication adherence. During interviews, many participants reported they lacked health knowledge and education. We suggest that the lack of health knowledge among this population may have contributed to a failure for family support to meaningfully translate into improvements in medication adherence. Our results underscore the need for further research to improve hypertension control among this uniquely disadvantaged population, especially with respect to the possible mediating influence of health education on family support and medication adherence.
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Al-Alaili MK, Abdi AM, Basgut B. Test performance of self-report adherence tools in patients with hypertension: A systematic review and a meta-analysis. J Clin Pharm Ther 2022; 47:1932-1944. [PMID: 36401121 DOI: 10.1111/jcpt.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/20/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Adherence has proved to have a positive influence on achieving plausible treatment outcomes. Self-report questionnaires are widely used in evaluating adherence, creating thus a high-powered research field. This review aims to provide an update of scales used in hypertension, which are compared and analysed against reliability and validity. METHODS PubMed, Web of Science and Cochrane Library were searched in May 2022 to identify studies. We extracted the study characteristics and evaluated their quality. A random-effects model with subgroup analysis was used to calculate estimates and heterogeneity parameters as well as regressions, funnel and forest plots. A bivariate model was selected to conduct validity analyses and draw receiver operating characteristic (ROC) curves. RESULTS AND DISCUSSION Fifty-five articles were identified and classified into 22 different reliable and validated tools. Pooled analyses predicted an overall good Cronbach's alpha of 0.76 (95%CI:0.67-0.83), a good ICC of 0.8 (95%CI:0.72-0.86) and an excellent correlation coefficient of 0.91 (95%CI:0.86-0.95), which all showed high heterogeneity and slight detection of asymmetry. Regression analyses showed that only time and the number of items/scale type influenced significantly retest and alpha, respectively. Overall validity showed acceptable sensitivity of 0.65 (95%CI:0.53-0.75) and specificity of 0.57 (95%CI:0.47-0.67) with a good Area Under Curve (AUC) of 0.637. Upon comparison, four tools showed superiority over Morisky's scale. WHAT IS NEW AND CONCLUSION Adherence is a multi-dimensional phenomenon, which deems scales to be highly variable or complex; thus, complicating the selection process. Adherence to Refills and Medications Scale (ARMS) is the most promising free non-inferior alternative to Morisky, the most used scale.
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Affiliation(s)
| | - Abdikarim Mohamed Abdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Mersin, Turkey.,Department of Clinical Pharmacy, Faculty of Pharmacy, Yeditepe University, Ankara, Turkey
| | - Bilgen Basgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Mersin, Turkey.,Department of Pharmacology, Faculty of Pharmacy, Başkent University, Ankara, Turkey
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Moyo E, Barham L, Mhango M, Musuka G, Dzinamarira T. Estimating the budget impact of adopting tenofovir/emtricitabine for pre-exposure prophylaxis of HIV in the public health sector in Namibia (2021 - 2023). J Infect Public Health 2022; 15:1147-1155. [PMID: 36162151 DOI: 10.1016/j.jiph.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Although Namibia started implementing pre-exposure prophylaxis (PrEP) of Human Immunodeficiency Virus (HIV) in 2016, no study to determine its budget impact has been conducted. This study, therefore, aimed to estimate the budget impact of adopting tenofovir/emtricitabine for PrEP of HIV for all eligible people in the public health sector in Namibia from 2021 to 2023. METHODS A country-specific model was developed for this budget impact analysis (BIA). PrEP has targeted all eligible people in Namibia who receive health services from the public sector. It was assumed that the adherence rate was 75% and PrEP effectiveness 60% in this study. Costs used in this study were taken from a study that included Namibian costs. RESULTS The BIA suggests that adopting PrEP may be cost saving as US$104 823, US$143 620, and US$182 452 of additional HIV care costs will potentially be saved in 2021, 2022, and 2023, respectively. Cost savings rely on high adherence rates, high PrEP effectiveness rates, low PrEP costs, and a small number of people living with HIV (PLHIV). CONCLUSION Further economic analysis could aid decision-making in Namibia, both to stress test assumptions in the BIA and conduct cost-effectiveness analysis to estimate the value for money of PrEP.
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Affiliation(s)
| | - Leela Barham
- Faculty of Life Science and Education, Learna, Cardiff CF14 5GF, Wales, UK.
| | - Malizgani Mhango
- School of Public Health, University of Western Cape, 7535 Cape Town, South Africa.
| | | | - Tafadzwa Dzinamarira
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa.
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Alsofyani MA, Aloufi AO, Al-Qhtani NS, Bamansour SO, Almathkori RS. Factors related to treatment adherence among hypertensive patients: A cross-sectional study in primary healthcare centers in Taif city. J Family Community Med 2022; 29:181-188. [PMID: 36389026 PMCID: PMC9664459 DOI: 10.4103/jfcm.jfcm_153_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Antihypertensive medications must be taken as prescribed since noncompliance can result in the lack of hypertension (HTN) control. The aim of this study was to determine the factors that influence adherence to treatment by HTN patients in Taif city. MATERIALS AND METHODS A cross-sectional study was undertaken in basic healthcare centers in Taif city, Saudi Arabia. A simple random sampling method was used to select participants from primary healthcare centers. Data was obtained on patients' demographic characteristics, smoking habits, anti-HTN drugs and treatment characteristics, barriers to medication compliance, systolic and diastolic blood pressure (BP), anthropometric measurements, and family history of HTN and diabetes mellitus (DM). We used the 4-item Morisky Medication Adherence Scale (MMAS-4™) as a valid questionnaire to assess medication adherence. Data were analyzed using SPSS. Qualitative data was presented as numbers and percentages, and Chi-squared test was applied to test the relationship between qualitative variables. For quantitative data, mean and standard deviation was calculated. Multiple logistic regression analysis were performed to determine correlates of treatment adherence, and results were presented as Odds Ratio (OR) and 95% confidence interval (CI) for OR. RESULTS Of the 549 patients included, 36.8% did not have a regular check of their BP at home and the majority had a family history of HTN and diabetes. About 86% patients showed a high level of adherence. Income ≥5000 SAR, age ≥60 years, female gender, who were being married, having ≤10 family members, being unemployed, and never having smoked were associated with high adherence level. The most important factor that affected MMAS scores was the regular BP checks at home. CONCLUSION When patients attend routine follow-up clinics, it is critical to strengthen reminder mechanisms and provide regular counseling.
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Affiliation(s)
| | - Adel O. Aloufi
- Post Graduated Department, Public Health, Ministry of Health, Saudi Arabia
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11
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Pallangyo P, Komba M, Mkojera ZS, Kisenge PR, Bhalia S, Mayala H, Kifai E, Richard MK, Khanbhai K, Wibonela S, Millinga J, Yeyeye R, Njau NF, Odemary TK, Janabi M. Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending a Tertiary Cardiovascular Hospital in Tanzania: A Cross-Sectional Study. Integr Blood Press Control 2022; 15:97-112. [PMID: 35991354 PMCID: PMC9390787 DOI: 10.2147/ibpc.s374674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. Suboptimal adherence to BP-lowering agents is a growing global concern that is associated with the substantial worsening of disease, increased service utilization and health-care cost escalation. This study aimed to explore medication adherence and its associated factors among hypertension outpatients attending a tertiary-level cardiovascular hospital in Tanzania. Methods The pill count adherence ratio (PCAR) was used to compute adherence rate. In descriptive analyses, adherence was dichotomized and consumption of less than 80% of the prescribed medications was used to denote poor adherence. Logistic regression analyses was used to determine factors associated with adherence. Results A total of 849 outpatients taking antihypertensive drugs for ≥1 month prior to recruitment were randomly enrolled in this study. The mean age was 59.9 years and about two-thirds were females. Overall, a total of 653 (76.9%) participants had good adherence and 367 (43.2%) had their blood pressure controlled. Multivariate logistic regression analysis showed; lack of a health insurance (OR 0.5, 95% CI 0.3–0.7, p<0.01), last BP measurement >1 week (OR 0.6, 95% CI 0.4–0.8, p<0.01), last clinic attendance >1 month (OR 0.4, 95% CI 0.3–0.6, p<0.001), frequent unavailability of drugs (OR 0.6, 95% CI 0.3–0.9, p = 0.03), running out of medication before the next appointment (OR 0.6, 95% CI 0.4–0.9, p = 0.01) and stopping medications when asymptomatic (OR 0.6, 95% CI 0.4–0.8, p<0.001) to be independent associated factors for poor adherence. Conclusion A substantial proportion of hypertensive outpatients in this tertiary-level setting had good medication adherence. Nonetheless, observed suboptimal blood pressure control regardless of a fairly satisfactory adherence rate suggests that lifestyle modification plays a central role in hypertension management.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Makrina Komba
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Engerasiya Kifai
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mwinyipembe K Richard
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Robert Yeyeye
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Nelson F Njau
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Thadei K Odemary
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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12
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Basenero A, Neidel J, Ikeda DJ, Ashivudhi H, Mpariwa S, Kamangu JWN, Mpalang Kakubu MA, Hans L, Mutandi G, Jed S, Tjituka F, Hamunime N, Agins BD. Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach. PLoS One 2022; 17:e0272727. [PMID: 35951592 PMCID: PMC9371294 DOI: 10.1371/journal.pone.0272727] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hypertension (HTN) is highly prevalent among people with HIV (PWH) in Namibia, but screening and treatment for HTN are not routinely offered as part of HIV care delivery. We report the implementation of a quality improvement collaborative (QIC) to accelerate integration of HTN and HIV care within public-sector health facilities in Namibia. Methods Twenty-four facilities participated in the QIC with the aim of increasing HTN screening and treatment among adult PWH (>15 years). HTN was defined according to national treatment guidelines (i.e., systolic blood pressure >140 and/or diastolic blood pressure >90 across three measurements and at least two occasions), and decisions regarding initiation of treatment were made by physicians only. Teams from participating hospitals used quality improvement methods, monthly measurement of performance indicators, and small-scale tests of change to implement contextually tailored interventions. Coaching of sites was performed on a monthly basis by clinical officers with expertise in QI and HIV, and sites were convened as part of learning sessions to facilitate diffusion of effective interventions. Results Between March 2017 and March 2018, hypertension screening occurred as part of 183,043 (86%) clinical encounters at participating facilities. Among 1,759 PWH newly diagnosed with HTN, 992 (56%) were initiated on first-line treatment. Rates of treatment initiation were higher in facilities with an on-site physician (61%) compared to those without one (51%). During the QIC, facility teams identified fourteen interventions to improve HTN screening and treatment. Among barriers to implementation, teams pointed to malfunctions of blood pressure machines and stock outs of antihypertensive medications as common challenges. Conclusions Implementation of a QIC provided a structured approach for integrating HTN and HIV services across 24 high-volume facilities in Namibia. As rates of HTN treatment remained low despite ongoing facility-level changes, policy-level interventions—such as task sharing and supply chain strengthening—should be pursued to further improve delivery of HTN care among PWH beyond initial screening.
