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Alfadly S, Anaam M, Alzunaydi SI, Almutlaq AS, Swidan AM, Alsahali S, Almogbel Y, Alshammari M, Almunef M, Siddeeg K. Community Pharmacy Professionals' Knowledge and Counseling Skills for the Treatment of Acute Diarrhea in Children in Qassim Region, Saudi Arabia: Questionnaire Based and Simulated Client Study. Patient Prefer Adherence 2024; 18:1451-1461. [PMID: 39011089 PMCID: PMC11247160 DOI: 10.2147/ppa.s462699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024] Open
Abstract
Objective The study aimed to evaluate the knowledge and counseling skills of community pharmacy professionals regarding managing acute diarrhea in children in the Qassim region of Saudi Arabia. Methods A cross-sectional study consisting of a questionnaire and simulated client scenario was conducted to collect data from pharmacy professionals working in community pharmacies over a period of 3 months in the Qassim region of Saudi Arabia. Pharmacy professionals were assessed for evaluating cases using 5 indicators (the age of the child, the frequency of diarrhea, fever and the presence of mucus or blood) and also for their recommendations and counseling. Results The data were collected from 60 pharmacy professionals after site visits. In the questionnaire, 60% of the pharmacy professionals used all 5 indicators, while in the simulation, 13.3% used at least 3 indicators and 80% used 2 or fewer indicators (p = 0.35). An oral rehydration solution was recommended alone by 35% of the pharmacy professionals and with other drugs by 13.3% in the questionnaire, while in the simulation, an oral rehydration solution alone was recommended by 15% and other drugs by 48.3%. Approximately 86.7% of the pharmacy professionals did not give any dietary advice, and 50% did not counsel the simulated client on the recommended drug. Conclusion The community pharmacy professionals in the study did not ask enough questions to evaluate a child suffering from acute diarrhea appropriately in the simulation. More questions were asked in the questionnaire; however, the difference is not significant. Additionally, they did not provide proper dietary advice, and their recommendation of an oral rehydration solution was insufficient.
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Affiliation(s)
- Saeed Alfadly
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
- Pharmacy Department, College of Medicine and Health Sciences, Hadramout University, Hadramout, Yemen
| | - Mohammed Anaam
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
- Al-Rowaad Medical College, Sana'a, Yemen
| | | | | | | | - Saud Alsahali
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - Yasser Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - Mohammed Alshammari
- Department of Pharmacy practice، College of Pharmacy, University of Hafr Albatin, Hafr Albatin, Saudi Arabia
| | - Mohammed Almunef
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - Khalid Siddeeg
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
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Anaam M. Community pharmacists' treatment patterns and counselling of acute diarrhea in children: A simulation-based cross-sectional study. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834241258673. [PMID: 38835340 PMCID: PMC11149438 DOI: 10.1177/27550834241258673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
Background Diarrhea is a significant global health concern, particularly among children, and its impact is particularly pronounced in countries with limited resources and ongoing conflicts, such as Yemen. Diarrheal diseases remain one of the leading causes of morbidity and mortality in children under the age of 5 years worldwide. Objectives The aim of our study is to assess the treatment patterns and counseling of community pharmacists regarding the management of acute diarrhea in children in Yemen. Design A simulation-based cross-sectional study was carried out targeting community pharmacy professionals in Sana'a city. Methods A questionnaire and simulated client methods were used to assess the pharmacists' evaluation of a case based on five indicators including the child's age, diarrhea frequency, presence of fever, and blood or mucus. In addition, the pharmacists' recommendations and counseling were also evaluated. Results During the study, a total of 100 pharmacists were visited and evaluated using both a questionnaire and simulation. The results demonstrated that 43.0% of the pharmacists utilized all five indicators in the questionnaire, with a mere 3.0% using all five indicators in the simulation. Oral rehydration solution (ORS) alone was recommended by 42.0% of the pharmacists and in combination with other drugs by 47.0% in the questionnaire, and the rest (11.0%) recommended only other drugs; while in the simulation, 7.0% of the pharmacists referred the patients to clinic, only 6.0% recommended ORS alone, 47.0% gave ORS plus other drugs including antibiotics, and 40.0% dispensed only antibiotics. In regards to counseling, 89.0% of pharmacists reported that they would explain to the patient regarding the recommended medicine during the questionnaire, and only 36.0% gave any sort of explanation to the simulated client. Conclusion In the current study, community pharmacists did not ask enough questions to accurately evaluate a child with acute diarrhea during the simulation. This finding has apparently differed from their responses in the questionnaire. Furthermore, the pharmacists failed to provide sufficient dietary advice, and their recommendation of ORS was inadequate.
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Affiliation(s)
- Mohammed Anaam
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Saudi Arabia
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Alenezi S, Alanazi M, Aljazaeri R, Almuzaini M, Alrasheidi S, Shamlan WB, Aljohani R, Alhawiti G, Alqarni M, Aljabri E, Qmmash M, Kanan M. Community Pharmacies in the Asian Countries of Developing Health System: Formation, Regulation, and Implication. PHARMACY 2023; 11:127. [PMID: 37624082 PMCID: PMC10460015 DOI: 10.3390/pharmacy11040127] [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: 05/17/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Community pharmacies (CPs) in Asian countries are often the first point of contact for patients withinthe healthcare system and their preferred place to purchase medicines. The number of CPs may vary across Asian countries, and each country has developed its own design and functioning. The regulatory environment plays a crucial role in shaping and governing CPs. The aim of this study was to conduct a comprehensive literature review in order to enhance understanding of the establishment and regulation of CPs. By undertaking this review, the researchers, policymakers, and practitioners sought to gain a deeper insight into the performance and functions of CPs and the regulatory frameworks that govern them. Moreover, this review shed light on implementation strategies, effects on patient outcomes, and the barriers and challenges associated with their establishment. A narrative literature review method was adopted with specific inclusion and exclusion criteria. Significant disparities can be observed when comparing the stated intentions of regulations with their actual implementation. Recently, there has been an inclusion of public health practices. Unfortunately, pharmacy procedures conducted in such environments have been characterized by inadequate understanding and inappropriate care. This poor performance can be attributed to employees' focus on maximizing profits. Several shortcomings can arise, including incomplete patient history documentation, failure to refer patients who require medical attention, unauthorized dispensing of prescription-only medicines (POM), dispensing clinically inappropriate or excessive medication doses, selling incomplete antibiotic courses, and inadequate information and counseling services. Regulatory interventions can help strengthen these services.
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Affiliation(s)
- Shaymaa Alenezi
- Al-Dawaa Pharmacy, Raiydh 12211, Saudi Arabia; (S.A.); (M.A.); (S.A.)
| | - Mona Alanazi
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Reaam Aljazaeri
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Marwah Almuzaini
- Al-Dawaa Pharmacy, Raiydh 12211, Saudi Arabia; (S.A.); (M.A.); (S.A.)
| | | | - Wafa Bin Shamlan
- Community Pharmacist, United Pharmaceutical Company, Jeddah 22230, Saudi Arabia;
| | - Raghad Aljohani
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Ghadeer Alhawiti
- Department of Clinical Pharmacy, Alkadi Medical Group, Tabuk 47311, Saudi Arabia;
| | - Meaad Alqarni
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Ehdaa Aljabri
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Majd Qmmash
- College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia;
| | - Mohammed Kanan
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh 12211, Saudi Arabia
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Poompruek P, Perris A, Whanpuch P, Chandler CIR, Sringernyuang L. Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand. Glob Public Health 2022; 17:3931-3943. [PMID: 35282798 DOI: 10.1080/17441692.2022.2049843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thailand's antimicrobial stewardship strategy has focussed on promoting 'rational drug use' in the public sector, to reduce the threat of drug resistance and control healthcare expenditure. The strategy's next ambition is to attend to the private sector, where antibiotics are widely available over the counter without prescription. Using ethnographic and survey data, this paper follows antibiotics through community pharmacies, to explore drug distribution and access, and identify potential challenges for stewardship. We extend the analytical frame beyond 'irrational' dispenser-customer transactions, to explore the logics of practice of a multiplicity of actors in the context of a highly competitive pharmaceutical market. Highlighting the role of the pharmaceutical industry in mystifying medicines, we show how antibiotics are collapsed into a category of 'strong medicines' and requested by customers using 'prescriptions by proxy'. We further examine how Thailand's drug regulation and classificatory systems, historically orientated around access to medicines, enable the proliferation of antibiotics in the context of contemporary efforts to control distribution. Recognising the negotiations involved in dispensing antibiotics in a pluralistic health system, we attempt to reconfigure allocations of responsibility, advocating for stewardship approaches that take into account local ecologies of care, as well as implications for access, equity, and accountability.
