Mohammad Waheedi

Knowledge, Perceptions and Attitudes toward Complementary and Alternative Therapies among Kuwaiti Medical and Pharmacy Students

Objective: To determine the knowledge, perceived effectiveness and harmfulness of complementary and alternative medicine (CAM) modalities, general attitude and the need for education in the use of CAM therapies among medical and pharmacy students. Methods: A descriptive and cross-sectional study was performed using a pre-tested questionnaire on a randomly selected sample of 250 students in Faculties of Medicine and Pharmacy, Kuwait University. Descriptive and logistic regression analyses were used in data analysis. Results: The response rate was 88.4%. CAM usage was reported by 122 (55.2%) of students, and mostly associated with females (OR 4.4, 95% CI 1.7–11.3). Herbal products were the most commonly used (83, 37.6%). Knowledge about 11 CAM modalities was generally poor, even among the respondents who claimed to know them most. The knowledge about herbal products was significantly better among 58 pharmacy students (49.2%) than 32 medical students (31.4%) (OR 2.0, 95% CI 1.1–3.6). Massage, herbal products and prayer/Qur’an reciting were perceived as being the most effective, while cauterization as the most harmful. Attitude toward CAM was positive, with 176 (79.7%) believing that CAM includes ideas and methods from which conventional medicine could benefit. Lack of trained professionals and lack of scientific evidence were the most perceived barriers for CAM implementation. 198 (89.6%) admitted the importance of knowledge about CAM for them as future healthcare practitioners. Conclusion: The students acknowledged the need to be well educated about CAM to better advise their patients in the future.

Barriers to medication taking among Kuwaiti patients with type 2 diabetes: A qualitative study

Background Nonadherence to medications among Kuwaitis with type 2 diabetes mellitus (T2DM) is believed to be a major barrier to appropriate management of the disease. Published studies of barriers to medication adherence in T2DM suggest a Western bias, which may not adequately describe the Kuwaiti experience. Aim The purpose of this study was to explore barriers to medication adherence among Kuwaiti adults with T2DM. Methods Semi-structured interviews were conducted with 20 Kuwaiti patients with type 2 diabetes. The interviews were digitally recorded, transcribed, and analyzed using thematic analysis. Results Barriers to medication adherence were identified. Emerging themes were: 1) lack of education/awareness about diabetes/medications, 2) beliefs about medicines/diabetes, 3) spirituality and God-centered locus of control, 4) attitudes toward diabetes 5) perceptions of self-expertise with the disease and body awareness, 6) social stigma, 7) perceptions of social support, 8) impact of illness on patient’s life, 9) perceptions of health care providers’ attitudes toward patients, and 10) health system-related factors, such as access difficulties and inequalities of medication supply and services. Conclusion Personal, sociocultural, religious, health care provider, and health care system-related factors may impede medication adherence among Kuwaitis with type 2 diabetes. Interventions to improve care and therapeutic outcomes in this particular population must recognize and attempt to resolve these factors.

Preparedness for the Smoking Cessation Role among Health Sciences Students in Kuwait

Objective: Our aim was to assess students’ preparedness for the smoking cessation role after a teaching module on tobacco cessation and to assess the relationship between smoking status and preparedness. Methods: Pharmacy students attended a 4-hour module on the role of health professionals in smoking cessation based on the Rx for Change training program. Two years after the first introduction of the module, a questionnaire on preparedness and smoking status was filled in by 64 pharmacy students who had attended the module and 243 students from other health sciences that had not been exposed to the module. Results: Preparedness scores for the smoking cessation role for pharmacy students were significantly higher (mean = 19.5, n = 63) for the nonsmoking pharmacy students compared to other nonsmoking students in medicine (mean = 16.2, n = 149), dentistry (mean = 16.1, n = 40) and physical therapy (mean = 14.9, n = 16) (p = 0.009). The smoking prevalence was 3% among all females and 31% among all males. Smoking students were significantly less likely (p = 0.031) to agree that it is their professional responsibility to help patients quit smoking. Conclusion: Significant and long-lasting differences in students’ perception of preparedness for the smoking cessation role based on exposure to a short teaching module were demonstrated. Furthermore, our results support previous findings that smoking compromises attitude towards helping smokers to quit.

Medication adherence in chronic illness: do beliefs about medications play a role?