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Affiliation(s)
| | - Julie Neidel
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Daniel J. Ikeda
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | | | - Linea Hans
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Gram Mutandi
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Suzanne Jed
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Pretoria, South Africa
| | | | | | - Bruce D. Agins
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- * E-mail:
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13
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A Cross-Sectional Study on Hypertension Medication Adherence in a High-Burden Region in Namibia: Exploring Hypertension Interventions and Validation of the Namibia Hill-Bone Compliance Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074416. [PMID: 35410095 PMCID: PMC8998252 DOI: 10.3390/ijerph19074416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
Abstract
In Namibia, the prevalence of hypertension among women and men aged 35−64 years is high, ranging from 44% to 57%. In this study, we aimed to determine adherence and predictors to antihypertensive therapy in Khomas region, Namibia. A cross-sectional study was performed to consecutively sample 400 patients from urban and peri-urban settings in Namibia. Results were validated using the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Crude associations between predictors of adherence and compliance were tested using the Pearson chi-square test. A multivariable logistic regression analysis was then performed on adherence variables found to be significant to adjust for confounders, and the results are presented as adjusted odds ratios (aOR) with 95% confidence intervals. A total of 400 patients participated in this study. The participants’ mean age and standard deviation were Mean ± SD = 48.9 ± 12.5. In this study, 351 (87.7%) patients were estimated to have good adherence. Education, employment, and the presence of other chronic diseases were associated with adherence. Following multivariate adjustment, the following factors were significantly associated and are therefore predictors of adherence (95%CI, p < 0.005): receiving enough medication at last check-up until next one (OR = 5.44, CI 1.76−16.85), lack of encouragement from family and friends (OR = 0.11 (0.03−0.42)), and attendance of follow-ups on schedule (OR = 8.49, CI = 3.82−18.85). The success of hypertension therapy is dependent on the healthcare systems and healthcare professionals in supplying enough medication, support of friends/family, and maintaining scheduled follow-ups. A combination of interventions using low-cost mobile technology led by healthcare professionals could be endorsed. To fully practice universal access to medication, public and private hospitals in Namibia should collaborate.
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14
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Shakya R, Shrestha R, Shrestha S, Sapkota P, Gautam R, Rai L, Khatiwada AP, Ranabhat K, KC B, Sapkota B, Khanal S, Paudyal V. Translation, Cultural Adaptation and Validation of the Hill Bone Compliance to High Blood Pressure Therapy Scale to Nepalese Language. Patient Prefer Adherence 2022; 16:957-970. [PMID: 35422613 PMCID: PMC9005151 DOI: 10.2147/ppa.s349760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/14/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Control of high blood pressure and prevention of cardiovascular complications among hypertensive patients depends on patients' adherence to therapy. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) is one of the most popular scale to assess hypertensive patients' adherence behaviour. Unfortunately, no questionnaire in the Nepalese language is available to date to assess adherence to anti-hypertensive therapy. AIM To translate, culturally adapt and validate the English original version of the HBCTS into Nepalese language to measure treatment adherence of Nepalese hypertensive patients. METHODS The cross-sectional study was conducted to translate, culturally adapt and validate the HBCTS into Nepalese version. The standard translation process was followed and was evaluated among 282 hypertensive patients visiting selected primary healthcare centers (PHCCs) of Kathmandu district, Nepal. Cronbach's alpha was measured to assess the reliability of the tool. Exploratory factor analysis using principal component analysis with varimax rotation was used to evaluate structural validity. RESULTS The mean±SD age of 282 participants was 58.49±12.44 years. Majority of participants were literate (75.2%), and consumed at least one anti-hypertensive medication per day (85.5%). Nearly half (42.2%) of the participants had a family history of hypertension, and almost half (48%) of them had comorbid conditions. Mean ±SD score for overall adherence was 17.85±3.87 while those of medication taking, reduced salt taking, and appointment keeping subscales were 10.63±2.55, 4.16±1.12 and 3.06±1.07, respectively. Kaiser Meyer Olkin (KMO) was found to be 0.877. Exploratory factor analysis revealed a three-component structure; however, the loading of components into medication adherence, reduced salt intake and appointment keeping constructs were not identical to the original tool. Cronbach's alpha score for the entire HBCTS scale was 0.846. CONCLUSION The translated Nepali version of the HBCTS demonstrated acceptable reliability and validity to measure adherence to antihypertensive therapy among hypertensive patients in clinical and community settings in Nepal.
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Affiliation(s)
- Rajina Shakya
- Department of Nursing, Nobel College, Kathmandu, Province Bagmati, Nepal
| | - Rajeev Shrestha
- Department of Pharmacy, District Hospital Lamjung, Lamjung, Province Gandaki, Nepal
- Correspondence: Rajeev Shrestha, Department of Pharmacy, District Hospital Lamjung, Besisahar, Province Gandaki, Nepal, Tel +977 9845445205, Email
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
- Sunil Shrestha, School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia, Tel +60 102874113, Email
| | - Priti Sapkota
- Department of Nursing, Nobel College, Kathmandu, Province Bagmati, Nepal
| | - Roshani Gautam
- Department of Nursing, Tribhuvan University, Maharajgunj Nursing Campus, Kathmandu, Nepal
| | - Lalita Rai
- Department of Nursing, Tribhuvan University, Maharajgunj Nursing Campus, Kathmandu, Nepal
| | - Asmita Priyadarshini Khatiwada
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal
| | - Kamal Ranabhat
- Center Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
- Ministry of Health and Population, Kathmandu, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Binaya Sapkota
- Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, Nepal
| | - Saval Khanal
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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15
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Hango E, Amakali K, Shilunga A, Kibuule D, Godman B, Kalemeera F. Assessing smoking cessation services and pharmacotherapy in Namibia; findings and implications for future policy initiatives. Expert Rev Pharmacoecon Outcomes Res 2021; 22:699-710. [PMID: 34720025 DOI: 10.1080/14737167.2022.2000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND : Tobacco smoking is a considerable barrier to reducing morbidity and mortality associated with non-communicable diseases (NCDs). However, few studies in sub-Saharan Africa have explored access to smoking cessation programs including smoking cessation pharmacotherapy (SCP). This needs to be addressed given the growing burden of NCDs across sub-Saharan Africa including Namibia. METHODS : Multi-facility cross sectional survey among physicians in both public and private sectors in Namibia. RESULTS : Of the 106 physicians recruited, 69% practiced in public health facilities and 92% were non-smokers. 67% offer smoking cessation services, with 64% of these offering SCP. This was mainly nicotine replacement therapy (53%) and bupropion SR (41%). Overall, all physicians had a low knowledge score of SCP (<50%). The mean knowledge score though was 77% lower among physicians in public versus private sectors (OR=0.23, 95%CI: 0.14-0.35, p<0.001). Principal barriers to prescribing SCP were inadequate knowledge and/or lack of smoking cessation guidelines. This is not surprising with SCP medicines not currently listed within the public medicine list in Namibia. CONCLUSION : Despite good attitudes towards SCP, there are concerns with physicians' knowledge and practices especially in the public sector. There is an urgent need to address this and integrate services to reduce NCDs in Namibia.
