Browsing by Author "Akande-Sholabi, W."

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Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University
(Springer Nature, 2021) Akande-Sholabi, W.; Ajamu, A. T.
Background: Inappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University. Methods: Respondents’ knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents’ knowledge. Results: Of the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7–22.96)], had greater knowledge of antimicrobial resistance. Conclusions: The healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.
"Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University"
(Springer Nature, 2021) Akande-Sholabi, W.; Ajamu, T.A.
Background: Inappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University. METHODS: Respondents’ knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents’ knowledge. RESULTS: Of the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7–22.96)], had greater knowledge of antimicrobial resistance. CONCLUSIONS: The healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.
Assessment of Attitude, Practice and Barriers to Pharmaceutical Care Among Community Pharmacists in Ibadan
(2022) Akande-Sholabi, W.; AKINBITAN, A.A.
Background: Pharmaceutical care (PC) is a professional responsibility of a pharmacist that involves medication management with the overall goal of improving the quality of life of patient. Objectives: To evaluate the attitude, practice, and barriers to PC among community pharmacists in Ibadan. Method: A cross-sectional survey was conducted among community pharmacists between May and July 2021, with the aid of a self-administered questionnaires, information on socio-demographic characteristics, practice, attitudes, and barriers to PC was obtained. A consecutive sampling technique was used for participants’ enrolment. Participating pharmacists must have had a minimum of one-year practice experience in a community pharmacy. Pharmacy students, interns, non-pharmacist attendants, and community pharmacists who were absent from their pharmacies during the study were excluded. Data were summarized with descriptive statistics. Results: Over 12 weeks, 120 survey were collected (90.9% response rate). About (115; 95.8%) of respondents had good practice of PC and reported that pharmaceutical care is a timely innovation to pharmacy practice. However, only (62; 52.0%) had positive attitude and (117; 97.5%) believed more pharmaceutical care could be provided. Regarding their practice, most respondents (118; 98.3%) stated pharmaceutical care involves monitoring improvement in patient response to treatment and adherence to treatment regime and counselling patients with drug therapy problems. The top detected barriers for PC provision included insufficient time (71; 59.2%), and inadequate collaboration with other healthcare professionals (56; 46.7%). Conclusion: Community pharmacists in Ibadan demonstrated good practice and positive attitudes towards PC provision. However, further work should emphasise on improving PC understanding, better collaboration among other healthcare professionals and overcoming system-related barriers.
Assessment of attitude, practice, and barriers to pharmaceutical care among community pharmacists in Ibadan
(Nigeria Association of Pharmacists in Academia (NAPA), 2022) Akande-Sholabi, W.; Akinbintan, A. A.
Background: Pharmaceutical care (PC) is a professional responsibility of a pharmacist that involves medication management with the overall goal of improving the quality of life of patient. OBJECTIVES: To evaluate the attitude, practice, and barriers to PC among community pharmacists in Ibadan. METHOD: A cross-sectional survey was conducted among community pharmacists between May and July 2021, with the aid of a self-administered questionnaires, information on socio-demographic characteristics, practice, attitudes, and barriers to PC was obtained. A consecutive sampling technique was used for participants’ enrolment. Participating pharmacists must have had a minimum of one-year practice experience in a community pharmacy. Pharmacy students, interns, non-pharmacist attendants, and community pharmacists who were absent from their pharmacies during the study were excluded. Data were summarized with descriptive statistics. RESULTS: Over 12 weeks, 120 survey were collected (90.9% response rate). About (115; 95.8%) of respondents had good practice of PC and reported that pharmaceutical care is a timely innovation to pharmacy practice. However, only (62; 52.0%) had positive attitude and (117; 97.5%) believed more pharmaceutical care could be provided. Regarding their practice, most respondents (118; 98.3%) stated pharmaceutical care involves monitoring improvement in patient response to treatment and adherence to treatment regime and counselling patients with drug therapy problems. The top detected barriers for PC provision included insufficient time (71; 59.2%), and inadequate collaboration with other healthcare professionals (56; 46.7%). CONCLUSION: Community pharmacists in Ibadan demonstrated good practice and positive attitudes towards PC provision. However, further work should emphasise on improving PC understanding, better collaboration among other healthcare professionals and overcoming system-related barriers.
