Clinical Pharmacy & Administration
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Item Evaluation of prescription pattern and patients’ opinion on healthcare practices in selected primary healthcare facilities in Ibadan, South-Western Nigeria(2015) Adisa, R.; Fakeye, T. O.; Aindero, V. O.Background: Inappropriate prescribing negatively impacts on health and economy of individual and the society. Objectives: To evaluate the prescribing patterns and patients’ opinions on healthcare practices in selected primary healthcare centres (PHC) in Ibadan, South-Western Nigeria. Methods: A prospective cross-sectional study was carried out among patients and healthcare workers in selected PHCs using semi-structured questionnaires. Also, patients’ prescription records were reviewed using the WHO-prescribing indicators. Results: About one-half (210; 52.5%) were very satisfied with convenience of obtaining prescribed medicines in the PHCs, accessibility of PHC to abode (158;39.5%) and affordable medications (136;34.0%). Patients were dissatisfied with follow-up of care (191; 47.8%), courtesy of workers (184; 46.3%) and non-availability of medicines (138;34.5%). Number of drugs per encounter was 5.8±2.3 and % encounter with an antibiotic was >26.8% in each facility. Hematinics accounted for (814; 35.0%), analgesics (544; 23.4%), antimicrobials (303;13.0%) and antihypertensives (5; 0.2%). Conclusion: Primary healthcare attendees were satisfied with medication costs affordability and accessibility of PHC to abode but expressed dissatisfaction with follow-up of care and courtesy of workers. Also, inappropriate prescriptions characterized by polypharmacy and overuse of antibiotics were common underscoring the need for regular training of PHC workers on rational drug use and instituting appropriate measures for improvementItem Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria(2018) Adisa, R.; Orherhe, O. M.; Fakeye, T. O.Background: Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring. Objectives: To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers’ usage of antibiotics for their under-five and reason(s) for use. Method: Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers. Results: Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage. Conclusion: Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.Item Evaluation of Adverse Drug Reactions to Artemisininbased Combination Therapy in a Nigeria University Community(Pharmacotherapy Group, 2008-06) Adisa, R.; Fakeye, T. O.; Dike, D.Purpose: The study was carried out to evaluate the incidence of adverse reactions to antimalarial drugs among residents of a Nigeria university community with a focus on artemisinin-based combination therapy (ACT). Specifically, the profile of use, and the reporting culture of people with respect to experienced reactions were noted. Method: Questionnaires were administered to respondents at the university health centre between November 2006 and January 2007. Information on demographic characteristics, nature of experienced adverse reactions and the most frequently used ACT, among other questions, were collected. Descriptive statistics and Fisher’s Exact test were used to evaluate the distribution of respondent’s opinion. Result: The study achieved a response rate of 86%. The results revealed that 210 (70.0 %) of respondents said they had used artemisinin-based combination drugs while 134 (44.7 %) said they used artemisinin derivatives alone as monotherapy for malaria treatment. Artesunate plus amodiaquine 94 (31.3%) as a co-packaged product was the most commonly used ACT. Incidence of the experienced adverse reactions to ACT was reported to be generally mild and well tolerated. Conclusion: Efforts to improve the use of ACT in the management of acute uncomplicated P. falciparum malaria is recommended. Furthermore, an effective mechanism to improve reporting of adverse effects of ACT is also recommendedItem 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.Item 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.