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Affiliation(s)
- Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Kristofina Amakali
- School of Nursing, Faculty of Health Sciences, University of Namibia, Namibia
| | - Anna Shilunga
- School of Public Health, Faculty of Health Sciences, University of Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Brian Godman
- Strathchlyde Institute of Pharmacy and Biomedical Science, Strathclyde University, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
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16
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Pan J, Hu B, Wu L, Li Y. The Effect of Social Support on Treatment Adherence in Hypertension in China. Patient Prefer Adherence 2021; 15:1953-1961. [PMID: 34522088 PMCID: PMC8434919 DOI: 10.2147/ppa.s325793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Treatment nonadherence is a major problem in the management of hypertension. There are many factors influencing the treatment adherence of hypertensive patients. The aim of this study was to examine the effect of social support on the treatment adherence in hypertension in China. PATIENTS AND METHODS A total of 453 patients with hypertension hospitalized in a tertiary hospital in Xi'an, China were invited to participate in this cross-sectional study. Data were collected by "modified Chinese Hill-Bone compliance to high blood pressure therapy scale" and "Chinese Family Support Scale". RESULTS It was found that 31.1% of patients were adherent with their antihypertensive treatments. Gender, duration of antihypertensive drug used, number of antihypertensive drugs used and social support were independently associated with hypertensive treatment adherence. Social support was strongly and positively associated with the hypertensive treatment adherence (P<0.001, OR = 0.752, 95% CI: 0.678-0.833). Family social support was provided to hypertensive patients mainly through their nuclear family, that is spouses, partner or children. Treatment adherence of hypertensive patients was positively correlated to the three subgroups of social support. It was found that social support provided to patients from social resource (r=0.568) had greater impact on treatment adherence than that from kinship (r=0.364) and nuclear family (r=0.262). CONCLUSION Treatment adherence of patients with hypertension was found to increase positively as their social support increased. In addition to the support given to patients from nuclear family members, other social support especially professional agencies and community organizations should also be promoted and strengthened.
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Affiliation(s)
- Jingjing Pan
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, People’s Republic of China
| | - Bin Hu
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, People’s Republic of China
| | - Lian Wu
- Department of Ophthalmology, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, People’s Republic of China
| | - Yarong Li
- Department of Pharmacy, School of Pharmaceutical Sciences, Xi’an Medical University, Xian, People’s Republic of China
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17
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Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life (Basel) 2021; 11:life11060528. [PMID: 34200116 PMCID: PMC8229985 DOI: 10.3390/life11060528] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia
- Correspondence: ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562
| | - Abiodun Egwuenu
- AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia;
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya;
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Natalie Schellack
- Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan;
| | - Jacqueline Sneddon
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania;
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Julius Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana;
| | - Renata Cristina Rezende Macedo do Nascimento
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil;
| | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil;
- Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon;
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini;
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana;
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia;
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria;
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria;
- Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan;
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam;
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia;
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Janney Wale
- Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia;
| | - R. Andrew Seaton
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
- Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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18
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Sefah IA, Essah DO, Kurdi A, Sneddon J, Alalbila TM, Kordorwu H, Godman B. Assessment of adherence to pneumonia guidelines and its determinants in an ambulatory care clinic in Ghana: findings and implications for the future. JAC Antimicrob Resist 2021; 3:dlab080. [PMID: 34223139 PMCID: PMC8210001 DOI: 10.1093/jacamr/dlab080] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/12/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Adherence to local standard guidelines is seen as a pragmatic way to measure and improve the quality of future prescribing in ambulatory care to reduce morbidity, mortality and healthcare costs. OBJECTIVES To evaluate adherence to the Ghana Standard Treatment Guidelines (STGs) for the empirical antibiotic treatment of ambulatory care patients with community-acquired pneumonia (CAP) in a region in Ghana and factors associated with it. METHODS A cross-sectional survey was conducted using a checklist to collect data from the hospital electronic database, which included sociodemographic details, payment type and clinical information of all ambulatory patients attending Keta Municipal Hospital, diagnosed and managed for CAP from September 2018 to January 2019. Prescriptions were assessed for adherence to the Ghana STG based on choice of antibiotics. A χ2 test and multiple logistic regression were subsequently conducted. RESULTS A total of 1929 patient records with diagnosis of CAP within the study period at the ambulatory clinic were identified. The overall rate of adherence to the Ghana STG was 32.50% (n = 627). From the patient records collected, 62.50% were female, 41.84% were children (0-12 years), and 97.15% had a valid national health insurance status. Adherence was associated with the duration of antibiotic prescribing, number of additional antibiotics prescribed and some patients' clinical characteristics. CONCLUSIONS The rate of adherence to Ghana STG among the study population was low. Efforts must be made to train and encourage prescribers to follow empirical guidelines to reduce inappropriate selection of antibiotics in the ambulatory care settings.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Darius Obeng Essah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G12NP, UK
| | - Thelma Mpoku Alalbila
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Hope Kordorwu
- Nursing Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, 0208, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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19
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Sarfo FS, Norman B, Appiah L, Ovbiagele B. Factors associated with incidence of stroke and heart failure among people living with HIV in Ghana: Evaluating Vascular Event Risk while on Long-Term Antiretroviral Suppressive Therapy (EVERLAST) Study. J Clin Hypertens (Greenwich) 2021; 23:1252-1259. [PMID: 33939257 PMCID: PMC8678797 DOI: 10.1111/jch.14255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022]
Abstract
People living with HIV (PLWH) have a two‐fold higher risk of cardiovascular diseases (CVDs) compared with HIV‐negative populations. Although 70% of the global HIV population reside in Africa, data on CVD outcomes among PLWH are scarce. We seek to evaluate factors associated with incidence of stroke and heart failure in a prospective cohort of Ghanaian PLWH. We followed up a cohort of PLWH on antiretroviral therapy for 12 months to assess rates of clinically adjudicated stroke, and heart failure. We calculated incidence rates of events/1000 person‐years and fitted Cox proportional hazards regression models to identify factors associated with incident stroke and heart failure as a combined outcome measure and as separate outcome measures. Among 255 participants, the mean age was 46 years and 211 (82.7%) were female. The participants contributed 245 years of follow‐up data with mean follow‐up duration of 11.5 months. There were three incident strokes giving an incidence rate of 12.24 per 1000 person‐years (95% CI: 3.13–33.33) and two heart failure events with an incidence rate of 8.16 (95%CI: 1.37–26.97) per 1000 py. The combined event rate was 20.41 (95% CI: 7.48–45.24) per 1000 py. Being hypertensive was associated with aHR of 8.61 (1.32–56.04) of the combined outcome while each 100 cells/mm3 rise in CD4 count was associated with aHR of 0.56 (0.35–0.88). Carotid bulb intimal media thickness was independently associated with stroke occurrence with aHR of 12.23 (1.28–117.07). People living with HIV on long‐term cART in this Ghanaian sample have high rates of clinically adjudicated cardiovascular diseases driven by uncontrolled hypertension and persisting immunosuppression. Integration of CVD care into routine HIV management may help alleviate this untoward confluence of rising CVDs among PLWH.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Betty Norman
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lambert Appiah
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
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20
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Naser AY. Cost-related nonadherence for prescription medications: a cross-sectional study in Jordan. Expert Rev Pharmacoecon Outcomes Res 2021; 22:497-503. [PMID: 33666532 DOI: 10.1080/14737167.2021.1899814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Cost-related nonadherence to medications is a commonly encountered problem posed by many patients, and specifically among elderly patients who use multiple chronic medications. This study aims to explore the prevalence of medication cost-related nonadherence and its predictors in Jordan.Method: A cross-sectional study was conducted between February 2019 and May 2019 in Jordan. The CRN questionnaire was used as a measure to assess the prevalence of cost-related nonadherence. Logistic regression was used to determine predictors of medication cost-related nonadherence.Results: The prevalence rate of CRN was 29.6% (95% CI: 27.0-32.3). Participants who are married or widowed were found to have higher odds of being non-adherent due to medication costs, with an odds ratio of 1.55 (95%CI: 1.19-2.00) and 1.95 (95%CI: 1.20-3.15), respectively. Lower educational level was associated with higher odds of being non-adherent 1.95 (95%CI: 1.25-3.05). Being retired was associated with higher odds of being non-adherent (2.20 (95%CI: 1.49-3.27)).Conclusion: Cost-related nonadherence is a common problem in Jordan and was most prevalent among those with hypertension and diabetes mellitus, low-income, and low levels of education. Our findings could help in developing interventions to improve cost-related medication nonadherence in developing countries.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmac eutics and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
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21
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Barbosa MM, Nascimento RC, Garcia MM, Acurcio FA, Godman B, Guerra AA, Alvares-Teodoro J. Strategies to improve the availability of medicines in primary health care in Brazil: findings and implications. J Comp Eff Res 2021; 10:243-253. [PMID: 33541125 DOI: 10.2217/cer-2020-0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Aim: Access to essential medicines is a key component of managing patients in ambulatory care. In 2008, the State of Minas Gerais, Brazil, created the Pharmacy Network of Minas (Rede Farmácia de Minas [RFM]) program to improve access to medicines, increasing availability and restructuring the infrastructures. The aim was to assess the current situation, comparing municipalities with and without RFM. Materials & methods: Descriptive survey study, data collected from 2014 July to May 2015. Availability was verified by stock levels. Results: The drug availability index was 61.0%, higher in municipalities with RFM. Most physicians considered the pharmaceutical services as good/very good. The main reasons for medicines shortage were 'financial transference problems', 'insufficient financial resources' and 'budget'. Conclusion: Strategies, such as the RFM can promote improvements in medicine availability.
