Maurice Hall

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

BackgroundChronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda.MethodsA cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data.ResultsOverall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37).ConclusionsPatients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

Associations between Achievement Goal Orientations and Academic Performance Among Students at a UK Pharmacy School

Objective. To ascertain goal orientations of pharmacy students and establish whether associations exist between academic performance, gender, or year of study. Methods. Goal orientations were assessed using a validated questionnaire. Respondents were categorized as high or low performers based on university grades. Associations and statistical significance were ascertained using parametric and nonparametric tests and linear regression, as appropriate. Results. A response rate of 60.7% was obtained. High performers were more likely to be female than male. The highest mean score was for mastery approach; the lowest for work avoidance. The mean score for work avoidance was significantly greater for low performers than for high performers and for males than for females. First-year students were most likely to have top scores in mastery and performance approaches. Conclusion. It is encouraging that the highest mean score was for mastery approach orientation, as goal orientation may play a role in academic performance of pharmacy students.

First-Year Pharmacy Students’ Views on Their Chosen Professional Career

Objective. To investigate what factors influenced students to study pharmacy and determine in which sector they hoped to gain employment, both in the short and longer term. Methods. First-year pharmacy students (n=124) were invited to complete a paper-based, self-administered questionnaire consisting of 4 sections. Descriptive statistics and nonparametric tests were conducted. Results. One hundred (96.8% response rate) students completed the questionnaire (22.5% male; 77.5% female). Key influential factors for choosing pharmacy included: enjoyment of science at school, a desire to improve people’s health and wellbeing, and to work in health care. Career aspirations were to work in a hospital or in community practice rather than in industry or academia. Conclusions. Students choose pharmacy as a career primarily for altruistic and clinical reasons. This research provides information for pharmacy schools about the career aspirations of students and data from future pharmacists is potentially helpful to pharmacy professional organizations and potential employers.

Appointment keeping for medical review among patients with selected chronic diseases in an urban area of Uganda

Introduction Proper management of chronic diseases is important for prevention of disease complications and yet some patients miss appointments for medical review thereby missing the opportunity for proper monitoring of their disease conditions. There is limited information on missed appointments among chronic disease patients in resource limited settings. This study aimed to determine the prevalence of missed appointments for medical review and associated factors among chronic disease patients in an urban area of Uganda. Methods Patients or caregivers of children with chronic diseases were identified as they bought medicines from a community pharmacy. They were visited at home to access their medical documents and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients. Results The prevalence of missed appointments was 42% (95%CI = 35-49%). The factors associated with missed appointments were: monthly income ≤30US Dollars (OR = 2.56, CI = 1.25–5.26), affording less than half of prescribed drugs (OR = 3.92, CI = 1.64–9.40), not experiencing adverse events (OR = 2.66, CI = 1.26–5.61), not sure if treatment helps (OR = 2.84, CI = 1.047.77), not having a medicines administration schedule (OR = 6.77, CI = 2.11–21.68), and increasing number of drugs (OR = 0.72, CI = 0.53–0.98). Conclusion Patients missed appointments mainly due to: financial and health system barriers, conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health services.

A Questionnaire Study to Investigate Stress among Future Pharmacists by Gender and Year Group

Background: This work aimed to ascertain future pharmacists’ stressors and stress-coping practices. Methods: Queens’ University Belfast Year 2 and 4 pharmacy students were invited to participate in an ethically approved, pre-piloted questionnaire study. Section A was the 10-item Perceived Stress Scale, Sections B and C related to stressors and stress-coping mechanisms, and Section D gathered non-identifiable demographic information. Data analysis largely took the form of descriptive statistics. Results: A response rate of 94.2% (213/226) was obtained. The mean Perceived Stress Scale score was 19.94 [standard deviation (SD) 6.37], with females having a higher mean score than males (20.55 SD 5.67 versus 18.16 SD 7.42). Common general stressors were career choice, employment opportunities, and finance. Common degree-specific stressors were particular assessments (objective structured clinical examinations and one-off written examinations) and the amount of course material. Popular stress-coping practices included getting emotional support from friends and family and using self-distractions. Conclusion: Stress appears to be an issue among these future pharmacists, and potentially more so for females. While the main stressors are unsurprising, this UK data enables comparisons to be made and helps inform support mechanisms within the university.

Launching and evaluating a mobile phone app to provide contemporary, evidence-based advice about self-treatable conditions.

Rationale, aims and objectives : As government-funded healthcare provisions are stretched to their limits, it is important that healthcare professionals provide evidence-based advice about minor ailments to facilitate people’s abilities to self-treat these conditions effectively and appropriately, given that self-care is one of the many components of person-centered healthcare. Unfortunately, despite the expanding over-the-counter (OTC) medicines market, there have been doubts cast about advice given by UK community pharmacists. Indeed, research conducted with pharmacists revealed that evidence of effectiveness was a secondary consideration when making decisions about OTC recommendations. We aimed to address these concerns and support decision-making by providing high quality, evidence-based, information about self-treatable conditions and over-the-counter consultations through a mobile phone app. Method: There were 4 main stages, namely: (1) app development (content and design); (2) piloting (use-testing); (3) publication on Apple and Android stores and marketing of the app and, finally, (4) an evaluation (using analytical data obtained through the app content management system, feedback obtained via email, the star-rating and reviews posted on Google Play and Apple stores and comments obtained at events. Additionally, following ethical approval and piloting, we invited 100 people, representing different groups within the pharmacy profession in Northern Ireland, to complete an evaluation questionnaire. Results: Since launching the project in February 2017, there have been over 5000 downloads, 68,453 sessions of use and the app has received a 5-star rating on both Apple and Google Play stores. Positive feedback has centred on the material being relevant and up-to-date, that it facilitates quick access to information in the workplace and is easy to navigate and that it is a good training tool. Future suggestions for improvement include expanding the number of conditions and providing self-assessment questions to help students prepare for professional examinations. Conclusions: The app appears to have had a positive impact on OTC consultations, but it is still evolving to ensure its usefulness in practice is maximised.

Assessment of Chinese students’ progression and perceptions in blended team-based learning approach at an international college in China

Blended team-based learning (TBL) as a major component of an undergraduate course was implemented at a UK joint college in China. The core components of TBL were introduced in the course for Chinese students and their academic performance and course evaluation data with blended TBL approach was compared with solely flipped classroom and traditional lecture-based courses. Students’ perceptions regarding traditional learning and TBL were investigated and compared through the use of an online perceptual learning style preference questionnaire. Students ranked blended TBL as a superior method of learning in comparison with didactic lecturing style. Higher data retention and classroom performance was achieved within blended TBL course compared to traditional learning style. Students’ perceptions and performance suggested that blended TBL can benefit non-native English speaker students, who are studying in a remote campus, where English language is not the first spoken language and provided positive feedback on their preparedness may help them to develop higher reasoning skills.

P209 Specialist respiratory pharmacist case management copd medicines optimisation clinics: implementation and outcomes

Introduction and objectives In line with ‘Transforming Your Care’ (restructuring of healthcare provision in Northern Ireland) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, this project brought specialist trust pharmacist-led medicines optimisation case management clinics to COPD patients in primary care. The aim of the project was to achieve sustained medicines optimisation with associated improved patient outcomes. Method An initial process mapping event resulted in establishing the existing COPD patient pathway between primary and secondary care. This informed the decision to base clinics in GP surgeries where the pharmacist: determined disease stage (GOLD classification); assessed medication adherence; established COPD medication appropriateness; prescribed COPD medications and smoking cessation; determined whether antibiotic prescribing was guideline-informed; and made appropriate referrals to primary and secondary care healthcare professionals. A 30-day telephone follow-up by the pharmacist involved reassessment of adherence, symptom scores and medication appropriateness. COPD exacerbations, antibiotic prescribing and unplanned hospital admissions were further recorded over 12 months. All data were analysed using SPSS Version 22. Results Results for a patient cohort seen over four months (n = 360) demonstrated: statistically significant improvements in COPD medication appropriateness and adherence (Wilcoxon Signed Rank Test, p < 0.001, n = 360); improvement in COPD symptoms (MRC Breathlessness and CAT score); and reduced guideline-informed antibiotic prescribing (12 months post baseline review). Projected annual drug cost savings were £235k. Sixty-eight percent of patients had experienced one or more COPD exacerbations over the year prior to clinic attendance reducing to 50% during the 12 months post-intervention. Non-elective COPD-related hospital admissions also decreased (9.2% versus 5.3% over 12 months). Conclusion Providing specialist hospital pharmacist COPD clinics in primary care resulted in safe and cost-effective medication use with improved patient outcomes 12 months post review.

Pharmacy students' use and views on over-the-counter (OTC) medicines; a questionnaire study

INTRODUCTION The role of the pharmacist centers on ensuring the safe and effective use of medicines, including over-the-counter (OTC) medicines. It is important to ascertain pharmacy students׳ use and opinions on OTC medicines, given that they are the pharmacists of the future and that this market continues to expand. This study aimed to investigate Queen׳s University Belfast (QUB) final-year pharmacy students׳ use and views on OTC medicines. Scarce work has been conducted in this area to date. METHODS Following ethical approval and a pilot study, all students (n = 155) were invited to participate in a self-completed questionnaire (n = 20 questions), distributed at a mandatory class. Descriptive statistics and non-parametric tests (Chi-squared and Mann-Whitney U test) were used for data analyses. RESULTS The response rate was 99.4% (154/155). The majority (153/155) reported using OTC medicines; the key consideration during personal product selection was effectiveness. Most [96.1% (147/153)] were in agreement that safety was the over-riding concern during OTC consultations. While 96.1% (149/155) considered that using an evidence-based approach improved the quality-of-patient care, 68.0% (104/153) would be prepared to sell a product that lacks evidence of effectiveness, provided it would not cause harm. CONCLUSIONS The importance of evidence of effectiveness was acknowledged, yet many students in this study were prepared to recommend unproven products. Further strategies are required at QUB to ensure this routine consideration alongside safety in practice.