Furqan Khurshid Hashmi

A qualitative exploration of knowledge, attitudes and practices of hospital pharmacists towards adverse drug reaction reporting system in Lahore, Pakistan

BackgroundMedication safety is a major public health concern and there are well established pharmacovigilance programmes in developed countries. However, there is scarcity of literature on the issue in low and middle income countries. In this context, the current study was aimed to evaluate the knowledge, attitudes and practices of hospital pharmacists towards medication safety and ADR reporting in Lahore, Pakistan.MethodsA qualitative approach was used to conduct this study. A semi-structured interview guide was developed, 10 hospital pharmacists were recruited and interviewed through convenience sampling technique. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents analysis.ResultsThematic content analysis of the interviews resulted in 6 major themes, including (1) Familiarity with medication safety & adverse drug reaction concept (2) Current system of practice and reporting of adverse drug reaction in hospital setting, (3) Willingness to accept the practice change (4) Barriers to adverse drug reaction reporting, (5) Policy change needs and (6) The recognition of the role. Majority of the hospital pharmacists were familiar with the concept of medication safety and ADR reactions reporting however they were unaware of the existence of national ADR reporting system in Pakistan. Several barriers hindering ADR reporting were identified including lack of awareness and training, communication gap between the hospitals and regulatory authorities.ConclusionThe study revealed that that hospital pharmacists were good in understanding of medication safety and ADR reporting; however they don’t practice this in real sense. The readiness of the hospital pharmacist towards the practice change has indicated that they are all set to be actively involved in the provision of medication safety in hospital setting. Involvement of key stake holders from ministry of health, academia, pharmaceutical industry and healthcare professionals is warranted to promote safe and effective use of medicines.

Genderwise clinical response of antipsychotics among schizophrenic patients: a prospective observational study from Lahore, Pakistan

Abstract Objective: The study was aimed to evaluate the gender specific response to adherence and occurrence of side effects among schizophrenic patients in Lahore, Pakistan. Methods: A prospective study was performed for a period of 1 year among 180 newly diagnosed schizophrenics, aged 20–60 years to observe the symptoms, medication adherence and side effects. Morisky–Green–Levine Scale was used to evaluate medication adherence, LUNSER for side effects and PANSS to measure positive and negative symptoms. Data were analyzed using SPSS. Results: Positive symptoms (Male: Baseline 36.14 vs. endpoint 23.58, Female: 35.29 vs. 23.74) and negative symptoms (Males 27.9 vs. 20.05, Females 28.41 vs. 20.2) of schizophrenia were equally reduced after a follow up of 1 year in both the genders. Male population suffered more accumulative side effects (11.4 in males vs. 6.40 in females), extrapyramidal symptoms such as tardive dyskinesia and tremors (1.21 in males vs. 0.57 in females) and other side effects as compared to women (p ≤ .005). Males were found poorly adherent to antipsychotic treatment than females (93.3% in males vs. 6.7% in females (p ≤ .005). Conclusions: Prescribing practices should not overlook sex specific factors like hormonal changes, altered brain morphology and socioeconomic factors that may be responsible for the difference in the response to the course of schizophrenia.

Occurrence of Medication Errors and Comparison of Manual and Computerized Prescription Systems in Public Sector Hospitals in Lahore, Pakistan

The knowledge of medication errors is an essential prerequisite for better healthcare delivery. The present study investigated prescribing errors in prescriptions from outpatient departments (OPDs) and emergency wards of two public sector hospitals in Lahore, Pakistan. A manual prescription system was followed in Hospital A. Hospital B was running a semi-computerised prescription system in the OPD and a fully computerised prescription system in the emergency ward. A total of 510 prescriptions from both departments of these two hospitals were evaluated for patient characteristics, demographics and medication errors. The data was analysed using a chi square test for comparison of errors between both the hospitals. The medical departments in OPDs of both hospitals were the highest prescribers at 45%–60%. The age group receiving the most treatment in emergency wards of both the hospitals was 21–30 years (21%–24%). A trend of omitting patient addresses and diagnoses was observed in almost all prescriptions from both of the hospitals. Nevertheless, patient information such as name, age, gender and legibility of the prescriber’s signature were found in almost 100% of the electronic-prescriptions. In addition, no prescribing error was found pertaining to drug concentrations, quantity and rate of administration in e-prescriptions. The total prescribing errors in the OPD and emergency ward of Hospital A were found to be 44% and 60%, respectively. In hospital B, the OPD had 39% medication errors and the emergency department had 73.5% errors; this unexpected difference between the emergency ward and OPD of hospital B was mainly due to the inclusion of 69.4% omissions of route of administration in the prescriptions. The incidence of prescription overdose was approximately 7%–19% in the manual system and approximately 8% in semi and fully electronic system. The omission of information and incomplete information are contributors of prescribing errors in both manual and electronic prescriptions.

