Clinical Pharmacy & Administration

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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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    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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    Management of uncomplicated gastric ulcer in community pharmacy: a pseudo‑patient study
    (2019) Showande S.J; Adenike R.A.
    Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists’ questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudopatient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:—Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists’ questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients’ minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients’ minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.
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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.