Prevalence, Associated Risk Factors, and Adverse Cardiovascular Outcomes of Statins Discontinuation: A Systematic Review.

PURPOSE: Statins are widely prescribed for cardiovascular diseases (CVD) prevention; however, a significant proportion of users discontinue the medication for various reasons. This review aimed to determine the prevalence of statin therapy discontinuation, its associated factors, and adverse cardiovascular outcomes within the first year of discontinuation. METHODS: The PubMed, EMBASE, ScienceDirect, SCOPUS, and Google Scholar databases were systematically searched from their inception to December 2022. Manual searches were also conducted on the bibliographies of relevant articles. Studies were included for qualitative data synthesis and assessed for methodological quality. RESULTS: Fifty-two studies, predominantly cohort studies (n = 38), involving 4 277 061 participants were included. The prevalence of statin discontinuation within the first year of statin initiation ranged from 0.8% to 70.5%, which was higher for primary prevention indications. Factors frequently associated with an increased likelihood of statin discontinuation included male sex, nonWhite ethnicity, smoking status, and being uninsured. Conversely, discontinuation was less likely in patients with CVD who received secondary prevention statin therapy and in patients with polypharmacy. Furthermore, age showed diverse and inconsistent relationships with statin discontinuation among various age categories. Five studies that reported the cardiovascular risk of statin discontinuation within the first year of initiation showed significantly increased risk of discontinuation, including all-cause mortality (hazard ratio: 1.36-3.65). CONCLUSION: Our findings indicate a high prevalence of statin discontinuation and an increased likelihood of adverse cardiovascular outcomes within the first year of discontinuation, despite wide variability across published studies. This review highlights the importance of addressing the modifiable risk factors associated with statin discontinuation, such as smoking and lack of insurance coverage.

Examining the perception of undergraduate health professional students of their learning environment, learning experience and professional identity development: a mixed-methods study.

BACKGROUND: The quality of the learning environment significantly impacts student engagement and professional identity formation in health professions education. Despite global recognition of its importance, research on student perceptions of learning environments across different health education programs is scarce. This study aimed to explore how health professional students perceive their learning environment and its influence on their professional identity development. METHODS: An explanatory mixed-methods approach was employed. In the quantitative phase, the Dundee Ready Education Environment Measure [Minimum-Maximum possible scores = 0-200] and Macleod Clark Professional Identity Scale [Minimum-Maximum possible scores = 1-45] were administered to Qatar University-Health students (N = 908), with a minimum required sample size of 271 students. Data were analyzed using SPSS, including descriptive statistics and inferential analysis. In the qualitative phase, seven focus groups (FGs) were conducted online via Microsoft Teams. FGs were guided by a topic guide developed from the quantitative results and the framework proposed by Gruppen et al. (Acad Med 94:969-74, 2019), transcribed verbatim, and thematically analyzed using NVIVO®. RESULTS: The questionnaire response rate was 57.8% (525 responses out of 908), with a usability rate of 74.3% (390 responses out of 525) after excluding students who only completed the demographic section. The study indicated a "more positive than negative" perception of the learning environment (Median [IQR] = 132 [116-174], Minimum-Maximum obtained scores = 43-185), and a "good" perception of their professional identity (Median [IQR] = 24 [22-27], Minimum-Maximum obtained scores = 3-36). Qualitative data confirmed that the learning environment was supportive in developing competence, interpersonal skills, and professional identity, though opinions on emotional support adequacy were mixed. Key attributes of an ideal learning environment included mentorship programs, a reward system, and measures to address fatigue and boredom. CONCLUSIONS: The learning environment at QU-Health was effective in developing competence and interpersonal skills. Students' perceptions of their learning environment positively correlated with their professional identity. Ideal environments should include mentorship programs, a reward system, and strategies to address fatigue and boredom, emphasizing the need for ongoing improvements in learning environments to enhance student satisfaction, professional identity development, and high-quality patient care.

Trends in prescribing and outcomes in obese versus non-obese patients receiving rivaroxaban therapy: an observational study using real-world data.

