International Journal of Hospital Pharmacy

  • Healthcare professionals’ awareness towards drug-drug interaction in Ayder comprehensive specialized hospital Mekelle, Ethiopia

    Background: Healthcare professionals are the most responsible body to identify potential interaction of drugs that are prescribed as well as those that the patient may be self-administering. However, awareness of healthcare professionals towards drug-drug interaction is poor. So to improve patient medication safety, it is important to assess healthcare professionals’ knowledge pertaining to drug-drug interactions and common drug-drug interactions information sources. Method: Cross-sectional study design was employed. Self-administered questionnaire was prepared to assess healthcare professionals’ knowledge of drug-drug interactions and usual sources of drug-drug interaction information. Participants were asked to classify 10 drug pairs as ‘contraindicated’, ‘can be used with monitoring’, ‘no interaction’ and ‘not sure’. Study was conducted from November 2017 to June 2018. Participants were selected using simple random sampling method. Data were analyzed using statistical software, SPSS for windows version 20. The relationship between knowledge and independent variables (age, sex, profession, work experience, training, familiarity with standard treatment guideline perception and source of information) was assessed using binary logistic regression analysis (Crude and adjusted Odds ratio, 95% confidence interval). Result: The study was done by enrolling 293 healthcare professionals among whom 46 were Physician, 31 Pharmacist, and 216 Nurses. Over all, healthcare professionals in Ayder Comprehensive Specialized Hospital had low score (24.29%) knowledge of drug-drug interactions. However, among the healthcare professionals pharmacists had good drug-drug interactions knowledge than physicians and nurses with an average score of 32.87%, 21.06% and 18.96% respectively. Drug reference books were the most cited drug-drug interaction information source used by 97 (33.10%) participants. Familiarity to the standard treatment guideline, profession and drug-drug interaction information sources were found to be associated with healthcare professionals’ knowledge of drug-drug interactions (p value

  • An observation cross sectional study to assess the prevalence of micro vascular complications in diabetes

    Diabetes mellitus is the commonest metabolic disorder and has a high prevalence in India. The prognosis of the diabetic patients largely depends on the complications seen in the natural course of illness. It was decided to undertake observational study to record various complications and the influence of various risk factors.(1) Diabetes mellitus is a long term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.(2) Diabetes is a syndrome characterised by chronic hyperglycemia and disturbance of carbohydrate, fat and protein metabolism associated with absolute or relative deficiencies in insulin secretion and/or insulin action(3). Complications of diabetes The longer duration of diabetes the less controlled of blood sugar levels leads to development of diabetic complications which are divided into microvascular ( damage to small blood vessel) and macrovascular (damage to large blood veseels). • Micro vascular complications: These are Long term complications that affect retina, kidney and nervous system(3). Permanent disability is a common outcome of diabetes, with late complications of diabetes being major determinants for disability. Diabetic eye disease particularly retinopathy, has become a major cause of blindness throughout the world. • Macro vascular complications: Type 2 diabetes can also affect the large blood vessels, causing plaque to eventually build up and potentially leading to a heart attack, stroke or vessel blockage in the legs (peripheral vascular disease) Diabetic foot also occur with higher frequency in diabetes(4,5).

  • Case Study of Gabapentin Induced Exfoliate Dermatitis

    OBJECTIVE : To report a case of possible Gabapentin-induced Exfoliate Dermatitis CASE SUMMARY : A 62 old male patient with the chief complaints of rash since 10 days . He was on treatment with Gabapentin and Pregabalin for paraesthesias by neurosurgeon from last month. Developed rash all over the body since 10 days. Past history includes similar rashes due to Diclofenac. No history of Psoriasis/eczema/no history of weight loss/cough/blood in stools. On examination patient has generalised scaling over background of erythema all over the body, exfoliation with rise of temperature. This presentation is consistent with the features of Exfoliative Dermatitis. Resolution of the clinical manifestations was observed after discontinuation of the drug; all other drugs, infections, or immunologic disorders that could have caused this syndrome were carefully excluded. An objective causality assessment revealed that exfoliative dermatitis was possibly associated with the use of Gabapentin. CONCLUSIONS: Although Gabapentin administration seems to be the underlying cause of the Exfoliative Dermatitis observed in our patient, establishment of a definite causal relationship requires additional cases and supportive data.