Background Several medicines are prescribed for chronic disease management; however, adherence to long-term therapy remains poor. Culture influences beliefs about medications and, ultimately, adherence to treatment. There is a paucity of data with regard to beliefs about medications in the Middle East region, and it remains to be determined how these beliefs would impact treatment adherence. Objectives To investigate the relationship between patients’ beliefs about medications with self-reported adherence to treatment among a chronically ill multicultural patient population. Methods A prospective cross-sectional study was conducted among patients treated for chronic illnesses in the Ministry of Health primary care clinics in Kuwait. Patients completed a questionnaire that consisted of questions to collect information about their health status and demographics using validated instruments: the Beliefs about Medication, Sensitive Soma Assessment Scale, and Medication Adherence Report Scale-5 items. The main outcome measures were self-reported adherence to medications, beliefs, and perceived sensitivity toward medications. Results Of the 1,150 questionnaires distributed, 783 were collected – giving a response rate of 68.1%. Of the 783 patients, 56.7% were male, 73.7% were married, 53.3% were non-Kuwaitis, and 49.4% had low income (<1,000 KD/3,350 USD monthly). Patients self-reported having a cardiovascular illness (80.2%), diabetes mellitus (67.7%), respiratory disease (24.3%), or mood disorder (28.6%). Participants had a mean of two comorbid illnesses and indicated taking an average of four prescription medicines to treat them. A structural equation model analysis showed adherence to medications was negatively impacted by higher negative beliefs toward medications (beta = −0.46). Factors associated with negative beliefs toward medications included marital status (being unmarried; beta = −0.14), nationality (being Kuwaiti; beta = 0.15), having lower education level (beta = −0.14), and higher illness severity (beta = 0.15). Younger age (beta = 0.10) and higher illness severity (beta = −0.9) were independently associated with lower medication adherence. Income and gender did not influence medication adherence or beliefs about medications. The combined effect of variables tested in the model explained 24% of the variance in medication adherence. Conclusion Medication adherence is a complex, multifaceted issue and patient beliefs about medications contribute significantly, although partially, to adherence among a multicultural Middle Eastern patient population.

White blood cell subpopulation changes and prevalence of neutropenia among Arab diabetic patients attending Dasman Diabetes Institute in Kuwait

Background The effects of diabetes mellitus on the differential white blood cell count are not widely studied in the Arab populations. The objective of this cross-sectional, retrospective study is to assess the influence of chronic diabetes mellitus on white blood cell counts, absolute neutrophil (ANC) and lymphocyte counts (ALC) as well as the prevalence of benign ethnic neutropenia among Arabs attending the Dasman Diabetes Institute (DDI) in Kuwait. Methods and findings 1,580 out of 5,200 patients registered in the DDI database qualified for our study. Age, gender, HbA1c and creatinine levels, estimated glomerular filtration rate as well as average WBC, ANC and ALC levels, presence of diabetes-associated complications and anti-diabetic medications were analyzed. Our results showed the mean value of the WBC was 7.6 ± 1.93 x 109/L (95% CI: 2.95–17.15). The mean ANC was 4.3 x 109/L (95% CI: 0.97–10.40) and mean ALC was 2.5 x 109/L (95% CI: 0.29–10.80). Neutropenia (ANC: <1.5 x 109/L) was detected in fifteen patients (0.94%). Six patients (0.4%) fulfilled the definition of lymphopenia (ALC < 1 x109/L). Patients with an HbA1c ≥ 7% and those taking at least 3 anti-diabetic medications showed higher values for ANC and ALC. Patients with diabetes-associated neuropathy or nephropathy displayed higher mean ANC values. Our study was limited by overrepresentation of patients over 50 years old compared to those under 50 as well as selection bias given its retrospective nature. Conclusions Our study showed that patients with poorly controlled diabetes displayed higher ANC and ALC levels. In addition, patients with DM-associated complications showed higher ANC levels. This finding would suggest that DM exerts a pro-inflammatory influence on differential WBC counts. Our study also showed that the prevalence of benign ethnic neutropenia was lower than previously reported in other studies.

Clinical pharmacy in Kuwait: Services provided, perceptions and barriers

Introduction Pharmacy practice has considerably evolved from a dispensing role to a patient-centered profession. Kuwait has minimal clinical pharmacy services established in its healthcare settings. Objectives The objectives of this study were to document existing clinical pharmacy services in public hospitals, identify barriers to their implementation and assess perceptions regarding pharmacists providing clinical services. Material & Method A cross sectional study using self-administered questionnaires among a total of 166 pharmacists and 284 physicians across 6 public hospitals in Kuwait was conducted. Results Over half of pharmacists (54%) provided clinical services, with the most common service being education and drug information (86%). Forty percent (40%) of the pharmacists reported that clinical services offered were of their own initiative but most of them (71%) were not sure whether they would offer additional services in the future. The majority of physicians were receptive to an expanded patient-centered role of the pharmacist (97%), believed pharmacists add to patient clinical care (92%) and considered pharmacists members of the healthcare team (96%). Major barriers reported by pharmacists to implement clinical pharmacy services included lack of policy (49%), time (36%) and clinical skills (28%), which is similar to barriers reported by physicians. Conclusion Although clinical pharmacy is in its infancy in Kuwait, it is well perceived and requested by physicians. Major barriers must be addressed and in this context, having a national framework for pharmacy practice from Ministry of Health, supported by cutting edge education and a pro-active professional association would be key assets to evolve the practice in Kuwait.

Drug therapy problems identification by clinical pharmacists in a private hospital in Kuwait

OBJECTIVES To report the types and frequency of drug therapy problems (DTPs) identified and the physician acceptance of the clinical pharmacist interventions in a private hospital in Kuwait. METHODS A retrospective cross-sectional study was conducted on 3500 patients admitted to the hospital between December 2010 and April 2013. A structured approach was used to identify DTPs and recommend interventions. Data were analyzed using MAXQDA version 11. KEY FINDINGS A total of 670 DTPs were identified and recommendations were proposed to treating physicians for each DTP. Overdosage was the most frequently identified drug therapy problem (30.8%), followed by low dosage (17.6%), unnecessary drug therapy (17.3%), need for additional drug therapy (11.6%), and need for different drug product (11.6%). The drug classes most frequently involved were anti-infectives (36.9%), analgesics (25.2%), and gastrointestinal agents (15.5%). More than two-third of the interventions (67.5%) were accepted and implemented by physicians. The most frequently accepted interventions were related to nonadherence, adverse drug reaction, monitoring parameters, inappropriate dosage, and need for additional drug therapy. CONCLUSION The current findings expand the existing body of data by reporting on pharmacist recommendations of identified DTPs and importantly, their high rate of acceptance and implementation by the treating physician. These results could serve as a springboard to support further development and implementation of clinical pharmacy services in other healthcare settings in Kuwait.

Anemia in diabetes: Experience of a single treatment center in Kuwait

AIMS Diabetes mellitus is the most common metabolic disorder in Kuwait. Anemia is a known outcome of diabetes and its related complications. This study examined the prevalence of anemia in diabetic subjects in Kuwait as well as any association between the presence of anemia with Hemoglobin A1c and diabetes complications. METHODS The study subjects were diabetic patients with complete records and two or more visits at Dasman Diabetes Institute. Patients data included demographics, complications, medications and laboratory results. Descriptive statistics were applied using SPSS. RESULTS Of 1580 included diabetic patients; the prevalence of anemia was 28.5% (95% CI: 26.3, 30.8). Diabetic females had a higher rate of anemia compared to males (35.8% vs. 21.3% respectively, p<0.001). There was no association between diabetes control (HbA1c) and anemia in both genders (p=0.887). Patients with elevated serum creatinine and microalbuminuria were more likely to be anemic (p<0.001). Diabetic patients with anemia had higher presence of peripheral neuropathy and diabetic foot (p<0.001). CONCLUSION This study shows high prevalence of anemia in diabetic patients, particularly in those with diabetic complications. These results should prompt treatment centers to include anemia investigation and management within their diabetes treatment protocols to reduce morbidity in diabetes.

“Patients’ understanding is the problem” : Physicians’ views of nonadherence among Arabs with type 2 diabetes

Purpose Nonadherence to diabetes medication is a significant barrier toward achieving positive treatment outcomes. There is an abundance of research looking at the problem from the patient perspective, but less from the provider perspective. The Middle East region has one of the highest prevalences of type 2 diabetes in the world, with special cultural characteristics, which require research attention. The aim of this study was to explore the views of primary-care physicians on medication nonadherence among type 2 diabetes patients. Materials and methods A descriptive qualitative study was performed using one-on-one semistructured interviews of 21 primary-care physicians who were selected using stratified and random sampling from polyclinics in the five health districts in Kuwait. The interviews elicited the participants’ views about barriers and facilitators of medication adherence in type 2 diabetes patients. The interviews were audio-recorded and transcribed verbatim. Thematic content analysis with constant comparison was used to generate the codes and themes to arrive at a core category. Results Patient understanding, including knowledge, beliefs, and attitudes, was identified by respondents as the core determinant of medication nonadherence in type 2 diabetes. This was composed of six major themes: four against understanding and two for understanding. The ones against were “Patients do not understand diabetes”, “Patients do not understand the importance of medications”, “What the patient hears from friends is more important than what the doctor says”, “Patients are in denial (or difficult)”. Themes for understanding were “I need to educate more” and “Patients must hear it from other sources”. Conclusion That lack of understanding among patients results in medication nonadherence is the dominant view of primary-care physicians. This finding has implications in relation to the evolution of diabetes care toward more patient-centeredness within the cultural context.