Manal Zaidan

Pharmacist characteristics, medication use perceptions, and professional satisfaction: a first national survey in the state of Qatar

correspondence: Peter J Jewesson College of Pharmacy, Qatar University, Doha 2713, Qatar Tel +974 4403 5553 Fax +974 4403 5551 Email pjj@qu.edu.qa Purpose: To characterize the professional demographics, opinions about the medication use process, perceived public satisfaction with pharmacy services, and professional satisfaction of pharmacists practicing in the state of Qatar. Materials and methods: The study was designed as a hypothesis-generating, online, anonymous, opinion survey of practicing pharmacists in Qatar. Results: Two hundred and sixty-four survey accesses were recorded during the 6-week study period, and 250 surveys containing responses to one or more questions were included in the analysis. Eighty-four percent of respondents reported graduating at least 5 years prior to the survey, and 86% held a baccalaureate degree in pharmacy as their highest degree. The most common source of the highest degree was one of five countries (Egypt, Jordan, India, Sudan, or Pakistan). Forty-five percent of respondents were working in a hospital setting, and 33% were in a community pharmacy. The lowest incidence of agreement across the 10 drug procurement and distribution process statements was observed for the adequacy of medication supplies statements (33% of all respondents). The highest incidence of agreement across the eight medication use process statements was for the statement pertaining to infrequent dispensing errors (68%), and the lowest incidence of agreement was observed for the statement pertaining to the adequacy of patient monitoring (30%). The pharmacist was chosen as the best candidate to resolve perceived unmet medication needs for four of eight statements, whereas physicians were most frequently chosen for three of the four remaining statements. Respondents’ perceptions regarding patient satisfaction with the different elements of the medication use process revealed that the lowest incidence of agreement pertained to patients’ satisfaction with the waiting time required to obtain their medications (35%). Forty percent of all respondents rated themselves as professionally dissatisfied. Improvements to their professional role, greater opportunities for professional development, and enhancements in human resource-related conditions were identified as potential remedies to this situation. Conclusion: This study represents the first known attempt to formally solicit the opinions of pharmacists in Qatar. The study results have provided valuable information regarding the demographic characteristics, pharmacist perceptions about the medication use process, and professional satisfaction of practicing pharmacists in the country. This information is being utilized to guide workforce planning, to help identify potential shortcomings in the health care system, and to better understand continuing education and professional satisfaction needs of Qatar’s pharmacy practitioners. We encourage other countries to conduct similar surveys in order to better understand the characteristics, perceptions, and needs of their health care workers.

Hospital pharmacists’ self-evaluation of their competence and confidence in conducting pharmacy practice research

Objectives: Research is essential to the advancement of pharmacy practice and healthcare. Pharmacists have a pivotal role to play in this strategy. However, there is a paucity of data about hospital pharmacists’ competence and ability in conducting health-related research. This study primarily aims to determine the research demographics of hospital pharmacists in Qatar and to assess the pharmacists’ perceptions of their competence and confidence to conduct research. Methods: A multi-centered survey using a 70-item piloted questionnaire was conducted among a randomly selected sample of pharmacists practicing at seven Hamad Medical Corporation-managed hospitals. Both descriptive and inferential statistical analyses were applied using IBM-SPSS® version 20. Key findings: A total of 120 participants responded to the survey (67% response rate). About 70% of the participants did not have any previous research experience. At least 20% of the respondents self-reported inadequate competence and/or confidence in developing research protocols, critically appraising the literature, undertaking and applying appropriate statistical techniques, and interpreting research findings. The level of education along with the current hospital of practice had significant effects on pharmacists’ self-assessed competence (p < 0.05). Overall, 85% of the participants were interested in pursuing postgraduate studies or research-related training. Conclusions: A large proportion of hospital pharmacists in Qatar self-assessed themselves as having deficiencies in several domains of research process or competencies, although they recognized the value of research in advancing pharmacy practice. These findings have important implications for developing informal research training programs and promoting the pursuit of formal postgraduate programs to bridge the knowledge gaps found among hospital-practicing pharmacists.

