Ali Azeez Al-Jumaili

Evaluation of instruments to assess health literacy in Arabic language among Iraqis

BACKGROUND Low health literacy is associated with lack of medical information, less use of preventive measures, low medication adherence rates, high health care costs and high risk of hospitalization. OBJECTIVE The aims were to compare the results of the three health literacy tests, to measure for the first time the health literacy level of Iraqis, to describe the use of standardized health literacy tests, to evaluate reliability and validity of the Arabic versions of these tests, and to investigate whether there is relationship between the participant characteristics and the health literacy level. METHODS A convenience sample of 95 subjects was studied in five community pharmacies in Al-Najaf and Babylon governorates, Iraq. Three health literacy tests, the Single Item Literacy Screener (SILS), the New Vital Sign (NVS) and the Short version of the Test of Functional Health Literacy in Adults (S-TOFHLA), were translated in the Arabic language and administered to the pharmacy customers. RESULTS There were no statistically significant associations between age, gender, education and current education status and NVS score, but there were significant positive associations between the level of education and each one of SILS, New SILS, and S-TOFHLA scores. CONCLUSIONS SILS has one subjective, possibly culturally biased question. Since Iraqis are generally not exposed to reading product labels, the NVS test might be not an accurate measure for them. S-TOFHLA was the most comprehensive test and gave equitable results. The Arabic version of S-TOFHLA can be used to measure health literacy in 22 Arabic speaking countries.

Pharmacy in Iraq: History, current status, and future directions

The Pharmacy Abroad section of AJHP features brief, informal, and topical communications related to pharmacy in other countries. Contributions are welcomed from pharmacists abroad or from pharmacists who have traveled abroad. AJHP also encourages pharmacists from outside of the United States to

A Systems Approach to Identify Factors Influencing Adverse Drug Events in Nursing Homes: Adverse Drug Events in Nursing Homes

The objectives of the study were to identify the incidence rate and characteristics of adverse drug events (ADEs) in nursing homes (NHs) using the ADE trigger tool and to evaluate the relationships between resident and facility work system factors and incidence of ADEs using the System Engineering Initiative for Patient Safety (SEIPS) model. The study used 2 observational quantitative methods, retrospective resident chart extraction, and surveys. The participating staff included Directors of nursing, registered nurses, certified nurse assistants (CNAs). Data were collected from fall 2016 to spring 2017 from 11 NHs in 9 cities in Iowa. Binary logistic regression with generalized estimated equations was used to measure the association between ADE incidence and resident and facility characteristics. We extracted data from 755 medical charts and conducted 33 staff surveys. There were 6.13 ADEs per 100 residents per month. More than half were fall‐related (51.1%), and half of those were due to hypotension. Regression analysis revealed significant associations between ADEs and opioid analgesics, psychotropic medications, warfarin, skilled care, consultant pharmacist accessibility, nurse‐physician collaboration, CNA vital sign assessment skills, number of physician visits, nurse workload, and use of electronic health records. Five resident characteristics (skilled care, dementia, use of opioids, warfarin, psychotropics) and variables from 5 domains of the facility work system (organization, task, environment, person, technology) had significant associations with ADE incidence. The SEIPS model successfully identified work system factors influencing ADEs in NHs.

Evaluation of community pharmacist–provided telephone interventions to improve adherence to hypertension and diabetes medications

OBJECTIVES To 1) identify specific patient barriers and pharmacist interventions to medication adherence by means of the Drug Adherence Work-Up (DRAW) tool; and 2) measure patient adherence to antihypertensive and antidiabetic medications by calculating proportion of days covered (PDC) before and after pharmacist telephone adherence interview. DESIGN This prospective quality-improvement study consisted of telephonic interviews and targeted interventions to increase medication adherence based on patient-specific barriers. The baseline PDC was electronically calculated for each patient, and postintervention PDCs were manually calculated at 90 days and 180 days after baseline. The measurement period in each PDC calculation was 180 days. SETTING AND PATIENTS This study was conducted in a small-chain independent pharmacy in rural Midwest United States. Patients taking an antihypertensive or oral antidiabetic medication were identified through an online platform and contacted if they had a PDC of less than 80% during the previous 180 days. OUTCOME MEASURES Baseline and postinterview PDC were calculated for each patient who received an adherence interview. Frequency of specific barriers and pharmacist interventions were identified and analyzed. RESULTS Ninety-seven eligible patients were identified. Fifty-six patients participated in an interview. Of these, a total of 66 barriers to adherence were identified. Pharmacists implemented 76 interventions for these patients, and 43 patients were included in final PDC calculations. From baseline, 69.0% of patients with hypertension and 64.3% of patients with diabetes reached a PDC of greater than 80% within 3 months. The most frequently identified barrier was forgetfulness on routine days, and the most common interventions were patient education, deactivated drug, and recommend or start medication synchronization program. CONCLUSION Using pharmacists to identify and address patient barriers to adherence resulted in a significant increase in PDC among patients with hypertension and diabetes. The DRAW tool can be used in a community pharmacist-delivered telephonic intervention to improve medication adherence.

Antimicrobial utilization in an Iraqi province: a comprehensive evaluation of antibiotic source and cost

The aims were to calculate total systemic antibiotic consumption and cost in both public and private sectors in all care settings in Al‐Najaf province, Iraq, during 2012, recognize the percentage of each pharmacological class for the dispensed antibiotics and identify oral and parenteral antibiotic percentages dispensed and the portions manufactured nationally and imported.

Factors influencing the degree of physician-pharmacist collaboration within Iraqi public healthcare settings

Medication safety and effectiveness can be improved through interprofessional collaboration. The goals of this study were to measure the degree of physician–pharmacist collaboration within Iraqi governmental healthcare settings and to investigate factors influencing this collaboration.

Estimating the cost of unclaimed electronic prescriptions at an independent pharmacy

OBJECTIVES The increasing rate of e-prescribing is associated with a significant number of unclaimed prescriptions. The costs of unclaimed e-prescriptions could create an unwanted burden on community pharmacy practices. The objective of this study was to calculate the rate and costs of filled but unclaimed e-prescriptions at an independent pharmacy. METHODS This study was performed at a rural independent pharmacy in a Midwestern state. The rate and costs of the unclaimed e-prescriptions were determined by collecting information about all unclaimed e-prescriptions for a 6-month period from August 2013 to January 2014. The costs of unclaimed prescriptions included those expenses incurred to prepare the prescription, contact the patient, and return the unclaimed prescription to inventory. Two sensitivity analyses were conducted. RESULTS The total cost of 147 unclaimed e-prescriptions equaled

Comprehensive Literature Review of Factors Influencing Medication Safety in Nursing Homes: Using a Systems Model

3,677.70 for the study period. Thus, the monthly cost of unclaimed e-prescriptions was

Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

612.92 and the average cost of each unclaimed prescription was

Measuring the health literacy level of Arabic speaking population in Saudi Arabia using translated health literacy instruments

25.02. The sensitivity analyses showed that using a technician to perform prescription return tasks reduced average costs to