Anan S. Jarab

Perceptions and attitudes towards off-label dispensing for pediatric patients, a study of hospital based pharmacists in Jordan

Background With growing responsibility of the pharmacists in ensuring public health and safe medicine use, an understanding of the issues surrounding off-label prescribing is crucial to allow pharmacists to make informed decisions about such practice. The aim of this study is to assess the perceptions and attitudes of hospital based pharmacists toward off-label medicine dispensing to children. Methods After obtaining the required approvals, a validated questionnaire about off-label dispensing to pediatric patients was administered to 250 randomly selected hospital pharmacists. Results One hundred and fifty (150) completed questionnaires were returned. Less than half of the respondents (44%, n = 66) admitted to being familiar with the concept of off-label dispensing, claiming to have obtained this knowledge basically through their dispensing experience rather than education. A minority of respondents (36%, n = 54) reported dispensing off-label medicines within their practice knowingly. The majority of respondents had concerns regarding the efficacy (82%, n = 123) and safety (98%, n = 147) of off-label medicines. The most common reasons given by respondents for a dispensed prescription being off label were younger age than recommended (88%, n = 132). Most of respondents (94%, n = 141) claimed to double check the calculations of doses of medicines before dispensing off-label medicines and 60% (n = 90) of them felt that parents and guardians should be told when an off-label medicine has been prescribed for their children. Conclusion The majority of respondents were not familiar with the concept of offlabel medicines. While reporting to have gained their knowledge from their professional experience, only a minority of respondents reported knowingly dispensing off-label medicines for pediatric patients. Respondents indicated that manufacturing more appropriate formulations for pediatric patients would reduce such practices in this population. Having concerns regarding the efficacy and safety of off-label medicines used for pediatric patients, respondents felt that the use of off-label medicines would increase the likelihood of adverse drug reactions (ADRs). Finally, respondents felt that such practice of prescribing and dispensing should receive parental consent.

Prevalence and nature of off-label antibiotic prescribing for children in a tertiary setting: a descriptive study from Jordan

Objective: The aim of the present study was to evaluate the use of off-label antibiotics in neonatal intensive care units (NICUs) and paediatric wards in Jordan. Methods: Data of patients admitted to the neonatal intensive care units and paediatric wards in King Abdulla University Hospital were collected over an 8-week survey between May and July 2012. Data collected in this study included patients’ age, weight, medical history, diagnosis and the details of antibiotics prescribed to each patient. Results: The study involved a total of 250 children (80 admitted to the NICU and 170 admitted to the wards). A total of 598 antibiotic prescriptions were issued for these patients (244 in NICUs and 354 in paediatricwards). The results of the present study show that off-label antibiotic prescribing to paediatric patients is very common. Off-label antibiotic prescribing to paediatric patients is related mostly to doses and indications, and rarely to age. The majority of admitted patients received at least one off-label antibiotic during their hospital stay. Conclusion: This study reveals the high prevalence of off-label use of antibiotic among paediatric children in Jordan. There is a serious need for robust and continuous educational programs to improve the awareness of paediatricians of guidelines surrounding the use of antibiotics in paediatric patients. Furthermore, true collaboration between paediatricians and clinical pharmacists towards safe and effective antibiotic prescribing in paediatric patients is crucial.

A focus group study of patient’s perspective and experiences of type 2 diabetes and its management in Jordan

Background Diabetes is increasingly becoming a major health problem in Jordan and glycemic goals are often not achieved. Objective To explore the patients’ perspectives regarding type 2 diabetes and its management in order to “fine-tune” future pharmaceutical care intervention programs. Method Focus groups method was used to explore views from individuals with type 2 diabetes attending outpatient diabetes clinic at the Royal Medical Services Hospital. All interviews were recorded, transcribed and analyzed using a thematic analysis approach. Results A total of 6 focus groups, with 6 participants in each one, were conducted. Participants in the present study demonstrated a great information needs about diabetes and the prescribed treatment. Medication regimen characteristics including rout of administration, number of prescribed medications and dosage frequency in addition to perceived side effects represented the major barriers to medication adherence. In addition to demonstrating negative beliefs about the illness and the prescribed medications, participants showed negative attitudes and low self-efficacy to adhere to necessary self-care activities including diet, physical activity and self-monitoring of blood glucose. Conclusion Future pharmaceutical care interventions designed to improve patients’ adherence and health outcomes in patients with type 2 diabetes should consider improving patients’ understanding of type 2 diabetes and its management, simplifying dosage regimen, improving patients beliefs and attitudes toward type 2 diabetes, prescribed medications and different self-care activities in addition to improving patients self efficacy to perform different treatment recommendations.

