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Mashozhera S, Bamitale SK, Godman B, Kibuule D. Compliance to hypertensive prescribing guidelines and blood pressure control in elderly patients in Namibia: findings and implications. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Objective
Resources-limited countries in sub-Saharan Africa are facing a crisis of hypertensive-related morbidity, mainly due to poor blood pressure (BP) control. The study aimed to evaluate BP control and hypertensive prescribing for elderly patients in a resource-limited setting.
Methods
Hospital-based survey assessing hypertensive prescribing practices among elderly patients (age, ≥60years) at a leading ambulatory care clinic in Namibia. The primary and secondary outcomes were compliance with prescribing guidelines, prescribing patterns and BP control respectively. Data were collected using patient exit interviews and a review of their prescription records. Data were analyzed using descriptive statistics using SPSS v25.
Key findings
Of the 189 elderly patients recruited, 69.3% were females, mean age was 70.3 ± 8.5 years and 2.6% had HIV. 61.4% of the prescriptions complied with the prescribing guidelines in terms of treatment choice and 78.3% (n = 148) had a poor BP control. 61.4% had at least one comorbidity, mainly diabetes mellitus (32.2%) or cardiac disease (20%). On average, 4.5 medicines were prescribed per patient and 4.8% were out of stock. Prevalence of non-INN prescribing was 64%. Diuretics, renin-angiotensin inhibitors were the most prescribed antihypertensive, 73.9% (n = 138/189) and 51.9% (n = 98/189) respectively. 90% of patients with good BP control were on ≥3 medicines compared to 77% for patients with poor BP controlled.
Conclusion
Whilst compliance with prescribing guidelines is modest, the sub-optimal BP control, high prevalence of co-morbidities and over prescribing with non-INN products is discouraging. Pharmacist-led medication audits could improve hypertensive prescribing and BP control among elderly patients, and we will be following this up
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Affiliation(s)
- Shylet Mashozhera
- Department of Pharmacology and Therapeutics, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Samuel Kayode Bamitale
- Department of Pharmacology and Therapeutics, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
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Wiggins BS, Dixon D, Bellone J, Gasbarro N, Marrs JC, Tran R. Key Articles and Guidelines in the Management of Dyslipidemia: 2019 Update. J Pharm Pract 2019; 33:882-894. [DOI: 10.1177/0897190019868413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the mortality from cardiovascular disease has declined, it remains the leading cause of morbidity and mortality in the United States. Dyslipidemia is a modifiable risk factor that plays a significant role in the development of atherosclerotic cardiovascular disease. Treating dyslipidemia by lowering cholesterol, predominately low-density lipoprotein cholesterol, has been shown to reduce cardiovascular events. The first article that provided dyslipidemia bibliographies was published in 2006. Since this time, new therapies have become available and older therapies that were once thought to provide benefit have since been shown to lack positive outcomes and have therefore fallen out of favor for routine use. As the body of evidence continues to expand, clinicians are faced with reevaluating their treatment strategies to ensure optimal outcomes and appropriate use of lipid-lowering therapies. Therefore, this compilation was created to serve as a resource for clinicians. This publication provides an update of key articles in dyslipidemia management including various guidelines and practice-changing randomized controlled trials.
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Affiliation(s)
| | - Dave Dixon
- Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | | | | | - Joel C. Marrs
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rebecca Tran
- Keck Graduate Institute School of Pharmacy, Claremont, CA, USA
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3
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Hollis IB, Jennings DL, Oliphant CS, Baker WL, Davis EM, Allender JE, Zemrak WR, Ensor C. Key articles and guidelines in the management of patients undergoing cardiac surgery. J Pharm Pract 2015; 28:67-85. [PMID: 25715085 DOI: 10.1177/0897190015570566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Significant numbers of patients undergo cardiac surgery worldwide each year. A large evidence base exists regarding the optimal pre-, intra-, and postoperative mediation management for patients undergoing coronary artery bypass grafting (CABG) surgery, valve replacements or repairs, and mechanical circulatory support (MCS). Prevention and treatment of perioperative arrhythmias, perioperative antimicrobial prophylaxis, prevention of thrombosis, and bleeding through proper management of perioperative antiplatelet and anticoagulant therapies, and the use of pharmacotherapy to optimize both short- and long-term patient outcomes after cardiac surgery are the focus of this first compilation of guidelines and key articles in this patient population to be published in the Journal of Pharmacy Practice.
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Affiliation(s)
- Ian B Hollis
- Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Douglas L Jennings
- Heart Transplant and Mechanical Circulatory Support, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Carrie S Oliphant
- Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA Department of Clinical Pharmacy, The University of Tennessee College of Pharmacy, Memphis, TN, USA
| | - William L Baker
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | - Estella M Davis
- Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - J Erin Allender
- Department of Pharmacy, WakeMed Health & Hospitals, Raleigh, NC, USA
| | - Wesley R Zemrak
- Department of Pharmacy, Maine Medical Center, Portland, ME, USA
| | - Christopher Ensor
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
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Ripley TL, Brenner M, Finks S, Hough A, McConnell KJ, Parker M, Dobesh PP. Key articles and guidelines in the management of hypertension: 2015 update. J Pharm Pract 2015; 28:146-61. [PMID: 25660583 DOI: 10.1177/0897190014568382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension is a major risk factor for cardiovascular disease. Evidence for optimal pharmacotherapy continues to accumulate at a very rapid pace; maintaining an up-to-date library of key articles for hypertension management can be challenging for busy clinicians. Further, there has been controversy surrounding the hypertension guidelines that were released in late 2013 and early 2014. The lack of congruence and simplicity in the current hypertension recommendations could result in delays with application of evidence to clinical practice. In order to facilitate clinicians' efficient access to high-impact clinical trials evaluating the management of hypertension, this compilation of annotated bibliographies was created to serve as a resource for any health care professional participating in the management of adult patients with hypertension.
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Affiliation(s)
- Toni L Ripley
- Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | | | - Shannon Finks
- College of Pharmacy, University of Tennessee, Memphis, TN, USA
| | - Augustus Hough
- West Palm Beach Veterans' Affairs Medical Center, West Palm Beach, FL, USA
| | - Karen J McConnell
- Department of Pharmacy, Kaiser Permanente Colorado, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver, CO, USA
| | - Mary Parker
- Durham Veterans' Affairs Medical Center, Durham, NC, USA
| | - Paul P Dobesh
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
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Dobesh PP, Beavers CJ, Herring HR, Spinler SA, Stacy ZA, Trujillo TC. Key articles and guidelines in the management of acute coronary syndrome and in percutaneous coronary intervention: 2012 update. Pharmacotherapy 2012; 32:e348-86. [PMID: 23165917 DOI: 10.1002/phar.1225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
More than 1 million people in the United States experience an acute coronary syndrome (ACS) every year, and almost 600,000 undergo percutaneous coronary intervention (PCI) for treatment of cardiovascular disease. There is a large amount of evidence-based literature to guide appropriate management of these patients. There have been a number of advances in the treatment of these patients over the last several years. Due to the large amount of rapidly available literature concerning the care of patients with ACS or undergoing PCI, clinicians can often find it difficult to keep up with the information needed for optimizing care of these patients. Therefore, we provide the second update to the first compiled bibliography of key articles and guidelines relative to patients with ACS published in Pharmacotherapy in 2004. The initial update was published in Pharmacotherapy in 2007 and also included bibliographies concerning management of patients undergoing PCI. A number of guidelines and practice-changing literature have been published since the update in 2007. Specific areas included in this review are updated summaries of clinical practice guidelines and clinical trials of anticoagulants, antiplatelets, platelet aggregation testing, pharmacogenomics testing in patients taking clopidogrel, clopidogrel loading dose comparisons, clopidogrel and proton pump inhibitor drug interactions, the impact of bleeding in ACS, and statins. As with previous versions of this document, we hope that this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with coronary heart disease.
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Affiliation(s)
- Paul P Dobesh
- Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198-6045, USA.
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Dobesh PP, Wittkowsky AK, Stacy Z, Dager WE, Haines ST, Lopez LM, Nutescu E, Phillips KW, Trujillo TC, Vondracek T. Key articles and guidelines for the prevention of venous thromboembolism. Pharmacotherapy 2009; 29:410-58. [PMID: 19323620 DOI: 10.1592/phco.29.4.410] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Venous thromboembolism (VTE) is an important medical problem that affects millions of patients each year. With appropriate prophylaxis, many of these thromboembolic events can be prevented. Although strong evidence supporting VTE prophylaxis spans several decades, several large American and global registries have documented very poor use of appropriate prophylaxis. Because of increasing regulatory requirements, hospitals nationwide are in the process of developing documentation of appropriate VTE prophylaxis programs for both surgical and medical patients. A wide range of clinicians must understand what constitutes appropriate VTE prophylaxis in various patient populations. With the existence of numerous pharmacologic agents, abundance of data from major clinical trials, and several nationally recognized clinical guidelines, compiling the needed reference material to make evidence-based decisions on appropriate VTE prophylaxis can be difficult for clinicians. Therefore, we provide a bibliography of key articles and guidelines related to the prevention of VTE in various patient groups. We hope this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients who may be at risk for VTE.
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Affiliation(s)
- Paul P Dobesh
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198-6045, USA.
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Gaffney SM, de Denus S, Olson KL, Ripley TL, Robinette B, Summers KM, Spencer AP. Key Articles and Guidelines in the Management of Hypertension: 2008 Update. Pharmacotherapy 2008; 28:1041-58. [DOI: 10.1592/phco.28.8.1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dobesh PP, Brouse SD, Dager WE, Spinler SA, Stacy Z, Wiggins BS. Key Articles and Guidelines in the Management of Acute Coronary Syndromes and in Percutaneous Coronary Intervention: 2007 Update. Pharmacotherapy 2007; 27:1722-58. [DOI: 10.1592/phco.27.12.1722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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