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Affiliation(s)
- Panoopat Poompruek
- Department of Community Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Anna Perris
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Phakha Whanpuch
- Department of Society and Health, Mahidol University, Nakhon Pathom, Thailand
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Edessa D, Assefa N, Dessie Y, Asefa F, Dinsa G, Oljira L. Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis. J Pharm Policy Pract 2022; 15:57. [PMID: 36180895 PMCID: PMC9524137 DOI: 10.1186/s40545-022-00454-8] [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: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries. METHODS A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage. RESULTS In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets. CONCLUSIONS We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries. TRIAL REGISTRATION NUMBER CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .
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Affiliation(s)
- Dumessa Edessa
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center-Oak Ridge National Laboratory (UTHSC-ORNL, Memphis, TN, USA
| | - Girmaye Dinsa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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6
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Edessa D, Sisay M, Hagos B, Amare F. Antimicrobial Use and Management of Childhood Diarrhea at Community Drug Retail Outlets in Eastern Ethiopia: A Matched Questionnaire-Based and Simulated Patient-Case Study. Pediatric Health Med Ther 2022; 13:63-79. [PMID: 35340354 PMCID: PMC8943828 DOI: 10.2147/phmt.s348204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Antimicrobial agents have saved millions of lives worldwide. However, inappropriate use has become a global concern leading to the emergence and spread of antimicrobial resistance (AMR). In this regard, the dispensing practices of pharmacy professionals in the community drug retail outlets (CDROs) plays a central role. Therefore, this study was aimed to assess the knowledge and dispensing practices of pharmacy professionals in the management of childhood diarrhea in CDROs of Eastern Ethiopia. Methods A community based cross-sectional study was conducted in 100 randomly selected CDROs in Eastern Ethiopia from 1 August to 30 September 2020. Data were collected with a structured questionnaire matched with a simulated patient case. Descriptive statistics were employed to summarize variables. Cohen's Kappa was analyzed to measure the degree of agreement between questionnaire-based and simulated patient-based methods. Binary logistic regression analysis was conducted to determine factors associated with inappropriate dispensing practice. Results Majority of the participants were aged 25-34 years (median: 29 years). High proportion of them were male (65%) and had work experiences of two or more years. Majority (61%) of the professionals were knowledgeable about AMR. Out of 2886 scores, 745 scores were agreed on Cohen's Kappa interrater agreement scale with the overall percent agreement between the two methods being 26.0%. Besides, about 67% of dispensing practices to the simulated patient case was found inappropriate. On the multivariate analysis, insufficient knowledge of retailers on AMR was significantly associated with the inappropriate dispensing of antimicrobial agents. Conclusion A considerable proportion of retailers had insufficient knowledge regarding the emergence and spread of AMR. Only a quarter of their questionnaire-based knowledge response agreed with simulated-patient-based actual practice, indicating weak agreement between the two methods and high level of inappropriate practice. Besides, insufficient knowledge of retailers was significantly associated with their inappropriate dispensing of antimicrobials.
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Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bisrat Hagos
- Department of Social Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Zheng C, Karkey A, Wang T, Makuka G, van Doorn HR, Lewycka S. Determinants and patterns of antibiotic consumption for children under five in Nepal: analysis and modelling of Demographic Health Survey data from 2006 to 2016. Trop Med Int Health 2021; 26:397-409. [PMID: 33338311 PMCID: PMC8048878 DOI: 10.1111/tmi.13540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Our aims were to examine AMR-specific and AMR-sensitive factors associated with antibiotic consumption in Nepal between 2006 and 2016, to explore health care-seeking patterns and the source of antibiotics. METHODS Cross-sectional data from children under five in households in Nepal were extracted from the 2006, 2011 and 2016 Demographic Health Surveys (DHS). Bivariable and multivariable analyses were carried out to assess the association of disease prevalence and antibiotic use with age, sex, ecological location, urban/rural location, wealth index, household size, maternal smoking, use of clean fuel, sanitation, nutritional status, access to health care and vaccinations. RESULTS Prevalence of fever, acute respiratory infection (ARI) and diarrhoea decreased between 2006 and 2016, whilst the proportion of children under five receiving antibiotics increased. Measles vaccination, basic vaccinations, nutritional status, sanitation and access to health care were associated with antibiotic use. Those in the highest wealth index use less antibiotics and antibiotic consumption in rural areas surpassed urban regions over time. Health seeking from the private sector has overtaken government facilities since 2006 with antibiotics mainly originating from pharmacies and private hospitals. Adherence to WHO-recommended antibiotics has fallen over time. CONCLUSIONS With rising wealth, there has been a decline in disease prevalence but an increase in antibiotic use and more access to unregulated sources. Understanding factors associated with antibiotic use will help to inform interventions to reduce inappropriate antibiotic use whilst ensuring access to those who need them.
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Affiliation(s)
- Charlotte Zheng
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Chelsea and Westminster NHS Foundation TrustWest Middlesex University Hospital siteLondonUK
| | - Abilasha Karkey
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Patan Hospital and the Patan Academy of Health SciencesKathmanduNepal
| | - Tianyi Wang
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Princeton UniversityPrincetonUSA
| | - Gerald Makuka
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Muhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - H. Rogier van Doorn
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global HealthNuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Sonia Lewycka
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global HealthNuffield Department of MedicineUniversity of OxfordOxfordUK
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Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study. Antibiotics (Basel) 2021; 10:antibiotics10020154. [PMID: 33546476 PMCID: PMC7913721 DOI: 10.3390/antibiotics10020154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
In Thailand, antibiotics are available lawfully from community pharmacies without a prescription. Inappropriate supply of antibiotics from Thai community pharmacies to the public for common, self-limiting diseases has been reported. The study aimed to evaluate the appropriateness of antibiotics selected by community pharmacists in Thailand in response to vignettes. A cross-sectional survey of community pharmacists across Thailand was conducted using a self-administered questionnaire including nine case vignettes with three conditions, namely upper respiratory infections (URIs), acute diarrhoea and simple wounds. A total of 208 questionnaires were completed and analysed (20.8% response rate). In response to vignettes relating to URIs, 50.8% of pharmacist recommendations were not in accordance with antibiotic guidelines. Inappropriate recommendations for diarrhoea and wound cases were 20.8% and 16.7%, respectively. A higher proportion of younger pharmacists, those with less experience, Pharm. D. graduate pharmacists, employee pharmacists and those pharmacists who worked in a chain pharmacy were more likely to recommend appropriate antibiotic treatment in response to the vignettes (p < 0.05). These findings will be useful to promote educational interventions for community pharmacists regarding common infectious disease management in order to improve appropriate antibiotic use.
