Clinical Pharmacy & Administration

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450 Barriers and enablers to medication deprescribing among older patients attending a geriatric clinic in southwestern nigeria: a cross-sectional study
(2023) Akande-Sholabi W.; Ajilore C. O.; Olowookere O.O; Adebusoye L.A
Introduction: Polypharmacy is an increasing health problem, leading to rise in morbidity and mortality, especially among older patients. De prescribing 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 socio-demographic characteristics, and barriers and enablers
A giant
(2019-05) Valantine
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.
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 compliance to treatment among ambulatory asthmatic patients in a secondary health care facility in nigeria
(2012) Obasan A.A.; Showande S.J.; Fakeye T.O.
This study assessed the level of compliance using three different methods: pill count, self report and peak expiratory flow rate, in asthmatic patients attending a secondary health care facility. Self report (using a pre-tested structured questionnaire), peak expiratory flow rate and pill count were used to assess patient’s compliance and identify the factors which may be responsible for non compliance. Measurement of peak expiratory flow rate and the pill count were done at two different occasions. The data obtained was analysed using descriptive statistics. The study showed that the patients were prescribed a range of one to four drugs: 54% (3 drugs), 32% (2 drugs), 8% (4 drugs) and 2% (1 drug). The levels of compliance were 86.57% for self report and 83.56% for pill count (p > 0.05). Reasons given for non compliance were: apparent wellness (33.31%), forgetfulness (26.67%), cost of drugs (6.67%), dysphagia (6.67%), presence of non-disturbing symptoms (6.67%), side effects (6.67%), ignorance/fear of addiction (6.67%), perceived lack of benefit from treatment (6.67%), and lethargy towards chronic medication (6.67%). However, there was a significant difference in the readings of the peak expiratory flow rate measured at two different occasions (p < 0.05). The study showed no significant difference in the methods used to assess the level of compliance. Non compliance can be overcome by proper education of patients on the importance of complying with the administration of medication and proper usage of metered dose devices.
Assessment of knowledge and reasons for medication non-adherence in ambulatory elderly patients with hypertension and diabetes mellitus in a geriatric centre in nigeria
(2021) Akande-Sholabi W.; Ogini D.E; Adebusoye L .; Fakeye T
Assessment of the knowledge of community pharmacists regarding common phytopharmaceuticals sold in South Western Nigeria
(Pharmacotherapy Group, 2006-12) Adisa, R.; Fakeye, T.
Purpose: The study was carried out to assess the knowledge of community pharmacists who sell herbal/phytopharmaceutical formulations in pharmacy retail outlets. Method: Questionnaires were administered to the pharmacists to gather information on phytopharmaceuticals regarding their use, side effects, potential drug-herb interactions and contraindications of the phytopharmaceuticals sold in their retail outlets. Opinions on regulation, safety and efficacy of herbal remedies were also obtained. Descriptive statistical tests and median scores were used to evaluate the distribution of responses, opinions and perception of the pharmacists on their level of knowledge of the phytopharmaceuticals, and effects of demographic data on the pharmacists’ knowledge of the herbal remedies. Results: The study revealed that 31 (62%) sold imported herbal remedies and nutritional supplements. Seventy-two (72) % had received no postgraduate training on herbal medications. Most of the community pharmacists agreed that they did not possess adequate knowledge of potential interaction profiles and side effects of the herbal remedies sold. The training in pharmacy schools on herbal drugs and sale of phytopharmaceuticals in their outlets also had no influence (p>0.05) on desired knowledge. Community pharmacists with less than 10 years of experience in the practice however possessed better knowledge than pharmacists with more than ten years of professional practice (p=0.05) Conclusions: There was gross inadequacy in the pharmacists’ knowledge of the phytopharmaceuticals sold in pharmacies indicating an urgent need for intensive training in order to render better services to their clients.
Associated With Hospitalisation of Hypertensive in-patients in a Tertiary Hospital, Southwestern Nigeria
(2023-05) Ipingbemi, E . L; Erhun, W . O; Rasaq, A.
The study aimed at estimating the cost of hospitalisation associated with medication non-adherence (MNA) among hypertensive in-patients in a tertiary healthcare facility in southwestern Nigeria. It involved a cross-sectional retrospective review of 322 medical records of hypertensive in-patients at the University College Hospital between 2013 and 2015. Physician’s documentation of MNA in the patients’ medical records prior to admission determined the eligibility into the study. Direct medical costs mainly consultation, medications, laboratory costs for individual patients during hospitalisation were calculated using out-of-pocket payer’s perspective approach. Data were summarised with descriptive statistics, Pearson’s product moment correlation coefficient was used to determine relationship between length of stay in hospital, cost of management and number of comorbidities at p < 0.05 considered statistically significant. Of the 322 medical records of hypertensive in-patients evaluated within the 3-year study period, 230 (71.4%) had a documentation of MNA. The average age was 55.9 ± 15.7 years old. Artisans/self-employed (n = 82; 35.7%) and petty traders (n = 61; 26.5%) made up the majority of the patients. The total cost of hospitalisation for the period studied was USD100,461.40 for all the patients, with an average of USD52.00 ± 28.10/patient/day, more than a quarter of which was spent on pharmaceuticals. Similarly, the costs of management also increased with increase in length of hospitalisation (Pearson’s product moment correlation r = 0.539, p = 0.000). The number of comorbid diseases increased the length of hospitalisation (r = 0.133, p = 0.044). Cost associated with hospitalisation in relation to MNA is high among the studied participants. There is a need to develop strategies to enhance medication adherence among patients with hypertension.
Attitude and opinion of nigerian community pharmacists to self medication practices
(2012) Fakeye T. O.; Adisa R.; Showande S. J. S.
This study evaluated the attitude and opinion of Nigerian community pharmacists on self medication practices with respect to the definition, advantages and disadvantages of self medication, ailments for which self medication should be allowed, as well as measures that may be instituted to ensure appropriate self medication practices. Pretested structured questionnaires were administered to licensed community pharmacists practicing in Southwestern Nigeria between December, 2009 and July, 2010. Descriptive statistics were used to summarize the data. Mann Whitney U and Kruskal Wallis tests were used to evaluate the respondents’ opinions in ordinal variables with p < 0.05 considered statistically significant. Respondents with postgraduate qualification (p < 0.05) believed that self medication solely done by patients without guidance of a health care professional may lead to mismanagement or subtherapeutic management of diseases (66; 91.66%), medication errors and likelihood of disease complications (68; 93.15%). Years of practice had a significant effect on community pharmacists’ perception of advantages of self medication (p < 0.05). Rigorous monitoring of drug advertisement in the media might help in controlling the practice of self medication (63, 86.30%). Respondents believed that keeping the identity of the medications (29; 39.73%) and diagnosis details (19; 27.14%) unknown to patients is unethical. Self medication may be acceptable for fever (53; 74.65%), diarrhea (46; 67.65%) and cough (39; 53.62%), but with specific time limits, for patients on chronic medication who have stable clinical conditions, including asthma (46; 66.67%), hypertension (36; 51.43%) and diabetes (37; 52.86%). Community pharmacists in Southwestern Nigeria possess a good understanding of the concept of self medication, believed the practice should not be discouraged in totality, but should be practiced under controlled conditions, and that public enlightenment may help to ensure safe self medication practices.
Attitude and use of herbal medicines among pregnant women in Nigeria
(Biomed central ltd, 2009-12) Fakeye, T. O.; Adisa, R.; Musa, I. E.
Background: The use of herbal medicines among pregnant women in Nigeria has not been widely studied. Methods: Opinion of 595 pregnant women in three geopolitical zones in Nigeria on the use of herbal medicines, safety on usage, knowledge of potential effects of herbal remedies on the fetus and potential benefits or harms that may be derived from combining herbal remedies with conventional therapies were obtained using a structured questionnaire between September 2007 and March 2008. Descriptive statistics and Fisher's exact tests were used at 95% confidence level to evaluate the data obtained. Level of significance was set at p < 0.05. Results: More than two-third of respondents [67.5%] had used herbal medicines in crude forms or as pharmaceutical prepackaged dosage forms, with 74.3% preferring self-prepared formulations. Almost 30% who were using herbal medicine at the time of the study believed that the use of herbal medicines during pregnancy is safe. Respondents' reasons for taking herbal medications were varied and included reasons such as herbs having better efficacy than conventional medicines [22.4%], herbs being natural, are safer to use during pregnancy than conventional medicines [21.1%], low efficacy of conventional medicines [19.7%], easier access to herbal medicines [11.2%], traditional and cultural belief in herbal medicines to cure many illnesses [12.5%], and comparatively low cost of herbal medicines [5.9%]. Over half the respondents, 56.6% did not support combining herbal medicines with conventional drugs to forestall drug-herb interaction. About 33.4% respondents believed herbal medicines possess no adverse effects while 181 [30.4%] were of the opinion that adverse/side effects of some herbal medicines could be dangerous. Marital status, geopolitical zones, and educational qualification of respondents had statistically significant effects on respondents views on side effects of herbal medicines [p < 0.05)] while only geopolitical zones and educational qualifications seemed to have influence on respondents' opinion on the harmful effects of herbal medicines to the fetus [p < 0.05]. Conclusion: The study emphasized the wide spread use of herbal medicines by pregnant women in Nigeria highlighting an urgent need for health care practitioners and other health care givers to be aware of this practice and make efforts in obtaining information about herb use during ante-natal care. This will help forestall possible interaction between herbal and conventional medicines.
Beers criteria and potentially inappropriate medications in elderly: awareness, practice, knowledge and barriers among community pharmacists in Nigeria
(Springer Open, 2022) Akande Sholabi,W.; Fafemi, A.
Background: Potential inappropriate medications (PIMs) used in the elderly are an avoidable source of disease and death. Beers Criteria is among the commonly used measures that document PIMs. Community pharmacists’ knowl edge on PIMs and existing criteria are essential to moderate the use of PIMs which would enhance overall health outcomes and costs. This study investigates awareness, knowledge, practice, and barriers of PIMs among community pharmacists in Ibadan, Nigeria. Methods: A cross-sectional study was carried out on 109 community pharmacists with the use of a self-administered questionnaire. Nine clinical vignettes based on the 2019 Beers Criteria were used to evaluate PIMs knowledge. Prac tice behavior regarding elderly clients was evaluated using a 5-point Likert scale with six items. Data were summa rized by descriptive and inferential statistics. Results: Respondents who knew guidelines that listed specifc PIMs were (49; 47.1%), and of these, (21; 42.9%) were aware of Beers Criteria. From all the respondents, only 45 (41.3%) demonstrated good knowledge of Beers Criteria, while 82 (75.2%) narrated good practice when dealing with elderly clients in terms of asking suitable questions and contemplating their ages while dispensing medications. Major barrier identifed was lack of knowledge of Beers Crite ria (80; 73.4%). Pharmacists who were aware of Beers Criteria statistically had better knowledge than others (p=0.003). Conclusion: Beers Criteria awareness among community pharmacists is sub-optimal in Ibadan, Nigeria. Although practice when dealing with elderly customers was satisfactory, the knowledge was unsatisfactory. This underscores the need to intensify the awareness and use of guidelines that document specifc PIMs such as Beers Criteria among community pharmacists.
Clinical and humanistic outcomes of pharmaceutical care interventions in diabetes mellitus: a systematic review and meta-analysis
(2019) Segun J. Showande; Akande-Sholabi W.; Titilayo O. Fakeye.
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 metaanalysis, 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 of the Relevance of Drug Package Insert as Source of Drug Information in Southwestern Nigeria
(Pharmacotherapy Group, 2013-04) Adisa, R.; Omitogun, T. I.
Purpose: To evaluate the opinions of community pharmacists on the usefulness and reliability of drug package inserts (DPI) as drug information source, and necessary modifications needed to improve their contents. Methods: A prospective cross-sectional study using a pretested questionnaire was administered to sixty-one superintendent community pharmacists (CP) across two cities in southwestern Nigeria. Descriptive statistics was used to summarize the data and evaluate respondents’ opinion. Kruskal-Wallis test was used to evaluate the rank variables with p < 0.05 considered significant. Results: A majority of CP believed that information from DPI was precise and may be helpful in achieving therapeutic success (n = 42; 72.8 %). CP believed there is need for the modification of DPI content with respect to patient-related information (n = 52; 92.8 %) and health provider-related information (n = 52; 94.5%), non-uniformity of information on the same generic medicines (n = 31; 50.8%), and ambiguity of content (n = 29; 47.5 %). Years of experience in practice significantly influenced respondents’ perception of precision and satisfaction with DPI as source of information. Conclusions: Community pharmacists in southwestern Nigeria believed that a properly modified drug package insert could be a useful and reliable source of drug information in daily practice.
Correction to: Treatment adherence and blood pressure outcome among hypertensive out-patients in two tertiary
(2020) Adisa, R.; Ilesanmi, O . A; Fakeye, T . O
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 and Older Adults: A Call to Accelerate Geriatrics Differentiated Healthcare Services in Africa
(2020-10) Akande-Sholabi W
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.
Developing a model for teaching and learning clinical pharmacy components of the pharmacy curriculum in Nigeria
(International pharmaceutical Federation, 2017-01) Fakeye, T. O.; Adisa, R.; Erhun, W. O.
Background: Increasing clinical roles of pharmacists necessitate the need for adopting innovative teaching and learning methods that will enhance pharmacist’s clinical skills especially in developing countries. Aim: To develop appropriate model(s) for teaching clinical pharmacy in Nigeria. Method: The study consisted of focus group discussions (FGDs) with final year pharmacy students of a Nigerian university investigating their preferred methods for learning clinical pharmacy. The FGDs resulted in a 50-item questionnaire exploring appropriate models for teaching clinical pharmacy among the teachers. Data was evaluated using thematic analysis and descriptive statistics. Result: Integrated and interactive active-learning teaching models were proposed in the FGDs. Models proposed included Direct Instruction (DI), Guided Design (GD) Cognitive apprenticeship (CA), Cooperative Learning (CL) and Problem-based learning (PBL) with clinical pharmacy teachers ranking them GD=DI>CA>>CL=PBL for teaching clinical pharmacy components Conclusion: FGDs preferred low structure while the teachers preferred moderate to high structure of learning.
Diabetes mortality and trends before 25 years of age: an analysis of the global burden of disease study 2019.
(2019) Akande-Sholabi W
Background Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r²=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (–28·4 to –2·9) for all diabetes, and by 21·0% (–33·0 to –5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (–13·6% [–28·4 to 3·4]) and for type 1 diabetes (–13·6% [–29·3 to 8·9]). Interpretation Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN’s Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations.
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.