Assessment of knowledge and reasons for medication non-adherence in ambulatory elderly patients with hypertension and diabetes mellitus in a geriatric centre in Nigeria
(Oxford University Press, 2021) Akande-Sholabi, W.; Ogini, D. E.; Adebusoye, L.; Fakeye, T. O.
Introduction: Hypertension and type 2 Diabetes mel¬litus are global health disorders afflicting millions of elderly patients worldwide with an ever-increasing incidence and prevalence. Non-adherence to medications affects the quality and length of life, and has been associated with negative health outcomes and increasing healthcare costs especially in the elderly [1]. Few empirical data exist on the know¬ledge and medication adherence among elderly patients in sub-Saharan Africa countries. Aim: This study aimed to assess the knowledge, medi¬cation adherence, and the factors associated with patient’s knowledge on diabetes mellitus and hypertension. Methods: A cross-sectional study of 423 elderly patients aged ≥60 years diagnosed with hypertension and diabetes mellitus, selected consecutively at the Geriatric centre in the University College Teaching Hospital, Ibadan was car¬ried out between October 2019 and January 2020. Socio-demographic information, knowledge of the indication of the medications, possible side effects, and details of medi¬cation adherence level with reasons for non-adherence were obtained using interviewer-administered semi-structured questionnaire. Bivariate and multivariate analyses were car¬ried out using SPSS 23. Alpha was set at 0.05. Results: The mean age (±SD) of the older patients was 69.6 ± 6.4 years and 253 (59.8%) were females. About three-quarter of participants (320; 75.7%) were retired. Majority of the elderly (381; 90.1%) were hypertensive, while 270 (63.8 %) were diabetic, and 85 (20.1%) had multimorbidity of both hypertension and diabetes mel¬litus. Patients that were non-adherent with their medication were 138 (32.6%). The most common reasons reported for non-adherence included patient slept off (41; 56.6%), pre-occupation (24; 33.1%) and unavailability of medications (12; 16.6%). Thirty-seven (8.7%) participants intentionally missed doses, out of which 22 (59.5%) reported pill burden as its reason for medication non-adherence. All patients 423 (100.0%) knew the indication for their medications and 20 (4.7%) experienced medication-related side effects. Overall, 299 (70.6%) and 309 (73.0%) of patients with hypertension and diabetes mellitus showed good knowledge about their conditions. Adherence to medication was associated with good knowledge in hypertensive patients (p=0.002), while being male (p=0.002), age-group of 60–69 (p=0.001) and poor adherence (p=0.001) were associated with good knowledge in diabetes mellitus patients. Conclusion: We found non-adherence was mainly as a result of patients’ behaviors, attitude, and unavailability of medications which could be the cause of low medication adherence among the elderly patients. A systematic review on factors associated with medication adherence in older patients reported medication review aimed at simplifying regimens and educating patients about their treatment as intervention.
Barriers and Enablers to Medication Deprescribing among older patients attending a Geriatric Clinic in Southwestern Nigeria: A Cross-Sectional Study.
(Oxford University Press, 2023) Akande-Sholabi, W.; Ajilore, C. O,; Olowookere, O,; Adebusoye, L. A.
Introduction: Polypharmacy is an increasing health problem, leading to rise in morbidity and mortality, especially among older patients. Deprescribing has been recommended for managing polypharmacy, but deprescribing medication in older patients is still uncommon (1). Safe deprescribing interventions can reduce exposure to inappropriate polypharmacy among older patients. However, few empirical data exist on the barriers and enablers to medication deprescribing among older patients in sub-Saharan African countries. Aim: This study aimed to assess the barriers and enablers of medication deprescribing among older patients. Methods: A cross-sectional study of 415 older patients aged ≥60 years, selected consecutively at the geriatric clinic in a Tertiary Hospital was carried out between May and July 2022. An interviewer-administered semi-structured questionnaire was used to obtain information on their sociodemographic characteristics, and barriers and enablers.
Beers criteria and potentially inappropriate medications in elderly: awareness, practice, knowledge and barriers among community pharmacists in Nigeria
(Springer Nature, 2022) Akande-Sholabi, W.; Fafemi, A.
Clinical and Humanistic Outcomes of Pharmaceutical care Interventions in Diabetes mellitus: A systematic review and meta-analysis.
(West African Postgraduate College of Pharmacists (WAPCP), 2019) Showande, J. S.; Akande-Sholabi, W.; Fakeye, O.T.