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Siltrakool B, Berrou I, Griffiths D, Alghamdi S. Antibiotics' Use in Thailand: Community Pharmacists' Knowledge, Attitudes and Practices. Antibiotics (Basel) 2021; 10:antibiotics10020137. [PMID: 33572497 PMCID: PMC7912083 DOI: 10.3390/antibiotics10020137] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
Thailand spends $203 million on antibiotics every year, and patients can still access antimicrobials over the counter without a prescription. Community pharmacy plays a pivotal role in improving access and ensuring the appropriate use of antimicrobials. However, little is known about current practices in this setting. This study aims to assess Thai community pharmacists’ knowledge, attitudes and practices (KAP) regarding antimicrobials’ use and resistance. A cross-sectional study was conducted in Bangkok and Chonburi province in 2017 using an online self-administered questionnaire. The questionnaire was completed by 372 community pharmacists (71.4% response rate). The most commonly encountered infections in the community were upper and lower respiratory tract infections. The most commonly dispensed antimicrobials were broad-spectrum antibiotics including aminopenicillins and fluoroquinolones. Thai pharmacists have a good knowledge, attitude, and practice regarding antimicrobials’ use and resistance. They dispense anti-microbials in line with local guidelines, although international guidelines may not indicate anti-biotics for viral self-limiting infections. While community pharmacy in Thailand could be the most accessible healthcare resource for patients, inappropriate provision of antimicrobials for self-limiting viral infections by pharmacists will increase antimicrobial resistance. This highlights the need for updated guidance and improved pharmacists’ training.
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Affiliation(s)
- Budh Siltrakool
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (B.S.); (D.G.)
| | - Ilhem Berrou
- Faculty of Health & Applied Sciences, University of the West of England, Bristol BS16 1DD, UK
- Correspondence: ; Tel.: +44-117-328-4053
| | - David Griffiths
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (B.S.); (D.G.)
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Albaha University, Albaha, Saudi Arabia;
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Batista AD, A. Rodrigues D, Figueiras A, Zapata-Cachafeiro M, Roque F, Herdeiro MT. Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review. Antibiotics (Basel) 2020; 9:E786. [PMID: 33171743 PMCID: PMC7694985 DOI: 10.3390/antibiotics9110786] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/31/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Antibiotic resistance still remains a major global public health problem and the dispensing of antibiotics without a prescription at community pharmacies is an important driver of this. MEDLINE, Pubmed and EMBASE databases were used to search and identify studies reporting the dispensing of non-prescribed antibiotics in community pharmacies or drugstores that sell drugs for human use, by applying pharmacy interviews/questionnaires methods and/or simulated patient methods. Of the 4683 studies retrieved, 85 were included, of which 59 (69.4%) were published in low-and middle-income countries. Most of the papers (83.3%) presented a percentage of antibiotic dispensing without a prescription above 60.0%. Sixty-one studies evaluated the active substance and the most sold antibiotics without a prescription were amoxicillin (86.9%), azithromycin (39.3%), ciprofloxacin (39.3%), and amoxicillin-clavulanic acid (39.3%). Among the 65 articles referencing the diseases/symptoms, this practice was shown to be mostly associated with respiratory system problems (100.0%), diarrhea (40.0%), and Urinary Tract Infections (30.8%). In sum, antibiotics are frequently dispensed without a prescription in many countries and can thus have an important impact on the development of resistance at a global level. Our results indicate the high need to implement educational and/or regulatory/administrative strategies in most countries, aiming to reduce this practice.
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Affiliation(s)
- Ana Daniela Batista
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Daniela A. Rodrigues
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), 6300-559 Guarda, Portugal; (D.A.R.); (F.R.)
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.F.); (M.Z.-C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15702 Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.F.); (M.Z.-C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001 Madrid, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), 6300-559 Guarda, Portugal; (D.A.R.); (F.R.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
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Ayele AA, Islam MS, Cosh S, East L. Involvement and practice of community pharmacists in maternal and child health services: A systematic review. Res Social Adm Pharm 2020; 17:643-652. [PMID: 32800713 DOI: 10.1016/j.sapharm.2020.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Community pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown. OBJECTIVE The objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services. METHODS Seven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors. RESULT A total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision. CONCLUSION Community pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea.
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Affiliation(s)
- Asnakew Achaw Ayele
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia; Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Suzanne Cosh
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Leah East
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia; Hunter New England Health, Armidale, 2350, Australia
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Gravningen K, Field N, Blix HS, Asfeldt AM, Småbrekke L. Non-prescription purchase of antibiotics during travel abroad among a general adult population in Norway: Findings from the seventh Tromsø Study. PLoS One 2020; 15:e0228792. [PMID: 32053671 PMCID: PMC7017991 DOI: 10.1371/journal.pone.0228792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-prescription purchase of antibiotics is undesirable and has not recently been investigated in a representative population in a high-income low-use country during travel abroad. This study examined self-reported prevalence of antibiotic purchase abroad with and without prescription among participants reporting international travel in a general adult population in Norway, and the associations with socio-demographic, lifestyle and health factors. METHODS We analysed questionnaire-data from 19995 participants (10470 women) ≥40 years in the population-based Tromsø Study 7, 2015-2016. Data from the Norwegian Prescription Database were used to examine antibiotic use in Norway. We calculated adjusted odds ratios (AOR) for "travel abroad", "any antibiotic purchase abroad", and "antibiotic purchase abroad with" and "without prescription" using multivariable logistic regression. RESULTS Over half (55.0%, 95%CI 54.3-55.7%) participants reported travel abroad of >1 week duration in the past year. Travelers were more likely than non-travelers to be women (AOR = 2.02, 95%CI 1.42-2.88%) and report high education/income, childhood mostly lived abroad, healthy lifestyle, and good/excellent self-rated health. In total, 17904 travel episodes to 148 countries were reported. Altogether, 3.7% (95% CI 3.4%-4.1%) of travelers had purchased antibiotic abroad in the past year. Non-prescription purchase (1.5%, 95% CI 1.3-1.7) was associated with younger age, being female (AOR 1.41, 1.0-1.97), number of travels (reference: one episode, two: AOR = 1.82, 1.25-2.67, three: 2.60, 1.58-4.28, four: 3.10, 1.40-6.36 and ≥five: 4.70, 2.30-9.62), occurrences of diarrhoea (one: 2.42, 1.50-3.93 and ≥two: 3.08, 1.29-7.35), and antibiotic use in Norway in the past year (1.84, 1.29-2.62), whereas purchase with prescription (2.4%, 2.1-2.7) was associated with low income, growing-up abroad, recent hospital admission, additionally including number of travels/diarrhoea, and antibiotic use in Norway. Thailand (10.7%, 95% CI 7.8-14.3), Turkey (5.5%, 3.8-7.8) and Spain (3.6%, 3.0-4.3) were the countries most commonly associated with any antibiotic purchase. About two in five travelers who bought antibiotics in Thailand had done so without prescription, three in five in Turkey, and less than one in three in Spain. CONCLUSION Overall, a small proportion of travelers had bought antibiotics abroad in the past year. Low prevalence of non-prescription purchase may be explained by awareness of the risks associated with self-medication, cultural views, unawareness of the non-prescription availability, and/or few infections. Divergent predictors for purchase abroad with versus without prescription may suggest different reasons for these practices.
