Clinical Pharmacy
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- ItemEvaluation of Potential Drug-drug Interactions among Medications Prescribed in Primary Health-Care Centers for Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study From Palestine(An-Najah National University, 2020-10-19) Athamneh, SabrineBackground Nowadays, there is a global healthcare concern associated with the risk of high incidence medication errors, many of which are attributed to drug-drug interactions (DDIs). Co-morbid conditions such as; diabetes mellitus, hypertension, dyslipidemia, renal disease and peripheral artery diseases require complex therapy with multiple medications. Thus, administration of more than one medication concomitantly is a common practice to control their conditions and, for this reason, polypharmacy patients are more prone to DDIs. In our country there are no local studies concerned with the prevalence of potential DDIs among type 2 diabetes mellitus patients (T2DM), that is why the study was carried out. Aim of the Study The aim of this study is to evaluate the potential of DDIs among medication prescribed for T2DM patients and examine factors associated with these interactions, in primary healthcare centers. Methods The study is an observational survey employing a cross sectional design and encompassing all T2DM patients, whom visited the primary healthcare centers of the ministry of health (MOH) between July and September 2018. The sample size is comprised of 400 patients, all from the southern part of the West Bank; Hebron and Beitlehem. The patients were interviewed for their social demographic characteristics, their medical conditions, management and treatment by questionnaire-guided interviews. All their prescriptions of drugs were input to Lexi-Comp checker to find out the potential DDIs in their medications. Besides, the assessing the modalities of DDIs according to severity to contraindicated, major, moderate, or minor interaction. Results Among 400 patients, a little less than the half were over 60 years, the majority of them were female. The most common co-morbid conditions present in the diabetes mellitus (DM) patients were as follows; 77.3% had cardiovascular disease (CVD), 64.5% had dyslipidemia, and 12.0% had gout. Moreover, a total of 114 different medications were used, the most commonly prescribed medications were metformin being used by 85.5%, followed by atorvastatin 74.5%, and Acetyl salicylic acid (ASA) used by 74.0% patients. The most common interactions in 61.5 % patients were ASA with Metformin followed by Glimepiride with Metformin in 40.5 % cases. Out of participants 96% patients had at least one potential DDIs. Overall 2627 interactions were identified, with an average of 6 interaction per prescription. According to the risk rating classification, 1.33% were A, 11.72% were B, 76.67% were C, 10.01%, and 0.27% were X risk rating. The number of potential DDIs that the patients had were also related to their age, educational level, comorbidities, number of medications prescribed and complication (p value < 0.05 for each one). However, there was no significant relationship with gender, material status or smoking (p value > 0.05). Conclusions The prevalence of DDIs among medications prescribed for T2DM was very common. This potentially is increasing parallel with increasing age, educational level, comorbidities, number of medications, in addition to the presence of complications. Updating data related to DDIs with good and effectively communicate among healthcare providers, especially prescribers and dispensers can play an important role in minimizing DDIs.
- ItemTREATMENT SATISFACTION AND ATTITUDES TOWARD TAKING MEDICATIONS AMONG HYPERTENSIVE PATIENTS: A CROSS-SECTIONAL STUDY FROM PALESTINE(An-Najah National University, 2025-02-13) Kareman, YaseenBackground: Millions of patients are living with hypertension worldwide. This study aimed to assess the attitudes of hypertensive patients toward taking antihypertensive medications and their satisfaction with the treatment. Methods: This research employed a cross-sectional design with a questionnaire as the instrument for data collection. This study was conducted in the primary healthcare centers of the Ministry of Health in Nablus, West Bank, Palestine. In addition to the demographic and clinical variables, the questionnaire also included the Arabic translated and culturally adapted Drug Attitude Inventory (DAI-10) and the Arabic version of the Treatment Satisfaction Questionnaire for Medication (TSQM). Results: In this study, 356 patients with hypertension were included. More than half of the patients (57.6%, n = 205) were on amlodipine. Additionally, valsartan was used by 117 (32.9%) of the patients. The vast majority of the patients (95.2%) believed that they benefited from their antihypertensive drugs, and in their opinion, the benefits of their antihypertensive drugs outweighed the drawbacks. The vast majority of the patients (95.2 %) believed that they benefited from their