Yazed Sulaiman Al-Ruthia

Shortage of psychotropic medications in community pharmacies in Saudi Arabia: Causes and solutions

Background: Patients with mental disorders, such as depression and anxiety, who seek medical care in private psychiatric clinics in Riyadh, Saudi Arabia, have recently expressed concerns to doctors about difficulty in filling psychotropic medications, such as Amitriptyline and Aripiprazole, at retail community pharmacies. Objectives: The aim of this study was to investigate whether there is a shortage of some commonly prescribed psychotropic medications in retail community pharmacies in Saudi Arabia, and if so, to explore the possible reasons behind the shortage of these medications. Methods: The availability of 28 commonly prescribed psychotropic medications was checked in multiple retail community pharmacies in 4 different regions of Saudi Arabia. Further, potential reasons behind the shortage of some psychotropic medications in retail community pharmacies were also explored. Results: Amitriptyline, Amoxapine, Aripiprazole, Bupropion, Buspirone, Duloxetine, Haloperidol, Hydroxyzine, Lithium, Prochlorperazine, Procyclidine, Promethazine, Thioridazine, Trazodone, and Trifluoperazine were unavailable in over half of the 248 community pharmacies surveyed. Four possible reasons behind the shortage of these medications were reported by 31 pharmacists working in different retail community pharmacies’ purchasing departments, with a majority (58.06%) reporting the primary reason for a shortage of these medications that they are slow-moving items with low profit margins. Conclusions: The findings of this study should expedite the reform process in both the Ministry of Health and the Saudi Food and Drug Authority (SFDA) to publish and enforce an essential list of medications for retail community pharmacies, which should include the most commonly prescribed psychotropic medications.

Relationship between health literacy and body mass index among Arab women with polycystic ovary syndrome

Background Polycystic ovary syndrome (PCOS) puts patients at higher risk for obesity and diabetes. Poor health literacy is also associated with these conditions. Notably, weight loss is associated with improved ovulation and pregnancy rates for women with PCOS. In this study the association between health literacy and body mass index (BMI) among women with PCOS was examined. Methods The health literacy of women with PCOS was measured using the Arabic version of the single item literacy screener (SILS) at a university medical center. Sociodemographic and medical information was collected by interviewing the participants and reviewing their medical records, respectively. The relationship between health literacy and BMI was assessed by multiple logistic regression analysis. Results Health literacy was assessed in 127 women with PCOS from September 2015 to February 2016. Only 16.54% of participants had limited health literacy. The mean BMI for all participants was 30.57 (kg/m2), and the mean age was 27.40 years. Further, most of the participants (74%) had a high school diploma or a higher degree. Almost 56% of the participants were taking metformin, and 11.81% had hypothyroidism. After controlling for age, education, hypothyroidism diagnosis, and the use of metformin, participants with high BMI were 10% less likely to have a good health literacy level (OR = 0.904; 95% CI = 0.829–0.987; P = 0.0238). Conclusion Improving the health literacy of patients with PCOS may have a positive impact on their BMI and eventually lead to favorable health outcomes.

Ovulation induction by metformin among obese versus non-obese women with polycystic ovary syndrome

Objectives There is some evidence that the efficacy of metformin as an ovulation stimulation agent depends on the body mass index (BMI) of the treated anovulatory women with polycystic ovary syndrome (PCOS). The aim of this study was to examine the likelihood of successful ovulation among obese (BMI ⩾30 kg/m2) versus non-obese (BMI <30 kg/m2) women with PCOS. Methods A total of 243 medical charts of women with PCOS who visited King Khaled University Hospital (KKUH) in Riyadh, Saudi Arabia, between 2006 and 2012 were reviewed. Patients’ sociodemographic, laboratory, and medical data were collected. Descriptive statistics and multiple logistic regression analyses were performed to compare the patients’ baseline data and successful ovulation among the obese and non-obese anovulatory women with PCOS, respectively. Results One hundred and nine women with PCOS who were prescribed metformin for ⩾3 months were included in the study. Almost 60% of the women who were included in the study were obese. The likelihood of ovulation among obese women with PCOS was 77.9% (odds ratio = 0.221, 95% CI 0.052–0.947, P = 0.042) less than that in their non-obese counterparts. Conclusion The findings of this study suggest that metformin is more effective as an ovulation stimulation agent when administered to non-obese women with PCOS. Lifestyle modifications such as diet and exercise should be emphasized upon as an integral part of any treatment plan for PCOS.

Advancing pharmaceuticals and patient safety in Saudi Arabia: A 2030 vision initiative

Low-quality medicines deliver sub-optimal clinical outcomes and waste precious health resources. It is important to ensure that public funds are spent on healthcare technologies that meet national regulatory bodies such as the Saudi Food and Drug Authority (SFDA), quality standards for safety, efficacy, and quality. Medicines quality is a complicated combination of pre-market regulatory specifications, appropriate sourcing of ingredients (active pharmaceutical ingredient (API), excipients, etc.), manufacturing processes, healthcare ecosystem communications, and regular and robust pharmacovigilance practices. A recent conference in Riyadh, sponsored by King Saud University, sought to discuss these issues and develop specific policy recommendations for the Saudi 2030 Vision plan. This and other efforts will require more and more creative educational programs for physicians, pharmacists, hospitals, and patients, and, most importantly evolving regulations on quality standards and oversight by Saudi health authorities.

Drug shortages in large hospitals in Riyadh: a cross-sectional study

BACKGROUND Drug shortages are a serious and complex issue in any healthcare system. We conducted this study because the prevalence of drug shortages in Saudi Arabia is largely unknown, while there have been reports of shortages. OBJECTIVE To explore the prevalence and characteristics of drug shortages as well as identify strategies to minimize their impact on patient care and safety in large hospitals. DESIGN Questionnaire-based cross-sectional study. SETTING Pharmacy departments in secondary and tertiary care hospitals in the city of Riyadh. SUBJECTS AND METHODS Pharmacists in ten hospitals, categorized as Ministry of Health [MOH], MOH-affiliated medical cities, and non-MOH, were recruited using convenience sampling. The European Association of Hospital Pharmacists drug shortage questionnaire was administered to survey pharmacists about drug shortages in their hospitals. MAIN OUTCOME MEASURES Percentages of drug class shortages, characteristics, and strategies to minimize impact on patient care and safety across each hospital sector. RESULTS Of 200 pharmacists invited to participate, 120 pharmacists completed the questionnaire (60% response rate). Twenty-four percent were from MOH hospitals, 32% from MOH-affiliated medical cities, and 44% from non-MOH hospitals. A significantly higher percentage of pharmacists from MOH-affiliated medical cities (42.11%) reported encountering drug shortages on a daily basis compared to 13.79% and 15.09% of participants from MOH-hospitals and non-MOH hospitals, respectively (P=.001). The top three drug classes that ≥ 25% of participants reported having shortages of were cardiovascular, antineoplastic, and endocrine drugs. The two most common strategies that were reported to minimize the impact of drug shortages on patient care by more than 70% of participants were informing prescribers and recommending alternative drugs, and alerting hospital staff about the presence of drug shortages using new communication tools. CONCLUSIONS The relatively high reported rates of drug shortages in some hospitals should encourage health policymakers to address this serious public health problem. LIMITATIONS The generazibility of the study’s findings were limited by the small sample size, convenience sampling technique, self-reported data, and the fact that only pharmacists were invited to participate.

Use of dietary and performance-enhancing supplements among male fitness center members in Riyadh: A cross-sectional study

This study aimed to explore the health beliefs and patterns of dietary supplement usage among fitness center members. This cross-sectional study was conducted in four large indoor fitness centers in Riyadh, Saudi Arabia. This study involved male fitness center members aged ≥18 years with no speech or hearing disabilities. In-person interviews were conducted with fitness center members who agreed to participate using a newly developed questionnaire. Information on participants’ sociodemographics (e.g., age and education), smoking status, health status, exercise frequency, average time spent exercising, different supplements used, used supplements sources, and health beliefs regarding dietary supplements were obtained. A total of 445 fitness center members agreed to participate, and 198 of them reported taking dietary supplements. Most participants were between the age of 18 and 25 years (66%), had a college degree (74%), non-smokers (77%), healthy (84%), and perform exercise at least thrice weekly (52%) for at least 1 hour (63%). The percentage of participants who had favorable health views on dietary supplements was significantly higher among the supplement users than among the non-users (P<0.0001). Proteins, multivitamins, amino acids, and omega 3 fatty acids were the most commonly reported supplements used. Almost 30% of the supplement users reported buying them overseas, 28% online, 25% from a pharmacy or supplement store, 19% from a medical clinic, and 17% from peddlers. Public health campaigns are needed to educate the public on the potential harmful effects of supplements if purchased from an unofficial seller or taken without seeking medical advice before using them.