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Affiliation(s)
- Kirsten Gravningen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, United Kingdom
| | - Hege Salvesen Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Anne Mette Asfeldt
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Lars Småbrekke
- Department of Pharmacy, UiT - The Arctic University of Norway, Tromsø, Norway
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Quality of tuberculosis care by pharmacies in low- and middle-income countries: Gaps and opportunities. J Clin Tuberc Other Mycobact Dis 2019; 18:100135. [PMID: 31872080 PMCID: PMC6911950 DOI: 10.1016/j.jctube.2019.100135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pharmacies hold great potential to contribute meaningfully to tuberculosis (TB) control efforts, given their accessibility and extensive utilisation by communities in many high burden countries. Despite this promise, the quality of care provided by pharmacies in these settings for a range of conditions has historically been poor. This paper sets out to conceptualise the key issues surrounding quality of TB care in the low- and middle-income country pharmacy setting; examine the empirical evidence on quality of care; and review the interventions employed to improve this. A number of quality challenges are apparent in relation to anti-TB medicine availability, pharmacopeial quality of anti-TB medicines stocked, pharmacy workers’ knowledge, and management of patients both prior to and following diagnosis. Poor management practices include inadequate questioning of symptomatic patients, lack of referral for testing, over-the-counter sale of anti-TB medication as well as unnecessary and harmful medicines (e.g., antibiotics and steroids), and insufficient counselling. Interventions to improve pharmacy practice in relation to TB control have all fallen under the umbrella of public-private mix (PPM) initiatives, whereby pharmacies are engaged into national TB programmes to improve case detection. These interventions all involved training of pharmacists to refer symptomatic patients for testing and have enjoyed reasonable success, although achieving scale remains a challenge. Future interventions would do well to expand their focus beyond case detection to also improve counselling of patients and inappropriate medicine sales. The lack of pharmacy-specific global guidelines and the regulatory environment were identified as key areas for future attention.
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Thi Quynh Nhi L, de Alwis R, Khanh Lam P, Nhon Hoa N, Minh Nhan N, Thi Tu Oanh L, Thanh Nam D, Nguyen Ngoc Han B, Thi Thuy Huyen H, Thi Tuyen D, Thuy Duong V, Lan Vi L, Thi Thuy Tien B, Thi Diem Tuyet H, Hoang Nha L, Thwaites GE, Van Dung D, Baker S. Quantifying antimicrobial access and usage for paediatric diarrhoeal disease in an urban community setting in Asia. J Antimicrob Chemother 2019; 73:2546-2554. [PMID: 29982636 PMCID: PMC6105870 DOI: 10.1093/jac/dky231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/21/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Antimicrobial-resistant infections are a major global health issue. Ease of antimicrobial access in developing countries is proposed to be a key driver of the antimicrobial resistance (AMR) epidemic despite a lack of community antimicrobial usage data. Methods Using a mixed-methods approach (geospatial mapping, simulated clients, healthcare utilization, longitudinal cohort) we assessed antimicrobial access in the community and quantified antimicrobial usage for childhood diarrhoea in an urban Vietnamese setting. Results The study area had a pharmacy density of 15.7 pharmacies/km2 (a pharmacy for every 1316 people). Using a simulated client method at pharmacies within the area, we found that 8% (3/37) and 22% (8/37) of outlets sold antimicrobials for paediatric watery and mucoid diarrhoea, respectively. However, despite ease of pharmacy access, the majority of caregivers would choose to take their child to a healthcare facility, with 81% (319/396) and 88% (347/396) of responders selecting a specialized hospital as one of their top three preferences when seeking treatment for watery and mucoid diarrhoea, respectively. We calculated that at least 19% (2688/14427) of diarrhoea episodes in those aged 1 to <5 years would receive an antimicrobial annually; however, antimicrobial usage was almost 10 times greater in hospitals than in the community. Conclusions Our data question the impact of community antimicrobial usage on AMR and highlight the need for better education and guidelines for all professionals with the authority to prescribe antimicrobials.
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Affiliation(s)
- Le Thi Quynh Nhi
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ruklanthi de Alwis
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Phung Khanh Lam
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Nhon Hoa
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Nhan
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Thi Tu Oanh
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dang Thanh Nam
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bui Nguyen Ngoc Han
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hoang Thi Thuy Huyen
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dinh Thi Tuyen
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vu Thuy Duong
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Children Hospital 1, Ho Chi Minh City, Vietnam
| | - Lu Lan Vi
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - Le Hoang Nha
- Ho Chi Minh City Department of Health, Ho Chi Minh City, Vietnam
| | - Guy E Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Do Van Dung
- University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK.,The Department of Medicine, University of Cambridge, Cambridge, UK
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Björnsdottir I, Granas AG, Bradley A, Norris P. A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:13-25. [PMID: 31397533 DOI: 10.1111/ijpp.12570] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/09/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Simulated patient (SP) methodology (mystery shopping) is used increasingly to assess quality of pharmacy services, and evaluate impact of interventions. Our objective was to review papers reporting on the use of SP methodology in pharmacy practice research 2006-2016 in community pharmacies worldwide. METHODS We searched EMBASE and MEDLINE for papers reporting on the use of mystery shopping in pharmacy settings, using a wide range of terms for SPs, based on previous review. We removed irrelevant papers, duplicates, papers not written in English, and review papers and reviewed remaining papers. Two reviewers carried out data abstraction, using the same tool as the previous review and inserting data into Excel, focusing on how the SP methodology is used. KEY FINDINGS A total of 148 papers from 52 countries from all regions of the world were included in the review. A wide range of terms described the method, and simulated patient was the most common (49 papers). Most studies were cross-sectional (124), and most investigated only community pharmacies (115). The most common aim was to evaluate some aspect of pharmacists' or other staff's advice and counselling (94). Number of visits is 2-7785. Many papers did not cover details, such as number of visits planned, and carried out, scenario used, training and background of SPs, and ethical approval for the study. CONCLUSIONS The use of SP methodology has increased substantially in the field of pharmacy over the past decade. This is a useful method in a wide range of countries and settings. Greater detail is required in reporting.
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Affiliation(s)
| | | | - Amanda Bradley
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Koji EM, Gebretekle GB, Tekle TA. Practice of over-the-counter dispensary of antibiotics for childhood illnesses in Addis Ababa, Ethiopia: a simulated patient encounter study. Antimicrob Resist Infect Control 2019; 8:119. [PMID: 31346460 PMCID: PMC6636089 DOI: 10.1186/s13756-019-0571-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Dispensary and use of antibiotics without prescriptions from qualified providers is a common practice in countries with poor pharmaceutical regulations and where due focus is not given to rational use. This practice is a main factor for the spread of antimicrobial resistance due to its non-reliance on pre-treatment microbiologic work-up, improper indications and dosing errors. This study was conducted to determine the rate of over-the-counter dispensary of antibiotics for common childhood illnesses among privately owned medicine retail outlets in Addis Ababa, Ethiopia. Methods Pre-determined simulated patient visits depicting common childhood illnesses were employed to request antibiotics without prescriptions. A simple random sampling was used to select medicine retail outlets within Addis Ababa city. Trained data collectors filled structured data forms (including antibiotic requested, reasons for denial of dispense and details enquired by pharmacist) shortly after each patient enactment. Multi-variable logistic regression analysis was employed to explore factors associated with over-the-counter sales of antibiotics. Results A total of 262 simulated encounters were surveyed. Of the 262 verbal antibiotic requests, 63.4% were dispensed. Close to 60% of encounters were accompanied by questions about a doctor's visit or the child's symptomatology while a past history of drug allergies was enquired in only 11.1% of visits. Over-the-counter dispensary was more likely when dispenser queried about symptoms was made (AOR: 2.412, 95%CI: 1.236, 4.706), for requests for more than one antibiotics (AOR: 2.988, 95%CI: 1.258, 7.095) and for simulated patient demands for oral antibiotics for children with acute diarrhea (AOR: 3.297, 95%CI: 1.248, 8.712) and parenteral antibiotics for those reported to receive in-patient care for pneumonia (4.516, 95% CI: 1.720, 11.857). Conclusions The prevalence of providing antibiotics over-the-counter for pediatric illnesses in Addis Ababa is markedly high. Further studies into factors encouraging this malpractice are required. Enhancing education of personnel dispensing antibiotics and strict enforcement of national regulations are needed.