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Affiliation(s)
- Mariana M Barbosa
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Renata Crm Nascimento
- School of Pharmacy, Department of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Marina M Garcia
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Francisco A Acurcio
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, SE 141 86, Sweden.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Augusto A Guerra
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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22
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Mashozhera S, Bamitale SK, Godman B, Kibuule D. Compliance to hypertensive prescribing guidelines and blood pressure control in elderly patients in Namibia: findings and implications. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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
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Affiliation(s)
- Shylet Mashozhera
- Department of Pharmacology and Therapeutics, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Samuel Kayode Bamitale
- Department of Pharmacology and Therapeutics, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
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23
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Sefah IA, Ogunleye OO, Essah DO, Opanga SA, Butt N, Wamaitha A, Guantai AN, Chikowe I, Khuluza F, Kibuule D, Nambahu L, Abubakar AR, Sani IH, Saleem Z, Kalungia AC, Thi Phuong TN, Haque M, Islam S, Kumar S, Sneddon J, Wamboga J, Wale J, Miljković N, Kurdi A, Martin AP, Godman B. Rapid Assessment of the Potential Paucity and Price Increases for Suggested Medicines and Protection Equipment for COVID-19 Across Developing Countries With a Particular Focus on Africa and the Implications. Front Pharmacol 2021; 11:588106. [PMID: 33628173 PMCID: PMC7898676 DOI: 10.3389/fphar.2020.588106] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Countries across Africa and Asia have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE). However, there has been considerable controversy surrounding some treatments including hydroxychloroquine where the initial hype and misinformation led to shortages, price rises and suicides. Price rises and shortages were also seen for PPE. Such activities can have catastrophic consequences especially in countries with high co-payment levels. Consequently, there is a need to investigate this further. Objective: Assess changes in utilisation, prices, and shortages of pertinent medicines and PPE among African and Asian countries since the start of pandemic. Our approach: Data gathering among community pharmacists to assess changes in patterns from the beginning of March until principally the end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: One hundred and thirty one pharmacists took part building on the earlier studies across Asia. There were increases in the utilisation of principally antimalarials (hydroxychloroquine) and antibiotics (azithromycin) especially in Nigeria and Ghana. There were limited changes in Namibia and Vietnam reflecting current initiatives to reduce inappropriate prescribing and dispensing of antimicrobials. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries where documented. In addition, generally limited change in the utilisation of herbal medicines. However, shortages have resulted in appreciable price increases in some countries although moderated in others through government initiatives. Suggestions in Namibia going forward included better planning and educating patients. Conclusion: Encouraging to see increases in the utilisation of vitamins/immune boosters and PPE. However, concerns with increased utilisation of antimicrobials needs addressing alongside misinformation, unintended consequences from the pandemic and any appreciable price rises. Community pharmacists and patient organisations can play key roles in providing evidence-based advice, helping moderate prices through improved stock management, and helping address unintended consequences of the pandemic.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Darius Obeng Essah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Nadia Butt
- Pharmaceutical Society of Kenya, Nairobi, Kenya
| | | | - Anastasia Nkatha Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Felix Khuluza
- Pharmacy Department, College of Medicine, Blantyre, Malawi
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Lahya Nambahu
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Abdullahi Rabiu Abubakar
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria
| | - Ibrahim Haruna Sani
- Unit of Pharmacology, College of Health Sciences, Yusuf Maitama Sule University, Kano, Nigeria
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | | | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | | | - Joshua Wamboga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Nenad Miljković
- Institute of Orthopaedic Surgery “Banjica”, University of Belgrade, Belgrade, Serbia
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Antony P. Martin
- Faculty of Health and Life Sciences, Brownlow Hill, Liverpool, United Kingdom
- QC Medica, York, United Kingdom
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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24
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Rampamba EM, Meyer JC, Helberg E, Godman B. Medicines Availability among Hypertensive Patients in Primary Health Care Facilities in a Rural Province in South Africa: Findings and Implications. J Res Pharm Pract 2021; 9:181-185. [PMID: 33912500 PMCID: PMC8067899 DOI: 10.4103/jrpp.jrpp_20_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022] Open
Abstract
Objective: Controlling blood pressure (BP) in hypertensive patients is a challenge, with the lack of antihypertensive medicines negatively impacting on BP control. Consequently, we assessed the availability of prescribed antihypertensives among patients with chronic hypertension attending primary health care (PHC) facilities in a rural province of South Africa and explored any association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data that included patients' demographics, BP, and data on medicines availability of the intervention group from a 3 months' operational study conducted in rural PHC facilities in South Africa were analyzed. The association between medicines availability, the number of antihypertensive medicines, and BP control was explored. Findings: Fifty-five African patients (89.1% females) with a mean age of 61.3 years were included. Two-thirds (67.2%) received all their medicines during their monthly visits, 25.5% received some, and for 7.3%, there was no record of whether medicines were dispensed or not. Patients with controlled BP (60.0%) were more likely to have been prescribed only one antihypertensive medicine compared to patients with uncontrolled BP (20.7%) (P = 0.017; odds ratio: 5.75; 95% confidence interval: 1.46, 22.61). Conclusion: It is concerning that one-third of patients went home without all of their antihypertensive medicines from PHC facilities in this Province of South Africa where there is evidence of use of herbal medicines and uncontrolled BP contributing to high morbidity and mortality from cardiovascular diseases. Additional studies are needed to fully explore the association between medicines availability, their use, and BP control among patients.
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Affiliation(s)
- Enos M Rampamba
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Province, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Elvera Helberg
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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25
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Sarfo FS, Norman B, Nichols M, Appiah L, Osei Assibey S, Tagge R, Ovbiagele B. Prevalence and incidence of pre-diabetes and diabetes mellitus among people living with HIV in Ghana: Evidence from the EVERLAST Study. HIV Med 2020; 22:231-243. [PMID: 33174302 DOI: 10.1111/hiv.13007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Available data from high-income countries suggest that people living with HIV (PLWH) have a four-fold higher risk of diabetes compared with HIV-negative people. In sub-Saharan Africa, with 80% of the global burden of HIV, there is a relative paucity of data on the burden and determinants of prevalent and incident dysglycaemia. OBJECTIVES To assess the prevalence and incidence of pre-diabetes (pre-DM) and overt diabetes mellitus (DM) among PLWH in a Ghanaian tertiary medical centre. METHODS We first performed a cross-sectional comparative analytical study involving PLWH on combination antiretroviral therapy (cART) (n = 258), PLWH not on cART (n = 244) and HIV-negative individuals (n = 242). Diabetes, pre-DM and normoglycaemia were defined as haemoglobin A1C (HBA1c) > 6.5%, in the range 5.7-6.4% and < 5.7% respectively. We then prospectively followed up the PLWH for 12 months to assess rates of new-onset DM, and composite of new-onset DM and pre-DM. Multivariate logistic regression models were fitted to identify factors associated with dysglycaemia among PLWH. RESULTS The frequencies of DM among PLWH on cART, PLWH not on cART and HIV-negative individuals were 7.4%, 6.6% and 7.4% (P = 0.91), respectively, while pre-DM prevalence rates were 13.2%, 27.9% and 27.3%, respectively (P < 0.0001). Prevalent DM was independently associated with increasing age [adjusted odds ratio (95% confidence interval) (aOR, 95% CI) = 1.82 (1.20-2.77) for each 10-year rise], male sex [aOR = 2.64 (1.20-5.80)] and log(triglyceride/HDL cholesterol) [aOR = 8.54 (2.53-28.83)]. Prevalent pre-DM was independently associated with being on cART [aOR (95% CI) = 0.35 (0.18-0.69)]. There were a total of 12 cases of incident DM over 359.25 person-years, giving 33.4/1000 person-years of follow-up (PYFU) (95% CI: 18.1-56.8/1000), and an rate of incident pre-DM of 212.7/1000 PYFU (95 CI: 164.5-270.9/1000). The two independent factors associated with new-onset DM were having pre-DM at enrolment [aOR = 6.27 (1.89-20.81)] and being established on cART at enrolment [aOR = 12.02 (1.48-97.70)]. CONCLUSIONS Incidence rates of pre-DM and overt DM among Ghanaian PLWH on cART ranks among the highest in the literature. There is an urgent need for routine screening and a multidisciplinary approach to cardiovascular disease risk reduction among PLWH to reduce morbidity and mortality from the detrimental effects of dysglycaemia.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.,Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Betty Norman
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.,Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Shadrack Osei Assibey
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Raelle Tagge
- Northern California Institute of Research and Education, San Francisco, CA, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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26
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Fadare JO, Enwere OO, Adeoti AO, Desalu OO, Godman B. Knowledge and Attitude of Physicians Towards the Cost of Commonly Prescribed Medicines: A Case Study in Three Nigerian Healthcare Facilities. Value Health Reg Issues 2020; 22:68-74. [PMID: 32798837 DOI: 10.1016/j.vhri.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE One of the core principles of rational prescribing is consideration of the cost of the medicines prescribed, especially in countries with high patient copayments and low incomes such as Nigeria. Little is known about Nigerian physicians' knowledge about the cost of commonly prescribed medicines. The principal objective of the study was to assess the knowledge of Nigerian physicians about the cost of commonly prescribed medicines. METHODS Descriptive cross-sectional survey conducted among physicians in 3 tertiary institutions in Nigeria. Apart from socio-demographic and other information, questions about the estimated costs of branded and generic versions of 11 commonly prescribed medications were included in the questionnaire. RESULTS One hundred and seventy-nine (179; 95.7%) respondents agreed that costs of medicines were important when writing prescriptions, although only 7 (3.7%) of them had any formal training in the economics of healthcare. The median percentages of respondents with accurate estimated costs for generic and originator brands were 6.2% and 12%, respectively. Respondents were more knowledgeable about the cost of medicines used for the treatment of infectious diseases (malaria, bacterial infections) than noncommunicable diseases (diabetes mellitus, hypertension, and dyslipidemia). CONCLUSIONS The knowledge of Nigerian physicians in the 3 participating hospitals about the costs of commonly prescribed medicines was poor. This is despite their awareness about the importance of costs of medicines when prescribing.
