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Patient medication knowledge governing adherence to asthma pharmacotherapy: A survey in rural Lagos, Nigeria
(2010-05) Omole, M.K.; Ilesanmi, N. A.
Asthma is a chronic disease and often requires complex management. This study was undertaken in four pharmacies–V-Ninat Pharmacy, Videc Chemists, Tomabel Pharmacy and Josbet Chemists, all in Isolo, Lagos, to determine the level of adherence to the anti-asthmatic drugs by asthmatic patients who participated in the study. Data was collected using structured questionnaires administered to patients coming into the pharmacies. The questionnaire was administered during a one-on-one interview. Times of recruitment were varied in an attempt to avoid any bias or restriction of the sample in relation to gender, age, or employment status such as trading and teaching. There were 73 participants in the study. The participation rate was 67 (92%) of those individuals eligible. The mean age of participants was 57(± 17.7) years. 30 (45.2%) of respondents were males and 37 (54.8%) were females. The mean number of occasion of exercise per week was 28.26. Twenty six (26) (39.0%) of patients used “preventer” medication, that is medication that prevents asthmatic attack on those who frequently suffer from asthma, and 5 (7%) never used it. Participants offered a number of reasons explaining their non-adherence, the most common 24 (58.5%) were those who forgot to take “preventer” medication. Nine (9) (21.9%) were too busy, 5 (12.2%) were concerned about side effects and 3 (7.3%) did not believe it was effective. Other responses were offered only by individual participants and were not endorsed by the participant sample. Older patients adhered to their medication regimen more closely than younger patients. Fifty (50) (68%) patients used “preventer” medication and 17 (26%) patients used “reliever” that is, agent that relieves asthmatic attack on those who frequently suffer from asthma. Based on these findings and the result of hypothesis testing (p < 0.05), the study established poor medication knowledge, suboptimal device technique, and disturbing levels of patients adherence with management recommendations. Asthma education strategies need to be modified to engage patients with low asthma knowledge to achieve improved patient outcome. Further, strategies should be employed to motivate patients to use “preventer” medications during the times they feel well.
PRESCRIBING ERRORS AND INTERVENTION OUTCOMES IN SELECTED TERTIARY HOSPITALS IN NIGERIA
(2014-11) AJEMIGBITSE, ADETUTU ADEBAMBO
Prescribing errors, particularly in the medical and paediatric specialties have been reported globally to affect up to 52.0% of hospitalized patients with potential to cause harm. Prescribing errors have however not been adequately investigated in Nigeria. This study was designed to carry out an in-depth evaluation of the nature, severity and causes of prescribing errors in three purposively selected tertiary hospitals in Nigeria with a view to providing pharmacist-led evidence-based recommendations for their prevention. A retrospective review of 8270 out-patient prescriptions and 1200 in-patient records from medical and paediatric units between January and December 2010 in National Hospital, Abuja (NHA) with University of Abuja Teaching Hospital, Gwagwalada (UATH) and University College Hospital, Ibadan (UCH) as controls. Baseline prescribing pattern was measured using the British National Formulary and Nigeria Standard Prescribing Guidelines. Causes of prescribing errors were investigated using a prospective qualitative approach involving semi-structured face-to-face interviews and questionnaires guided by the Reason’s accident causation model. Error rates were studied in the three tertiary hospitals while intervention was carried out at NHA. Interventions involved educational outreaches consisting of structured teaching and training. Data collected compared error rates pre- and post- intervention, to determine impact of the intervention. Data were analysed using descriptive and Chi-square statistics. Prescribing error rates were 24.6 ± 1.4 (UATH), 5.7 ± 1.2 (NHA) and 6.7 ± 2.3 (UCH) for out-patient prescriptions and 28.7 ± 2.3 (UATH), 26.3 ± 2.1 (NHA) and 41.0 ± 3.1 (UCH) for in-patient prescriptions. Non-inclusion of direction of use (38.1%, UATH); missing signature and/or name of prescriber (66.6%, NHA) and omitting end date of therapy (54.4%, UCH) were the commonest errors in out-patient prescriptions. The most common in-patient prescribing error was missing end date of therapy: 71.3% (UATH), 65.9% (NHA) and 86.0% (UCH). The highest proportion of medications was ordered at admission: 57.3% (UATH), 44.3% (NHA) and 44.7% (UCH) while time of discharge was associated with the highest error rates of 37.8% (UATH), 58.6% (NHA) and 80.8% (UCH). Severity of prescribing error rates for in-patients was 4.9% (UATH), 2.8% (NHA) and 1.3% (UCH). Prescriptions involving antimicrobials contained the highest prescribing UNIVERSITY OF IBADAN LIBRARY iii errors 53.8% (UATH), 37.9% (NHA), and 36.3% (UCH). Risk factors identified in error causation included organisational (91.0%), environment (50.0%), individual (45.0%), task (45.0%) and team (36.0%) factors. Absence of self-awareness of errors and organisational factors identified included inadequate training and experience and absence of reference materials. Defences against errors, particularly pharmacists’ involvement, were deficient. There was no change in overall error rates 5.8%, pre- and post- intervention (p = 0.98). However, there were reductions in drug-drug interactions 1.2% to 0.4% (p<0.001), omission of drug route 0.3% to 0.1% (p<0.001) and ambiguous orders 0.2% to 0.0% (p<0.001) at the NHA. Prescribing errors were common in the 3 facilities resulting from writing prescriptions that lacked details and slips in attention. Majority of the errors, though of minor severity, had potential of causing harm. Continuing prescriber education and training will likely result in error reduction. Pharmacists’ involvement in prescribing error prevention should be an on-going process. Key words: Prescribing errors, Reason’s accident causation model, In- and out-patients. Word count: 500
A survey of antimalarial drug use practices among urban dwellers in Abeokuta, Nigeria
(2010-01) Omole, M. K.; Onademuren, O. T.
Drug-use pattern of anti-malarial has been associated with development of resistant strain and therapeutic failure. This descriptive cross-sectional study was carried out to assess anti-malarial drug-use practices among dwellers of Adigbe communities within Abeokuta environment. The study documented the knowledge, the attitude and behaviour of three hundred and fifty (350) respondents in terms of drug preference, attitude to drug use and the effects of non-compliance to antimalarial drug. Structured questionnaires were used for data collection, as total of 370 questionnaires were distributed and 350 questionnaires were retrieved for analysis. One hundred and twenty five (125) (35.71) of the respondents frequently experienced malaria attack and practiced self-medication. One hundred and fifteen (115) (32.86%) of the respondents treated their malaria episode with Sulphadoxine-Pyrimethamine (SP) combination while 90 (25.71%) of the respondents frequently purchased Artesunate as monotherapy for malaria treatment due to cost-implication of the newer and available Artemisinin combination therapy (ACT’s). The finding reveals that 43 (12.29%) of the respondents only purchased Artemisinin-Combination Therapy (ACTs). One hundred and eight can 118 (33.71%) of the respondents practiced self-medication with anti-malarial drug. The results revealed therapeutic failure to conventional use of Sulphadoxine-Pyrimethamine (SP) by the respondents as One hundred and thirty nine (139) (33.71%) of the respondents experienced no cure and have to repeat the treatment with anti-malarias. If drug-use pattern of anti-malarials is not monitored, there is possibility of early emergence of resistance to the highly effective anti-malarial drugs presently in use.