Perspectives of psychiatric patients in rural areas of Jordan: Barriers to compliance and pharmacist role

BACKGROUND

Successful management of psychiatric disorders is affected by patient perspectives and several barriers, that is, conceptual, psychological, social, or logistic reasons that can decrease patient adherence to therapy. In this perspective, pharmacists have a vital role in identifying patients in need of help and in dealing with barriers.

OBJECTIVE

The aim of this study was to investigate perspectives of patients diagnosed with psychiatric disorders, living in rural areas in Jerash, Jordan, regarding their awareness about their conditions, including religious and cultural factors, adherence to their treatment and related barriers, with special focus on pharmacist's role.

METHODS

This cross-sectional survey study was conducted in Jordan from August to November 2019. A validated questionnaire was administered by two pharmacy students via a structured interview with patients waiting for their appointment in the psychiatric clinic. Data were analysed using the Statistical Package for the Social Sciences.

RESULTS

One hundred twenty patients (age 39.4 ± 9.5, 66.7% males) completed the questionnaire. Most of them (71.0%) reported adherence to their medications, and 47.5% reported complete control of their symptoms with treatment. Most patients (59.2%) reported that they perceive their psychiatric problem in terms of religious faith as being counted for their favour in the Hereafter, and 52.5% of them always/usually looked at themselves positively and unaffected by their psychiatric problem; with both factors correlating significantly with better treatment adherence (P < .045 and P < .001; respectively). Barriers affecting adherence included mainly suffering from adverse effects (31.9%) and being unconvinced that they needed a medication (23.3%). Only 14.2% of patients reported that they refer to the pharmacist to get information about their medications.

CONCLUSION

This study shows suboptimal symptom control of psychiatric patients in Jerash. Nonadherence is an issue, with barriers identified. Positive religious and self-image perspectives correlated with better adherence. Patient referral to pharmacists is minimal and needs to be optimised.

A high rate of COVID-19 vaccine hesitancy in a large-scale survey on Arabs

Background

Vaccine hesitancy can limit the benefits of available vaccines in halting the spread of COVID-19 pandemic. Previously published studies paid little attention to Arab countries, which has a population of over 440 million. In this study, we present the results of the first large-scale multinational study that measures vaccine hesitancy among Arab-speaking subjects.

Methods

An online survey in Arabic was conducted from 14 January 2021 to 29 January 2021. It consisted of 17 questions capturing demographic data, acceptance of COVID-19 vaccine, attitudes toward the need for COVID-19 vaccination and associated health policies, and reasons for vaccination hesitancy. R software v.4.0.2 was used for data analysis and visualization.

Results

The survey recruited 36,220 eligible participants (61.1% males, 38.9% females, mean age 32.6 ± 10.8 years) from all the 23 Arab countries and territories (83.4%) and 122 other countries (16.6%). Our analysis shows a significant rate of vaccine hesitancy among Arabs in and outside the Arab region (83% and 81%, respectively). The most cited reasons for hesitancy are concerns about side effects and distrust in health care policies, vaccine expedited production, published studies and vaccine producing companies. We also found that female participants, those who are 30-59 years old, those with no chronic diseases, those with lower level of academic education, and those who do not know the type of vaccine authorized in their countries are more hesitant to receive COVID-19 vaccination. On the other hand, participants who regularly receive the influenza vaccine, health care workers, and those from countries with higher rates of COVID-19 infections showed more vaccination willingness. Interactive representation of our results is posted on our project website at https://mainapp.shinyapps.io/CVHAA.

Conclusions

Our results show higher vaccine hesitancy and refusal among Arab subjects, related mainly to distrust and concerns about side effects. Health authorities and Arab scientific community have to transparently address these concerns to improve vaccine acceptance.

Funding

This study received no funding.

Associations between patient factors and medication adherence: A Jordanian experience

Objective:

To explore the effect of patient characteristics and health beliefs on their medication adherence.

Methods:

Patients (n=167) with chronic conditions (mean age 58.9; SD=13.54, 53% males) were recruited from March 2009- to March 2010 using a cross sectional study design. Data collected included patients’ demographics, medical conditions, medications therapeutic regimen, frequency of physician visits and health beliefs. Patient self-reported adherence to medications was assessed by the researcher using a validated and published scale. Treatment related problems (TRPs) were evaluated for each patient by competent clinical pharmacists. Associations between patient characteristics/health beliefs with adherence were explored.

Results:

About half of the patients (46.1%) were non-adherent. A significant association was found between lower adherence and higher number of disease states (p<0.001), higher number of medications (p=0.001), and higher number of identified TRPs (p = 0.003). Patient adherence was positively affected by older age, higher educational level, and higher number of physician visits per month, while it was negatively affected by reporting difficulties with getting prescription refills on time.

Conclusion:

This study identified different factors that may negatively affect adherence, including higher number of medications and disease states, higher number of identified TRPs and inability to getting prescription refills on time. Hence, more care needs to be provided to patients with complex therapeutic regimens in order to enhance adherence.

Psychological Impact of Life as Refugees: A Pilot Study on a Syrian Camp in Jordan

Purpose: To investigate types and prevalence of psychological distresses endured by Syrian refugees at Alzatary Camp in Jordan.Methods: This observational study was conducted over a period of 2 months (November and December, 2012) at Alzatary Camp for Syrian refugees in Jordan. A validated questionnaire was filled by a field researcher to gather information on respondents’ living conditions, psychological distresses and perspectives of the medical care services provided.Results: The questionnaire was completed for 73 respondents with a mean age of 37.7 ± 11.2. A majority of refugees (63.3 %) lived in tents, and the rest in caravans. Some of the respondents (56 %) suffered from psychological distresses; 46 % believed that psychological therapy and support is needed, out of which 14.5 % reported receiving such therapy. Refugees staying in tents reported low satisfaction with the medical care  services provided (54.2 % vs. 23.8 %) and great need for psychological support (66.7 % vs. 31.3 %) when compared to refugees staying in caravans.Conclusion: Syrian refugees at Alzatary Camp suffer from psychological distress that requires urgent attention. Current medical support is not sufficient, especially for refugees staying in tents.Keywords: Syrian refugees, Jordan camps, Alzatary Camp, Psychological disorders, Mental health

Inhaler technique training and health-care professionals: effective long-term solution for a current problem

INTRODUCTION

The aims of this study were (1) to assess the ability of a range of health-care professionals (HCPs: specialists [physicians specializing in management of airways disease], general practitioners, pharmacists, pharmacist assistants, nurses, and respiratory therapists) in Jordan to demonstrate the correct use of some commonly used inhalers using standardized checklists, with highest scores indicating optimal use, and (2) to evaluate the short-term and long-term effectiveness of a single educational intervention on the HCPs' skills in using inhalers.

METHODS

HCPs' inhaler technique was assessed at baseline. All HCPs were then invited to attend a workshop on asthma management with particular reference to inhaler use. At the workshop, HCP skills in inhaler technique were optimized. Inhaler technique was assessed before and after training. All participants were assessed on their inhaler technique at follow-up (after 4 months).

RESULTS

Two hundred HCPs (10 specialists, 46 general practitioners, 79 pharmacists, 15 pharmacist assistants, 40 nurses, and 10 respiratory therapists) participated in the study. Specialists scored highest on baseline inhaler technique demonstration skills. All HCPs scored poorly in demonstrating the correct use of the dry powder inhalers when compared with pressurized metered-dose inhalers (MDIs) (range of mean scores ± SD: MDI, 7.24 ± 0.97 to 8.70 ± 0.67; Diskus, 4.83 ± 0.51 to 6.30 ± 1.7; Turbuhaler, 4.90 ± 0.32 to 6.40 ± 1.7). Participants attending the workshop showed improved inhaler skills (mean scores before and after training: MDI, 4.77 ± 1.60 vs 8.77 ± 0.52; Diskus, 4.40 ± 2.60 vs 8.85 ± 0.41; Turbuhaler, 4.96 ± 2.05 vs 8.63 ± 0.67). Four months after the workshop, the inhaler technique of 129 participants was again assessed. Those who had attended the workshop (n = 48) scored significantly higher mean scores for all devices (score = 7.64) than nonattendees (n = 81, score = 5.99, P < .001), by one-way analysis of covariance.

CONCLUSIONS

With the exception of specialists, HCPs in Jordan need to be updated on their inhaler technique skills, specifically the newer dry powder inhalers. A single effective educational workshop on inhaler technique can significantly improve HCPs' long-term ability to demonstrate these skills.

Home medication reviews in a patient care experience for undergraduate pharmacy students

OBJECTIVES

To evaluate the effectiveness of conducting medication management reviews (MMRs) and home medication reviews (HMRs) on improving undergraduate pharmacy students' pharmaceutical care skills and clinical knowledge.

DESIGN

Fifth-year bachelor of science in pharmacy students were enrolled in a structured course in which MMR cases based on real patient scenarios were completed, findings were discussed in groups, and comprehensive feedback was provided by course instructors. Each student was then asked to recruit a real patient through a community pharmacy and conduct an HMR.

ASSESSMENT

Students' pre- and post-course scores on the same MMR case improved significantly, with 84.6% of students passing the post-course assessment. Students also completed a new post-course MMR case and 74.8% received a passing score. Students' answers on a post-course self-assessment showed a significant improvement in their scores regarding knowledge and skills in conducting MMRs and HMRs.

CONCLUSION

Medication management reviews and home medication reviews are excellent tools for educating pharmacy students and providing them with needed actual clinical practice experience.

Phenytoin enhances collagenization in excision wounds and tensile strength in incision wounds

BACKGROUND

Hard-to-heal wounds present a major medical problem. The anticonvulsant drug phenytoin has been shown to have prohealing effects in various types of wounds. In this study we evaluated the effect of phenytoin on some phases of wound healing in a rat excision wound model.

METHODS

A total of 98 adult male Wistar rats were used in this study. The effect of phenytoin ointment on the time for complete wound closure, as well as its biochemical and histological effects were evaluated in an excision wound. In addition, mechanical effect of phenytoin was evaluated in an incision wound rat model.

RESULTS

Phenytoin hastened the healing and increased protein and hydroxyproline contents as well as histological collagenization of excision wounds. In addition, it increased the tensile strength in incision wound model.

CONCLUSION

This study is the first to profile in detail the effects of phenytoin on morphology and biochemistry of excision wounds. We have shown that phenytoin not only shortens the time for wound healing but also improves the quality of the healing tissue. These effects are sought for in various clinical settings in which unaided healing is inconveniently prolonged or where the forming scar is not fully developed, allowing relapse of the wound.