Background: Diabetes mellitus is a chronic disease for which life-long medications and care are needed. Effectiveness of care is related to good glycemic control, which is desired to forestall complications. Objective: This study evaluated the effectiveness of pharmaceutical care (PC) services provided by pharmacists in improving clinical and humanistic outcomes in diabetes mellitus patients. Method: Five databases (PubMed/Medline, Embase, Scopus, Cochrane Central Register of Control Trials and Google Scholar) were systematically searched for randomized controlled trials (RCTs) reported in English using free text and medical subject headings keywords. Studies which had PC intervention arm, a control group, type1 and type 2 diabetes mellitus patients; clinical and/or humanistic outcomes were included. For meta-analysis, standard mean difference evaluated with random effect model at P<0.05 was reported. Significant heterogeneity was further evaluated with sensitivity and subgroup analyses. Results: A total of 41 RCTs with 7,448 patients were eligible out of 1222 citations. PC intervention significantly lowered glycosylated hemoglobin, fasting blood glucose, systolic blood pressure, diastolic blood pressure, total cholesterol, and low density lipoprotein cholesterol (P < 0.05), with significant heterogeneity. PC intervention also improved self-care but medication adherence, disease knowledge and quality of life were not improved. PC services offered (patient education, identification and resolution of drug therapy problems, and pharmacotherapy evaluation) were not uniform across the studies. Conclusion: The review and meta-analysis showed that PC intervention is of great benefit to improve most clinical outcomes which may result in better disease management. A call is however made for standardized pharmaceutical care intervention.
Community Pharmacists’ Perception about Mental Healthcare and Barriers to providing Pharmaceutical Care Services to Patients with Mental Disorder in Ibadan, Nigeria
(Biomedical Journal Consult, 2023) Akande-Sholabi, W.; Bakare, O. E.
Community pharmacists play a significant role by providing pharmaceutical care for patients with mental disorders. Mental disorder is a health priority in national health strategies around the world, including in Nigeria. However, personal perception and practice-related barriers may prevent full involvement. This study therefore aims to assess community pharmacists’ perception and level of comfort towards mental healthcare, as well as the barriers in providing pharmaceutical care to patients with mental disorder in Ibadan. A cross-sectional study among 120 community pharmacists in Ibadan, using a self-administered questionnaire. Descriptive statistics including frequency and percentage were used to summarize the data. The majority (99;82.5%) agreed they will deal with mentally ill patients, while 81 (67.5%) feel confident and comfortable to provide pharmaceutical care to patients with mental illness. Major barriers to pharmaceutical care cited includes inability to monitor outcomes as patients may never return to the pharmacy again (88; 73.3%) and having only limited patient information (85;70.8%). This corresponds with the revelation that (88; 73.3%) believe that follow up for adverse drug related problem is not easy. About 23% community pharmacies do not stock psychotropic medication at all, mainly due to few requests and tough regulations of record keeping required by law. Despite willingness to provide services to patients with mental illness, reduced stockings of psychotropics and practice-related barriers prevent full participation of community pharmacists.
COVID-19 and Older Adults: A Call to Accelerate Geriatrics Differentiated Healthcare Services in Africa
(ResearchGate, 2020-08) Akande-Sholabi, W.
Introduction: COVID-19 pandemic is having a global impact on healthcare system around the world. Everyone is susceptible to COVID-19, but older adults aged  60 years due to physiological changes that come with ageing and possible underlying medical disorders are more susceptible [1]. The need to ensure access to healthcare services by the elderly during this pandemic is paramount. Nonetheless, it is essential that stakeholders continue to prioritize access to healthcare services and medicines among the older adults amid the fight against this global public health, especially in Africa where little attention is paid to geriatric care. Methods: This is a descriptive recommendation abstract for countries in Africa based on tailored strategies to improve access to healthcare among the geriatric population during this pandemic and in the post-pandemic era. Discussion and key conclusion: When implementing interventions to reduce the spread of disease, such as partial or total lockdown, exceptional attention must be offered to older people. Remote consultations such as telemedicine have the potential to protect healthcare workers and older adults from unnecessary exposure to disease, while ensuring continuity in the delivery of care, and in addition, decreases resource utilization across the already stressed health-care infrastructure[2]. COVID-19 is a call to accelerate improved geriatrics differentiated healthcare services in Africa by leveraging on telemedicine and technology without necessarily exposing older adults to the risk of contracting diseases by visiting healthcare settings. During COVID-19 pandemic and post-pandemic telemedicine would have unlimited potential to provide effective, appropriate, and secure care in the context of highly transmissible disease epidemics, both for management, and for regular follow-up of chronic disease among older adults. The implementation of this technology should ensure that the future policy on telemedicine includes the end-users in the planning and implementation.
COVID-19 in Nigeria: Is the pharmaceutical sector spared?
(Elsevier Ltd, 2020) Akande-Sholabi, W.; Adebisi, Y. A.; Bello, A.; Ilesanmi, O. S.
The coronavirus disease 2019 (COVID-19) is an infectious disease caused by the newly discovered Severe Acute Respiratory Syndrome Coronavirus 2. The World Health Organization declared the novel coronavirus outbreak as pandemic after it was previously referred to as a public health emergency of international concern [1]. The first case of the disease in Nigeria was reported by the Federal Ministry of Health on the February 27, 2020 in Lagos. Since this period, there has been a steady geometric rise in the number of daily reported cases in the country with over 58,000 confirmed cases and 1100 deaths as of September 25, 2020. Many sectors have been impacted by the pandemic and the pharmaceutical sector is not an exception. This letter emphasizes how COVID-19 pandemic has impacted industrial, community and hospital pharmacy practice in Nigeria. The emergence of this pandemic brought with it, unprecedented challenges, and changes to all the nations of the world, Nigeria inclusive [1]. In a bid to contain the spread of this virus and to decrease the associated mortality and morbidity, a consensus of restricted movement, total lockdown in some places, have been reached in various countries. As a result of this, a country such as Nigeria which is heavily dependent on importation to meet its demands, will suffer a huge blow to several sectors including the pharmaceutical industry. Even though the local industry in Nigeria fairs better when compared to its counterparts in other developing countries in Sub-Saharan Africa [2], Nigeria is only able to meet 25% of its local demand. Nigeria’s pharmaceutical market predominantly runs on imports of active pharmaceutical ingredients machinery and quality control analytical equipment from abroad [2] . In Nigeria, over 70% of the prescribed medications are produced from active ingredients primarily sourced from firms in China and India [2]. Taking these into consideration alongside the travel restrictions in most countries, and the recently imposed travel ban on Nigerians, the current and future drug security in Nigeria is threatened. The added COVID-19 burden on the feeble healthcare system of Nigeria provides cause for grave concern. In an effort to manage the situation, the Central Bank of Nigeria has provided credit support as a palliative measure to reduce the impact of the pandemic on the health sector [3] . However, the availability of this fund to pharmaceutical industries is unknown. Lack of adequate infrastructures such as constant power supply, good water supply, functional transportation system and under-utilized manufacturing capacity have been some of the major challenges facing pharmaceutical industry in Nigeria [2]. Efforts should be made to address these challenges in order to reduce the total manufacturing and distribution costs. Adopting and enforcing production and distribution friendly policies amid and post-COVID-19 pandemic is essential. Community and hospital pharmacies have also been impacted as a result of the COVID-19 pandemic in Nigeria [4]. For instance, mode of operations has also evolved from face-to-face counselling into window-dispensing/counselling in hospital and community pharmacies. Low pharmacy workforce in the pre-COVID-19 era has also been previously reported. In a study carried out by Aniekan et al., in 2018 [5], there were 21,892 registered pharmacists in the country, of which only 59% are in active professional practice. It further stated that 42% of this licensed workforce are in community practice and 11% are hospital-based. A steady rise in number of migrating pharmacists have been observed thus bringing the pharmacists-patients ratio to about 1:14, 000 in 2018 which is way below the WHO recommendation of 1:2000. This remains worrisome in this COVID-19 era where the essential roles of pharmacists are much-needed. A large proportion of patients have stayed away from hospitals with the notion that health facilities increase their risk of contracting the virus. This has therefore resulted to a decline in the frequency of hospital visits which will negatively affect the provision of pharmaceutical care services including provision of point-of-care testing to patients. In lieu of hospitals treating COVID-19 patients, healthcare workers including pharmacists are constantly exposed to this highly infectious disease. This is a further concern since the lack of adequate personal protective equipment has been reported in Nigeria. Of great concern is that most community and hospital pharmacies are also not structured for effective physical distancing. In Nigeria, there is no guideline or standard operating procedure specific to the community and hospital pharmacies on COVID-19. Guidelines from international bodies or countries may not be applicable to Nigeria due to significant differences in pharmacy practice, demographics, and different COVID-19 transmission dynamics. There is a need for relevant tailor-made guidelines on how to handle COVID-19 in community and hospital pharmacies. Decline in patients’ hospital visits implies a higher flux of patients to community pharmacies for refills and as first points of contact for minor ailments. A large proportion of COVID-19 patients present with mild symptoms similar to a cold or flu and do not require hospitalization. Consultation with such patients put the community pharmacist at risk of contracting the virus. More than 30 frontline pharmacists across the country have tested positive for COVID-19 [6]. This situation suggests a possible increase in pressure on the available community pharmacy outlets in the country. Coupled with the reduced importation capacity which signifies impending drug scarcity, the surge to community pharmacies intensifies the pressure on the available stock of medicines which may result into price hikes and scarcity. COVID-19 presents an opportunity for increased production of drugs locally, while also relieving stock-out burden on available retail outlets. It is time to rethink pharmaceutical sector in Nigeria and ensure that health emergencies do not disrupt their much-needed roles in the health system.
COVID-19 in Nigeria; Is the pharmaceutical sector spread?
(Elsevier, 2020) Akande-Sholabi, W.; Adebisi, A. Y.; Bello, A.; Ilesanmi, O
Emergency contraception: Pharmacists’ knowledge and attitude on emergency contraceptives dispensing practices
(Oxford University Press, 2023) Akande-Sholabi, W.; Dehinde-Joseph, V.; Showande, J. S.
Objectives: Emergency contraceptives have the potential to reduce health complications in women with unintended/unwanted pregnancies. Access to availability and use of emergency contraceptive pills (ECPs) is influenced by pharmacist knowledge and attitudes, and there are limited data in Nigeria on pharmacists’ ECPs dispensing practices. This study assessed pharmacists’ knowledge, attitude and practice towards the use of emergency contraceptives. Methods: A cross-sectional study conducted among 100 community pharmacists in Ibadan metropolis, Nigeria with the use of a self-administered structured questionnaire. The questionnaire contained Likert-type 17-item knowledge, 9-item attitude and 15-item practice scales. The scales utilised 5–7 graded responses. The scaled score was graded as good and poor knowledge, positive and negative attitude and high, moderate or low-level practice of emergency contraception. The ability to predict the level of practice of emergency contraception, based on the pharmacist’s knowledge and attitude towards the use of ECP, was determined with hierarchical multiple regression as P < 0.05. Key findings: Good knowledge of emergency contraceptives was displayed by 51.5% of the pharmacists, and 51.9% had a positive attitude towards the use of ECPs. The level of ECP dispensing practices was high among 43.4% of pharmacists and low among 30.1% of pharmacists. More than 30% of the pharmacists offer a high level of educational services practice for ECPs. Pharmacists’ knowledge (β = 0.348, P = 0.002) and attitude (β = −0.302, P = 0.007) were predictive of the dispensing practice of ECPs. Conclusion: The community pharmacists have good knowledge of emergency contraceptive use and showed a positive attitude towards the dispensing of emergency contraceptive pills.
Evaluation of physician’s knowledge of deprescribing, deprescribing tools and assessment of factors affecting deprescribing process
(BioMed Central Ltd. (Springer Nature), 2023) Akande-Sholabi, W.; Ajilore, O. C.; Ilori, T. O.
Background Polypharmacy is a common global health concern in the older population. Deprescribing has been acknowledged as an important aspect of medication use review that helps to reduce polypharmacy, inappropriate medication uses and medication adverse events, thus ensuring medication optimization and improving health-related quality of life. As physicians are primarily responsible for prescribing and monitoring of drug therapy, their perception of deprescribing and knowledge of available deprescribing tools is highly important. This study aimed to explore physicians’ knowledge of deprescribing, deprescribing tools and factors that may affect the deprescribing process. Methods This was a cross-sectional survey carried out among 70 physicians in selected units of a teaching hospital in Nigeria between May and June 2022. Social-demographic information, knowledge of deprescribing and deprescribing tools were obtained using a self-administered, semi-structured questionnaire, while barriers and enablers of medication deprescribing were assessed with modified Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire. Descriptive and bivariate analyses were carried out using SPSS and α was set at p<0.05. Results Most of the physicians (56; 80.0%) were aware of the term “deprescribing” and had good knowledge (53;75.7%) of the steps to deprescribing. However, (16; 22.9%) respondents knew of the deprescribing tools, of this, (5;31.3%) were aware of Beers criteria and STOPP/START criteria. Awareness of the term “deprescribing” was significantly associated with knowledge of deprescribing steps (p=0.012), while knowledge of deprescribing tools was significantly associated with; awareness of the term “deprescribing” (p=0.029), and daily encounters with older multimorbid patients (p=0.031). Very important factor affecting physicians deprescribing decisions include benefit of the medication. The most common barrier is lack of information for a full clinical picture of the patient. Conclusion The physicians had good knowledge of the term “deprescribing” and the steps to deprescribing. Specific measures to target the barriers faced by the physicians in deprescribing medications and policies to implement physicians use of existing guidelines to facilitate their deprescribing decisions are essential.
Evaluation of Prescription Pattern of Analgesic use Among Ambulatory elderly in Southwestern Nigeria.
(Wolters Kluwer - Medknow, 2020) Akande-Sholabi, W.; Agha, C. P.; Olowookere, O. O.; Adebusoye, L.
Background: Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients(≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients’ case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients(259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival
Extent of misuse and dependence of codeine-containing products among medical and pharmacy students in a Nigerian University
(Springer Open, 2019) Akande-Sholabi, W.; Adisa, R.; Ilesanmi, O.S.; Bello, A. E.
Background: Misuse and dependency of opioids especially codeine-containing products is of increasing global concern. Inappropriate use of opioids among healthcare students could affect quality of service and ethical conducts of these future professionals, thereby putting the society at risk. This study aimed to evaluate knowledge and perception of medical and pharmacy students in a Nigerian tertiary University on use of opioids with focus on codeine-containing products. Methods: A cross-sectional survey among 335-medical and 185-pharmacy students from University of Ibadan, Nigeria, between September and December 2018, using a self-administered semi-structured questionnaire. Results: A total of 178 (34.2%) in multiple responses had used opioid-containing products among the respondents, of this, 171 (96.1%) used codeine-containing formulation. Precisely, 146 (28.1%) of the students had used codeine-containing products before, of this, 16 (11.0%) used the products for non-medical or recreational purpose regarded as a misuse/ abuse. In all, 201 (38.7%) had good knowledge of opioid use, with 51 (34.9%) among those who had used opioids and 150 (40.1%) among those who had not used opioids (X2 = 1.186; p = 0.276). Majority (469; 90.2%) had good perception of risks associated with opioid use; comprising (130; 89.0%) among those who had taken opioids and (339; 90.6%) among those who had not taken opioids before (X2 = 0.304; p = 0.508). Logistic-regression shows that students who experienced some side effects to be experienced again 22.1 [AOR = 22.1, 95% CI: (5.98–81.72)] as well as those pressured into using codeine-containing products 10.6 [AOR = 10.6, 95% CI: (1.36–82.39)] had more tendency of misuse. Conclusion: There is a potential for misuse of codeine-containing products among medical and pharmacy students. Peer-influence and experience of some side effects are possible predictors of misuse among the students. Thus, healthcare students’ curriculum should incorporate preventive programme, while public education and policy that favours peer-support programme on medication misuse is advocated for healthcare students.
Medications and the risk of falls among older people in a geriatric centre in Nigeria: a cross-sectional study
(Springer Nature, 2021) Akande-Sholabi, W.; Ogundipe, F.; Adebusoye, L
Background Falls are a major cause of morbidity and hospitalization in older people. Many drugs have been shown to increase the risk of falls in this population. Few empirical data exist on the use of fall-risk-increasing drugs among older people of sub-Saharan Africa countries. Objective This study aimed to assess the prevalence and predictors of falls, and the association between FRIDs, drugs causing orthostatic hypotension and falls. Setting Geriatric center, University College Hospital, Ibadan, Nigeria. Methods A cross-sectional study of 400 older patients aged ≥ 60 years selected consecutively at the geriatric centre, between September and November 2019, were interviewed using a semi-structured questionnaire. Socio-demographic information, medication utilization, and history of falls were obtained. Bivariate and multivariate analyses were carried out using SPSS 23. Alpha was set at 0.05. Main outcome measure Prevalence and predictors of falls among ambulatory older patients. Results The mean age of the older patients was 72.4 ± 7.3 years and 255 (63.7%) were females. The total number of FRIDs and ODs used by older patients was 578 (35.2%). The prevalence of fall was 181 (45.3%) which was significantly higher among the females compared with the males (51.8% vs 33.8%) p = 0.01. Classes of medications such as anti-Parkinson’s (p = 0.027), sedatives (p = 0.033), antipsychotics (p = 0.011) and anticholinergic (p = 0.027) were significantly associated with fall. Predictive factors for falls on logistic regression were female [OR = 2.375; 95% CI 0.274–3.704, p = 0.001] and use of antipsychotics [OR = 5.132; 95% CI 1.352–19.480, p = 0.016]. Conclusion The prevalence of falls was high and being a woman ≥ 60 years is a major risk factor for falling. Interventions to decrease falls in older patients by drug modification and deprescribing of FRIDs and ODs might reduce fall-related injuries. Thus, a multidisciplinary approach is essential for intervention to reduce the risk of falls and improve therapeutic outcomes among older patients.