Standardization in the Evaluation System of Pakistan's Pharmacy Institutes

I am immensely pleased that my letter “Unstandardized and Defective Evaluation Practices in the Examination System in Pharmacy Institutes of Pakistan”1 has been the center of attention among Pakistans pharmacy academics and authorities controlling the examination system, leading to a debate on the existing unstandardized evaluation practice. However, a response letter from Mahmood and Usman2 suggests the need for an explanation of some of the facts and latest advances related to standardization in pharmacy education in Pakistan. At present, 3 types of examination systems are being used in Pakistan: semester without external evaluation, semester with external evaluation, and annual with external evaluation. The first is being practiced in all private and few public sector institutions, whereas the latter 2 are in use in most of the public sector and a few private institutes affiliated with public-sector universities. The grading scheme in all these systems is quite dissimilar. In collaboration with the Higher Education Commission of Pakistan, the Pharmacy Council of Pakistan devised the doctor of pharmacy (PharmD) curriculum in 2004 for both annual and semester systems without mentioning the need for external evaluation or the timeframe for adapting to a single system in the country. This is the root cause of unstandardization.3 Mahmood and Usman2 witnessed the defects of the annual system, which prompted institutions to slowly adapt to a semester system. However, this report was neither factual nor evidence-based, but rather a mere assumption. Standardization cannot be achieved by adapting a single examination system without incorporating a standardized grading procedure. A good examination system whether annual or semester, indicates what is taught and how it is taught. Moreover, evaluation outcomes allow teachers to tailor teaching strategies and methodologies that may improve both teaching and learning. Presently, such goals are a daydream, particularly in public sector institutes. My previous letter was not a comparison between semester and annual systems but rather an attempt to draw the attention of the authorities to a few points that need to be addressed in support of pharmacy students. Contrary to the opinions expressed by Mahmood and Usman,2 my letter1 indicated that the examination of theory in the annual system was quite fair. The real hitch was student failure of the practical examination because they failed the oral examination portion, which accounted for 20% to 30 % of the total grade. This situation was grave because students who failed either the theory (written) or practical (oral) portion had to retake both examinations, despite that the subjects were independent. Furthermore, there is no professional body comprised of institutional-level experts who are available to lend a hand to students by investigating this situation. In 2004, pharmacy academia separated the 2 examinations, which resulted in some improvement, but there was still a need to further refine the system. As a result of some of the remaining problems, some students fail and discontinue their education or require psychiatric care. Some reported cases of suicide could have been avoided by establishing a body of experts to probe the reasons for failure and counsel students. Counseling or psychoanalysis of failing students can play a pivotal role in improving the success rate among this group and decreasing depression that leads to suicide. Turning a blind eye to the grave incidences of suicides by considering them isolated reports in this and other countries, as mentioned by Mahmood and Usman,2 is beyond comprehension. In my opinion, based on my experience as officer in charge of examinations, a mentor needs to be vigilant to students who do not achieve the required outcome and has a paternal role to motivate and guide such fellows. A teacher may be more inclined to do so if he/she is held accountable for ghastly results, but at present, this is not occurring at most of Pakistans institutes. In this context, a recent healthy development occurred when a vice chancellor of a public sector university ordered that a teacher would be held responsible if the failing rate in his class was more than 10%. I am encouraged that the National Test Service, a public sector organization, has taken the initiative to launch a pharmacy subjects-based Graduate Assessment Test (GAT), which is compulsory for those intending to pursue higher education.4 The Punjab Public Service Commission conducted an examination of over 10,000 candidates who were competing for 117 vacant positions in the Hospital Pharmacists/Inspector of Drugs in the Punjab Health Department. Despite the graduate assessment requirement, only 1290 candidates passed the examination and were invited to appear in front of a board of experts for final selection.5 There is still a dire need for the Pharmacy Council of Pakistan to take an affirmative role in controlling/restricting growth in the number of pharmacy institutes in the country, improving the standard of education, and producing pharmacists needed to meet the national demand. Moreover, the council needs to ponder the prevailing employment situation before accrediting new pharmacy institutes because there is already an unemployment problem and the jobs that are available pay exceptionally low wages. If the number of pharmacy institutes in Pakistan is allowed to increase, increasing the number of pharmacists in the country, it will only exacerbate the unemployment problem.6 There is a dire need for a mandatory GAT-type test for the registration of pharmacists with provincial pharmacy councils, which is obligatory for pharmacy practice in Pakistan.