  • Pharmacist-Patient Relationship: Commitment to Care

    Pharmacy practice has changed substantially in recent years. The professionals have the opportunity to contribute directly to patient care in order to reduce morbimortality related to medication use, promoting health and preventing diseases. Healthcare organizations worldwide are under substantial pressure from increasing patient demand. Unfortunately, a cure is not always possible particularly in this era of chronic diseases, and the role of physicians has become limited to controlling and palliating symptoms. The increasing population of patients with long-term conditions are associated with high levels of morbidity, healthcare costs and GP workloads. This has raised questions about the role of many community pharmacists who traditionally have not had access to important data needed for the first step of the patient care process that defines a valid patient-practitioner relationship. However, community pharmacies are accessible and convenient primary care venues with long opening hours and non-appointment-based services. Community pharmacists are increasingly clinically trained healthcare professionals whose skills and knowledge could be further utilized. Medical professionals have traditionally abided by a set of ethical tenets including autonomy, justice, beneficence and non-maleficence. Much emphasis is often placed in medicine on non-maleficence, or “do no harm,” but the other ethical tenets deserve further consideration when discussing the right-to-refuse legislation. Pharmacists have an obligation to do what is in the best interest of their patients (beneficence), to treat patients justly or fairly (justice), and to respect a patient’s decision to know and do what is best for them (autonomy). To put a pharmacist’s autonomy above the ethical commitments owed to the patient is fraught with challenges, regardless of legal protections for pharmacists provided through legislation such as the conscience clauses. To transition to patient-centered care, pharmacy services should organize around the understanding of patients’ needs, preferences, and expectations for the clinical judgment and decision-making processes. This is…

  • Prevalence of Plasmodium Falciparum Malaria and the Antenatal Health Care Utilization for Prevention Among Pregnant Women in a Secondary Health Facility in Enugu State, Nigeria

    Pregnant women in endemic areas are highly susceptible to malaria, and both the frequency and severity of the disease are higher in pregnant women than non- pregnant women.[1] In pregnancy, there is a transient depression of cell mediated immunity that allows foetal allograft retention but also interferes with resistance to various infectious diseases. Malaria infection during pregnancy is a major public health problem in the tropics and subtropics. It affects approximately 24 million pregnant women.[2] In the area of Africa with stable malaria transmission, plasmodium falciparum infection during pregnancy is estimated to cause as many as 10,000 maternal death each year, 8-14% of all low birth weight babies and 75,000-200,000 of all infant death.[3] In Nigeria, there is an estimated 25-30% of mortality in children under the age of five and 300,000 death each year due to malaria.[3] Studies have shown that 40% of pregnant African women start attending antenatal clinics in the first and second trimester of their pregnancy. [3] In addition, pregnant women are at immense risk of malaria due to natural immune depression in pregnancy. [4] The symptoms and complications of malaria during pregnancy differ with the intensity of malaria transmission and thus with the level of immunity the pregnant woman acquired. [5] Malaria cases and death have been increasing in the country mainly due to injudicious use of anti-malaria drugs, delayed health seeking and reliance on clinical judgment without laboratory confirmation in most of the peripheral health facilities. [6] There have been considerable numbers of reports about knowledge, attitude and practices relating to malaria and its control from different parts of Africa. Misconceptions concerning malaria still exist and the practices for the control of malaria have been unsatisfactory. [7] The promising news is that during the past decade, potentially more effective strategies for control of malaria…

  • The New Era of Pharmacists in Ambulatory Patient Care

    Pharmacy is evolving from a product-oriented to a patient-oriented profession. This role modification is extremely healthy for the patient, the pharmacist, and other members of the health-care team. However, the evolution will present pharmacists with a number of new challenges. Now, more than in the past, pharmacists must make the acquisition of contemporary practice knowledge and skills a high priority, to render the level of service embodied in the concept of pharmaceutical care. Pharmacy educators’ organizations and regulatory bodies must all work together to support pharmacists as they assume expanded health-care roles. Pharmacy and the health-care industry must work to ensure that the pharmacist is compensated justly for all services. But before this can happen it will be necessary for pharmacy to demonstrate value-added to the cost of the prescription. Marketing of the purpose of pharmacy in the health-care morass and of the services provided by the pharmacist is needed to generate an appropriate perceived value among purchasers and users of health-care services. Pharmacists should view themselves as dispensers of therapy and drug effect interpretations as well as of drugs themselves. Service components of pharmacy should be identified clearly to third party payers and be visible to consumers, so that they know what is available at what cost and how it may be accessed. In the future, pharmacy services must be evaluated on patient outcome (i.e., pharmaceutical care) rather than the number of prescriptions dispensed, and pharmacy must evolve toward interpretation and patient consultation, related to the use of medication technologies.

