Exit-Knowledge of Ambulatory Patients About Medications Dispensed in Government Hospital in Eastern Ethiopia: The Need for Focused Patient Counseling

What do patients know about their newly prescribed medication: Application of a novel knowledge index

OBJECTIVE

The present study aimed to evaluate patients' knowledge about their newly prescribed medications, contributing factors, and preferred sources of medication-related information.

METHODS

A cross-sectional study using an online survey was conducted among 931 customers of a mail-order pharmacy. Medication-related knowledge was examined using a novel knowledge index (KI) assessing medication dosage, indication, time of administration, and side effects. Patients' preferred sources of information were assessed. Univariate and multivariate regression analyses were performed to investigate predictors of medication-related knowledge.

RESULTS

The average KI score was 2.97 (SD = 0.73); most participants answered correctly when asked about indication (94.2 %), dosage (90.0 %), and time of administration (92.3 %); however, knowledge of medication-related side effects was limited (23.1 %). KI scores were predicted by greater perceived informedness, younger age, and having received a medication plan (all ps < 0.05). Preferred sources of medication-related information included physicians, written information, and information obtained via secure electronic patient records.

CONCLUSION

Knowledge gaps were found for medication-related side effects. Insufficient medication-related knowledge is linked to non-adherence and subsequent personal and economic costs. Electronically issued information could provide a cost-effective solution. Practical applications including "OpenNotes" are discussed.

PRACTICE IMPLICATIONS

Issuing medication plans via platforms such as "OpenNotes" can increase patient understanding and participation, and decrease non-adherence.

An Evaluation on Five Dimensions of a Mobile Health Application for Patient Counseling in Ambulatory Care Pharmacy: A Single-center Cross-sectional Survey Based on Pediatric Caregiver's Opinion

Objective

Due to high workloads and insufficient counseling time in ambulatory care pharmacy, outpatient pharmacists for pediatric patients in China proposed a mobile health application (mHealth app) that they considered could provide patient counseling more efficiently. To improve it accordingly, we need to design a more specific and multi-dimensional evaluation method to obtain pediatric caregivers' evaluations of a mHealth app.

Methods

A cross-sectional survey on five dimensions (transmission, accuracy, accessibility, completeness, and experience) of the mHealth app was conducted using a random questionnaire among outpatient caregivers at a children's hospital.

Findings

We received 478 valid questionnaires from 500 caregivers. The Item-Level Content Validity Index (I-CVI) indicated the content validity of the questions (I-CVI =1.000). The Content Validity Index for Scales (S-CVI) confirmed their content validity (S-CVI =1.000). The intraclass correlation coefficients (ICCs) of test-retest reliability were acceptable (0.806≤ ICC ≤0.869). The mean scores for transmission, accuracy, accessibility, and completeness were more than 3.5 when the experience was 2.1. Caregivers of different ages agreed that their accuracy was satisfactory; however, their experience was not. Caregivers aged over 50 years did not recognize its transmission and accessibility, whereas caregivers aged under 29 years and over 50 years were not satisfied with its completeness.

Conclusion

The accuracy of the mHealth app is excellent; the transmission and accessibility need to give the silver generation time to accept and adapt, and experience and completeness should be improved. The five-dimensional assessment model can also be used to evaluate other mHealth apps for patient counseling.

Clients' knowledge and satisfaction with outpatient pharmacy services and associated factors at Felege Hiwot comprehensive specialized hospital, Ethiopia: A cross-sectional study

Objective

This study aimed to assess patient knowledge and satisfaction and associated factors with outpatient pharmacy service at Felege Hiwot comprehensive specialized hospital.

Design setting and participants

An institution-based cross-sectional study was conducted at Felege Hiwot comprehensive specialized hospital on patients getting outpatient Pharmacy service from 01 March 2022 to 30 May 2022. The study participants were selected by simple random sampling method.

Main outcome measured

Patients' knowledge and satisfaction with pharmacy service was measured by a structured questionnaire and Data were collected, cleared, and coded, then entered into EPI Info (Epidemiological information. version 7.1.5.2) and analyzed using SPSS (version 25).

Results

The overall knowledge result of the respondents showed that only 13.3% of individuals have good drug knowledge and 72.01% of respondents were satisfied with the outpatient pharmacy service. Following up on the multivariate analysis of service modality patients by credit (AOR: 5.50 (1.71-17.74), who are with the occupation of merchants (AOR: 0.09 (0.01-0.83)) and labeling (AOR: 3.13 (1.58-6.20) had an association with drug knowledge. Multivariate analysis showed that waiting time, dispensing time and privacy had an association with satisfaction. When we consider waiting time; respondents with 3-6 min, 6.1-9 min and >9 min waiting times are 0.06 times, 0.02 times, and 0.01 less likely satisfied compared with respondents having waiting time <3 min. It shows that as the patient stays without getting serviced for a long time, satisfaction decreases.

Conclusions

Overall, around three-fourths of the respondents were satisfied with the outpatient pharmacy services which is approaching the national satisfaction assessment result. Respondents were strongly satisfied with Dose, route, frequency, and duration. However, they were strongly dissatisfied with the name of the drug. After the multivariate analysis privacy, waiting time, and dispensing time had an association with patient satisfaction.

Patterns in counselling services provided at Saudi Ministry of Health medication counselling clinics - Reasons for referrals and subjects discussed: A cross-sectional study

Background

Pharmacists provide medication counselling services to improve patient knowledge and their adherence to prescription instructions, and to achieve the best possible health-related outcomes. Our study aim was to describe the patterns of the reasons for referral to counselling and the subjects discussed between pharmacists and patients, and the possible associations related to the susceptible patient groups (chronic and elderly), in Saudi Ministry of Health (MOH) medication counselling clinics.

Method

This was a descriptive cross-sectional study. An electronic data collection form was developed to document details about the medication counselling services that were provided to patients. The form consisted of three main areas: (1) patient demographics and counselling services characteristics; (2) reasons for referrals to the medication counselling clinics; and (3) the subjects that were discussed between pharmacists and patients in the counselling session. A comparison was conducted between chronic and non-chronic, and elderly and non-elderly patients.

Results

From May 2020 to December 2021, a total of 36,672 counselling service sessions were provided to 28,998 patients. The greatest proportion of reasons for referrals to counselling was that patients had chronic diseases (50.84%), patients were added a new medication (33.69%) or patients received multiple medications (polypharmacy) (22.71%). The most frequent subject discussed during counselling was general knowledge about medication (85.62%), the duration of therapy (68.42%) and the action that patients should take if they missed a dose of their medication (44.51%). Patients with chronic diseases showed a significantly greater frequency of referral to counselling compared to patients without chronic disease, due to polypharmacy, medication use during Ramadhan, adverse drug reactions (ADRs), dosing/interactions, high-alert medication and suspected nonadherence (P < 0.001). This led to a significantly greater frequency of discussions with patients with chronic conditions about their general medication knowledge, the duration of their therapy, missed doses, ADRs, medication reconciliation and medication use during Ramadhan (P < 0.001). Elderly patients recorded significantly more referrals to counselling related to chronic diseases and polypharmacy than their younger counterparts (P < 0.001); however, there was no significant difference between the elderly and non-elderly in the patterns of subjects discussed that were related to polypharmacy and chronic disease consequences. A significant spike was also reported in the frequency of delivery of counselling services to caregivers for the elderly (P < 0.001).

Conclusion

The current state of medication counselling services in Saudi MOH facilities indicates that chronic disease and polypharmacy are the most significant reasons for referral to counselling, and that the subjects discussed the most during counselling are general knowledge about medication, duration of therapy and missed doses. Patients with chronic diseases have a higher frequency of referral to counselling and discussion about polypharmacy and its consequences than those without chronic conditions. Elderly patients also show a high frequency of referral to counselling about chronic diseases and polypharmacy. Caregivers of elderly patients require more education to maximise counselling effectiveness as they attend the majority of elderly patient counselling sessions.

An exploratory study of outpatient medication knowledge and satisfaction with medication counselling at selected hospital pharmacies in Northwestern Nigeria

Background

Medication counselling is an important activity that improves patient therapeutic outcomes. After this activity has been carried out, patients should be satisfied with counselling, and possess adequate knowledge about their medications.

Objectives

To describe outpatient/caregiver medication knowledge and satisfaction with medication counselling at the main outpatient pharmacies of eight public secondary and tertiary hospitals located in two states in Northwestern Nigeria.

Methods

Exit interviews were conducted from December 2019 to March 2020 with randomly sampled patients/caregivers who had just been dispensed one or more prescription medications from the main pharmacies of the hospitals. The questionnaire used contained 31 questions in three sections. The first section collected demographic information. The second section assessed respondents’ experiences and overall satisfaction with the counselling they had received. The last section evaluated respondents’ knowledge of one randomly selected prescription medication that had been dispensed to them. Data collected were coded and analyzed to generate descriptive statistics. To explore associations between respondent characteristics and overall satisfaction, non-parametric tests were used, and statistical significance set at p<0.05.

Results

A total of 684 patients/caregivers were interviewed. Majority of respondents agreed that the time spent (97.1%) and quantity of information (99.1%) provided during counselling was adequate. However, over 60% of them also agreed that dispensers did not assess their understanding of information provided or invite them to ask questions. Despite this, their average overall satisfaction with counselling on a 10-point scale was 8.6 ± 1.6. Over 90% of them also correctly identified the routes and frequency of administration of the prescribed medication selected for the knowledge assessment. Although, more than 60% of respondents did not know the duration of therapy or names of these medications.

Conclusion

Respondents’ satisfaction with medication counselling was fairly high even though they did not seem to know much about their medication.

Exit-Knowledge About Dispensed Medications and Associated Factors Among Patients Attending the Outpatient Pharmacy of Ambo General Hospital, Western Ethiopia

BACKGROUND

Insufficient knowledge of patients about their dispensed medications may result in inappropriate use of medication which can lead to treatment failure and poor therapeutic outcome.

PURPOSE

This study aimed to determine the exit-knowledge level and its determinants among patients attending outpatient pharmacy of the Ambo General Hospital.

PATIENTS AND METHODS

Hospital-based cross-sectional study was conducted on 400 study participants who visited the outpatient pharmacy in Ambo General Hospital from October to December 2019. Face-to-face interview was conducted using structured questionnaires to assess the exit-knowledge of the patients about their dispensed medication at the pharmacy exit. A binary logistic regression was employed to determine factors associated with the exit-knowledge. The association was statistically significant at 95% of confidence interval with a p-value less than 0.05.

RESULTS

A total of 400 patients participated in the study with a 100% response rate. Of the total, 222 (55.5%) patients had sufficient exit-knowledge about their dispensed medication. Patients in the age group of 19-29 (AOR=3.1; 95% CI (1.7-5.6) and 49 -59 (AOR = 3.7; 95% CI (2.3-6.0)) had greater exit-knowledge than the elderly participants (>60 years). Participants who reported the comfort of the waiting area was not suitable had lower odds of sufficient exit-knowledge (AOR= 0.7; 95% CI (0.2-3.0)) in comparison to those who reported a suitable waiting area. Lower odds of sufficient exit-knowledge (AOR=0.4; 95% CI (0.3-0.7)) was determined among those who responded fairly clarity of the dispensers guidance in comparison with those reported clear guidance. The gender and the residence of the participants were also had a significant association with the exit-knowledge level.

CONCLUSION

Modest number of the patients had sufficient exit-knowledge of their dispensed medication. Age, gender, residence, perceived comfort of the waiting area and perceived clarity of the pharmacists' guidances were significantly associated with the exit-knowledge.

Assessment of Patients Misunderstanding of Dosing Instructions Among Outpatients in Dessie Referral Hospital, Northeast Ethiopia

Background

Lack of clear and precise oral and written information from both the doctors and/or pharmacists on the management of prescribed medication has led to therapeutic failure, as a result of patients not comprehending instructions. Incorrect interpretation of labels can lead to incorrect usage of medication therefore the occurrence of medication error and/or adverse event. The concern of this study was to assess misunderstanding of dosing instructions among outpatients in Dessie Referral Hospital (DRH).

Methods

An institution-based cross-sectional study was conducted on 384 outpatients at DRH from February 10 to March 15, 2019. Study subjects were selected by using a systematic random sampling technique and data was collected by using questionnaires and observation. The data was coded individually and entered in a computer using Epi Info™ version 3.5.1 and then exported to SPSS version 23.0 for analysis. Univariate analyses were used to describe the categorical variables. Chi-square test was used to assess association of variables with primary outcome. P-value <0.05 was considered as statistical significance.

Results

This study showed that most of the respondents n=298 (77.6%) misunderstood more than one dosage instruction, 8.75% misunderstood the dose, 51.3% misunderstood the frequency while 58.59% misunderstood the duration of treatment. The misunderstanding was higher for labeled medications (11.4%) than unlabelled (7.7%).

Conclusion

The prevalence of misunderstanding of dosing instruction was high in outpatients of DRH. Hence standard procedures must be developed to provide easy and clear dosing instructions to patients, and continuous training must be provided for pharmacists on proper communication of dosing instructions to patients.

Knowledge on Dispensed Medications and Its Determinants Among Patients Attending Outpatient Pharmacy at Chencha Primary Level Hospital, Southwest Ethiopia

Background

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

Methods

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

Results

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

Conclusion

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

Patient-Pharmacist Interaction in Ethiopia: Systematic Review of Barriers to Communication

Despite the fact that pharmaceutical care has been expanding simultaneously with the increasing role of pharmacists and the number of prescriptions dispensed, the extended role of community pharmacists is largely confined to the dispensing of medications. This advancement in pharmacy services demands competent pharmacists and patient-centered communication. The objective of this review was to explore the barriers to patient-pharmacy interaction. Relevant kinds of literature were searched from Google Scholar, PubMed, Hinari, We of Science, Scopus, and Science Direct. A total of 3025 kinds of literature were searched. After excluding redundant and irrelevant literature, 13 kinds of literature were reviewed. Lack of adequate knowledge of drugs, lack of updated drug information, work experience, poor job satisfaction, lack of good communication skills, shortage of time, and clearness of pharmacist's voice and tone were barriers to communication from the side of pharmacy professionals. Factors like not wanting to talk much, bad attitude toward the pharmacy, being in a rush to leave, lack of willingness, language and educational status of the patient were patients' communication obstacles while high patient load, the suitability of dispensing area, and waiting time for service were associated challenges for patient-centered communication faced by health facilities. Barriers to patient-pharmacist interactions were related to patients, pharmacy professionals, and health institutions. These factors are not independent and the presence of one factor may trigger others and further compromise the patient-pharmacist interaction and result in poor medication outcomes.

Exit-Knowledge About Dispensed Medications and Associated Factors Among Ambulatory Patients Attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

BACKGROUND

Optimizing exit-knowledge of ambulatory patients is a major professional responsibility of pharmacists to reassure safe and cost-effective medicines use. The study assessed the exit-knowledge of ambulatory patients on their dispensed medications and associated factors.

PATIENTS AND METHODS

Institutional-based cross-sectional study was conducted among ambulatory patients who visited the outpatient pharmacy of Ayder Comprehensive Specialized Hospital (ACSH) from December 2019 to February 2020. Data were entered, cleaned, and analyzed using SPSS version 20. Binary logistic regression was employed to determine factors associated with exit-knowledge on their dispensed medications. At a 95% confidence interval (CI), p≤0.05 was considered statistically significant.

RESULTS

The study analyzed 400 patients; more than half of the participants were males (55.5%). The mean age of the participants was 41.3 years (mean ± standard deviation (SD), ±13). Less than half of the patients did not recall the name (44.5%) and major side effects (31.2%) of each medication. Furthermore, the overall sufficient knowledge was found to be 81%. Patients with single marital status were 4.454 times to have sufficient exit-knowledge of their dispensed medications than widowed (p=0.050) participants. Besides, patients who responded neutral clarity of pharmacist instruction had 4.745 times sufficient exit-knowledge than those who responded not clear (p=0.049). On the other hand, participants who got "enough" (p<0.0001) and "not enough" (p=0.006) information from the pharmacist were found to have a positive association with sufficient exit-knowledge than those who responded "I do not know".

CONCLUSION

The majority of patients had sufficient exit-knowledge of their dispensed medications. Martially single, neutral clarity of pharmacist's instructions and adequacy of the information delivered by the pharmacist were positively associated with participants' exit-knowledge of their dispensed medications. Hence, conducting a multicenter study, we recommend pharmacists to counsel their patients to underpin patients' knowledge of their dispensed medications.

The New Era of Pharmacists in Ambulatory Patient Care

Pharmacy is evolving from a product-oriented to a patient-oriented profession. This role modification is extremely healthy for the patient, the pharmacist, and other members of the health-care team. However, the evolution will present pharmacists with a number of new challenges. Now, more than in the past, pharmacists must make the acquisition of contemporary practice knowledge and skills a high priority, to render the level of service embodied in the concept of pharmaceutical care. Pharmacy educators' organizations and regulatory bodies must all work together to support pharmacists as they assume expanded health-care roles. Pharmacy and the healthcare industry must work to ensure that the pharmacist is compensated justly for all services. But before this can happen it will be necessary for pharmacy to demonstrate value-added to the cost of the prescription. Marketing of the purpose of pharmacy in the health-care morass and of the services provided by the pharmacist is needed to generate an appropriate perceived value among purchasers and users of health-care services. Pharmacists should view themselves as dispensers of therapy and drug effect interpretations as well as of drugs themselves. Service components of pharmacy should be identified clearly to third party payers and be visible to consumers, so that they know what is available at what cost and how it may be accessed. In the future, pharmacy services must be evaluated on patient outcome (i.e., pharmaceutical care) rather than the number of prescriptions dispensed, and pharmacy must evolve toward interpretation and patient consultation, related to the use of medication technologies.