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Al-Taani GM, Muflih SM, Al-Azzam SI, Alzoubi KH. Costs saved and avoided from pharmacist interventions to address drug-related problems identified from outpatient clinics in Jordan. PLoS One 2024; 19:e0302287. [PMID: 38843244 PMCID: PMC11156302 DOI: 10.1371/journal.pone.0302287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/02/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems. RESEARCH DESIGN AND METHODS Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective. RESULTS A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069-1.142), prescribed gastrointestinal drugs (3.485; 2.86-4.247), prescribed antimicrobials (3.326; 1.084-10.205), and prescribed musculoskeletal drugs (1.385; 1.011-1.852). CONCLUSIONS The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness.
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Affiliation(s)
- Ghaith M. Al-Taani
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Suhaib M. Muflih
- Faculty of Pharmacy, Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sayer I. Al-Azzam
- Faculty of Pharmacy, Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, UAE
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Huynh BH, Nathisuwan S, Tragulpiankit P, Nguyen VD, Huynh NH, Vu TLA, Huynh LTH, Vo HT. Drug-Related Problems and Pharmacists' Interventions in Hypertensive Outpatients: A Multicenter Prospective Study in 3 Vietnamese Hospitals. J Pharm Technol 2023; 39:259-268. [PMID: 37974593 PMCID: PMC10640860 DOI: 10.1177/87551225231199358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Clinical pharmacists' interventions (PIs) on drug-related problems (DRPs) in Vietnamese hypertensive outpatients are limited. Objectives: The objective was to investigate the prevalence and nature of DRPs, and factors which are likely to have DRPs, types of PIs, and their acceptance rate in 3 Vietnamese hospitals. Method: A prospective interventional study was conducted over a period of 3 months in 3 hospitals (from October 2021 to March 2022). Clinical pharmacists conducted medication reviews after collecting patient information from prescriptions and patient interviewing, and then identified the DRPs and suggested PIs according to the Vi-Med tool. These DRPs and PIs were reviewed by other superior clinical pharmacists and a consensus meeting with 3 cardiologists. Results: Of 381 patients included, 344 (90.23%) experienced 1 or more DRPs. A total of 820 DRPs were identified with an average of 2.15 DRPs per patient and 415 (50.61%) were hypertension-related issues. The most common DRPs identified were "administration mode" (46.34%), "missing indication" (18.05%), "non-conformity indication" (17.80%), and "dosage" (11.95%). Comorbidity (adjusted odds ratio [AOR] = 3.985, 95% CI: 1.597-9.942, P = 0.003) was the predictor of DRPs. Clinical pharmacists provided 739 PIs and 94.45% were accepted by physicians. Conclusion: The results of this study showed that DRPs were very common in hypertensive outpatients and highlighted the role of clinical pharmacists to identify and resolve DRPs through prompt interventions.
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Affiliation(s)
- Bon Huu Huynh
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Pharmacology and Clinical Pharmacy, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Surakit Nathisuwan
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Pramote Tragulpiankit
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | - Nam Huu Huynh
- Department of Interventional Cardiology, Da Nang General Hospital, Da Nang, Vietnam
| | - Thu Le Anh Vu
- Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Loc Thi Hong Huynh
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
| | - Ha Thi Vo
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
- Department of Pharmacy, Nguyen Tri Phuong Hospital, Ho Chi Minh, Vietnam
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Al-Azayzih A, Kanaan RJ, Altawalbeh SM. Assessment of Drug-Related Problems and Health-Related Quality of Life Domains in Elderly Patients with Type 2 Diabetes Mellitus. Ther Clin Risk Manag 2023; 19:913-928. [PMID: 38023626 PMCID: PMC10655742 DOI: 10.2147/tcrm.s434235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Aims of the Study This study aimed to investigate the prevalence and predictors of Drug-related problems (DRPs), as well as to evaluate the impact of DRPs on the health-related quality of life in geriatric patients with type 2 diabetes mellitus. Methodology A cross-sectional study was conducted over a three-month period. Patients aged 60 years and older visited diabetes clinics from October 1, 2022, to December 31, 2022, were included in the study. Data were collected through structured questionnaires, whereas lab results, medication records, comorbidities, and the consequences of DRPs were collected from electronic medical records. DRPs were identified and classified using the PCNE V501 classification system. Health-related quality of life (HRQoL) was evaluated using the validated EuroQol criteria. Results A total of 491 patients participated in the study, and the mean age of the patients was 67.51 years (SD = 5.84 years). Female patients represented 52.34% of total subjects. A total of 461 (around 94%) experienced at least one drug-related problem (DRP), ranging from one to nine DRPs per patient, with a total number of DRPs equal to 1625 identified. The most common DRP was the drug choice problem, affecting 52.98% of patients. Factors such as high drug frequency, living conditions, the number of diabetes medications, comorbidities, and smoking were significantly associated with higher numbers of DRPs. Higher numbers of DRPs were found to significantly worsen health-related quality of life (HRQoL) among patients. Conclusion Geriatric individuals with type 2 diabetes mellitus encounter a significant prevalence of DRPs, with drug choice problems being the most common followed by dosing problems. Risk factors contributing to these DRPs include high drug frequency, living conditions, high number of diabetes medications, multimorbidity, and smoking. Also, the study concluded that the increased number of DRPs was associated with negative impact on HRQoL domains in geriatric patients with type 2 diabetes.