Administration of off-label medicines to paediatrics, self-reported experiences and perceptions of nurses working in paediatric wards in Jordan

The purpose of this study was to explore perceptions and experiences of nurses working in paediatric wards in Jordan towards the off‐label administration of medicines in children.

An audit on parental attitudes towards medicines used in children

Introduction There is growing concerns regarding the use of medicines in children. Therefore, many strategies were implemented to improve such use and make safe and effective medicines more available for children. Enhancing interaction between parents and health care providers plays an important role in insuring the proper use of medicines. In order to optimize such interaction, the attitudes, beliefs and practices of parents toward medicine use in children need to be explored. Methods A validated questionnaire was administered via face to face interviews to 1000 parents attending pediatric outpatient clinics with their children in order to investigate their attitudes toward childrens medicines. Results The majority of respondents (83.2%) were mothers. The majority participants (84.4%) agreed that medicines are necessary in treating illnesses, 80% of the parents had worries about the side effects and interactions of medicines, and 60% of the parents said they try to avoid giving medicines to their children. Moreover, parents in this study varied considerably in their views toward prescription and over-the- counter medicines. More than half of the participants (55.2%) declared that doctors in Jordan prescribe antibiotics to children too easily. Conclusion Participants had positive attitudes toward the necessity of medicines for ill children. However, a considerable proportion of the parents had negative attitudes toward childrens medicines with respect to their side effects and interactions, their capability of disturbing the bodys own capability of healing illnesses, their unnatural characteristic and other aspects related to medicines.

Exploring variables associated with poor health-related quality of life in patients with type 2 diabetes in Jordan

The study aim was to evaluate health‐related quality of life (HRQoL) and to explore factors associated with poor HRQoL in patients with type 2 diabetes in Jordan.

Off-label medicine use in children, a study of community pharmacists in Jordan

The aim of this study was to explore self‐reported experiences of community pharmacists towards off‐label prescribing.

Investigation of variables associated with medication nonadherence in patients with hypertension

Medication nonadherence represents a major barrier to achieve optimal health outcomes in patients with hypertension. The study aim was to identify obstacles to medication adherence in patients with hypertension in Jordan.

Patients’ perspective of the impact of COPD on quality of life: a focus group study for patients with COPD

Background The quality of life has been shown to be poor in patients with chronic obstructive pulmonary disease (COPD). Furthermore, patients’ perspective and attitudes toward COPD and its impact on their quality of life have been remarkably ignored. Objective To explore patients’ views and perceptions regarding COPD and its impact on their quality of life. Setting COPD clinic at the Royal Medical Services Hospital, Amman, Jordan. Method Focus groups discussions to explore patients’ views and perceptions about COPD were conducted using purposive sampling technique till data saturation achieved. A predesigned topic guides including knowledge about COPD and its management and the impact of COPD on the quality of life in patients with COPD was used to facilitate discussion during the interviews. All interviews were transcribed and analyzed using a thematic analysis approach. Main outcome measure Impact of COPD on patients’ quality of life. Results The main themes emerged included information needs about COPD and its management, physical and psychological impact of COPD and reliance on others. The most commonly expressed problem was breathlessness which restricted physical activity and led to panic and anxiety attacks. Constant breathlessness coupled with anxiety can force COPD patient to avoid all physical activity and becoming reliant on others. Conclusion In addition to the lack of knowledge about COPD and its management, it was evident that COPD had a negative physical and psychological impact on COPD patients. Future disease management and clinical pharmacy services programs should address the current study findings in order to improve the health outcomes for patients with COPD.

Factors associated with poor Hemoglobin A1c control in Patients with Type 2 Diabetes

BACKGROUND The limited implementation of clinical pharmacy service programs and the lack of studies identifying barriers to achieve blood glucose control have all attributed to the increased proportion of type 2 diabetes patients who have poor glycemic control in Jordan. OBJECTIVE To explore factors associated with higher HbA1c in patients with type 2 diabetes in Jordan. METHODS Variables including socio-demographics, disease and treatment factors were collected from171 patients with type2 diabetes at an outpatient diabetes clinic in Amman. Validated questionnaires were used to assess medication adherence, self-care activities, diabetes knowledge and healthrelated quality of life in addition to data collected from medical records. After the single-predictor analysis, stepwise linear regression was performed to develop a model with variables that best predicted hemoglobin A1c. RESULTS Medication adherence was inversely associated with HbA1c values (β = -0.275; t = 2.666; P < 0.01), indicating better glycemic control. Receiving insulin therapy was also associated with less HbA1c values and better glycemic control (β = - 0.184; t = 2.080; P < 0.05). Patients who had one or more comorbid conditions (β = 0.215; t = 2.264; P < 0.05) and those with longer diabetes duration (β = 0.092; t = 1.339; P < 0.05) were found to have significantly higher HbA1c values. CONCLUSION Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes.