scholarly works

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Start date: 2020End date: 2023

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    Utility of information in package inserts by pharmacists and pharmacy clients in a metropolitan city in Southwest Nigeria
    (Oxford University Press, 2021) Showande S.J; Babalola O.V
    Objective Package inserts provide relevant information to patients and health care professionals on the safety and rational use of drugs. This study evaluated the utility of package inserts by pharmacy clients for information, and by pharmacists during consultation and counselling with patients. Methods This cross-sectional self-administered questionnaire-based study was conducted in Ibadan, Nigeria among 705 pharmacy clients and 344 community and hospital pharmacists. The questionnaire had a 12-item and a 14-item package insert utility scale for pharmacists and pharmacy clients, respectively. The level of utility and association between demographic variables and package insert utility scores were determined with Mann–Whitney U and Kruskal–Wallis tests at P < 0.05. Key findings The response rate was 88.2% for pharmacy clients and 67.2% for pharmacists. Most of the pharmacy clients, 459 (73.8%), check for package inserts in drug packs. The most assessed information in package inserts was dose 432 (69.5%). Some of the pharmacy clients, 276 (44.4%), considered information from health professionals more reliable than that in package inserts. The pharmacy clients’ level of education was associated with package insert utility score (P = 0.001). Most of the pharmacists, 137 (59.3%), read package inserts but only 36 (15.6%) consulted package inserts during counselling with patients. The pharmacists’ age and the number of years spent in practice were significantly associated with package insert utility scores (P < 0.05). The level of utility of the information in package inserts by the pharmacy clients and the pharmacists was moderate – 66.8 and 60.0%, respectively. Conclusion Both pharmacists and pharmacy clients use package insert content moderately. Pharmacy clients rely more on information provided by health professionals than the information in package inserts but pharmacists seldom consult package inserts during counselling process.
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    Readability of medication package inserts accompanying prescription drugs and conformity of the package inserts information with regulatory requirements
    (2022) Showande S.J; Babalola V.O.
    Background: Medication package inserts (MPIs) provides patients with appropriate information on the rational use of drugs. This study evaluated the level of conformity of MPIs with the regulatory drug labelling requirements and determined the readability of selected prescription MPIs. Methods: One hundred and fifty-six MPIs of commonly used and prescribed antilipidemics, anticonvulsants, anti-diabetes, antiarthritis and antihypertensives in Nigeria were retrieved from four pharmacies. The MPIs were evaluated on the availability of 20 items drug labelling requirements for prescription drugs by the National Agency for Food and Drug Administration and Control (NAFDAC). The readability of 31 randomly selected MPIs was assessed with seven readability measures. Primary outcomes were percentage conformity with the labelling requirements and reading grade level of the MPIs. Secondary outcomes were the MPIs sentence characteristics. Results: The percentage conformity with NAFDAC drug requirements of the MPIs ranged from 82.9% to 89.6%. All the MPIs included information on active ingredient(s), adverse drug reactions, and indications. Few MPIs, 46.8% had section on product net content and 53 (34.0%) omitted information on overdose. The reading grade level for the MPIs was 14.55 ± 1.71 (undergraduate level). Most of the MPIs, 25 (80.6%), were very difficult to read. Conclusion: The percentage conformity of the MPIs with NAFDAC drug labelling requirements was high though few vital information were missing in some MPIs. Majority of the MPIs were very difficult to read. The regulatory authority may need to optimize MPIs readability and conformity of content with drug labelling requirements prior to marketing.
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    Prevalence and clusters of modifiable cardiovascular disease risk factors among intra-city commercial motor vehicle drivers in a Nigerian metropolitan city
    (2020) Showande S.J.; Odukoya O.I.
    Background: Commercial motor vehicle drivers (CMVDs) have worst health profiles among different occupations, yet the presence of clusters of cardiovascular disease (CVD) risk factors in this group have not been described in a resource-limited setting. Objectives: The prevalence of CVD risk factors and the clusters among CMVDs was evaluated. Design: A cross-sectional descriptive study. Setting: Four motor parks in three local government areas of Ibadan city, Nigeria. Participants: Consented and conveniently sampled 152 intra-city CMVDs aged ≥ 18 years. Main outcome measures: Prevalence of CVD risk factors (hypertension, diabetes, high triglyceride, low HDLc, high waist-hip ratio, central obesity, physical inactivity, smoking, alcohol, and overweight/obesity) and their clusters were determined. Results: All participants were male from 20 – 77 years old. Most of the CMVDs were physically inactive (80, 52.6%), take alcohol (78, 51.3%), and few smokes (35, 12.4%). The prevalence of hypertension, diabetes, hypertriglyceridemia, obesity, and central obesity were 36.2%, 5.9%, 23.7%, 4.6%, and 5.3%, respectively. Four clusters of CVD risk factors in the CMVDs with the prevalence of 36.2%. 33.5%, 17.1% and 13.2% were identified with significant differences (p<0.05) in the risk factors. Conclusion: The prevalence of diabetes, obesity, central obesity, and smoking was low while the prevalence of hypertension and hypertriglyceridemia was moderate among the CMVDs, but the prevalence of alcohol intake and physical inactivity were high. Four distinct clusters of CVD risk factors were observed among the drivers.
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    Potential inappropriate prescribing among ambulatory elderly patients in a geriatric centre in southwestern nigeria: beers criteria versus stopp/start criteria
    (2020) Akande W.S; Ajilore O.C.; Segun J Showande S.J.; Adebusoye L.A.
    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.
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    Patient medication counselling in community pharmacy: evaluation of the quality and content
    (2022) Showande S.J.; Laniyan M.W.
    Background: Patient medication counseling (PMC) is a pharmaceutical care service targeted at optimizing patient drug use, safety and improving treatment outcomes. This study assessed the content and quality of PMC from the community pharmacists’ (CPs) and pharmacy customers’ (PCs) perspectives. Methods: A cross-sectional questionnaire-guided survey was conducted in Ibadan, Nigeria, among 125 CPs and 612 PCs. The 35-counselling items validated United States Pharmacopeia Medication Counseling Behavior Guideline scale with 10-point graded responses (1 = poor to 10 = excellent) was used. Self-reported medication counseling information content provided by CPs and received by PCs was assessed and expressed in median and interquartile ranges. The quality of PMC was evaluated and graded as poor (1–29.9%), unsatisfactory (30–59.9%), satisfactory (60–79.9%) and excellent (80–100%). Associations between demographic variables and overall quality of counseling were determined with Mann–Whitney U and Kruskal–Wallis tests at p < 0.05. Results: The response rate was 92.5% and 97.6% for PCs and CPs, respectively. The PCs’ opinions on the individual content of the PMC provided by the CPs were significantly different from the pharmacists’ self-report (p < 0.05). Some of the PMC content included how to take the medicine PC = 6.00 (2.00) vs CP = 8.00 (2.00), information on possible side effects PC = 6.00 (2.00) vs CP = 8.00 (2.00), taking history of allergies and other medications PC = 6.00 (6.00) vs CP = 7.00 (1.00), and how to incorporate drug regimen into daily routine PC = 5.00 (6.00) vs CP = 8.00 (3.00). The quality of PMC purportedly provided by CPs and received by the PCs was satisfactory (75%) and unsatisfactory (55%), respectively. The quality of communication counseling offered by CPs trained in Nigeria (Mean rank = 62.49) was higher than those trained outside Nigeria (Mean rank = 26.40), U = 228.00, p = 0.024. The PC’s age, marital status, and highest educational qualification were significantly associated with their opinion on the quality of counseling received. Conclusions: Both the community pharmacists and pharmacy customers reported the provision of patient medication counseling on side effects, drug usage, medication history and allergies among others. However, the quality of counseling provided by the pharmacists was satisfactory, but the quality of counseling received by the pharmacy customers was unsatisfactory. Pharmacists may need to engage pharmacy customers more during medication counseling
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    Effect of educational intervention on medication reconciliation practice of hospital pharmacists in a developing country - A non-randomised controlled trial
    (2023) Akinniyi A. Aje; Segun J. Showande; Rasaq Adisa; Titilayo O. Fakeye; Oluwakemi A. Olutayo; Lawrence A. Adebusoye; Olufemi O. Olowooker
    Background: Medication reconciliation is an evidence-based practice that reduces medication-related harm to patients. This study evaluated the effect of educational intervention on medication reconciliation practice of pharmacists among ambulatory diabetes and hypertensive patients. Methods: A non-randomized clinical trial on medication reconciliation practice was carried out among 85 and 61 pharmacists at the intervention site and control site, respectively. Medication reconciliation was carried out among 334 (intervention-183; control-151) diabetes and/or hypertensive patients by the principal investigator to indirectly evaluate pharmacists’ baseline medication reconciliation practice at both sites. A general educational intervention was carried out among intervention pharmacists. Medication reconciliation was carried out by the principal investigator among another cohort of 96 (intervention-46; control-50) and 90 (intervention-44; control-46) patients at three and six months postintervention, respectively, to indirectly assess pharmacists’ postintervention medication reconciliation practice. Thereafter, a focused educational intervention was carried out among 15 of the intervention pharmacists. Three experts in clinical pharmacy analysed the medication reconciliation form filled by the 15 pharmacists after carrying out medication reconciliation on another cohort of 140 patients, after the focused intervention. Data was summarized with descriptive and inferential statistics with level of significance set at p<0.05. Key findings: Baseline medication reconciliation practice was poor at both sites. Post-general educational intervention, medication discrepancy was significantly reduced by 42.8% at the intervention site (p<0.001). At the intervention site, a significant increase of 54.3% was observed in patients bringing their medication packs for clinic appointments making medication reconciliation easier (p=0.003), at 6-months postintervention. Thirty-five, 66 and 48 drug therapy problems were detected by 31 (43.1%), 33 (66.0%) and 32 (71.1%) intervention pharmacists at 1-, 3- and 6-month post-general educational intervention, respectively. Post-focused educational intervention, out of a total of 695 medications prescribed, 75 (10.8%) medication discrepancies were detected and resolved among 42 (30%) patients by the 15 pharmacists. Conclusions: The educational interventions improved pharmacists’ medication reconciliation practice at the intervention site.