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Affiliation(s)
- Eyosait Mekonnen Koji
- 1Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tinsae Alemayehu Tekle
- 1Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mengistu G, Gietnet K, Amare F, Sisay M, Hagos B, Misganaw D. Self-Reported and Actual Involvement of Community Pharmacy Professionals in the Management of Childhood Diarrhea: A Cross-Sectional and Simulated Patient Study at two Towns of Eastern Ethiopia. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519855380. [PMID: 31223236 PMCID: PMC6566488 DOI: 10.1177/1179556519855380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
Background Role of community pharmacy professionals is observed in the prevention and treatment of diarrhea and the associated problem of dehydration in children. The aim of this study was to assess self-reported knowledge and actual practices of community pharmacy professionals toward the management of diarrhea in Harar town and Dire Dawa city administration. Methodology Community-based cross-sectional study was conducted on community pharmacy professionals practicing in community drug outlets of the two towns. Structured questionnaires and simulated patient were used to collect data. Results A total of 105 community pharmacy professionals from 105 community pharmacies were invited, out of which 69.5% were men. Age was the most frequently taken history in both studies and none of the participants take history about weight of the child, medication history, and nutrition condition in the simulated study. Even though more than 90% of the participants reported to recommend oral rehydration salt (ORS) plus zinc, above 85% of them dispense antimicrobial agents for the simulated patient. Dose (96%), frequency (98%), how to prepare ORS (98%), and duration (98%) were the most frequently given information in the questionnaire survey. However, the simulated study revealed that information about common side effects and major interactions were not given to the patient. Conclusion The study identified that there is a great difference between self-reported knowledge and actual practices on the management of childhood diarrhea in community pharmacies.
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Affiliation(s)
- Getnet Mengistu
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kassahun Gietnet
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Bisrat Hagos
- Department of Social Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Desye Misganaw
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Brata C, Schneider CR, Marjadi B, Clifford RM. The provision of advice by pharmacy staff in eastern Indonesian community pharmacies. Pharm Pract (Granada) 2019; 17:1452. [PMID: 31275500 PMCID: PMC6594425 DOI: 10.18549/pharmpract.2019.2.1452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background: Indonesian community pharmacies hold a strategic position from which to
promote the rational use of medicines by providing appropriate advice for
patients requesting self-medication. To date, published studies related to
the provision of advice in Indonesian community pharmacies are limited and
have been conducted only in more developed western Indonesia. No studies
have been undertaken in eastern Indonesia, which is less developed than and
culturally different from the western region. Objectives: This paper aims to: (1) describe the types and amount of advice provided by
pharmacy staff for three scenarios in a patient simulation study and for two
scenarios in pharmacy staff interviews; and (2) ascertain the frequency of
appropriate advice given in response to the scenarios. Methods: A patient simulation study was conducted at community pharmacies in an
eastern Indonesian provincial capital. Four weeks after completing a patient
simulation study, structured interviews with pharmacy staff were conducted.
Two cough scenarios and one diarrhoea scenario were developed for the
patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced
cough and a common cough and cold) were developed for pharmacy staff
interviews. The types and amount of advice provided by pharmacy staff were
recorded on paper and assessed for its appropriateness. The determination of
appropriate advice was based on the literature and by consensus of two
Indonesian experts. Results: In patient simulation, the most common type of advice provided in all
scenarios was product recommendations. In interviews, medical referrals and
recommending cough and cold medicine were the most common types of advice
provided for ACE inhibitor-induced cough and common cough and cold scenarios
respectively. Appropriate advice was provided in less than 0.5% in
the patient simulation study, but two-third of participants in the
interviews responded to the scenarios appropriately. Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they
may have adequate knowledge. A contributing factor was insufficient
information gathered in patient encounters. Optimising information-gathering
practice by pharmacy staff is needed.
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Affiliation(s)
- Cecilia Brata
- Centre of Medicine Information and Pharmaceutical Care, University of Surabaya, Surabaya (Indonesia).
| | - Carl R Schneider
- Faculty of Pharmacy, University of Sydney. Sydney, NSW (Australia).
| | | | - Rhonda M Clifford
- School of Medicine and Pharmacology, University of Western Australia. Perth, WA (Australia).
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Auta A, Hadi MA, Oga E, Adewuyi EO, Abdu-Aguye SN, Adeloye D, Strickland-Hodge B, Morgan DJ. Global access to antibiotics without prescription in community pharmacies: A systematic review and meta-analysis. J Infect 2019; 78:8-18. [DOI: 10.1016/j.jinf.2018.07.001] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
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Sakeena M, Bennett AA, McLachlan AJ. Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: a systematic review. Int J Antimicrob Agents 2018; 52:771-782. [DOI: 10.1016/j.ijantimicag.2018.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/28/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022]
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Sinopoulou V, Gordon M, Rutter P. A systematic review of community pharmacies' staff diagnostic assessment and performance in patient consultations. Res Social Adm Pharm 2018; 15:1068-1079. [PMID: 30342907 DOI: 10.1016/j.sapharm.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Increases in patients seeking advice at pharmacies has led to pharmacy staff engaging in diagnostic behaviours. Approaches to diagnosis include using mnemonics and clinical reasoning. OBJECTIVES The primary aim of this review was to assess the degree to which the criteria researchers use to evaluate diagnostic performance in pharmacy consultations, in studies that have simulated patients or vignettes, conform with a clinical reasoning and a mnemonic framework. A secondary aim of the review was to characterize staff performance in the studies, based on the authors' comments of their results. METHODS MEDLINE, EMBASE and Web of Science were searched between October 2016 and April 2017. Only peer-reviewed studies assessing pharmacy staff's diagnostic performance using simulated patients or vignettes were eligible for inclusion. Data were extracted about how each study's criteria conformed with clinical reasoning and mnemonic frameworks. A scoring system between 0 and 4 was devised to determine the degree to which studies aligned to these two approaches. Risk of bias was assessed using the NHI Study Quality Assessment Tools. The review was registered in PROSPERO with identification number CRD42017054827. RESULTS Sixty-eight studies (55 cross-sectional, 11 educational interventions and 2 RCTs) with sample sizes between 10 and 2700 were included in the review. Most studies were of poor or fair quality. Performance of pharmacy staff was overwhelmingly reported as poor by study authors. This was the case regardless of geography, scenario used, or assessment framework adopted. Scrutiny on how authors arrived at these conclusions revealed that mnemonic criteria were employed to assess pharmacy staff's diagnostic performance rather than a clinical reasoning approach. CONCLUSIONS Potentially important aspects of the decision-making process, such as clinical reasoning, were left unexplored. The number and geographic distribution of the included studies is a strength of this review; however, a validated tool was not employed.
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Affiliation(s)
- Vassiliki Sinopoulou
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, United Kingdom.