Posaconazole-Vincristine Coadministration Triggers Seizure in a Young Female Adult: A Case Report

Coadministration of azoles and vincristine has been shown to increase vincristine neurotoxic effects due to the inhibition of cytochrome P450 (CYP) isoform 3A4, for which vincristine is a substrate. Despite the absence of any casual relationship between seizure and coadministration of azoles, few case reports of vincristine-induced seizure have been documented after coadministration of fluconazole or posaconazole in children. In this paper we are reporting the first young female adult who experienced generalized seizure after coadministration of posaconazole and vincristine. The 19-year-old female was diagnosed with acute lymphoblastic leukemia. She started induction phase of Berlin Frankfurt Muenster protocol along with posaconazole 200 mg three times daily as prophylactic antifungal therapy. Five days after the third vincristine dose, she developed generalized seizure accompanied by high blood pressure and SIADH. Her neurological exam/CT scan did not show any abnormality. In conclusion, this study reports a novel finding in the sense that all previous case reports pertaining to posaconazole-vincristine-induced seizure in literature involved children. Physicians should be made aware of this rare possible outcome to closely monitor their patients and take appropriate measures to prevent such possible adverse effect.

Posaconazole, a prophylactic therapy in patients with haematological cancer: drug use evaluation study

Background Posaconazole (PSZ), is an antifungal prophylactic therapy that is used in haematological cancer patients. In 2010, PSZ was added to the formulary of the National Centre for Cancer Care & Research (NCCCR), the only adult cancer hospital in Qatar. Objective To conduct a drug use evaluation (DUE) study of PSZ at NCCCR. Method A retrospective, single centred, observational DUE study was conducted to include a convenient sample of haematological cancer patients who used PSZ prophylactically in 2010. All 31 patients were nominated; 20 patients profiles were reviewed. Data were collected using a pre-prepared collection sheet and descriptive analysis was performed. Results One patient was excluded as he was not a haematological cancer patient. All remaining 19 patients received PSZ for prophylaxis and were compliant. More than 50% of patients received proton pump inhibitors concurrently with PSZ. Only 1 case had a recorded recommendation regarding the administration of PSZ with food. Five patients received a vincristine based chemotherapy protocol, one of which developed seizures. Two patients developed mild breakthrough fungal infection while on PSZ. Conclusions The PSZ practice in NCCCR abides by its regulations of use. However, clear recommendations regarding administration of PSZ with meals is essential. PSZ co-administration with proton pump inhibitors should be either stopped or managed by PSZ therapeutic drug monitoring to avoid PSZ sub-therapeutic levels. Possible serious drug interactions in patients treated with vincristine based chemotherapy should be highlighted and monitored.

The utility of an electronic adherence assessment device in type 2 diabetes mellitus: a pilot study of single medication

Objectives: The primary objective of this pilot study was to determine if the Medication Event Monitoring System (MEMS) is capable of providing meaningful estimates of compliance within the indigenous Qatari population. The secondary objective was to highlight any specific problems which might be associated with the use of MEMS within this population. Method: A sample of adult diabetic Qatari patients attending an outpatient diabetic clinic were administered a Knowledge, Attitude, and Practices (KAP) questionnaire and then dispensed one of their regular medications in a MEMS®-fitted bottle. Data contained in the MEMS® were downloaded after the patients returned for a refill and adherence was estimated using 2 methods: pill count and MEMS® data. Results: A total of 54 patients agreed to participate in this pilot study. Adherence to daily doses was 67.7% and with regimen 13.7%. No correlation was found between adherence assessed by pill count and MEMS®. The association between KAP and adherence was generally poor. A number of other issues and challenges in the use of MEMS® that could affect its utility were noted and will be discussed. Conclusions: Our results revealed problems associated with the use of MEMS® that could affect its usefulness in assessing adherence in this part of the world. Some issues identified in this pilot study included retrieving the MEMS®, registering extra opening of MEMS®, desire to hoard medicine by taking doses at different frequency than recorded in MEMS®. All these issues could be closely associated with the attitudes and practices of the patients, as demonstrated by our KAP analysis and correlations.