antihypertensive drugs, and in their opinion, the benefits of their antihypertensive drugs outweighed the drawbacks. The Drug Attitude Inventory (DAI-10) measures the attitudes and adherence of hypertensive patients toward their antihypertensive medications via 10 statements. The DAI-10 scores were affected by the time since diagnosis (p = 0.004), presence of a documented food or drug allergy (p < 0.001), body mass index (p = 0.004), perceived effectiveness of the antihypertensive medications (p = 0.010), side effects (p = 0.001), convenience (p = 0.040), and global satisfaction scores (p < 0.001). The perceived effectiveness of antihypertensive medications was affected by side effect scores (p = 0.002), convenience scores (p < 0.001), and global satisfaction scores (p < 0.001). The global satisfaction scores were affected by the time since diagnosis (p = 0.008), DAI-10 score (p < 0.001), perceived effectiveness of antihypertensive medications (p < 0.001), and side effects (p < 0.001). Conclusions: The findings of this study revealed positive attitudes and high levels of satisfaction with antihypertensive medications among patients, especially with respect to the perceived effectiveness and convenience of antihypertensive medications. The time elapsed since diagnosis with hypertension, the presence of documented allergies, and high BMI are important factors that can predict negative attitudes and low satisfaction with treatment. Healthcare providers and decision makers should consider measures to improve, maintain, and support positive attitudes and satisfaction with treatment among hypertensive patients. Keywords: Attitudes, Satisfaction, Hypertension, Antihypertensive medications, Treatment, Cardiovascular disease, Primary healthcare
- ItemCOMMUNITY PHARMACISTS’ PERCEPTIONS AND ROLE IN THE MANAGEMENT OF COMMON DERMATOLOGICAL PROBLEMS IN PALESTINE: A CROSS-SECTIONAL STUDY(An-Najah National University, 2024-09-10) Salah, ZohdeyaBackground: Skin diseases are common health issues that affect 30% to 70% of the global population. This study aims to explore the perceptions and role of community pharmacists in the management of common dermatological problems in Palestine. Methods: This study was implemented in a cross-sectional design. The study was conducted in different community pharmacies that were distributed all over the different governorates of the West Bank of Palestine. The data collection instrument was a questionnaire that was developed after a search of the literature. Results: In this study, a total of 385 community pharmacists returned complete questionnaires. Of the community pharmacists, 367 (95.3%) stated that they refer patients to consult a dermatologist. The common reasons for referrals to dermatologists included being unsure of diagnosis, when a dermatologist supervision was needed, and when a prescription product was needed. The community pharmacists who were female (p = 0.043), were in practice for 10 or more years (p = 0.035), received a dedicated course on dermatology during pharmacy training (p = 0.045), and have seen 10 or more dermatological cases seen per week (p = 0.017) practiced significantly more referrals compared to the community pharmacists who were male, practice for less than 10 years, did not receive a course on dermatology, and have seen less than 10 dermatological cases per week. When the community pharmacists were asked to rate their confidence in providing education/counseling to patients with dermatological issues on a scale of 1-5, the median score was 3.0 [IQR = 2.0, 4.0]. Acne, dry skin, nail problems, fungal infections, skin rash, skin blisters, scalp problems, lip problems, sunburn, eczema/dermatitis, candidiasis, insect bites, head lice, psoriasis, and alopecia were the commonly encountered dermatological problems. Combination products containing antibiotics/antifungals/steroids, topical antibiotics, topical steroids, topical retinoids, vitamins/vitamin derivatives/pantothenic acid, topical antihistamines/anticholinergics were the most commonly dispensed dermatological products. The majority of the community pharmacists agreed or strongly agreed that they should be consulted by patients with dermatological conditions, they have a valuable role in assisting patients with dermatological conditions, they are an important source of advice/counseling/education on medications use for dermatological conditions, and the pharmacy-based dermatology services are helpful for patients with dermatological conditions. Conclusions: The findings of this study showed that community pharmacists in Palestine provided care services to patients with dermatological health issues. The findings of this study also showed that community pharmacists often referred patients with complex dermatological health issues to consult dermatologists, notably, when prescription dermatological products were required. This might suggest that community pharmacists need to be integrated with the multidisciplinary team to care for patients with dermatological health issues.
- ItemKNOWLEDGE OF COMMUNITY PHARMACISTS AND PREGNANT WOMEN ABOUT MEDICINES GIVEN DURING PREGNANCY: A CROSS-SECTIONAL STUDY FROM PALESTINE(An-Najah National University, 2024-06-30) EL-Baou, BayanBackground: Pregnant women often suffer health conditions that need medication therapy. Therefore, the use of medications in pregnant women cannot be completely avoided. This study was conducted to assess the knowledge and practices of community pharmacists and pregnant women regarding the use of medications during pregnancy. Methods: This study was conducted in a cross-sectional design. In this study, there were two target groups: community pharmacists and pregnant women. The study tools were two questionnaires that were developed based on previous studies. A purposive random sampling method was used for approximately (n=400) community pharmacists and (n=400) pregnant women distributed in the West Bank. All analyses were performed using SPSS 21. Descriptive statistics such as frequencies (numbers), percentages (%), mean, and standard deviation (SD) were generated. Data were evaluated for normal distribution using skewness and kurtosis and data were normally distributed. Chi-square and T-test were used to control for potential confounding factors. Multivariable logistic regression was also performed in order to adjust for potential confounders. A P value of less than 0.05 was considered statistically significant. Results: In this study, complete questionnaires were returned by (n=400) community pharmacists and (n=400) pregnant women. The mean knowledge score was 71.0% ± 12.5% and 42.8%of the community pharmacists scored below 70%. Multiple linear regression, higher scores were predicted by years of experience, self-rating knowledge about the use of medicines during pregnancy, and belief that community pharmacists needed continuing education courses, especially in medicines used in pregnancy. In this study, 23.8% pregnant women stated that they had health issues that needed a visit to the physicians during the past 12 months. During the current pregnancy 96.8% pregnant women reported that they have used medications or supplements. Of the women, 88.5% stated that they needed information about the use of medications during pregnancy. The majority of the women 65.0% stated that pharmacists were their main source of information about the medications or supplements used during pregnancy. Of the pregnant women, 70.3% stated that women can use medications and supplements during pregnancy without a prescription. Conclusions: The findings reported in this study identified gaps in knowledge about the safety of medication use in pregnancy among the community pharmacists practicing in the West Bank of Palestine. Similarly, pregnant women reported inadequate knowledge about the importance of seeking medical advice before using medications during pregnancy. There is a need to improve the knowledge and practices of community pharmacists about medication use in pregnancy. Again, there is a need to improve information-seeking behavior among pregnant women when using medications during pregnancy.
- ItemEVALUATION OF ANTIBIOTIC RESISTANCE AT A TERTIARY CARE HOSPITAL IN PALESTINE: A THREE- YEAR RETROSPECTIVE STUDY(2022-08-15) Aya Ayed Abu-DiakBackground: Antimicrobial resistance is now one of the most critical medical threats worldwide. Historical facts and diverse data collected over the years have proved that something urgent should be done to control this growing phenomenon. The problem arises from the overuse and misuse of antibiotics. This has made —in some circumstances— the treatment of a simple infection a complicated process. Therefore, many countries around the world have found themselves compelled to devote efforts to control this antibiotic overuse and misuse in the hope of controlling it and its clinical, economic and societal consequences. Against this background, this study has sought to assess the frequency and antibiotic susceptibility patterns of the most common bacterial pathogens and candida isolated at An-Najah National University Hospital (NNUH) in Nablus, Palestine, between 2018–2020. Methodology: A retrospective cross-sectional study was done to assess antimicrobial resistance patterns of the pathogens isolated from patients in different hospital wards during the study period (2018–2020), using sensitivity reports saved into the computerized database of NNUH microbiology lab. Data was then collected, coded and imported to Statistical Package for Social Sciences (SPSS) version 21 for further analysis. Descriptive statistics were run to generate frequency and percentages, tables and graphs. Approval was obtained from the university’s Institutional Review Board. Results: Out of 5, 585 clinical cultures, 46.9% were Gram-Negative Bacteria (GNB), 37.9% were Gram-Positive Bacteria (GPB) and 15.2% were candida. The most frequent Enterobacteriaceae was ESBL E. coli (15.6% of GNB) followed by E. coli (14%), ESBL k. pneumoniae (7.7%), k. pneumoniae (5.5%). P. aeruginosa and A. baumannii were the most obtained Non-Fermenting Gram Negative Bacilli (NFGNB). For GBP, the most frequent isolate was Coagulase-negative Staphylococci (CoNS), representing an isolation rate of 38.8% of GPB in total, followed by E. faecalis (18.6%), S. aureus (8.2%), and VRE E. faecium (7.5%). Clinical specimens were mostly collected from 27.7% of the urine samples. This was followed by wound specimens (19.6%) and blood specimens (19.2%). The total in-patients from all wards was 3, 895 cases (N%=69.7%). Of these, the surgical ward (SW) was the most prominent (14.6%) followed by the Intensive Care Unit (ICU): 10.7%. A. baumannii showed high resistance (over 85%) for ceftazidim, cefipim, gentamycin, ciprofloxacin, levofloxacin, piperacillin, and imipenem. ESBL E. coli. ESBL k. pneumoniae showed nearly complete resistance to ampicillin and cephalosporin agents. MRSA S. aureus was also nearly completely resistant to penicillin, oxacillin, amoxicillin\clavulinic acid, cefuroxime. VRE E. faecium showed full resistance to penicillin, amoxicillin\clavulinic acid, ampicillin, vancomycin, levofloxacin, ciprofloxacin, and erythromycin. Conclusions: High rates of resistance were observed during the study period for most isolated bacteria species. Efforts need to be made on enhancing appropriate control and monitoring measures to stop the overuse and misuse of antibiotics and limit the prevalence of Multi-Drug Resistant Organisms (MDRO). Keywords: Antibiotics; resistance; Palestine; MDRO.