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, United Kingdom
| | - Paul Rutter
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, United Kingdom
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Servia-Dopazo M, Figueiras A. Determinants of antibiotic dispensing without prescription: a systematic review. J Antimicrob Chemother 2018; 73:3244-3253. [DOI: 10.1093/jac/dky319] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Miguel Servia-Dopazo
- Department of Preventive Medicine and Public Health, Santiago de Compostela University Clinical Teaching Hospital, Santiago de Compostela, Spain
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, Santiago de Compostela University Clinical Teaching Hospital, Santiago de Compostela, Spain
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública ‒ CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Sakeena MHF, Bennett AA, Jamshed S, Mohamed F, Herath DR, Gawarammana I, McLachlan AJ. Investigating knowledge regarding antibiotics and antimicrobial resistance among pharmacy students in Sri Lankan universities. BMC Infect Dis 2018; 18:209. [PMID: 29739360 PMCID: PMC5941408 DOI: 10.1186/s12879-018-3107-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/20/2018] [Indexed: 11/26/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a major challenge for global health care. Pharmacists play a key role in the health care setting to help support the quality use of medicines. The education, training, and experiences of pharmacy students have the potential to impact on patterns of antibiotic use in community and hospital settings. The aim of this study was to investigate antibiotic use, knowledge of antibiotics and AMR among undergraduate pharmacy students at Sri Lankan universities and to compare this between junior and senior pharmacy student groups. Methods A cross-sectional study was conducted at the six universities in Sri Lanka that offer pharmacy undergraduate programmes. All pharmacy students in each university were invited to participate in this study using a self-administered questionnaire with ethics approval. The study instrument comprised five major sections: demographic information, self-reported antibiotic use, knowledge of antibiotic uses in human health, knowledge of AMR and antibiotic use in agriculture. Descriptive data analyses were conducted and Chi-squared analysis was used to explore associations between different variables and level of pharmacy education. Results Four hundred sixty-six pharmacy students completed the questionnaire. A majority of participants (76%) reported antibiotic use in the past year. More than half (57%) of the junior pharmacy students incorrectly indicated that antibiotic use is appropriate for the management of cold and flu conditions. Senior pharmacy students (n = 206) reported significantly better antibiotic knowledge than junior students (n = 260), p < 0.05. Overall pharmacy students showed good understanding of AMR and their knowledge level increased as the year of pharmacy study increased. Conclusions This study found that pharmacy students commonly report using antibiotics. Junior students report some misconceptions about antimicrobials. A comparison between junior and senior pharmacy students suggests that pharmacy education is associated with improved understanding of appropriate antibiotic use and AMR among undergraduate pharmacy students in Sri Lanka. Electronic supplementary material The online version of this article (10.1186/s12879-018-3107-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M H F Sakeena
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka. .,Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.
| | | | - Shazia Jamshed
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Fahim Mohamed
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Dilanthi R Herath
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew J McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney, NSW, Australia
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Jaisue S, Phomtavong S, Eua-anant S, Borlace GN. Dispensing pattern for acute non-infectious diarrhoea in children at community pharmacies in Thailand. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Siriluk Jaisue
- Faculty of Pharmaceutical Sciences; Khon Kaen University; Khon Kaen Thailand
| | - Sommaly Phomtavong
- Faculty of Pharmacy; University of Health Sciences; Ministry of Health; Vientiane Lao People's Democratic Republic
| | | | - Glenn N. Borlace
- Faculty of Pharmaceutical Sciences; Khon Kaen University; Khon Kaen Thailand
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25
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Management of childhood diarrhea by healthcare professionals in low income countries: An integrative review. Int J Nurs Stud 2017; 66:82-92. [DOI: 10.1016/j.ijnurstu.2016.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/24/2022]
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Hermansyah A, Sainsbury E, Krass I. Community pharmacy and emerging public health initiatives in developing Southeast Asian countries: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e11-e22. [PMID: 26427905 DOI: 10.1111/hsc.12289] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 06/05/2023]
Abstract
The development of health and healthcare systems in South-East Asia has influenced the practice of community pharmacy. Over the years, community pharmacy in the region has striven to expand services beyond dispensing to encompass more involvement in public health issues. Searches were conducted in Scopus, EMBASE, MEDLINE and PubMed for articles published between January 2000 and December 2014, with 21 studies in five countries meeting the inclusion criteria. The findings showed increasing interest in research into the delivery of pharmacy services and public health initiatives. Overall, the review found that provision of some health services in pharmacies was common; however, most public health initiatives appeared to be poorly implemented, had limited evidence and were not demonstrated to be sustainable across the sector. This indicates that the practice of community pharmacy in the region has not significantly changed over the past 14 years with respect to the scope and quality of pharmacy services provided, and fundamental policy changes are necessary to improve this situation.
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Affiliation(s)
- Andi Hermansyah
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Pharmacy, Airlangga University, Surabaya, Indonesia
| | - Erica Sainsbury
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ines Krass
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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Foroughinia F, Zarei P. Evaluation of knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter drugs for the treatment of diarrhea in children: A pretest-posttest survey. J Res Pharm Pract 2016; 5:200-4. [PMID: 27512712 PMCID: PMC4966240 DOI: 10.4103/2279-042x.185735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: In this study, we aimed to assess knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter (OTC) antidiarrheal drugs in our city pharmacies, Shiraz, Iran. Methods: In this descriptive cross-sectional study, 90 pharmacies among 128 pharmacies in our city were randomly chosen. The study was designed into two phases: A standard questionnaire to determine the level of knowledge and attitude of pharmacists and a simulated client method to evaluate practice among them. An educational pamphlet was then given to the pharmacists. One month later, knowledge, attitude, and performance of studied pharmacists were evaluated again using the same method. Findings: Our results showed that an average consultation time by female pharmacists was considerably more than male pharmacists (P < 0.001). Before intervention, only 37.8% of pharmacists performed appropriately by prescribing the proper medicine while this increased to 58.44% after intervention. The average score of pharmacists’ knowledge was statistically increased (P < 0.001) and the pharmacists’ performance was significantly improved (P < 0.001) after the educational intervention. In related to the attitude, pharmacists’ tendency toward prescribing oral rehydration salt solutions (ORS) (P < 0.001) and their belief about the great effect of ORS on the treatment of diarrhea increased significantly after the intervention. Conclusion: It is concluded that training programs such as educational pamphlets and continuing educational seminars may play important roles in increasing pharmacists’ knowledge and therefore improving their performance in prescribing OTC medicines.
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Affiliation(s)
- Farzaneh Foroughinia
- Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Zarei
- Student Research Committee, International Branch, Shiraz University of Medical Sciences, Shiraz, Iran
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Miller R, Goodman C. Performance of retail pharmacies in low- and middle-income Asian settings: a systematic review. Health Policy Plan 2016; 31:940-953. [PMID: 26962123 PMCID: PMC4977427 DOI: 10.1093/heapol/czw007] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In low- and middle-income countries (LMIC) in Asia, pharmacies are often patients' first point of contact with the health care system and their preferred channel for purchasing medicines. Unfortunately, pharmacy practice in these settings has been characterized by deficient knowledge and inappropriate treatment. This paper systematically reviews both the performance of all types of pharmacies and drug stores across Asia's LMIC, and the determinants of poor practice, in order to reflect on how this could best be addressed. Poor pharmacy practice in Asia appears to have persisted over the past 30 years. We identify a set of inadequacies that occur at key moments throughout the pharmacy encounter, including: insufficient history taking; lack of referral of patients who require medical attention; illegal sale of a wide range of prescription only medicines without a prescription; sale of medicines that are either clinically inappropriate and/or in doses that are outside of the therapeutic range; sale of incomplete courses of antibiotics; and limited provision of information and counselling. In terms of determinants of poor practice, first knowledge was found to be necessary but not sufficient to ensure correct management of patients presenting at the pharmacy. This is evidenced by large discrepancies between stated and actual practice; little difference in the treatment behaviour of less and more qualified personnel and the failure of training programmes to improve practice to a satisfactory level. Second, we identified a number of profit maximizing strategies employed by pharmacy staff that can be linked to poor practices. Finally, whilst the research is relatively sparse, the regulatory environment appears to play an important role in shaping behaviour. Future efforts to improve the situation may yield more success than historical attempts, which have tended to concentrate on education, if they address the profit incentives faced by pharmacy personnel and the regulatory system.
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Affiliation(s)
- Rosalind Miller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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29
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Assessment of Community Pharmacists’ Counseling Practices With Simulated Patients Who Have Minor Illness. Simul Healthc 2015. [DOI: 10.1097/sih.0000000000000100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brata C, Marjadi B, Schneider CR, Murray K, Clifford RM. Information-gathering for self-medication via Eastern Indonesian community pharmacies: a cross-sectional study. BMC Health Serv Res 2015; 15:8. [PMID: 25608555 PMCID: PMC4312435 DOI: 10.1186/s12913-014-0670-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 12/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Gathering sufficient information when handling self-medication requests in community pharmacies is an important factor in assisting patients to obtain appropriate health outcomes. Common types of information usually gathered include patient identity, signs and symptoms, action taken, medical history, and current medications being used. The aims of the study were (1) to describe the types and amount of information gathered by Eastern Indonesian community pharmacy staff when handling self-medication requests, and (2) to identify factors associated with the reported amount of information gathered. Methods Patient simulation and pharmacy staff interviews were used. First, patient simulation was conducted using 2 cough scenarios and 1 diarrhoea scenario. Second, a structured interview was administered to eligible pharmacy staff in the setting. The types and amount of information gathered during patient simulation encounters and reported during pharmacy staff interviews were noted. A regression analysis was performed to identify factors associated with the amount of information gathered from the interview data. Results The most frequent types of information gathered in patient simulation encounters were the nature of symptoms (88% in one of the cough scenarios) and patient identity (96% in the diarrhoea scenario). Other types of information were gathered in <40% of encounters in each scenario. From the pharmacy staff interviews, >90% of the 173 interviewees reported that they gathered information on patient identity, nature of symptoms, and associated symptoms. Information on medical history and medication used was gathered by 20% and 26% respectively of the 173 interviewees. The majority of pharmacy staff asked 0 to 2 questions in the patient simulation encounters compared to 5 questions pharmacy staff reported as their usual practice during the interviews. Being qualified as a pharmacist or a pharmacy technician was one of the factors positively associated with the reported amount of information gathered. Conclusion There were deficits in the types of information gathered when pharmacy staff handling self-medication requests. Having a pharmacy educational background and additional work experience in the pharmacy was positively associated with the reported amount of information gathered. There could be other factors contributing to shortcomings in the actual practice which need to be explored.
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Affiliation(s)
- Cecilia Brata
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia. .,Centre of Medicine Information and Pharmaceutical Care, The University of Surabaya, Surabaya, Indonesia.
| | | | - Carl R Schneider
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
| | - Kevin Murray
- Centre for Applied Statistics, The University of Western Australia, Perth, Australia.
| | - Rhonda M Clifford
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia.
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31
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Brata C, Gudka S, Schneider CR, Clifford RM. A review of the provision of appropriate advice by pharmacy staff for self-medication in developing countries. Res Social Adm Pharm 2014; 11:136-53. [PMID: 25139059 DOI: 10.1016/j.sapharm.2014.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/11/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients in developing countries often prefer to self-medicate via community pharmacies. Pharmacy staff are therefore in a strategic position to optimize the health of the public by providing appropriate advice to patients who self-medicate. OBJECTIVE To determine the proportion of pharmacy staff who provide appropriate advice when handling self-medication requests in developing countries. METHOD A literature search was undertaken via MEDLINE, EMBASE, CINAHL Plus, Web of Science and International Pharmaceutical Abstracts. Studies that reported on the proportion of pharmacy staff providing appropriate advice when handling self-medication requests in developing countries were included. The appropriateness of advice was determined by each author's definition in the original studies. RESULTS Twenty-eight studies met the inclusion criteria. There were variations in methods, scenarios, how the authors reported and defined appropriate advice, and study populations. The proportion of pharmacy staff providing appropriate advice varied widely from 0% to 96%, with a minority providing appropriate advice in 83% of the scenarios performed. CONCLUSION There was considerable variation in results, with the majority of studies reporting that inappropriate advice was provided by pharmacy staff when handling self-medication requests in developing countries. Consistent and robust methods are required to provide comparisons across practice settings. There is also a need to identify contributing factors to poor provision of advice for developing intervention strategies for practice improvement.
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Affiliation(s)
- Cecilia Brata
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia; Centre of Medicine Information and Pharmaceutical Care, The University of Surabaya, Surabaya, Indonesia.
| | - Sajni Gudka
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Carl R Schneider
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Rhonda M Clifford
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
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Ogbo PU, Aina BA, Aderemi-Williams RI. Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria. Pharm Pract (Granada) 2014; 12:376. [PMID: 24644521 PMCID: PMC3955866 DOI: 10.4321/s1886-36552014000100002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/23/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Acute diarrhea in children leads to dehydration and death if not appropriately managed. World Health Organization (WHO) recommends treating diarrhea with oral rehydration therapy (ORT), fluids and foods. Proper management is hinged on accurate assessment of patients to identify the acute watery diarrhea. OBJECTIVE To compare the knowledge and attitude of community pharmacists in the management of acute diarrhea in children with their observed practice. METHODS THIS STUDY WAS CARRIED OUT USING TWO INSTRUMENTS: structured self-administered questionnaire to assess knowledge and attitude of community pharmacists in the management of acute diarrhea in children and simulated patient visits to evaluate assessment of patients, recommendation of products and instructions on feeding and fluid intake. The simulated patient visits were done in 186 pharmacies in the city of Lagos, Nigeria. RESULTS The study reveals that the knowledge and attitude of community pharmacists in the management of acute diarrhea in children was different from their observed practice. The difference was statistically significant (p<0.05). During the simulations, 23% carried out appropriate assessment before recommending any products, and 15% recommended ORT alone. Although information to the pharmacists indicated non-dysentery, non-cholera, acute watery diarrhea, antibiotics and antidiarrheals were irrationally recommended and these were the mainstay of symptoms' management in practice. Questionnaire data revealed that 24% of pharmacists knew the correct instructions to give on food and fluid intake during diarrhea, whereas 8% followed WHO guideline on food and fluid intake during the visits. CONCLUSIONS Assessment of patients to determine acute diarrhea was inadequate. Observed practice in managing acute diarrhea in children was inappropriate and significantly different from their claims in the questionnaire. The recommendation of ORT was scanty and advice on food and fluid intake was inadequate and sometimes inappropriate. This study shows that only 15% of community pharmacists managed acute diarrhea in children according to the WHO guidelines.
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Affiliation(s)
- Patricia U Ogbo
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos . Lagos ( Nigeria ).
| | - Bolajoko A Aina
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos . Lagos ( Nigeria ).
| | - Roseline I Aderemi-Williams
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos . Lagos ( Nigeria ).
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Pham DM, Byrkit M, Pham HV, Pham T, Nguyen CT. Improving pharmacy staff knowledge and practice on childhood diarrhea management in Vietnam: are educational interventions effective? PLoS One 2013; 8:e74882. [PMID: 24098355 PMCID: PMC3789740 DOI: 10.1371/journal.pone.0074882] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 08/11/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In many developing countries, private pharmacies play an important role in providing health information and services to local communities for common health issues. The aim of this study was to ascertain medium-term impact of educational interventions on knowledge and practice of pharmacy staff regarding management of childhood diarrhea in Vietnam. METHODS This was a pre- and post-intervention study with 32 and 44 months difference from the time of the baseline survey to the conclusion of trainings and the time of the end-line survey, respectively. Interventions included in-class training for pharmacy staff, printed materials at the pharmacy, and supportive supervision. Knowledge/reported practice and actual practice of pharmacy staff were measured before and after interventions. RESULTS After interventions, significant improvements (p<0.01) were observed for all indexes related to pharmacy staff's knowledge about childhood diarrhea; for instance, 31% and 60% of surveyed staff asked about weight of the child and accompanying symptoms of childhood diarrhea, respectively, an increase from 11% and 45% at the baseline. Oral rehydration solution (ORS) was the most frequently reported product recommended (97% to 99%), but probiotics and antidiarrheals were the products most frequently prescribed at pharmacies. Public health facilities remained the preferred choice for referrals from pharmacies, but the use of private clinics was increasing. Consultations and advice provided to caregivers also improved, but considerable gaps between knowledge and actual practice of staff in real pharmacy settings remained. CONCLUSIONS Educational interventions were effective in improving pharmacy staff knowledge and practice regarding management of childhood diarrhea. Knowledge and actual practice of staff in real pharmacy settings did not always correlate; there is need for a stronger regulatory and law enforcement system. Interventions to improve pharmacy practice in developing countries should be focused, comprehensive, and evidence-based.
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Affiliation(s)
- Duc Minh Pham
- PATH, Hanoi, Vietnam
- Management Science for Health, Hanoi, Vietnam
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Saengcharoen W, Lerkiatbundit S. Migraine management in community pharmacies: practice patterns and knowledge of pharmacy personnel in Thailand. Headache 2013; 53:1451-63. [PMID: 23808927 DOI: 10.1111/head.12163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe practice behavior and understanding among pharmacy personnel, both pharmacists and non-pharmacist staff, in the management of mild and moderate migraines. BACKGROUND Migraine is recognized as a prevalent and chronic neurological disorder. In developing countries, such as Thailand, community pharmacies are a widely used source of health care for various illnesses including migraine. However, the quality of migraine management and knowledge among pharmacy personnel is unclear. METHODS Cross-sectional study. The sample comprised 142 randomly selected community pharmacies in a city in the south of Thailand. Simulated clients visited the pharmacies twice, at least 1 month apart, to ask for the treatment of mild and moderate migraines. After the encounters, question asking, drug dispensing, and advice giving by pharmacy staff were recorded. Subsequently, the providers in 135 pharmacies participated in the interview to evaluate their knowledge in migraine management. RESULTS The majority of pharmacy personnel were less likely to ask questions in cases of mild migraine when compared with moderate attack (mean score [full score = 12] 1.8 ± 1.6 vs 2.6 ± 1.5, respectively, P < 0.001). Mean difference of question asking between mild and moderate migraines was -0.8 (95% confidence interval -1.1 to -0.5, P < 0.001). Approximately 33% and 54% of the providers appropriately dispensed non-steroidal anti-inflammatory drugs for mild attack and ergotamine for moderate migraine, respectively, P < 0.001. Prophylactic medications (eg, atenolol, propranolol, flunarizine) were inappropriately recommended, particularly in moderate attack (28.2% vs 17.6% in mild migraine, P = 0.018). Less than 30% of providers advised the patients on the maximum limit of dose or discontinuity of medications when recovered. Compared with non-pharmacists, pharmacists tended to ask more questions, give more advice, and dispense less appropriately; however, there were no significant differences. The results from the interview showed that most pharmacy personnel had inadequate knowledge on migraine management. Pharmacists had better knowledge on question asking (mild migraine 5.1 ± 2.1 vs 3.1 ± 1.3, respectively, P < .001; moderate disorder 6.5 ± 3.1 vs 3.9 ± 2.1, respectively, P < .001) and tended to have more knowledge on advice giving but poorer drug dispensing in moderate migraine according to the guidelines, relative to non-pharmacists (20.5% vs 40.3%, P = .014). CONCLUSIONS A large number of community pharmacists and non-pharmacist staff had inappropriate practice behavior and understanding. Continuing education and interventions are important to improve the practice and knowledge of pharmacy personnel, particularly the pharmacists.
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Affiliation(s)
- Woranuch Saengcharoen
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Gao W, Yan H, Wang D, Dang S. Oral rehydration salt use and its correlates in low-level care of diarrhea among children under 36 months old in rural Western China. BMC Public Health 2013; 13:238. [PMID: 23506435 PMCID: PMC3606826 DOI: 10.1186/1471-2458-13-238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/13/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Since 2000, there has been a decline in the proportion of oral rehydration salts (ORS) therapy in childhood diarrhea. How to sustain and achieve a high level of ORS therapy continues to be a challenge. METHODS The data of 14112 households and 894 villages in 45 counties across 10 provinces of Western China were collected in 2005. Generalized estimated equation logistic regression models were used to identify the determinants of ORS use in home-based and village-level care. RESULTS The therapy rate of ORS was 34.62%. This rate in home-based care (HBC) was significantly lower than that in village-level care (VLC), township-level care or county-level-or-above care. The children in the families with several pre-school-aged children (OR = 0.29 95% CI: 0.10, 0.86) or of the smaller age (12 vs 36 months: OR = 0.10 95% CI 0.02, 0.41; 24 vs 36 months: OR = 0.26 95% CI 0.09, 0.77) were less likely to receive ORS therapy against diarrhea in HBC. The children whose family had the habit of drinking boiled water (OR = 2.77 95% CI 1.30-5.91), or whose caretakers received educational materials about childhood diseases (OR = 3.08 95% CI 1.54, 6.16), or who were living in the villages in which village clinics had the available ORS packages (OR = 3.94 95% CI 2.25, 6.90) were more likely to receive ORS therapy against diarrhea in VLC. CONCLUSION There thus, ORS promoting program should give the highest priority to home care. ORS promoting strategies for low-level care could be strengthened based on children characteristics, the habit of drinking water and the situation of receiving educational material in the families and on the availability of ORS packages in village clinics in rural Western China.
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Affiliation(s)
- Wenlong Gao
- Department of Epidemiology and Health Statistics, School of Public Health, College of Medicine, Xi’an Jiaotong University, PO Box 46, Xi’an, Shaanxi 710061, PR China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, College of Medicine, Xi’an Jiaotong University, PO Box 46, Xi’an, Shaanxi 710061, PR China
| | - Duolao Wang
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, College of Medicine, Xi’an Jiaotong University, PO Box 46, Xi’an, Shaanxi 710061, PR China
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Brata C, Gudka S, Schneider CR, Everett A, Fisher C, Clifford RM. A review of the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries. Res Social Adm Pharm 2012; 9:370-83. [PMID: 23089294 DOI: 10.1016/j.sapharm.2012.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Currently, no review has been completed regarding the information-gathering process for the provision of medicines for self-medication in community pharmacies in developing countries. OBJECTIVE To review the rate of information gathering and the types of information gathered when patients present for self-medication requests. METHODS Six databases were searched for studies that described the rate of information gathering and/or the types of information gathered in the provision of medicines for self-medication in community pharmacies in developing countries. The types of information reported were classified as: signs and symptoms, patient identity, action taken, medications, medical history, and others. RESULTS Twenty-two studies met the inclusion criteria. Variations in the study populations, types of scenarios, research methods, and data reporting were observed. The reported rate of information gathering varied from 18% to 97%, depending on the research methods used. Information on signs and symptoms and patient identity was more frequently reported to be gathered compared with information on action taken, medications, and medical history. CONCLUSION Evidence showed that the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries is inconsistent. There is a need to determine the barriers to appropriate information-gathering practice as well as to develop strategies to implement effective information-gathering processes. It is also recommended that international and national pharmacy organizations, including pharmacy academics and pharmacy researchers, develop a consensus on the types of information that should be reported in the original studies. This will facilitate comparison across studies so that areas that need improvement can be identified.
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Affiliation(s)
- Cecilia Brata
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia.
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