Translation and cultural adaptation of Glasgow Antipsychotic Side-effects Scale (GASS) in Arabic

Background In view of a constant increase in the number of patients treated with antipsychotic medications, the problem of nonadherence to the prescribed treatment becomes particularly relevant. Since one of the major contributors to the nonadherence is the presence of side effects of the drugs being used, the availability of tools for assessment of adverse reactions is of great importance. Objective The objective of the present work was to develop an Arabic language version of the Glasgow Antipsychotic Side-effect Scale (GASS). Methods After confirming the accuracy of translation, the questionnaire was given to 100 patients in two psychiatric centers in Saudi Arabia. Results The Cronbach’s alpha (0.793) indicated a good reliability of the survey. The mean GASS score was 19.09, indicating absent or mild side effects of antipsychotics, but 46% of patients experienced moderate, and 25% experienced severe side effects. An analysis of the correlation between patients’ characteristics and side effects revealed the presence of a positive relationship between the side effects and health literacy. Conclusions It is expected that the Arabic-GASS will benefit Arabic-speaking psychiatric patients by helping them to express their concerns about side effects of antipsychotics. The collected results also document the importance of patients’ health literacy in achieving high-quality healthcare.

Drug Shortages in Saudi Arabia: Root Causes and Recommendations

Drug shortages are a multifaceted problem that has been recurring in Saudi Arabia over the past decade with its significant negative impact on patient care. However, there is a dearth of evidence about possible domestic reasons, if any, behind this recurring problem. Recently, the Pharmacy Education Unit at King Saud University College of Pharmacy has called for a meeting with multiple stakeholders from academia, pharmaceutical care, pharmaceutical industry, purchasing and planning, and regulatory bodies to unveil the root domestic causes of the drug shortages in the Kingdom. Four major topics were used to guide the discussion in this meeting, including: current situation of drug shortages in Saudi Arabia, major factors contributing to drug shortages, challenges and obstacles to improve drug supply, and stakeholders’ recommendations to manage drug shortages. The meeting was audio-recorded and transcribed into verbatim by five authors. The text was then reviewed and analyzed to identify different themes by the first and third authors. Multiple causes were identified and several recommendations were proposed. The main domestic causes of drug shortages that were explored in this study included poor medication supply chain management, lack of government regulation that mandates early notification of drug shortages, a government procurement policy that does not keep pace with the changes in the pharmaceutical market, low profit margins of some essential drugs, weak and ineffective law-violation penalties against pharmaceutical companies and licensed drug importers and distributors, and overdependence on drug imports. The participants have also proposed multiple recommendations to address drug shortages. Policy makers should consider these factors that contribute to drug shortages in Saudi Arabia as well as the recommendations when designing future initiatives and interventions to prevent drug shortages.

The status of licensed pharmacy workforce in Saudi Arabia: a 2030 economic vision perspective

BackgroundThe economy of Saudi Arabia is currently undergoing a major transformation which will have an impact on employment in the pharmacy sector. However, quantitative data characterizing the pharmacy workforce in the Kingdom are currently not available. Therefore, the aim of this study was to determine the current status of the licensed pharmacy workforce in the pharmacy field in Saudi Arabia.MethodsDescriptive statistics were performed on data from the Saudi Commission for Health Specialties (SCFHS) as of March 2017.ResultsThe labor market for pharmacists in Saudi Arabia is dominated by expatriates. Saudi nationals constitute less than 20% of the pharmacists employed in the Kingdom. The underemployment of Saudis is most evident in the largest sectors of the pharmacy field, namely, private health care establishments, community pharmacies, and pharmaceutical companies.ConclusionThere is an unmet need to train Saudi citizens as pharmacists and retain them in the workforce. Addressing this issue should become an important objective in Saudi Arabia’s Vision for 2030.

The impact of old versus new antiepileptic drugs on costs and patient reported outcomes among older adults

&NA; The aim of this prospective questionnaire‐based cross‐sectional study was to examine whether the new generation of Antiepileptic drugs (AEDs) with higher acquisition cost generate lower adverse effects than the old AEDs among a sample of 102 Arabic‐speaking older adults (60 years of age or older) with seizure disorders. The mean scores of the Arabic version of the Liverpool Adverse Events Profile (LAEP), which assessed the adverse effects of the AEDs, did not differ between patients taking the old and new generations of AEDs. Despite their 4‐fold higher cost, the new generation of AEDs were not characterized by lower LAEP scores of adverse effects. However, higher LAEP scores were associated with better health literacy. In conclusion, the use of new AEDs was not associated with lower self‐reported adverse effects scores among Arabic‐speaking older adults with seizure disorders despite their higher acquisition costs.