Eman A. Hammad

Pharmacist provided medicines reconciliation within 24 hours of admission and on discharge: a randomised controlled pilot study

Background The UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken. Method Patients were recruited 7 days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay (LOS), quality of life (EQ-5D-3L), unintentional discrepancies (UDs) and emergency readmission (ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention-associated resources was determined. Result 200 patients were randomised to either intervention or control. Groups were comparable at baseline. 95 (99%) patients in the intervention received MR within 24 hours, while 62 (60.8%) control patients received MR at some point during admission. The intervention resolved 250 of the 255 UDs identified at admission. Only 2 UDs were identified in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%, respectively. Assuming 5% loss to follow-up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3-month ER rates. Conclusions The results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted. Trial registration number ISRCTN23949491.

Active educational intervention as a tool to improve safe and appropriate use of antibiotics

Misconception about antibiotics use among the public has been widely outlined to be a main reason for inappropriate use of antibiotics including failure to complete treatment, skipping of doses, re-use of leftover medicines and overuse of antibiotics. The study was devised to evaluate whether education might be a potential strategy to promote safer use of antibiotics and reducing self-medication. Two hundred seventy one adults were asked to complete two questionnaires; a pre and posteducation. The questionnaires comprised of three parts consisting of 17 statements assessing the knowledge on: appropriate use, safe use and resistance of antibiotics. Knowledge score was estimated by calculating the percentage of correct responses. The mean (SD) knowledge score pre-education was 59.4% (20.3). However, posteducation the score was 65.9% (17.9), p < 0.001(t-test). Knowledge scores were classified as poor, adequate and good. Posteducation, participants within poor and adequate knowledge categories were significantly shifted to the good category describing better knowledge, McNemar-χ2 = 28.7, df = 3, p < 0.001. It is concluded that using tailored education material targeting antibiotic need and use with a major aim of improving the public knowledge about antibiotics can be an effective and feasible strategy. This pilot study could be considered as the starting point for a wider scale public educational intervention study and national antibiotic campaign. However, the improvement in participant’s knowledge might not reflect an actual change in antibiotics–seeking behaviour or future retention of knowledge. Future research should seek to assess the impact of education on participant’s behaviour.

The Use of Economic Evidence to Inform Drug Pricing Decisions in Jordan

BACKGROUND Drug pricing is an example of a priority setting in a developing country with official requirements for the use of cost-effectiveness (CE) evidence. OBJECTIVE To describe the role of economic evidence in drug pricing decisions in Jordan. METHODS A prospective review of all applications submitted between November 2013 and May 2015 to the Jordan Food and Drug Associations drug pricing committee was carried out. All applications that involved requests for CE evidence were reviewed. Details on the type of study, the extent, and whether the evidence submitted was part of the formal deliberations were extracted and summarized. RESULTS The committee reviewed a total of 1608 drug pricing applications over the period of the study. CE evidence was requested in only 11 applications. The submitted evidence was of limited use to the committee due to concerns about quality, relevance of studies, and lack of pharmacoeconomic expertise. There were also no clear rules describing how CE would inform pricing decisions. CONCLUSIONS Limited local data and health economic experience were the main barriers to the use of economic evidence in drug pricing decisions in Jordan. In addition, there are no official rules describing the elements and process by which the CE evidence would inform drug pricing decisions. This study summarized accumulated observations for the current use of economic evaluations and evidence-based decision making in Jordan. Recommendations have been proposed to applicants and key decision makers to enhance the role of economic evidence in influencing health policies and evidence-based decision making across priority settings.

The impact of clinical pharmacists in improving Jordanian patients’ health outcomes

Objectives: To assess the impacts of clinical pharmacists on Jordanian patients’ health outcomes. Methods: A systematic review was conducted until July 2016 within EBSCO, Pubmed, Cochrane database, and ISI Web of Knowledge. Published studies evaluating the benefit of clinical pharmacy services on therapeutic, safety, humanistic, and economic outcomes in hospital or community settings in Jordan were targeted. Two reviewers independently extracted and assessed risk of bias using a pre-published validated tool. The literature search identified 130 publications of which 21 full texts met predetermined inclusion criteria. Results: Studies were of moderate quality. Pharmacist interventions resulted in an average reduction (95% CI) in systolic blood pressure of 5.45 mm Hg (2.95-7.92) and diastolic blood pressure of 3.03 mm Hg (1.09-4.96). The mean reduction in glycosylated hemoglobin was 0.75% (-0.49-1.99) and fasting blood sugar was 36.73 mg/dl (-19.7-93.1). The average reduction in low-density lipoprotein cholesterol was 2.36 (1.8-16.62) mg/dl and triglycerides was 20.16 (6.14-46.47). There was a minimal increase in the level of high-density lipoprotein cholesterol of 1.24 (1.64-4.11) mg/dl. Effects on safety along with humanistic and economic outcomes and long term effects remained unclear. Conclusion: Published evidence from Jordan highlights service opportunities for clinical pharmacists. Favorable but not always statistically significant impacts were found on therapeutic outcomes. More studies are needed to understand safety, humanistic, economic, and long-term outcomes. Therefore, the add-on benefits of this service to the health system are not well understood. Future studies of higher rigor and multi-perspective outcomes are mandated.

Costs of hospital services in Jordan

BACKGROUND Policy makers are on quest for estimates of health costs to achieve maximum efficiency and sustainability. In Jordan, there is a scarcity of information on hospital service costs. AIM The purpose of this study was to estimate the direct cost of hospital services in one of the biggest public hospitals in Amman, Jordan. METHODS A retrospective analysis forms a 400-bed public urban hospital. Costs were estimated in Jordanian dinars (JD) (exchange rate was US

Pharmacy-led medicine reconciliation at hospital: A systematic review and quantitative analysis of effects and costs

1.41). RESULTS Inpatient costs contributed to 50% of all costs whilst outpatient clinics consumed 17%. Average cost per admission was JD 481.6 (US

A Randomized Controlled Trial to Assess Pharmacist-Physician Collaborative Practice in the Management of Metabolic Syndrome in a University Medical Clinic in Jordan

674.2), JD 106.7 (US

Adherence to UK national guidance for discharge information: an audit in primary care

149.3) per inpatient day and JD 63.1 (US

Pharmacist-physician collaboration improves blood pressure control.

88.3) per bed day. The average cost per visit to emergency room was JD 14.1 s (US

A simulated patient study assessing over the counter supply and counseling in Jordan: responding to headache complaints

19.7). Cost per visit to ambulatory care services ranged between JD 37.3 and 473 (US