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Affiliation(s)
- Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria.
| | - Okezie O Enwere
- Department of Medicine, Imo State University, Orlu, Imo State, Nigeria
| | - Adekunle O Adeoti
- Department of Medicine, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | - Olufemi O Desalu
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
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27
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Niaz Q, Godman B, Campbell S, Kibuule D. Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications. Int J Clin Pharm 2020; 42:1227-1236. [PMID: 32458227 PMCID: PMC7476965 DOI: 10.1007/s11096-020-01056-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.
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Affiliation(s)
- Qamar Niaz
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK.
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
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Haines HM, Meyer JC, Summers RS, Godman BB. Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district. Eur J Clin Pharmacol 2020; 76:991-1001. [PMID: 32296857 PMCID: PMC7306046 DOI: 10.1007/s00228-020-02862-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/26/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Adverse drug reactions (ADRs) have an appreciable impact on patients' health. Little is known however about ADR reporting in ambulatory care environments especially in low- and middle-income countries. Consequently, our aim was to determine knowledge, attitudes and practices (KAP) among health care professionals (HCPs) towards ADR reporting in primary health care (PHC) facilities in South Africa. The findings will be used to direct future activities. METHODS Descriptive, cross-sectional design using quantitative methodology among 8 public sector community health care centres and 40 PHC clinics in the Tshwane Health District, Gauteng Province. A self-administered questionnaire was distributed to 218 HCPs, including all key groups. RESULTS A total of 200 responses were received (91.7%). Although an appropriate attitude towards ADR reporting existed, the actual frequency of ADR reporting was low (16.0%). Of the respondents, 60.5% did not know how to report, where to report or when to report an ADR and 51.5% said the level of their clinical knowledge made it difficult to decide whether or not an ADR had occurred. Over 97.5% stated they should be reporting ADRs with 89% feeling that ADR reporting is a professional obligation and over 70% that ADR reporting should be compulsory. When results were combined, the overall mean score in terms of positive or preferred practices for ADR reporting was 24.6% with pharmacists having the highest scores. CONCLUSION Under-reporting of ADRs with gaps in KAP was evident. There is a serious and urgent need for education and training of HCPs on ADR reporting in South Africa.
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Affiliation(s)
- H. M. Haines
- Tshwane Regional Pharmacy, Tshwane, South Africa
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
| | - J. C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
| | - R. S. Summers
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
| | - B. B. Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE UK
- Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool, UK
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Herskind J, Zelasko J, Bacher K, Holmes D. The outpatient management of hypertension at two Sierra Leonean health centres: A mixed-method investigation of follow-up compliance and patient-reported barriers to care. Afr J Prim Health Care Fam Med 2020; 12:e1-e7. [PMID: 32634014 PMCID: PMC7343919 DOI: 10.4102/phcfm.v12i1.2222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. AIM This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. SETTING Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. METHODS A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. RESULTS Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. CONCLUSIONS In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts.
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Affiliation(s)
- Jenna Herskind
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
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30
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Khan TA, Hussain S, Ikram A, Mahmood S, Riaz H, Jamil A, Amin A, Haider YG, Sandhu M, Mushtaq A, Barbui C, Johnson CF, Godman B. Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications. Hosp Pract (1995) 2020; 48:145-160. [PMID: 32343632 DOI: 10.1080/21548331.2020.1762366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives. METHODS Multi-centered, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population. RESULTS 57,664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population. CONCLUSIONS There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.
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Affiliation(s)
- Tanveer Ahmed Khan
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Shahzad Hussain
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Aamer Ikram
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Sidra Mahmood
- Department of Pharmacy, Quaid-e-Azam University , Islamabad, Pakistan
| | - Humayun Riaz
- Department of Pharmaceutics, Rashid Latif College of Pharmacy , Lahore, Pakistan
| | - Ayesha Jamil
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | - Amina Amin
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | | | - Marva Sandhu
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Atifa Mushtaq
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona , Verona, Italy
| | - Chris F Johnson
- Pharmacy Services, National Health Service Greater Glasgow and Clyde (NHS GGC) , Glasgow, UK
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden.,Department of Pharmacoepidemiolgy, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK.,Health Economics Centre, Liverpool University , Liverpool, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
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31
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Kudzinesta M, Mubita M, Kalemeera F, Godman B, Hango E, Kibuule D. Utility of medicines information leaflets in hypertensive care in a setting with low health literacy: A cross-sectional study. MEDICINE ACCESS @ POINT OF CARE 2020; 4:2399202620910031. [PMID: 36204088 PMCID: PMC9413747 DOI: 10.1177/2399202620910031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 02/05/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Higher levels of health literacy improve utilization of health information,
medication adherence and outcomes. Few studies evaluate the utility of
medicines information in hypertensive care in settings with low health
literacy. Aim: To determine the level of health literacy and utility of medicines
information leaflets (MILs) among hypertensive patients in public health
care in Namibia. Methods: A hospital-based survey among hypertensive patients receiving care at a
referral hospital in Namibia from the 8 June 2018 to 29 June 2018. Patient’s
health literacy and utility of MIL were assessed using three literacy tools
and a survey questionnaire. Quantitative data were analysed using
descriptive statistics and qualitative thematic content analysis for factors
associate with the utility of the MIL. Results: Of the 139 patients, 63% were female and the mean age was 45.7 (range:
19.0–84.0) years. Over 85.6% had of low literacy skills (Rapid Estimate of
Literacy in Medicine (REALM) score <44, that is, unable to read simple
health materials), 38.8% had positive Single Item Literacy Screener (SILS)
scores (⩾2, require help to read medicines information) and 66.9% had
inadequate skills for comprehension, appraisal and decision-making with
regard to health information (Health Literacy Skills Instrument-Short Form
(HLSI-SF) score <70%). The level of access to and utility of MIL were
low, 32.4% and 34.6%, respectively. The main factors associated with poor
utility of the MIL were low patient health literacy, lack of guidelines on
the use of MIL and MIL written in non-native languages. Conclusion: Low rates of health literacy and utility of MIL were observed among
hypertensive patients in Namibia. The integration of health literacy
programmes, and MIL guidelines are needed to promote utility of medicine
information and improve medication adherence.
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Affiliation(s)
| | - Mwangana Mubita
- Pharmacy Practice and Policy, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Pharmacology and Therapeutics, University of Namibia, Windhoek, Namibia
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ester Hango
- Pharmacy Practice and Policy, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Pharmacy Practice and Policy, University of Namibia, Windhoek, Namibia
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Garcia MM, Azevedo PS, Mirelman A, Safatle LP, Iunes R, Bennie MC, Godman B, Guerra Junior AA. Funding and Service Organization to Achieve Universal Health Coverage for Medicines: An Economic Evaluation of the Best Investment and Service Organization for the Brazilian Scenario. Front Pharmacol 2020; 11:370. [PMID: 32351382 PMCID: PMC7175689 DOI: 10.3389/fphar.2020.00370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There are many health benefits since 31 years after the foundation of the National Health Service (NHS) in Brazil, especially the increase in life expectancy. However, family-income inequalities, insufficient funding, and suboptimal private sector-public sector collaboration are still areas for improvement. The efforts of Brazil to achieve universal health coverage (UHC) for medicines have resulted in increased public financing of medicines and their availability, reducing avoidable hospitalization and mortality. However, lack of access to medicines still remains. Due to historical reasons, pharmaceutical service organization in developing countries may have important differences from high-income countries. In some cases, developing countries finance and promote medicine access by using the public infrastructure of health care/medical units as dispensing sites and cover all costs of medicines dispensed. In contrast, many high-income countries use private community pharmacies and cover the costs of medicines dispensed plus a fee, which includes all logistic costs. In this study, we will undertake an economic evaluation to understand the funding needs of the Brazilian NHS to reduce inequalities in access to medicines through adopting a pharmaceutical service organization similar to that seen in many high-income countries with hiring/accrediting private pharmacies. METHODS We performed an economic evaluation of a model to provide access to medicines within public funds based on a decision tree model with two alternative scenarios public pharmacies (NHS, state-owned facilities) versus private pharmacies (NHS, agreements). The analysis assumed the perspective of the NHS. We identified the types of resources consumed, the amount, and costs in both scenarios. We also performed a budget impact forecast to estimate the incremental funding required to reduce inequalities in access to essential medicines in Brazil. FINDINGS The model without rebates for medicines estimated an incremental cost of US$3.1 billion in purchasing power parity (PPP) but with an increase in the average availability of medicines from 65% to 90% for citizens across the country irrespective of family income. This amount places the NHS in a very good position to negotiate extensive rebates without the need for external reference pricing for government purchases. Forecast scenarios above 35% rebates place the alternative of hiring private pharmacies as dominant. Higher rebate rates are feasible and may lead to savings of more than US$1.3 billion per year (30%). The impact of incremental funding is related to medicine access improvement of 25% in the second year when paying by dispensing fee. The estimate of the incremental budget in five years would be US$4.8 billion PPP. We have yet to explore the potential reduction in hospital and outpatient costs, as well as in lawsuits, with increased availability with the yearly expenses for these at US$9 billion and US$1.4 billion PPP respectively in 2017. INTERPRETATION The results of the economic evaluation demonstrate potential savings for the NHS and society. Achieving UHC for medicines reduces household expenses with health costs, health litigation, outpatient care, hospitalization, and mortality. An optimal private sector-public sector collaboration model with private community pharmacy accreditation is economically dominant with a feasible medicine price negotiation. The results show the potential to improve access to medicines by 25% for all income classes. This is most beneficial to the poorest families, whose medicines account for 76% of their total health expenses, with potential savings of lives and public resources.