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Affiliation(s)
- Ahmad Al-Azayzih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Roaa J Kanaan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Septiani V, Kartidjo P, Islamiyah AN, Aziz MSW A, Rukmawati I. Identification of Drug-Related Problems in Hypertension Comorbid Type 2 Diabetes Mellitus Patients at Primary Health Care Center Batununggal District Bandung. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i3.1971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many factors can increase the risk of hypertension, one of which is diabetes mellitus. The study aims to provide an overview of Drug-Related Problems (DRPs) in patients with hypertension comorbid type 2 diabetes mellitus at Primary Health Care Center Batununggal District Bandung. This research was an observational study with retrospective data collection and descriptive analysis. Data were taken from patient prescriptions January-December 2019 period. The sample inclusion criteria are patients aged 30-75 years, patients diagnosed with hypertension comorbid type 2 diabetes mellitus, and patients treated in January-December 2019. The number of samples that met the inclusion criteria was 268 patients, of which 69 patients (25.75%) are male, and 199 patients (74.25%) are female. 164 patients (61.2%) are aged 60-75 years old. It is found that 1 case (0.37%) has the drug-related problem of drug overdose and as many as 34 cases (12.69%) have potential drug interactions.
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Draime JA, Wicker E, Laswell E, Chen AMH. Implementation and assessment patient cases using the SBAR method to teach patient quality of life issues. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1040-1045. [PMID: 34294245 DOI: 10.1016/j.cptl.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/15/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Quality of life (QoL) preferences are an important consideration with respect to the Pharmacists' Patient Care Process (PPCP) and should be assessed prior to implementing a patient-centered plan. The objectives of this intervention were to determine if the design of a QoL activity impacts student performance, and to discern student perceptions of an innovative, case-based activity. EDUCATIONAL ACTIVITY AND SETTING Two cohorts of students in their second professional year were asked to present an article that included a QoL consideration. The two student cohorts were asked to complete the activity using a case report and modified SBAR (Situation, Background, Assessment, Recommendation) format. Presentations were graded using a rubric, and scores were assessed retrospectively. An unpaired t-test was used to examine differences. The final cohort of students was also asked to complete a survey to gather their perspectives. Results were described using descriptive statistics; thematic analyses were also performed. FINDINGS Students who completed the SBAR activity (N = 71) performed significantly better than those who completed the article (N = 98) presentation (95.62 ± 5.47 vs. 86.30 ± 16.54, P < .001). Those who completed the survey (N = 22) felt they made moderate to excellent progress explaining QoL (86%) and that the activity was helpful (68%). Overall, students reported an improved understanding of the patient's perspective. SUMMARY The PPCP requires that students must consider the patient's QoL in order to develop an optimal patient-centered plan. Activities such as this may improve student understanding of QoL implications.