Quality of Life in Patients with Skin Diseases Attending a Public Healthcare Institute of Quetta City, Pakistan

Background: The current study is aimed to document the Dermatology Life Quality Index (DLQI) of patients with skin disorders attending a public healthcare institute in Quetta city, Pakistan. Methods: A questionnaire based, cross-sectional study was planned for this research. The study was conducted at Bolan Medical Complex Hospital, Quetta. A response based, double design sampling method was used to identify the sample required for the study. Patients were asked to answer the Dermatology Life Quality Index (DLQI) for the assessment of QoL. SPSS v. 20 was used for data analysis. The Chi Square test was used for cross tabulation analysis and p Key words: Quality of life, Skin diseases, Public healthcare institute, Quetta city, Pakistan.

Exploring the knowledge and attitude of medical and pharmacy students about generic medicine in Lahore, Pakistan:

Background The age of out-of-pocket health-care expenditures demands the practice of generic medicine. Our objective was to evaluate the knowledge and attitude about generic medicine among medical and pharmacy students of Lahore, Pakistan. Methods A cross-sectional study was performed among calculated sample size (via online Raosoft calculator) of 295 students including 185 pharmacy and 110 medical students from third, fourth, and final year of studies using convenient sampling approach. A pre-validated questionnaire was used to assess the knowledge of students regarding generic medicine. Data were analyzed using SPSS version 20. Results We found that a majority of both pharmacy and medical students were aware of the meaning of brand and generic medicine where 86 (29.7%) students believed that generic medicine is bioequivalent to brand name product and 108 (36.5%) students agreed that cost burden will be reduced with the use of generics. There were concerns about quality (P ≤ 0.05) and side effects (P ≤ 0.005) of generic medicine as compared to brands. Significant associations were found between the knowledge of medical and pharmacy students (P ≤ 0.005). Conclusion Educational interventions and policies regarding generic medicine practices are strongly needed to overcome the knowledge deficits among pharmacy and medical students.

Impact of duration of therapy on side effect profile of anti-HCV protocol: A retrospective cohort study from two tertiary health facilities in Pakistan

Purpose: To evaluate the plausible risks and adverse effects related to the duration of therapy in hepatitis C (HCV) patients in Lahore, Pakistan. Method: A retrospective observational study involving 250 HCV patients who received combination therapy with ribavirin and interferon was conducted. The patients were segregated into two groups on the basis of duration of therapy (≤ 6 months and > 6 months). Adverse effect profiles of patients under treatment were collected using a pre-validated questionnaire and compared using Pearson’s Chi- Square Test/Chi-Square Goodness-of-Fit tests and unpaired t-test. Results: Patients who underwent treatment for ≤ 6 months frequently encountered side-effects such as GIT disturbance (23.77 %) and joint pains (29.63 %). Additionally, diabetes mellitus (27.86 %) and frequent injections (74.59 %) were the most commonly observed co-morbid condition and disease risk, respectively. On the other hand, in patients who underwent therapy for > 6 months, skin disorders (30.46 %) and gastric acidity (10.15 %) were the most frequently observed side-effects with less frequent reporting on co-morbid conditions and disease risk factors. Moreover, there was a significant reduction in body weight (p = 0.03), serum bilirubin (p = 0.0005), albumin (p = 0.003) and triglycerides (p = 0.006) levels due to longer duration of treatment. Conclusion: The data suggest that treatment-related risks are higher among HCV patients on shorter treatment duration whereas adverse events subside in patients on longer duration of therapy (>6 months). Changes in biochemical profile were also more evident in those receiving treatment for periods >6 months. Keywords: Interferon, Ribavirin, Side effects, Duration of therapy, Outcomes of therapy