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Affiliation(s)
- Marina Morgado Garcia
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Pamela Santos Azevedo
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Andrew Mirelman
- Centre for Health Economics, University of York, York, United Kingdom
| | - Leandro Pinheiro Safatle
- Department of Medicines Market Regulation - Brazilian Health Regulatory Agency (ANVISA), Brasília, Brazil
| | | | - Marion Clark Bennie
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
| | - Brian Godman
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
- Management School, University of Liverpool, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Augusto Afonso Guerra Junior
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
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33
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Godman B, McCabe H, D Leong T. Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries. Expert Rev Pharmacoecon Outcomes Res 2020; 20:1-26. [PMID: 32237953 DOI: 10.1080/14737167.2020.1734456] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability.Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value.Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country's essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Holly McCabe
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Trudy D Leong
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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35
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Godman B, Basu D, Pillay Y, Almeida PHRF, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Patrick O, Niba LL, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia AC, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future. Hosp Pract (1995) 2020; 48:51-67. [PMID: 32196395 DOI: 10.1080/21548331.2020.1745509] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/18/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. METHODOLOGY Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilizing input from senior-level government, academic and other professionals from across Africa. RESULTS Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organizations, patient organizations, and pharmaceutical companies. Their impact though remains to be seen. In the meantime, a range of activities has been documented for all key stakeholder groups to improve future care. CONCLUSION There are concerns with the management of patients with T1DM across Africa. A number of activities has been suggested to address this and will be monitored.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Pretoria, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria , Pretoria, South Africa
| | - Yogan Pillay
- National Department of Health, Pretoria, South Africa
| | - Paulo H R F Almeida
- School of Pharmacy, Postgraduate Program in Medicines and Pharmaceutical Services, Federal University of Minas Gerais (UFMG) , Belo Horizonte, Brazil
- Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde, Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde, Ministry of Health , Brasília, Brazil
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana , Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital , Gaborone, Botswana
| | - Bene D Anand Paramadhas
- Department of Pharmacy, Central Medical Stores, Ministry of Health and Wellness , Gaborone, Botswana
| | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness , Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (Ebase) Africa , Bamenda, Africa
- Adelaide University , Adelaide, Australia
| | - Loveline Lum Niba
- Effective Basic Services (Ebase) Africa , Bamenda, Africa
- Department of Public Health, University of Bamenda , Bambili, Cameroon
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service , Keta, Ghana; Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi , Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi , Nairobi, Kenya
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia , Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia , Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia , Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University , Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital , Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine , Ikeja, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital , Ikeja, Nigeria
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Pretoria, South Africa
- Department of Health, Tshilidzini Hospital, Department of Pharmacy , Shayandima, South Africa
| | - Jeffrey Wing
- Charlotte Maxeke Medical Research Cluster , Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria , Pretoria, South Africa
- Charlotte Maxeke Medical Research Cluster , Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health , Khartoum, Sudan
- Unaizah College of Pharmacy, Qassim University , Unaizah, Saudi Arabia
| | - Adefolarin A Amu
- Eswatini Medical Christian University , Swazi Plaza, Kingdom of Eswatini
| | | | | | - Trust Zaranyika
- Department Of Medicine, University of Zimbabwe College of Health Sciences , Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant , Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate , Brunswick, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Whelan Building, University of Liverpool , Liverpool, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University , Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- NHS Lothian Director of Pharmacy, NHS Lothian , Edinburgh, UK
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester , Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester , Manchester, UK
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Pretoria, South Africa
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Mutneja E, Yadav R, Dey AB, Gupta P. Frequency and predictors of compliance among patients taking antihypertensive medicines. Indian Heart J 2020; 72:136-139. [PMID: 32534690 PMCID: PMC7296243 DOI: 10.1016/j.ihj.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/01/2019] [Accepted: 03/28/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Medication compliance, an important aspect in the treatment of chronic disease research, is often assessed using pill count method. The patient perception is usually not addressed objectively. The present study was conducted to assess patient cognizance, prevalence and predictors of compliance towards antihypertensive therapy in Indian patients. METHODS Adult patients taking antihypertensive medicines were included from the cardiology and geriatric OPDs of a tertiary care hospital in India. Socio-demographic data and disease awareness information was collected. Hill-Bone high blood pressure compliance scale was administered for compliance score. RESULTS For the 452 participants, mean age was 54.6 ± 13.7 years with approximate 2:1 ratio of males to females. Cronbach's alpha value of 0.7 for Hill Bone compliance scale showed good internal consistency. More than 80% participants had a score of ≥80%, showing good compliance among Indian patients. Factors that were significantly associated with uncontrolled blood pressure with correlation analysis were age, gender and awareness regarding disease. CONCLUSION The study suggests that Hill-Bone high blood pressure compliance scale may be useful for assessing compliance in Indian population. An age appropriate intervention for continued compliance should be considered to improve compliance and hence, reduce long term sequelae of hypertension.
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Affiliation(s)
- Ekta Mutneja
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
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Godman B, Grobler C, Van-De-Lisle M, Wale J, Barbosa WB, Massele A, Opondo P, Petrova G, Tachkov K, Sefah I, Abdulsalim S, Alrasheedy AA, Unnikrishnan MK, Garuoliene K, Bamitale K, Kibuule D, Kalemeera F, Fadare J, Khan TA, Hussain S, Bochenek T, Kalungia AC, Mwanza J, Martin AP, Hill R, Barbui C. Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries. Expert Opin Pharmacother 2020; 20:2237-2255. [PMID: 31762343 DOI: 10.1080/14656566.2019.1684473] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Christoffel Grobler
- Elizabeth Donkin Hospital, Port Elizabeth, South Africa.,Walter Sisulu University, East London, South Africa.,Nelson Mandela University, Port Elizabeth, South Africa
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Philip Opondo
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Suhaj Abdulsalim
- Unaizah College of Pharmacy, Qassim University, Buraidah Saudi Arabia
| | | | | | - Kristina Garuoliene
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Lithuania and Ministry of Health, Vilnius, Lithuania
| | - Kayode Bamitale
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | | | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - James Mwanza
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,HCD Economics, The Innovation Centre, Daresbury, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Whelan Building, Liverpool University, Liverpool, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona Italy
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Godman B, Haque M, McKimm J, Abu Bakar M, Sneddon J, Wale J, Campbell S, Martin AP, Hoxha I, Abilova V, Anand Paramadhas BD, Mpinda-Joseph P, Matome M, de Lemos LLP, Sefah I, Kurdi A, Opanga S, Jakupi A, Saleem Z, Hassali MA, Kibuule D, Fadare J, Bochenek T, Rothe C, Furst J, Markovic-Pekovic V, Bojanić L, Schellack N, Meyer JC, Matsebula Z, Phuong TNT, Thanh BN, Jan S, Kalungia A, Mtapuri-Zinyowera S, Sartelli M, Hill R. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future. Curr Med Res Opin 2020; 36:301-327. [PMID: 31794332 DOI: 10.1080/03007995.2019.1700947] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Health Economics Centre, University of Liverpool, Liverpool, UK
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Wales UK
| | - Muhamad Abu Bakar
- Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Janney Wale
- Independent Consumer Advocate, Brunswick, Victoria, Australia
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Antony P Martin
- Health Economics Centre, University of Liverpool, Liverpool, UK
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Vafa Abilova
- Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic
| | | | - Pinkie Mpinda-Joseph
- Department of Infection Prevention and Control, Nyangabgwe Hospital, Francistown, Botswana
| | | | - Livia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Campus Pampulha, Minas Gerais, CEP, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, CEP, Brazil
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sylvia Opanga
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | | | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Celia Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Jurij Furst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ljubica Bojanić
- Public Health Institute, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Thuy Nguyen Thi Phuong
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Saira Jan
- Department of Clinical Pharmacy, Rutgers State University of New Jersey, Piscataway, NJ, USA
- Department of Pharmacy Strategy and Clinical Integration, Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | | | - Massimo Sartelli
- Department of Surgery, University of Macerata, Macerata Hospital, Macerata, MC, Italy
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, UK
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Nyaaba GN, Masana L, de-Graft Aikins A, Beune E, Agyemang C. Factors hindering hypertension control: perspectives of front-line health professionals in rural Ghana. Public Health 2020; 181:16-23. [PMID: 31923796 DOI: 10.1016/j.puhe.2019.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/14/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Hypertension (HTN) control remains a major public health challenge in sub-Saharan Africa (SSA). Health professionals influence patient adherence and self-management practices for HTN particularly in rural and lower socio-economic communities in SSA. Contextual evidence on the reasons for the suboptimal control of HTN in clinical settings is crucial to improving health delivery practices for HTN and preventing HTN related-complications. STUDY DESIGN A cross-sectional qualitative study. METHODS Semistructured interviews were conducted among 40 purposively sampled front-line health professionals in seven health facilities in northern Ghana. Data were analysed using a thematic approach through pre-identified and evolving themes. RESULTS We identified three key themes underlying the poor HTN control. First, health professionals' barriers included communication difficulties, poor collaboration and referrals among health professionals and limited training on HTN and other non-communicable diseases (NCDs). Secondly, health system-related barriers included limited health personnel, drug shortages, inadequate facilities and equipment and challenges with National Health Insurance (NHIS). The third theme was patient-related barriers including non-adherence, use of traditional treatments, sociocultural factors and lack of appreciation. CONCLUSION A holistic public health approach, which builds upon health professionals' capacities, harnesses and integrates into existing health policy and systems structures and empowers and collaborates with communities could contribute to improving HTN control in rural settings. Health policymakers need to consider the sociocultural, economic and geographical characteristics in such settings, which influence health service delivery practices in designing and implementing HTN interventions. There is also a need for health policy to integrate NCD training and management of multiple and comorbid conditions into the training curriculum of health training institutions to build health professionals capacity to facilitate the uptake of evidence-based NCD interventions and manage the double burden of diseases.
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Affiliation(s)
- G N Nyaaba
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands; Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain.
| | - L Masana
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain; Medical Anthropology Research Centre-URV, Av. Catalonia, 35, Tarragona, 43002, Spain.
| | - A de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon, Ghana.
| | - E Beune
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| | - C Agyemang
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
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40
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Shakya R, Shrestha S, Gautam R, Rai L, Maharjan S, Satyal GK, KC B, Rai MK. Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal. Patient Prefer Adherence 2020; 14:2287-2300. [PMID: 33244224 PMCID: PMC7685346 DOI: 10.2147/ppa.s270786] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal. METHODS Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation). RESULTS Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01). CONCLUSION Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.
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Affiliation(s)
- Rajina Shakya
- Department of Nursing, Nobel College, Pokhara University, Sinamangal, Kathmandu, Nepal
- Correspondence: Rajina Shakya Email
| | - Sunil Shrestha
- Department of Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Roshani Gautam
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Lalita Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | | | - Gita Kumari Satyal
- Female Surgical Ward, Department of Nursing, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Subang Jaya47500, Selangor, Malaysia
- Bhuvan KC Email
| | - Mana Kumari Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
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Godman B. Ongoing initiatives to improve the prescribing of medicines across sectors and the implications. ADVANCES IN HUMAN BIOLOGY 2020. [DOI: 10.4103/aihb.aihb_90_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Makhele L, Matlala M, Sibanda M, Martin AP, Godman B. A Cost Analysis of Haemodialysis and Peritoneal Dialysis for the Management of End-Stage Renal Failure At an Academic Hospital in Pretoria, South Africa. PHARMACOECONOMICS - OPEN 2019; 3:631-641. [PMID: 30868410 PMCID: PMC6861399 DOI: 10.1007/s41669-019-0124-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Haemodialysis (HD) and peritoneal dialysis (PD) are commonly used treatments for the management of patients with end-stage renal disease (ESRD). The costs of managing these patients have grown in recent years with increasing rates of non-communicable diseases, which will adversely impact on national health budgets unless addressed. Currently, there is limited knowledge of the costs of ESRD within the public healthcare system in South Africa. OBJECTIVE The aim of this study was to examine the direct costs of HD and PD in South Africa from a healthcare provider's perspective. METHODS A prospective, observational study was undertaken at a leading public hospital in South Africa. A micro-costing approach was applied to estimate healthcare costs using 46 adult patients with ESRD who had been receiving HD and PD for at least 3 months. RESULTS The highest proportion of patients (35%) were aged 40-50 years. Patients aged 29-39 years were mostly on HD (28% vs. 21% on PD) while those aged 51-59 years mostly used PD (29% vs. 16% on HD). The average age of patients on HD and PD were 41 and 42 years, respectively. Fixed costs were the principal cost driver for HD ($16,231.45) while variable costs were the principal cost driver for PD (US$20,488.79). The annual cost of HD per patient (US$31,993.12) was higher than PD (US$25,282.00 per patient), even though the difference was not statistically significant (p = 0.816). CONCLUSION HD costs more than PD from the provider's perspective. These cost estimates may be useful for carrying out future cost-effectiveness and cost-utility analyses in South Africa.
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Affiliation(s)
- Letlhogonolo Makhele
- Department of Public Health and Pharmacy Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Moliehi Matlala
- Department of Public Health and Pharmacy Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mncengeli Sibanda
- Department of Public Health and Pharmacy Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Antony P. Martin
- Health Economics Centre, University of Liverpool Management School, Chatham Street, Liverpool, UK
- HCD Economics, The Innovation Centre, Daresbury, WA4 4FS UK
| | - Brian Godman
- Department of Public Health and Pharmacy Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Health Economics Centre, University of Liverpool Management School, Chatham Street, Liverpool, UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
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Ali MH, Alrasheedy AA, Kibuule D, Godman B, Hassali MA, Ali HMH. Assessment of multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in Sudan; findings and implications. Expert Rev Anti Infect Ther 2019; 17:927-937. [PMID: 31689134 DOI: 10.1080/14787210.2019.1689818] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Multidrug-resistant tuberculosis (MDR-TB) has a socioeconomic impact and threatens global public health. We assessed treatment outcomes of MDR-TB and predictors of poor treatment outcomes in Sudan given current high prevalence rates.Methods: Combined retrospective and prospective cohort study at Abu-Anga hospital (TB specialized hospital in Sudan). All patients with MDR-TB between 2013 and 2017 were targeted.Results: A total of 156 patients were recruited as having good records, 117 (75%) were male, and 152 (97.4%) had pulmonary TB. Patients were followed for a median of 18 months and a total of 2108 person-months. The overall success rate was 63.5% and the mortality rate was 14.1%. Rural residency (P < 0.05) and relapsing on previous treatments (P < 0.05) were determinants of time to poor MDR-TB treatment outcomes.Conclusion: Overall, more attention needs to be given to special MDR-TB groups that are highly susceptible to poor outcomes, i.e. rural patients. As a result, it is highly recommended to maintain total coverage of medicines for all MDR-TB patients for the entire period of treatment in Sudan. It is also recommended to instigate more treatment centers in rural areas in Sudan together with programs to enhance adherence to treatments including patient counseling to improve future outcomes.
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Affiliation(s)
- Monadil H Ali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.,Department of Clinical Pharmacy, College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | | | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Brian Godman
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Hamdan Mustafa Hamdan Ali
- Multidrug-Resistant Tuberculosis Unit, National Tuberculosis Control Program, Disease Control Directorate, Federal Ministry of Health, Khartoum, Sudan
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Harsha N, Kőrösi L, Pálinkás A, Bíró K, Boruzs K, Ádány R, Sándor J, Czifra Á. Determinants of Primary Nonadherence to Medications Prescribed by General Practitioners Among Adults in Hungary: Cross-Sectional Evaluation of Health Insurance Data. Front Pharmacol 2019; 10:1280. [PMID: 31736757 PMCID: PMC6836763 DOI: 10.3389/fphar.2019.01280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = -0.099, 95%CI = -0.103 to -0.094), higher level of education (b = -0.440, 95%CI = -0.468 to -0.413), and vacancy of the general practices (b = -0.193, 95%CI = -0.204 to -0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one-third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed-to-prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.
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Affiliation(s)
- Nouh Harsha
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Budapest, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Árpád Czifra
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Sheikh AM, Rwegerera GM, Godman B, Habte D. Adjustments of medication dosages in patients with renal impairment in Botswana; findings and implications to improve patient care. Hosp Pract (1995) 2019; 47:231-240. [PMID: 31662005 DOI: 10.1080/21548331.2019.1685800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and aims: Medication dosage adjustments for renally impaired patients have not been studied in Botswana. This study was conducted to determine prescribing practices among patients with renal impairment in medical wards to improve future patient care.Methods: We conducted a retrospective study involving medical charts of patients admitted at a tertiary level hospital in Gaborone Botswana. Study participants included all patients admitted between August and October 2016 who were hospitalized for ≥24 h. 'Drug prescribing in renal failure: dosing guidelines for adults and children'. was used to determine the extent of dosage adjustments. A logistic regression model was used to assess which patient factors were associated with inappropriate dosage adjustment.Results: Twenty-nine percent (233/804) of patients had renal impairment. Of these, 184 patients with renal impairment were included in the final analysis. There were 1143 prescription entries, of which 20.5% (n = 234) required dosage adjustment for renal function but only 45.7% (n = 107) were adjusted correctly. Of note, 112 patients were prescribed at least one drug that required dosage adjustment and only 30.4% (n = 34) patients had all of their medications appropriately adjusted. Patient factors associated with inappropriate dosage adjustment included a higher number of medicines being prescribed. Mortality among patients with renal impairment was independently associated with higher scores of the Charlson comorbidity index and hospital stay duration of 1-7 days.Conclusion: The renal function status of patients was not sufficiently taken into account when prescribing medicines especially in patients with severely impaired kidney function in Botswana. Continuous medical education needs to be encouraged to address this, which is being implemented. We will be following this up in future studies.