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Affiliation(s)
- Juanita A Draime
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main Street, Cedarville, OH 45314, United States.
| | - Emily Wicker
- Class of 2021, Cedarville University School of Pharmacy, 251 N. Main Street, Cedarville, OH 45314, United States.
| | - Emily Laswell
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main Street, Cedarville, OH 45314, United States.
| | - Aleda M H Chen
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main Street, Cedarville, OH 45314, United States.
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Horodnycha O, Zimenkovsky A. Antibiotic allergy as a cause of hospitalization in adults: a hospital-based study in Ukraine. Pharm Pract (Granada) 2021; 19:2055. [PMID: 33520036 PMCID: PMC7819703 DOI: 10.18549/pharmpract.2021.1.2055] [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: 06/30/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Antibiotic allergy is an important clinical and social-economical issue. Objective:
The main objectives of this study were to determine the incidence, causative
drugs, and risk groups of antibiotic allergy as a reason for
hospitalization. The secondary objective was to evaluate the treatment of
antibiotic allergy through the identification of drug related problems
(DRPs).
Methods:
This retrospective hospital-based study was carried out in one of Lviv city
hospitals (Ukraine) from January 2015 to December 2017. Patients with
antibiotic allergy as a cause for hospitalization were included in this
study.
Results:
In this study the incidence of antibiotic allergy was 2.0%
(95%CI 1.6:2.4) of all admissions to the Unit that provides special
medical care for adult inpatients with allergy diseases and allergy
reactions. The mean age of patients was 48.5 years (SD=17.0; range 18-83
years) with female predominance (78.2%; 95%CI 68.9:85.2).
Antibiotic hypersensitivity reactions manifested as urticaria with
angioedema (52.5%; 95%CI 42.3:62.5), urticaria (36.6%;
95%CI 27.8:46.8) or angioedema (10.9%; 95%CI 5.6:18.7).
Beta-lactams (48.5%; 95%CI 38.5:58.7), fluoroquinolones
(13.9%; 95%CI 7.8%:22.2%) and macrolides
(7.9%; 95%CI 3.5:15.0) were specified as the main causative
drugs. All patients during hospitalization (a mean of 8.2 days; SD=2.2;
range 2-13 days) took at least 3 medicines (a mean of 5.4 medicines per
patient; SD=1.2; range 3-12 medicines). The total number of identified DRPs
was 400, a mean of 4.0 DRPs per patient (SD=1.8). The most frequently
identified type of DRPs was inappropriate route of drug administration
(25.0%; 95%CI 20.8:29.5). This was followed by duplicate
prescriptions (23.5%; 95%CI 19.4:28.0) and insufficient
frequency of drug administration (19.0%; 95%CI 15.3:23.2).
Potential drug-drug interactions and inappropriate drug prescriptions each
accounted for 16.0% (95% CI 12.6:20.0) of all DRPs. Comparing
all above items in 2015, 2016 and 2017 showed no statistically significant
changes (p>0.05).
Conclusions:
Antibiotic allergy is a common reason for admissions. The treatment of
antibiotic allergy is associated with numerous DRPs. Our results could be
useful for development of strategies for improving the safety and quality of
pharmacotherapy.
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Affiliation(s)
- Oksana Horodnycha
- PhD. Assistant professor. Department of Clinical Pharmacy, Pharmacotherapy and Medical Standardization, Danylo Halytsky Lviv National Medical University . Lviv ( Ukraine ).
| | - Andriy Zimenkovsky
- MD, PhD, DSc. Professor, Chief of Department. Clinical Pharmacy, Pharmacotherapy and Medical Standardization, Danylo Halytsky Lviv National Medical University . Lviv ( Ukraine ).