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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.
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    Drug therapy-related problem management
    (2022) Showande S.J.; Lawal S.D.
    Background: Unresolved drug therapy-related problems (DTRPs) have economic and clinical consequences and are common causes of patients’ morbidity and mortality. This study evaluated the ability of community pharmacists to identify and resolve DTRPs and assessed the perceived barriers to DTRP identification and resolution. Methods: A cross-sectional study which employed the use of three simulated patients (SPs) visit to 36 selected community pharmacies in 11 local government areas in Ibadan, Nigeria. The SPs played the role of a patient with prescription for multiple ailments (23-year-old male), type 2 diabetes and hypertensive patient with medication packs (45-year-old male) and hypertensive patient with gastric ulcer with a prescription (37-year-old female). They reenacted three rehearsed vignettes when they spoke with the pharmacists. A five-member panel of experts predetermined the DTRPs present in the vignettes (n = 11), actions to take to investigate the DTRPs (n = 9) and recommendations to resolve the DTRPs (n = 9). Pharmacists’ perceived barriers to the identification and resolution of DTRPs were assessed with a self-administered questionnaire. The percentage ability to detect and resolve DTRPs was determined and classified as poor ability (≤30%), fair ability (> 30 - ≤50%), moderate ability (> 50 - ≤70%) and high ability (> 70%). Results: One hundred and eight visits were made by the three SPs to the pharmacies. In total, 4.42/11 (40.2%) DTRPs were identified, 3.50/9 (38.9%) actions were taken, and 3.94/9 (43.8%) recommendations were made to resolve the identified DTRPs. The percentage ability of the community pharmacists to detect and resolve DTRPs varied slightly from one vignette to another (vignette 1–49.3%, vignette 2–39.1%, vignette 3–38.8%). But overall, it was fair (40.9%). Pharmacists’ perceived barriers to DTRP detection and resolution included lack of access to patient’s/client’s medical history and lack of software for DTRP detection. Conclusions: The community pharmacists displayed fair ability in detecting and resolving DTRPs. Several barriers preventing the optimal performance of pharmacist in DTRP identification and resolution were identified including inaccessibility of patient’s/client’s medical history. The regulatory authority of pharmacy education and practice in Nigeria need to mount Continuing Education Program to address this deficit among community pharmacists.
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    Pharmacists’ knowledge and counselling on fall risk increasing drugs in a tertiary teaching hospital in Nigeria
    (Springer Nature, 2020) Akande-Sholabi,W.; Ogundipe, F. S.; Adisa, R.
    Background: Falls and fall-related injuries are a foremost health concern among older adults aged 60 years and above. Fall-risk-increasing drugs (FRIDs) use by older adults is one related cause of falling, and it is frequently used among older adults. Pharmacist-led counselling is an aspect of patient education that has been associated with improved therapeutic outcome and quality of life in high income countries with scarcity of information in lowmiddle income countries. This study therefore aims to assess hospital pharmacists’ knowledge and counselling on fall-related medications using the list compiled by the Swedish National Board of Health and Welfare on FRIDs and orthostatic drugs (ODs). Methods: A cross-sectional survey was carried out among 56 pharmacists working in a teaching hospital in Nigeria, between July and August 2019, using a self-administered questionnaire. Data were summarized with descriptive statistics while chi-square test was used for categorical variables at p < 0.05. Results: Thirty-five (62.5%) were within 10 years of practice experience. Two-third (62.5%) of the pharmacists possessed an additional qualification to Bachelor of Pharmacy degree. Twenty-two (40.0%) were aware of the FRIDs and ODs list. In all, (89.3%) had “unsatisfactory” knowledge of classes of medications and specific medicines that could cause a fall. Most pharmacists 42 (80.8%) focused counsel on appropriate medication use, adverse effects of drugs and storage of medications. Knowledge score of both FRIDs and ODs were neither significantly associated with pharmacists’ years of qualification (χ 2 = 1.282; p = 0.733), (χ 2 = 2.311; p = 0.510) nor with possession of additional qualification (χ 2 = 0.854; p = 0.836), (χ 2 = 2.996; p = 0.392). Majority, 53 (98.1%) believed that patients will benefit from effective counselling on FRIDs and ODs. About half (25; 51.0%) suggested training through seminar presentation as a measure for FRIDs and ODs sensitization. Conclusion: A substantial gap in knowledge and awareness of FRIDs and ODs was noted among the hospital pharmacists. However, engagement of pharmacists on counsel that focus on medication use, adverse effect and storage was relatively better. Thus, there is a general need to create awareness about fall-risk-increasing drugs among hospital pharmacists, so as to help improve the therapeutic outcome particularly in the older adults.