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Affiliation(s)
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana AND Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Health Economics Centre, Liverpool University Management School, Liverpool, UK.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Dereje Habte
- Consultant Public Health Specialist, Addis Ababa, Ethiopia
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Kamati M, Godman B, Kibuule D. Prevalence of Self-Medication for Acute Respiratory Infections in Young Children in Namibia: Findings and Implications. J Res Pharm Pract 2019; 8:220-224. [PMID: 31956636 PMCID: PMC6952762 DOI: 10.4103/jrpp.jrpp_19_121] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/11/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among under-fives. However, self-medication and "self-care" care practices remain common, especially among informal settlements in Namibia. Consequently, we sought to ascertain the rationale for this to guide the future activities. METHODS Mixed method approach among residents in an informal settlement in Namibia to determine the extent of health-seeking behaviors and the rationale for any self-medication. FINDINGS Of the 100 everyday households surveyed, 60% used self-medication for ARIs in children under five including cold/flu medication, paracetamol, and decongestants. There was no self-purchasing of antibiotics. The main drivers of self-medication were a perceived diagnosis of ARI as "minor or mild" as well as long waiting times and queues to receive care at public health facilities. CONCLUSION The majority of households in this settlement self-medicate their children for ARIs. There are needs for outreach primary health care services in the future in townships to screen and appropriately manage ARI to address concerns. This can include increasing pharmacy services.
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Affiliation(s)
- Monika Kamati
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Brian Godman
- Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Health Economics Centre, Management School, Liverpool University, Liverpool, United Kingdom
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
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47
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Farid SF. Conceptual Framework of the Impact of Health Technology on Healthcare System. Front Pharmacol 2019; 10:933. [PMID: 31551764 PMCID: PMC6733916 DOI: 10.3389/fphar.2019.00933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 07/22/2019] [Indexed: 01/19/2023] Open
Abstract
The World Health Organization (WHO) promotes health systems strengthening as a means of improving population health, especially in low- and middle-income countries. The United Nations Sustainable Development Goals highlight the importance of investing in workforce development to improve population health and economic well-being. In relation to pharmaceuticals, health systems face challenges in terms of i) guaranteeing access to needed drugs, ii) rationalizing medicines use, and iii) avoiding harm from adverse events. There is a pressing need to better understand the relationships between technology and pharmacy practice when strengthening pharmaceutical care systems. In response, this paper examines ways in which harnessing new technologies can change pharmacy practice and strengthen pharmaceutical systems for the benefit of patients. The paper will present a conceptual framework as well as exploring case studies.
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Affiliation(s)
- Samar F Farid
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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48
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Mwita JC, Francis JM, Omech B, Botsile E, Oyewo A, Mokgwathi M, Molefe-Baikai OJ, Godman B, Tshikuka JG. Glycaemic, blood pressure and low-density lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study. BMJ Open 2019; 9:e026807. [PMID: 31340960 PMCID: PMC6661581 DOI: 10.1136/bmjopen-2018-026807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Control of glycaemic, hypertension and low-density lipoprotein-cholesterol (LDL-C) among patients with type 2 diabetes mellitus (T2DM) is vital for the prevention of cardiovascular diseases. The current study was an audit of glycaemic, hypertension and LDL-C control among ambulant patients with T2DM in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals. DESIGN A cross-sectional study. SETTING A specialised public diabetes clinic in Gaborone, Botswana. PARTICIPANTS Patients with T2DM who had attended the clinic for ≥3 months between August 2017 and February 2018. PRIMARY OUTCOME MEASURE The proportion of patients with optimal glycaemic (HbA1c<7%), hypertension (blood pressure <140/90 mm Hg) and LDL-C (<1.8 mmol/L) control. RESULTS The proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension and 20.4% for LDL-C. Age≥ 50 years was positively associated with optimal glycaemic control (adjusted OR [AOR] 5.79; 95% CI 1.08 to 31.14). On the other hand, an increase in diabetes duration was inversely associated with optimal glycemic control (AOR 0.91; 95% CI 0.85 to 0.98). Being on an ACE inhibitor was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 to 0.85). Being female was inversely associated with optimal LDL-C control (AOR 0.24; 95% CI (0.09 - 0.59). CONCLUSION Patients with T2DM in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.
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Affiliation(s)
- Julius Chacha Mwita
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Joel M Francis
- Wits Reproductive Health and HIV Institute, Wits Health Consortium Pty Ltd, Johannesburg, South Africa
- Global Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Bernard Omech
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Elizabeth Botsile
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Aderonke Oyewo
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Matshidiso Mokgwathi
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Onkabetse Julia Molefe-Baikai
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Brian Godman
- Health Economics, University of Liverpool, Liverpool, UK
- Laboratory of Medicine, Division of Clinical Pharmacology, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Jose-Gaby Tshikuka
- Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Faculty of Health Sciences, National Pedagogical University, Kinshasa, Congo (the Democratic Republic of the)
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Agasha DB, Edwin BMR, Baine SO. Effect of the eQuality Health Bwindi Scheme on Utilization of Health Services at Bwindi Community Hospital in Uganda. Front Public Health 2019; 7:71. [PMID: 31019907 PMCID: PMC6458260 DOI: 10.3389/fpubh.2019.00071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: eQuality Health Bwindi (eQHB), a Community Based Health Insurance (CBHI) scheme was launched in March 2010 with the aim of generating income to maintain high quality care as well as increasing access to and utilization of health services at Bwindi Community Hospital (BCH). The main objective of this study was to explore evidence showing that eQHB scheme affected access and utilization of health services at BCH. The evidence generated would be used to inform decision making, policy and scale up of the scheme. Methods and Materials: This study applied qualitative and quantitative research methods. It involved a review of hospital records for the period July 2009-June 2014, a survey of 272 households, four focus group discussions, and six key informant interviews. Both quantitative and qualitative analysis techniques were applied for the analysis. Results: Outpatient attendance, inpatient admissions, and deliveries at the hospital increased by 65, 73, and 27%, respectively between FY 2009/10 and FY 2012/13. Utilization of health services by sick children from insured participants was greater than that of the uninsured members of the community (p-value = 0.0038). BCH services became more affordable. However, opting out of the scheme at a later stage in the review period was attributed to rising unaffordable premiums and co-payments. Failure to afford scheme membership, residing far from BCH and limited understanding of health insurance led to reduced BCH service utilization. Conclusions: eQHB has potential to increase access and utilization of health services at BCH. The challenges are; limited understanding of the concept of health insurance and unaffordable premiums and co-payments set to enable provision of high quality services. Recommendations: Based on these findings, intensified community sensitization on health insurance, establishment of satellite health facilities by BCH to bring services closer to members and transformation of eQHB to a savings/credit society in order to grow savings and subsequently reduce premiums are recommended. Government of Uganda should engage CBHIs countrywide to discuss achievement of UHC and establishment of a national health insurance scheme. A further study to guide setting of affordable premiums and copayments for eQHB is also recommended.
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50
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Ogunleye OO, Fadare JO, Eriksen J, Oaiya O, Massele A, Truter I, Taylor SJE, Godman B, Gustafsson LL. Reported needs of information resources, research tools, connectivity and infrastructure among African Pharmacological Scientists to improve future patient care and health. Expert Rev Clin Pharmacol 2019; 12:481-489. [PMID: 30961406 DOI: 10.1080/17512433.2019.1605903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The potentials of Africa for growth and economic transformation through science remains challenging because of existing gaps in knowledge and infrastructure. The Africa Pharmacological Science Gateway project and the Medicines Utilization Research in Africa Group seek to meet the research needs of African pharmacologists. This study aimed at identifying priority needs that might be met by access to information and tools through e-infrastructure. METHODS A web-based cross-sectional study among 472 members of pharmacological societies in Africa to obtain information on their research interests and skills, available resources, needs, and knowledge gaps. Descriptive analyses were done. RESULTS A total of 118 responses from 13 countries were received, mostly from Nigeria (48.3%) and South Africa (21.3%). Respondents had wide ranges of research interests predominantly in drug utilization research. The desired resources included drug utilization research training and tools, pharmacokinetics and pharmacometrics modeling training and tools, drug-drug interaction and medicine prices resources, statistical analysis resources, access to journals, training in specific laboratory techniques, equipment and funding for research-related activities. CONCLUSIONS Key areas of needs not currently provided by the African Pharmacological Science Gateway e-infrastructure were identified to guide the further provision of resources on the e-infrastructure and potentially enhance research capacity within the continent.
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Affiliation(s)
- Olayinka O Ogunleye
- a Department of Pharmacology, Therapeutics and Toxicology , Lagos State University College of Medicine , Lagos , Nigeria.,b Department of Medicine , Lagos State University Teaching Hospital , Lagos , Nigeria
| | - Joseph O Fadare
- c Department of Pharmacology and Therapeutics , College of Medicine, Ekiti State University , Ado-Ekiti , Nigeria
| | - Jaran Eriksen
- d Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.,e Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Omo Oaiya
- f West and Central Africa Research and Education Network , Accra , Ghana
| | - Amos Massele
- g Department of Biomedical Sciences, Faculty of Medicine , University of Botswana , Gaborone , Botswana
| | - Ilse Truter
- h Drug Utilization Research Unit (DURU), Department of Pharmacy , Nelson Mandela Metropolitan University , Port Elizabeth , South Africa
| | - Simon J E Taylor
- i Department of Computer Science , Brunel University , London , U.K
| | - Brian Godman
- d Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.,j Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , U.K .,k Department of Health Economics , Liverpool Management School, Liverpool University , Liverpool , U.K .,l School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | - Lars L Gustafsson
- d Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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