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Daliri S, Bekker CL, Buurman BM, Scholte op Reimer WJM, van den Bemt BJF, Karapinar – Çarkit F. Barriers and facilitators with medication use during the transition from hospital to home: a qualitative study among patients. BMC Health Serv Res 2019; 19:204. [PMID: 30925880 PMCID: PMC6441233 DOI: 10.1186/s12913-019-4028-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During transitions from hospital to home, up to half of all patients experience medication-related problems, such as adverse drug events. To reduce these problems, knowledge of patient experiences with medication use during this transition is needed. This study aims to identify the perspectives of patients on barriers and facilitators with medication use, during the transition from hospital to home. METHODS A qualitative study was conducted in 2017 among patients discharged from two hospitals using a semi-structured interview guide. Patients were asked to identify all barriers they experienced with medication use during transitions from hospital to home, and facilitators needed to overcome those barriers. Data were analyzed following thematic content analysis and visualized using an "Ishikawa" diagram. RESULTS In total, three focus groups were conducted with 19 patients (mean age: 70.8 (SD 9.3) years, 63% female). Three barriers were identified; lack of personalized care in the care continuum, insufficient information transfer (e.g. regarding changes in pharmacotherapy), and problems in care organization (e.g. medication substitution). Facilitators to overcome these barriers included a personal medication-counselor in the care continuum to guide patients with medication use and overcome communication barriers, and post-discharge follow-up care (e.g. home visits from healthcare providers). CONCLUSIONS During transitions from hospital to home patients experience individual-, healthcare provider- and organization level barriers. Future research should focus on personal-medication counselors in the care continuum and post-discharge follow-up care as it may overcome communication, emotional, information and organization barriers with medication use.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Clinical Pharmacy, OLVG hospital, Amsterdam, 1061AE The Netherlands
| | - Charlotte L. Bekker
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, 6574 NA The Netherlands
- Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, 3584 CX The Netherlands
| | - Bianca M. Buurman
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, 1105 AZ the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, ACHIEVE Center of Expertise, Amsterdam University of Applied Sciences, Amsterdam, 1105 BD the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, 1105 AZ The Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, 6574 NA The Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, 6525 GA The Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, Maastricht, 6229 HX The Netherlands
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Samiei Siboni F, Alimoradi Z, Atashi V. Health-Promoting Lifestyle: A Considerable Contributing Factor to Quality of Life in Patients With Hypertension. Am J Lifestyle Med 2018; 15:191-199. [PMID: 33786035 DOI: 10.1177/1559827618803853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/02/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022] Open
Abstract
Aim: Investigating the relationship between health promoting behaviors and quality of life in patients with hypertension. Methods: In this cross-sectional study, health-promoting behaviors and quality of life in patients with hypertension were assessed in a cardiology clinic of a university hospital in an urban area of Iran. The sample consisted of 93 patients with hypertension who were recruited using a convenience sampling method. Demographic data, Health Promoting Lifestyle Behaviors Profile (HPLP II) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires were used to gather data. Data were analyzed using SPSS software version 21. Results: The mean score of health promoting behaviors was moderate (2.51 ± 0.47) with highest and lowest scores in nutritional (2.80 ± 0.52) and physical activity (1.78 ± 0.62) dimension, respectively. There was a statistically significant relationship between health-promoting behaviors and quality of life. The relationship between health-promoting behaviors and quality of life had the highest power in psychological health dimension (β = 5.353, P < .001) and lowest power in the environmental dimension (β = 0.365, P < .001). Conclusion: Improving quality of life of patients requires paying attention to educational interventions for creating changes in the lifestyle to improve all aspects of quality of life.
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Affiliation(s)
- Fatemeh Samiei Siboni
- Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.,Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.,School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zainab Alimoradi
- Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.,Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.,School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Atashi
- Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.,Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.,School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Abu Farha RK, Mukattash TL, Qudah R, Alkhalaileh W, Alsaffar S. Drug-related problems and health-related quality of life in outpatients with type 2 diabetes: a cross-sectional study from Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Rana K. Abu Farha
- Department of Clinical Pharmacy and Therapeutics; Faculty of Pharmacy; Applied Science Private University; Amman Jordan
| | - Tareq L. Mukattash
- Department Clinical Pharmacy; Faculty of Pharmacy; Jordan University of Science and Technology; Irbid Jordan
| | - Rajaa Qudah
- Department of Clinical Pharmacy and Therapeutics; Faculty of Pharmacy; Applied Science Private University; Amman Jordan
| | - Waed Alkhalaileh
- Department Biopharmaceutics and Clinical Pharmacy; Faculty of Pharmacy; The University of Jordan; Amman Jordan
| | - Sama Alsaffar
- Department of Clinical Pharmacy and Therapeutics; Faculty of Pharmacy; Applied Science Private University; Amman Jordan
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