  • Assessment of Drug Prescribing in Jordan Using World Health Organization Indicators

    Background: Irrational drug use is a major public health problem worldwide. Patterns of prescribing of pharmaceuticals by physicians in Jordan have been scarcely studied. Objectives: To assess the drug prescribing patterns using World Health Organization Drug Use Indicators at 7 primary health care centers in Amman, the capital of Jordan. Methods: We prospectively evaluated 1055 prescriptions over a period of 2 months from May/2017 to July/2017, using the WHO prescribing indicators recommended protocol. Core prescribing indicators assessed in this study included the average number of drugs per prescription, the percentage of drugs prescribed by generic name, the percentage of prescriptions containing injections, the percentage of prescriptions containing antibiotics, and the percentage of drugs from the essential drugs list. Results: Our results showed that the average number of drugs per prescription was 3.0, the percentage of drugs written by generic name was 50.3%, the percentage of drugs written from essential drug list was 97.6%, and the percentages of prescriptions that contain injections and antibiotics were 7.1%, 61.0%, respectively. Conclusion: Three of the 5 indicators, namely, the average number of drugs per prescription, the percentage of drugs written by generic name, and the percentage of prescriptions that contain antibiotics, fell short of WHO optimal values indicating that there is a room for improvement in prescribing.

  • Pharmacovigilance and Managing ADRS in Bangladesh: Eccentric or Non-existent?

    Bangladesh became the 120th member of the WHO’s International Drug Monitoring Center (WHO-UMC). Through this membership, Bangladesh has gained international recognition and access to early worldwide information about potential safety risks. It was introduced in Bangladesh in 1999. However, due to a shortage of manpower and a lack of financial support, the program became dormant. It was revived in 2013 when the DGDA established the ADR Monitoring cell. Major advancements of the discipline of pharmacovigilance have taken place in the West, still, not much has been achieved in Bangladesh. The article highlights the various serious incidences ADRs, present health situation and broader scope of pharmacovigilance in Bangladesh.

  • Patient-Provider Relationship: Compliance with Care

    The Provider-Patient Relationship (PPR) is a novel concept of medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tend to abide with the doctor’s guidance. It has been proposed that an ideal PPR has six components, namely voluntary choice, practitioner’s competence, good communication, empathy by the doctors, continuity, and no conflict of interest. In fact, a poor PPR has been proved to be a major obstacle for both doctors and patients, and has eventually affected the quality of healthcare and ability of the patients to cope with their illness. Owing to poor PPR, patients does not show compliance with doctor advice completely; opt for practitioner -shopping by changing their practitioner repeatedly; remain anxious; may choose quacks or other non-scientific forms of treatment; significant increase in direct and indirect medical expenses. Because of recurrent change in line of treatment as per the advice of different practitioner and non-completion of the entire course of drugs, there is a definite scope for the emergence of antimicrobial resistance, which further compounds the medical cost and anxiety, and finally may develop serious forms of disease or complications. From the practitioners’ perspective, they may ask for unnecessary investigations or may give over-prescriptions, just to be safe. There is also observed a remarkable decline in human touch or empathy; and a significant rise in unhealthy competition among doctors.

  • Pharmacovigilance: Present Scenario and Future Goals

    Melon Pharmacovigilance is the science and activity relating to the collection, detection, assessment, monitoring, and prevention of adverse effects with pharmaceutical products. Pharmacovigilance basically targets safety of medicine. Pharmacists have crucial role in health systems to maintain the rational and safe use of medicine for they are drug experts who are specifically trained in this field. The perspective of pharmacy students on pharmacovigilance and ADR reporting has also been discussed with an aim to highlight the need to improve content related to ADR reporting and pharmacovigilance in undergraduate pharmacy curriculum. Globally, although the role of pharmacists within national pharmacovigilance systems varies, it is very well recognized. Incorporation of ADR reporting concepts in education curriculum, training of pharmacists and voluntary participation of pharmacists in ADR reporting is very crucial in achieving the safety goals and safeguarding public health. Also, these knowledge gaps can be fulfilled through continuous professional development programs and reinforcing theoretical and practical knowledge in undergraduate pharmacy curriculums. Without adequately identifying and fulfilling training needs of pharmacists and other health care professionals, the efficiency of national pharmacovigilance systems is unlikely to improve which may compromise patient’s safety.