Willingness to Pay for Clinical Pharmacy Services Among People With Diabetes in Nigerian Community Pharmacies.

OBJECTIVES: This study aimed to assess willingness to pay (WTP) for clinical pharmacy services among people with diabetes and to determine the factors affecting WTP for these services. METHODS: This was a cross-sectional exit survey of 450 people with diabetes visiting 15 community pharmacies in Uyo metropolis, Akwa Ibom State, Nigeria, between August and September 2021. Self-reported questionnaires were administered to eligible patients just before leaving the community pharmacy. Data were analyzed using SPSS (version 25.0). Statistical significance was set at P < .05. RESULTS: Response rate was 87.3%. Two hundred respondents (50.9%) were willing to pay an average amount of US$2.83 (minimum-maximum, US$0.12-US$24.27) for clinical pharmacy services. The two most often cited reasons for those who were unwilling to pay were their inability to pay and their opposition to paying for any healthcare services. Employment status (P < .001), personal monthly income (P < .001), satisfaction with income (P < .001), household monthly income (P < .001), health insurance coverage (P < .001), insulin use (P < .001), perception of the pharmacist's relevance in healthcare (P = .013) and in diabetes care (P < .001), and satisfaction with the pharmacist's services (P < .001) significantly affected WTP choices. None of the patient characteristics predicted the maximum amounts patients were willing to pay. CONCLUSIONS: Many of the people with diabetes assessed were willing to pay for clinical services at a reasonable price. Although most patient variables affected their WTP choices, none of the variables predicted the maximum amount they were willing to pay. For possible remuneration for clinical services, community pharmacists should continue to grow their practices and stay current with patient care.

Health-Related Quality of Life of HIV Positive Patients with Hypertension: Is There an Association with Blood Pressure Control?

INTRODUCTION: The presence of comorbidities could affect the health-related quality of life (HRQoL) of people living with HIV (PLHIV). AIM: To assess the HRQoL of PLHIV and Hypertension, as well as its association with blood pressure (BP) control. METHODS: This cross-sectional study was conducted in the HIV clinic of the University of Uyo Teaching Hospial in Akwa Ibom State, Nigeria, between August and October 2018. The EQ-5D-5L was administered to 201 eligible outpatients in the waiting area of the clinic before consulting the physician. Patients' socio-demographic and clinical data were obtained from the medical records. Blood pressure was measured using an automatic BP monitor. Data were analyzed with SPSS version 20.0. RESULTS: Majority (58.6%) of the respondents were females; mean age was 49.59 ± 8.97 years; mean systolic and diastolic BP were 152.77 ± 19.38 mmHg and 90.28 ± 11.33 mmHg, respectively. EQ-VAS and EQ-5D index scores were 80.99 ± 15.97 and 0.86 ± 0.05, respectively. There were no significant differences in EQ-VAS score (z = - 0.113,  p = 0.910) or EQ-5D utility (z = - 0.523, p = 0.601) between participants with controlled and uncontrolled BP. Duration on antihypertensive drugs was associated with EQ-VAS score (χ2(2) = 6.558, p = 0.038), while employment status was associated with EQ-5D utility (z = - 2.661,  p = 0.008). CONCLUSIONS: PLHIV and hypertension accessing care at a Nigerian hospital reported a high HRQoL, irrespective of BP control status. Nevertheless, there is a need to provide psychological support and employment for this population to maximise their HRQoL.

Effects of pharmaceutical care interventions on humanistic outcomes in hypertensive people living with HIV: results of a randomized controlled trial.

OBJECTIVES: To evaluate the effects of pharmaceutical care (PC) interventions on humanistic outcomes in HIV-positive patients with hypertension. METHODS: This prospective, open-label, parallel randomized controlled trial was conducted in the HIV clinic of the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria, from August 2018 to October 2019. Eligible patients were randomized sequentially and equally into two study arms: the control arm (CA), where participants received the traditional care and the intervention arm (IA), where participants received PC by the research pharmacist. The patient's HIV knowledge questionnaire, the Hypertension Knowledge-Level Scale, the Medical Outcome Study-HIV Health Survey and the Patient Satisfaction with Pharmaceutical Service questionnaire were used to assess participants' HIV-related knowledge, hypertension-related knowledge, health-related quality of life (HRQoL) and satisfaction with PC, respectively. These were self-completed at baseline, 6 months and 12 months. Data were analysed using SPSS (IBM version 25.0). KEY FINDINGS: Out of the 206 participants randomized, 182 completed the 12-month follow-up. After 12 months, there was a significant improvement in HIV-related knowledge (∆ = 11.28%, t(180) = 4.41, P < 0.001) and hypertension-related knowledge (∆ = 5.94%, t(180) = 3.25, P = 0.001) in the IA over and above those observed in the CA. Similarly, PC interventions led to significant improvements in HRQoL (∆ = 6.5%, t(180) = 5.50, P < 0.001) and satisfaction with PC in the IA (∆ = 18.12%, t(180) = 11.85, P < 0.001) at the end of the study. CONCLUSIONS: PC significantly improved humanistic outcomes in HIV-positive patients with hypertension after a 12-month intervention.

Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study.

WHAT IS KNOWN AND OBJECTIVE: Pharmaceutical care (PC) has been shown to improve clinical outcomes in hypertensive patients as well as in people living with HIV (PLWHV). The objective of this study was to evaluate the impact of PC on blood pressure (BP) control, viral load and adherence to medications in hypertensive PLWHV. METHODS: This was a prospective, randomized controlled study conducted in the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. Eligible ambulatory patients were randomized equally to two study arms. The control arm (CA) received the traditional care offered at the HIV clinic; the intervention arm (IA) received the traditional care in addition to PC by the research pharmacist, which included structured education/counselling. BP and self-reported medication adherence were measured at baseline, 6 months and 12 months. Viral load was obtained at baseline and after 12 months. Data were analysed with spss, version 25.0. RESULTS AND DISCUSSION: Of the 206 participants initially randomized, 182 (91 in each study arm) completed the 12-month follow-up. No significant differences existed in both arms concerning socio-demographic/clinical characteristics of participants at baseline (p > 0.05). After 12 months, BP control was significantly higher in the IA (53.4% vs. 25.2%; p < 0.001, adjusted odds ratio, aOR = 3.20 (95% CI 1.59-6.44). Systolic BP reduced by 0.9 mmHg from baseline in the CA (p = 0.668) and by 16.67 mmHg from baseline value in the IA (p < 0.001). Diastolic BP increased by 1.9 mmHg in the CA (p = 0.444), but reduced by 7.0 mmHg in the IA (p < 0.001). No significant differences were observed in the change from baseline in the proportion with undetectable plasma viral load (UPVL) in both groups (p > 0.05). PC led to an increase in mean adherence to antiretroviral drugs (Δ = 0.55; p = 0.015), and an increase in mean adherence to antihypertensive drugs (Δ = 2.32; p < 0.001) in the IA. WHAT IS NEW AND CONCLUSION: To our knowledge, this is the first prospective randomized controlled study evaluating the impacts of PC on clinical outcomes in hypertensive PLWHV with a 12-month follow-up. Our results show that PC significantly improved BP control and adherence to antiretroviral and antihypertensive medications, but had no significant effect on viral load in HIV positive patients with hypertension. Providers of care for PLWHV should leverage the established HIV treatment successes for promoting adherence to treatment for common comorbidities like hypertension in PLWHV in order to improve clinical outcomes.

Self-care activities, glycaemic control and health-related quality of life of patients with type 2 diabetes in a tertiary hospital in Nigeria.

BACKGROUND AND AIMS: Diabetes is one of the global health emergencies of the 21st century. This study sought to assess self-care behaviours, glycaemic control and health-related quality of life (HRQoL) of type 2 diabetes patients at a Nigerian hospital, determine factors associated with HRQoL, and assess the inter-relationship among these outcomes. METHODS: The Summary of Diabetes Self-Care Activities (SDSCA) measure was used to assess self-care behaviours; HRQoL was assessed with the Appraisal of Diabetes Scale (ADS) and SF-12v2 Health Survey. Glycaemic control was assessed with fasting blood sugar (FBS). The questionnaires were distributed to 250 eligible patients attending Endocrinology clinic at the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria. RESULTS: Mean scores (±SD) of self-care behaviours were 4.0 ± 1.3, 3.9 ± 1.0, 2.4 ± 1.2, 1.0 ± 1.1, and 2.5 ± 2.1 for general diet, specific diet, exercise, blood glucose monitoring, and foot care respectively. Mean FBS was 7.1 ± 2.1 mmol/L. Mean ADS score was 18.1 ± 4.2. The physical and mental component summary scores were 47.84 ± 8.21 and 45.66 ± 8.74 respectively. HRQoL was significantly associated with patient socio-demographic (except gender) and clinical variables (p < 0.05). Self-care activities, FBS and HRQoL were significantly inter-correlated (rs -0.31 to 0.68; p < 0.01, p < 0.001). CONCLUSIONS: Patients were more adherent to diet recommendations than to other aspects of self-care. Though most patients had adequate glucose control, the presence of diabetes had a negative impact on the mental component of health. HRQoL was affected by most of the patient-related variables. Interventions to improve adherence to self-care are recommended to achieve good glycaemic control and improve HRQoL.

Development and psychometric evaluation of the patient's HIV knowledge questionnaire (PHKQ).

Background Valid and reliable instruments for measuring knowledge about human immuno-deficiency virus (HIV) among people living with the virus are necessary to identify knowledge gaps and evaluate effectiveness or outcomes of education programmes. However such instruments are scarce, particularly in developing countries. Objective This study aimed to develop and validate a self-administered instrument for measuring HIV-related knowledge among people living with HIV in Nigeria. Setting This study was conducted in the HIV/AIDS clinic of the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria. Methods The Patient's HIV Knowledge Questionnaire (PHKQ) items, designed with response choices of 'yes', 'no' and 'don't know', were developed based on relevant literature and similar published studies. Face and content validity were established. Evidence of construct validity was established by factor analysis and group differences. Factor analysis was done using principal components and varimax rotation with Kaiser Normalization. Estimates of reliability were evaluated using internal consistency approach (with Cronbach's alpha coefficient) as well as the test-retest method for estimating the stability of the PHKQ scores over time (with Pearson's r). Main outcome measure Validity/reliability of the Patient's HIV Knowledge Questionnaire. Result Response rate in this study was 95.0%. Item analysis of the 20-item instrument resulted in the deletion of 5 items; thus the final instrument consists of 15 items. Cronbach's alpha coefficient for the scale was 0.77, while test-retest reliability was 0.80 (p < 0.001). Factor analysis resulted in 3 components-Transmission and Misconceptions, Causes and Treatment Outcomes, and Diet and Immunity-with Cronbach's alpha of 0.70, 0.56 and 0.46 respectively. The Patient's HIV Knowledge Questionnaire differentiated between newly diagnosed (≤ 1 year) individuals and those with at least 10 years since HIV diagnosis, and also between those with only primary education and those who had had up to tertiary education (p < 0.001). Conclusion The Patient's HIV Knowledge Questionnaire appears to be a valid and reliable tool for assessing HIV-related knowledge among people living with HIV in Nigeria. Further studies are needed to explore the instrument's responsiveness to change, and to evaluate its psychometrics in different settings.

Medication adherence in type 2 diabetes patients in Nigeria.

BACKGROUND: Medication adherence is a major universal factor influencing patient health outcomes, particularly in chronic diseases such as diabetes. Poor adherence to antidiabetes medication can cause therapeutic failure, leading to manifestation of diabetes-related complications, such as retinopathy, neuropathy, nephropathy, etc., reduced quality of life, and increased healthcare costs. To forestall these, likely predictors of medication nonadherence should be assessed and addressed appropriately. The purpose of this work was therefore to assess medication adherence among type 2 diabetes patients and to identify patient characteristics and probable factors associated with nonadherence. SUBJECTS AND METHODS: A descriptive, cross-sectional research design was used. The study was conducted on 360 ambulatory type 2 diabetes patients attending an endocrinology clinic between June 2012 and February 2013. The eight-item Modified Morisky Adherence Scale was used to assess medication adherence; sociodemographic information and respondents' opinion on the possible barrier(s) to medication adherence were also obtained. Data were analyzed using SPSS version 14.0 software (SPSS, Inc., Chicago, IL). RESULTS: Of the 303 patients included in the final analysis, 19.8% of respondents were judged to be highly adherent. Medium and low adherers were 30.0% and 50.2%, respectively. The median adherence score was 5.75 (interquartile range, 4.5-7.0). Adherence to medication correlated with low literacy level (P=0.008), forgetfulness (P=0.009), high cost of medication (P=0.014), limited access to care (P=0.001), complexity of regimen (P=0.001), poor patient-provider communication (P=0.000), lack of trust in the provider (P=0.046), and depression (P=0.031). No statistically significant relationship was found between patients' characteristics and medication adherence. CONCLUSIONS: Medication adherence was generally poor among the cohorts studied.

Knowledge of self-care among type 2 diabetes patients in two states of Nigeria.

OBJECTIVE: To assess the knowledge of self-care practices, as well as factors responsible for such knowledge among type 2 diabetes patients in two states of Nigeria. METHODS: Descriptive, cross sectional survey research design was employed. The study was conducted on type 2 diabetes out-patients attending Endocrinology Clinic at the University of Uyo Teaching Hospital (UUTH) and University of Calabar Teaching Hospital (UCTH) between June 2012 and February 2013. The Diabetes Self-care Knowledge (DSCK-30) was used in evaluating knowledge of self-care practices. Socio-demographic information and respondents' opinion on the possible barrier(s) to knowledge of self-care were also obtained. Data were analysed using Microsoft Excel and SPSS version 14.0. Statistical significance for all analyses was defined as a p value less than 0.05. RESULTS: A total of 303 out of 380 questionnaires distributed were completed and returned (response rate =79.7%). The majority of the study sample (79.5%) had 70% or more overall knowledge level about self-care. Self-care knowledge was associated with level of education (p<0.001), monthly income (p<0.001) and duration of diabetes (p=0.008). Negative attitude to disease condition was the only factor associated with knowledge (chi-square value at one degree of freedom =6.215; p=0.013). CONCLUSION: Diabetes self-care knowledge was generally high among the population studied. Educational status, monthly income, duration of diabetes and negative attitude to disease condition predicted knowledge level.