Clinical Pharmacy & Administration

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    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.
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    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.
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    Public health activities: Evaluation of community pharmacists’ attitude, practice, and barriers in a Nigerian southwestern state
    (Universiti Sains Malaysia (USM), 2023) Akande-Sholabi, W.; Akinbintan, A. A; Adebisi, A. Y.
    The Nigerian health system continues to face double burden of communicable and non-communicable diseases. To meet the country’s health needs, the number of healthcare professionals participating in public health activities must be increased. The purpose of this study was to assess the attitudes, practices and barriers to rendering public health services among community pharmacists in a southwestern Nigerian state. We used a pretested self-administered questionnaire to collect data on 120 community pharmacists’ socio-demographic characteristics, practices, attitudes and barriers to providing public health services. Participating pharmacists must have at least one year of experience working in a community pharmacy. Data were summarised descriptively using IBM SPSS (version 23.0). Females’ respondents were (n = 69, 57.5%) and (n = 82, 68.3%) pharmacists had 1 year–5 years’ experience. Most (n = 116, 96.7%) of the respondents agreed that pharmacists should be involved in public health activities, and (n = 106, 88.3%) respondents disagreed that public health activities should be carried out only by doctors and nurses. Overall (n =89, 74.0%) of the respondents had positive attitude to public health activities (score ≥ 80%) and majority of the community pharmacists had been practicing public health activities. Insufficient time (n = 65, 54.2%) and lack of financial capital to implement changes (n = 84, 70.0%) were identified as prominent barriers that hindered community pharmacists from rendering public health services. Community pharmacists had positive attitude towards the practice of public health activities. However, further studies should emphasise on how to overcome barriers preventing their involvement in public health activities. Providing incentives for public health services rendered could increase community pharmacists’ involvement in public health activities.
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    Self-medication with over-the-counter drugs among consumers: a cross-sectional survey in a Southwestern State in Nigeria
    (BMJ., 2023) Akande-Sholabi, W.; Akinyemi, O.O.
    Objectives: This study set out to assess the knowledge, perception and practices of consumers regarding selfmedication with over-the-counter (OTC) drugs, the prevalence of risky practices and their associated factors in pharmacy outlets in Ibadan, Southwestern Nigeria. Setting A cross-sectional study was conducted using an interviewer administered questionnaire. Descriptive statistics and multivariate analysis were performed by using SPSS V.23 with statistical significance set at p<0.05. Participants 658 adult consumers aged 18 years and above. Primary and secondary outcome measures: The primary outcome was self-medication, measured using the following question: A positive answer indicates a selfmedicated participant. Do you practise self-medication? Results: Respondents who had practised self-medication with OTC drugs were 562 (85.4%), of which over 95% were involved in risky practice. Consumers agreed (73.4%) that OTC drugs can be recommended by pharmacists and perceived (60.4%) that OTC drugs are harmless regardless of how they are used. Reasons for practising self-medication with OTC drugs include: if it is a minor condition, I can take the initiative (90.9%), visiting a hospital wastes my time (75.5%) and ease accessibility of the pharmacy (88.9%). Overall, (83.7%) respondents had good practices of handling and use of OTC drugs, while (56.1%) had good knowledge of OTC drugs and identification of OTC drugs. Factors associated with consumer handling and use of OTC drugs in selfmedication were older participants (p=0.01), those with postsecondary education (p=0.02), and who possessed good knowledge (0.02), were more likely to practise selfmedication with OTC drugs. Conclusion The study revealed a high prevalence of selfmedication, good practices towards handling and use of OTC drugs, and moderate knowledge of OTC drugs by the consumers. This underscores the need for policy-makers to introduce measures to enforce consumer education by community pharmacists to minimise the risks of inappropriate self-medication with OTC drugs.
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    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.
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    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.
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    Pharmacy students’ knowledge of psychotropic medicines and their attitude towards providing pharmaceutical care to patients with anxiety in Nigeria
    (Nigeria Association of Pharmacists in Academia (NAPA), 2022) Akande-Sholabi, W.|| || ||; Bakare, O. E.; Adebisi, A. Y.; Odeku, O.
    Background: Healthcare professionals, such as pharmacists, play critical roles in the management of mental disorders by assessing the potential for adverse reactions, providing medication counseling, and medication review optimize treatment regimens. Objectives: This study aims to assess the knowledge of pharmacy students in a Nigerian university regarding psychotropic medicines and their attitude towards providing pharmaceutical care to patients with anxiety. Method: A cross-sectional web-based survey was conducted in May 2021 among fourth- and fifth-year pharmacy students in a Nigerian university. The data were summarized using descriptive statistics, such as frequencies and percentages. Chi square was utilized to examine the association between the demographic characteristics and the respondents' overall knowledge and attitude. Results: The response rate was 85%, as 126 responses were received. About half of the respondents 69 (54.8%) reported that they have received training on psychotropic medicines and 9 (9.1%) have been previously diagnosed with anxiety disorders. Only 53 (42.1%) and 71 (56.3%) of our respondents knew that escitalopram and alprazolam are categorized as anxiolytics respectively. Most respondents would like to talk to patients with anxiety about their medications 110 (87.3%), attend training on pharmaceutical care for patients with anxiety 103 (81.7%), and obtain a medication history for people with anxiety 113 (89.7%). Ninety-four (74.6%) pharmacy students would like to suggest prescription medication for a patient with anxiety and only 88 (69.8%) would like to correct any errors in prescription in any anxiety cases. Our findings also revealed that there is a significant association between the students’ attitude and year of study (p=0.038) and previous training on psychotropic medicines (p=0.004). Conclusion: Findings from this study suggested that participants require improved knowledge and training of psychotropic medicines.
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    Potentially inappropriate medication use in the elderly: physicians’ and hospital pharmacists knowledge, practice, confidence, and barriers
    (BioMed Central, 2022) Akande-Sholabi, W.; Fafemi, A.
    Background: Inappropriate medication prescribing and dispensing by physicians and pharmacists is a preventable cause of morbidity and mortality in the elderly. Signifying the importance of healthcare professionals’ knowledge of potentially inappropriate prescribing tools/ guidelines which would improve overall health outcomes. Beers Criteria is one of the most used guidelines that list specific potentially inappropriate medications (PIMs). This study aimed to investigate physicians’ and hospital pharmacists’ awareness, knowledge, practice, confidence, and barriers to the use of Beers criteria. METHODS: A cross-sectional survey was carried out among 66 hospital pharmacists and 31 family medicine physicians working in a teaching hospital in Nigeria, between May and September 2021 using a self-administered questionnaire. Knowledge of PIMs was assessed using 11 clinical vignettes based on the 2019 Beers Criteria. Practice behavior towards elderly patients was assessed using a 5-item statement with a 5-point Likert scale. Perceived barriers to the appropriate use of Beers Criteria were assessed using a 15-item statement. Descriptive and inferential statistics were used to analyze the data. RESULTS: A total of 66 hospital pharmacists and 31 family medicine physicians participated in the study. Only (24;36.4%) pharmacists and (4; 12.9%) physicians knew guidelines that listed specific PIMs. In all (21; 31.8%) pharmacists and (11; 35.4%) physicians demonstrated good knowledge of Beers Criteria, while most pharmacists (55; 83.3%) and physicians (29; 93.5%) reported good practice when dealing with elderly patients in terms of asking relevant questions and considering their ages while dispensing medications. Knowledge scores were not significantly associated with hospital pharmacists’ socio-demographics. Most of the physicians and pharmacists were confident in the care provided for geriatric patients. The majority (66; 100.0%) pharmacists and (28; 93.5%) physicians suggested training through seminar presentations as a measure to improve the use of Beers’ criteria. Lack of time to counsel patients was a major barrier recounted by both physicians and pharmacists. CONCLUSION: Healthcare professionals that participated in this study had satisfactory practice, although a gap in the knowledge of hospital pharmacists and family medicine physicians was noted. In addition to creating awareness among healthcare professionals and training on PIMs and Beers’ criteria, a multidisciplinary approach to reduce potentially inappropriate prescribing and dispensing would greatly help reduce the incidence of potentially inappropriate medication use among elderly patients.
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    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.