Polypharmacy and Factors Associated with their Prevalence Among Older Patients Attending a Geriatric Centre in South-West Nigeria
(West African Postgraduate College of Pharmacists (WAPCP), 2018) Akande-Sholabi, W.; Olowookere, O.; Adebusoye, L.
Background: Polypharmacy among older people in Nigeria are prominent issues of public health dimension. Polypharmacy especially in older people with multiple diseases often results in poor health status and outcomes. Objectives: To determine the prevalence and factors associated with polypharmacy among older patients attending the geriatric clinic. Methods: Cross sectional study of 400 elderly patients aged 60 years and above who presented at geriatric clinic, UCH, Ibadan. Polypharmacy was taken as concurrent consumption of =5 medications. Socio-demographic characteristics, lifestyle habits, attitudinal factors on medication understanding, medication pattern and intake were assessed through a questionnaire. Bivariate and multivariate analyses were carried out using SPSS 20 and alpha was set at 0.05. Results: Mean age of the respondents was 70.2 ± 5.9 years and 240 (60.0%) were females. The point prevalence of polypharmacy was 23.8%. The average medications consumed were 4 without sex difference. Logistic regression analysis showed that taking too many prescription medications (OR = 2.188; 95% CI =1.014 – 4.808, p = 0.05), intentionally skipping my medications because they are too many (OR = 3.756; 95% CI = 1.354 – 10.424, p = 0.01) and receiving prescriptions from more than one physicians on regular basis (OR= 2.336; 95% CI = 1.058 – 5.155, p = 0.04) were the most significant factors associated with polypharmacy. Conclusion: Polypharmacy is common among older people in this setting. Healthcare workers should address the attitudinal, social and health related factors, which could lead to polypharmacy.
Potential Inappropriate Prescribing Among Ambulatory Elderly Patients in a Geriatric Centre in Southwestern Nigeria: Beers criteria versus STOPP/START criteria.
(Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, 2020-05) Akande-Sholabi, W.; Ajilore, O. C.; Showande, J. S.; Adebusoye, L.
Purpose: To identify potentially inappropriate prescribing in ambulatory elderly patients and compare the appropriateness of guidelines; Beers' and Screening Tool of Older Person’s Prescription (STOPP)/Screening Tool to Alert Right Treatment (START) criteria to detect potentially inappropriate prescribing among the elderly. Methods: A retrospective study was conducted using case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December 2016, using a data extraction sheet. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs). Results: Mean age of patients was 69 ± 0.4 years (range 60 - 85 years) and 219 (65.4 %) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5 % PIP, while STOPP criteria identified 57.1 % PIP. START detected 29 PPOs in 15 (4.4 %) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1 %) and osteoarthritis 64 (19.3 %). Polypharmacy was significantly associated with PIP in both Beers (p = 0.002) and STOPP (p = 0.001) criteria. Conclusion: The prevalence of PIP is high among elderly patients. The STOPP/START criteria identified a higher proportion of PIP among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criterion to be adopted by health care professionals in Nigeria.
Potentially Inappropriate Medication Use Among Older Patients Attending a Geriatric Centre in South-West Nigeria
(Sage, 2018) Akande-Sholabi, W.; Olowookere, O.; Adebusoye, L.
Objectives: To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients. Methods: Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer’s criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05. Results: Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080–2.725)] and being physically active [OR =1.879 (1.026–3.436)] as the most significantly associated with PIMs use. Conclusions: The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists’, working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons.