Salah Aburuz

Pharmaceutical care in a community-based practice setting in Jordan: where are we now with our attitudes and perceived barriers?

Objectives  The objective of this study was to answer the following questions. How do community pharmacists in Jordan understand pharmaceutical care? What is the extent of pharmaceutical care practice in community pharmacies in Jordan? What are the main barriers to practising pharmaceutical care in Jordan? What is the attitude of community pharmacies in Jordan when considering provision of pharmaceutical care?

Validation of a comprehensive classification tool for treatment-related problems

ObjectiveSeveral drug-related problem classification systems can be found in the literature. However, it is generally agreed that a comprehensive, well constructed and validated instrument is currently lacking. The aim of this study is the development and validation of a comprehensive treatment-related problems assessment and classification tool for use in teaching, practicing and researching pharmaceutical care and to improve identification, resolving and preventing of treatment-related problems.MethodThe development and validation involved five steps starting with literature search to define a treatment related problem and also to form a database of treatment-related problems identified in the literature. In the next step, all problems that were identified in the first step and passed the evaluation of the three authors were pooled together and then divided into groups according to their common or shared construct, in the third step a suitable assessment method was developed according to the construct of the different problems, in the next step the developed instrument was validated for content, internal and external validity. Finally the tool was finalized and tested for reproducibility and inter-rater agreement.ResultsThe final validated version included six main categories for treatment-related problems (Indication, Effectiveness, Safety, Knowledge, Adherence and Miscellaneous). These categories include a total of nine subcategories and a total of 29 treatment related problems.ConclusionThe treatment-related problems assessment and classification tool introduced in this paper was applied to actual patient cases and proved to be valid. This tool also has several features that are new.

Comprehensive assessment of treatment related problems in hospitalized medicine patients in Jordan.

Objectives The aim of this study was to identify the prevalence and characteristics of treatment related problems (TRPs) in hospitalized internal medicine patients in Jordan as well as to identify diseases and drugs associated with each specific TRP. We have also aimed at investigating physicians’ acceptance of recommendations made by clinical pharmacist and to identify the outcomes of pharmacist interventions. Setting Internal medicine department of a general hospital in Jordan. Methods We have utilized a systematic, prospective, bedside, comprehensive clinical assessment approach that allowed us to effectively identify, communicate and follow up TRPs. Main outcome measures: prevalence and nature of identified TRPs, clinical significance of TRPs, associated diseases and drugs and clinical outcomes of clinical pharmacist interventions. Results 402 patients were included in the study. The average number of the identified TRPs was 9.35. Fifty-three percent of identified TRPs were classified as major and 28% were classified as moderate. Ninety-one percent of the recommendations were accepted by physicians. Efficacy related problems were the most common TRP category followed by safety related problems and indication related problems. Sixty-four percent of the TRPs were resolved or prevented through the clinical pharmacist intervention. Conclusions We have found that prevalence of TRPs is substantially high among patients hospitalized at the internal medicine department. TRPs related to Dosage regimens, untreated conditions, patient monitoring, drug interactions, and drug choices were the most common. Most of TRPs identified by pharmacists were clinically significant. Pharmacists’ interventions contributed substantially to the resolving of many of the identified TRPs. Patients suffering from higher number of medical conditions and receiving higher number of medications should be given the priority for clinical pharmacy service in hospitalized internal medicine patients.

The validity and reliability of the Arabic version of the EQ-5D: a study from Jordan.

Background and Objectives :EQ-5D is a generic measure that permits comparisons in quality of life across disease states, and which may provide useful data for health policy and resource allocation decision-making. There are no published reports on the acceptability and psychometric properties of the EQ-5D in the Arabic language. We therefore investigated the validity and reliability of the Arabic translation of the EQ-5D in Jordan. Methods: The study was conducted on a convenience sample consisting of consecutive adult Arabic-speaking outpatients or visitors attending a university teaching hospital. Subjects were interviewed twice using a standardized questionnaire containing the EQ-5D, Short Form 36 Health Survey (SF-36). To assess the validity of the Arabic version of the EQ-5D, ten hypotheses relating responses to EQ-5D dimensions or the visual analogue scale (EQ-VAS) to SF-36 scores or other variables were examined and test-retest reliability was assessed. Results: The study included 186 subjects who had a mean age of 45.3 years and included 87 (47%) females. The major problem reported in more than 102 (55%) of the subjects was anxiety/depression. All of the ten a-priori hypothesis relating EQ-5D responses to external variables were fulfilled. Cohen′s k for test-retest reliability (n=52) ranged from 0.48 to 1.0. Conclusion: The Arabic translation of EQ-5D appears to be valid and reliable in measuring quality of life in Jordanian people.

Relationship between lung function and asthma symptoms in patients with difficult to control asthma.

Several studies have demonstrated a poor relationship between measures of asthma control and lung function in patients with asthma. We sought to examine this relationship in a cohort of difficult to control asthmatics attending a hospital outpatient clinic. FEV1% and asthma control scores (ACSs) were measured at the first clinic visit and at a follow-up visit. A total of 59 patients took part in the study. At the initial visit, FEV1% correlated with limitation of activity (p = 0.002), shortness of breath (p = 0.02), wheezing (p = 0.029), and ACS (p = 0.014). However, at follow-up, there was no correlation between FEV1% and any measured index of asthma control. When patients with severe fixed airflow obstruction were excluded from the analysis (n = 16), FEV1% at follow-up became significantly correlated with night waking (p = 0.02), wheezing (p = 0.05), and ACS (p = 0.036). The improvement in asthma control score at follow-up was significantly and strongly associated (r = 0.51 for total asthma control, p < 0.001) with the improvement in lung function in patients without severe fixed airflow obstruction. Lung function was not associated with any measure of asthma control in patients with severe fixed airflow obstruction. FEV1% correlates well with asthma symptoms in difficult asthma patients with poor control but not when control improves. This loss of relationship is due to subjects with severe fixed airflow obstruction where good subjective control does not exclude the presence of significant obstruction. How severe fixed airflow obstruction should be prevented, delayed, or managed in asthma requires further research.

Skin prick test reactivity to aeroallergens in Jordanian allergic rhinitis patients.

Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis. The aim of this cross-sectional study was to investigate the pattern of skin prick test reactivity to various aeroallergens among allergic rhinitis patients attending outpatient clinics in Amman, Jordan. Skin prick test with 18 standardized allergen extracts was performed on 538 patients. Most allergic rhinitis patients in the study sample had polysensitization. Grasses mix (51.4% of patients), thistleweed (46.9%) and olive tree (45.3%) pollens were the most common allergens in this group of patients (all seasonal). Cat allergen was the most common perennial allergen (41.6%), followed by dust mite Dermatophagoides pteronyssinus (32.9%). These allergens should be given the highest priority when educating allergic rhinitis patients in Amman regarding allergen avoidance strategies.

Assessment of impairment in health-related quality of life in patients with difficult asthma: psychometric performance of the Asthma Quality of Life Questionnaire.

Objective and background:  To understand the effects of asthma and its treatment and to draw accurate conclusions with respect to different management programmes, including clinical trials. In more severe asthmatics, it is imperative that the health‐related quality of life (HRQL) be measured accurately and validly. This study had a twofold objective: (i) to examine the psychometric characteristics of the Asthma Quality of Life Questionnaire (AQLQ) in patients with difficult asthma, and (ii) to explore to what extent suffering from asthma affects the HRQL in patients with difficult asthma.

Value of a Community‐Based Medication Management Review Service in Jordan: A Prospective Randomized Controlled Study

To assess the impact of a medication management review (MMR) service on treatment‐related problems (TRPs) and certain clinical outcomes in outpatients.

Associations between patient factors and medication adherence: A Jordanian experience

Objective: To explore the effect of patient characteristics and health beliefs on their medication adherence. Methods: Patients (n=167) with chronic conditions (mean age 58.9; SD=13.54, 53% males) were recruited from March 2009- to March 2010 using a cross sectional study design. Data collected included patients’ demographics, medical conditions, medications therapeutic regimen, frequency of physician visits and health beliefs. Patient self-reported adherence to medications was assessed by the researcher using a validated and published scale. Treatment related problems (TRPs) were evaluated for each patient by competent clinical pharmacists. Associations between patient characteristics/health beliefs with adherence were explored. Results: About half of the patients (46.1%) were non-adherent. A significant association was found between lower adherence and higher number of disease states (p<0.001), higher number of medications (p=0.001), and higher number of identified TRPs (p = 0.003). Patient adherence was positively affected by older age, higher educational level, and higher number of physician visits per month, while it was negatively affected by reporting difficulties with getting prescription refills on time. Conclusion: This study identified different factors that may negatively affect adherence, including higher number of medications and disease states, higher number of identified TRPs and inability to getting prescription refills on time. Hence, more care needs to be provided to patients with complex therapeutic regimens in order to enhance adherence.

The case for evidence-based pharmaceutical care

Pharmaceutical care was defined by Hepler and Strand in the early 1990s as the responsible provision of drug-related care for the purpose of achieving definite outcomes that improve patients’ quality of life. Since that time, pharmaceutical care has evolved and is currently being applied in many countries around the world. Medication therapy management represents some addition to the paradigm but is based mainly on the concept and principles of pharmaceutical care. Evidence-based medicine was introduced at approximately the same time as pharmaceutical care. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidencebased medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Both concepts are currently well defined and implemented in many practice settings around the world. Any one who is expert in the field of clinical pharmacy and pharmaceutical care will find an important connection between the two concepts. In pharmaceutical care, as well as in medication therapy management, our major functions as practitioners are to identify, resolve, and prevent drug-related problems and to improve patients’ health-related quality of life. Traditionally, in pharmaceutical care, we identify drug-related problems by analyzing patient data and comparing patient treatment and doses with what we know from peer-reviewed literature and disease management guidelines.Wemay also use drug information resources, drug interactions software, and any other relevant resources. At the University of