PURPOSE: To investigate real-world prescribing trends and clinical outcomes based on body mass index (BMI) categorization in patients who received rivaroxaban therapy. METHODS: This was a retrospective cohort study involving all patients who received rivaroxaban therapy across all Hamad Medical Corporation (HMC) hospitals from 2015 to 2020. RESULTS: The number of patients initiated on rivaroxaban therapy significantly increased from 152 (3.3%) in 2015 to 1342 (28.9%) in 2020 (p <0.001). Within BMI categories, a similar increasing trend was observed in underweight, normal, and overweight patients, while from 2018 to 2020, there was a decreasing trend in rivaroxaban prescribing in all obese classes. The prevalence rate of all-cause mortality differed significantly between the BMI groups, with the highest mortality being among morbidly obese patients (BMI ≥ 40 kg/m2) (p< 0.001). On the other hand, no significant differences were found between the BMI groups in terms of bleeding, pulmonary embolism, deep vein thrombosis and stroke incidences. Multivariate logistic regression analyses showed that the likelihood of all-cause mortality was significantly higher in overweight and all categories of obese patients compared to underweight patients: overweight (OR: 5.3, 95% CI: 2.3-11.9, p< 0.001); obese class 1 (OR: 5.4, 95% CI: 2.3 - 12.2, p< 0.001); obese class 2 (OR: 6.5, 95% CI: 2.7 - 15.6, p< 0.001); and obese class 3 (OR: 3.7, 95% CI: 1.6 - 8.7, p = 0.003). CONCLUSIONS: Rivaroxaban prescribing has significantly increased over the years across general population, with a noticeable decline in obese population during the last few years (from 2018 onwards). Furthermore, an appreciable association was evident between all-cause mortality and BMI of these patients.

Predictors of enablers and barriers to community pharmacists' management of minor ailments in a developing setting: A theory-driven assessment.

BACKGROUND: The clinical and financial burdens associated with minor ailments are well documented, but published evidence suggests that minor ailment services led by community pharmacists have a remarkable positive impact, mainly in developed settings. There is a paucity of evidence on community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments. OBJECTIVES: The objective of the study was to identify community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments as well as their significant predictors. METHODS: A Kurt Lewin's theory-driven cross-sectional survey of 305 community pharmacists was conducted in Qatar using a pretested 25-item structured questionnaire developed with an adapted conceptual framework focused on 4 key areas: education, regulation, practice, and research. Bivariate logistic regression was used to identify significant predictors of community pharmacists' self-perceived enablers and barriers. RESULTS: The response rate was 92.5% (282/305). Most of the respondents (68.1%) were males, who were 31-40 years of age (55.3%) and worked for pharmacy chains (77.3%). Community pharmacists identified a higher proportion of enablers (positive force) (82.4%) relative to only 3 barriers (negative force) (17.6%). The barriers identified included insufficient private or semiprivate space for patient counseling, the paucity of invitations to participate in practice-based research, and lack of feedback regarding the results and recommendations of previous research in which they were participants. The significant predictors of self-perceived enablers and barriers were female gender (odds ratio [OR], 2.21; 95% CI, 1.25-3.91; P = 0.007) and age group of ≤40 years (OR, 4.74; 95% CI, 3.50-7.16; P = 0.006). CONCLUSION: Community pharmacists' perceptions of the factors that enhance their effective management of minor ailments were overwhelmingly positive, as 14 enablers were identified relative to only 3 barriers. Female and young community pharmacists were significantly more likely to perceive enablers than barriers. The insights provided are potentially useful in developing pharmacy-based schemes to improve the effective management of minor ailments.

Pill-burden and its association with treatment burden among patients with advanced stages of chronic kidney disease.

Introduction: Chronic kidney disease (CKD) is associated with multimorbidity and high treatment burden. Pill-burden is one component of the overall treatment burden. However, little is known about its magnitude and contribution to the overall treatment burden among patients with advanced stages of CKD. This study aimed to quantify the magnitude of pill-burden in dialysis-dependent vs. non-dialysis-dependent advanced-stage CKD patients and its association with treatment burden. Methods: This was a cross-sectional study for the assessment of pill-burden and treatment burden among non-dialysis and hemodialysis (HD)-dependent CKD patients. Pill-burden was quantified as "number of pills/patient/week" through electronic medical record, while treatment burden was assessed using the "Treatment Burden Questionnaire (TBQ)". Furthermore, oral and parenteral medication burden was also quantified. Data were analyzed using both descriptive and inferential analysis, including Mann - Whitney U test and two-way between groups analysis of variance (ANOVA). Results: Among the 280 patients included in the analysis, the median (IQR) number of prescribed chronic medications was 12 (5.7) oral and 3 (2) parenteral medications. The median (IQR) pill-burden was 112 (55) pills/week. HD patients experienced higher pill-burden than non-dialysis patients [122 (61) vs. 109 (33) pills/week]; however, this difference did not reach statistical significance (p = 0.81). The most commonly prescribed oral medications were vitamin D (90.4%), sevelamer carbonate (65%), cinacalcet (67.5%), and statins (67.1%). Overall, patients who had high pill-burden (≥112 pills/week) had significantly higher perceived treatment burden compared to low pill-burden patients (<112 pills/week) [47(36.2) vs. 38.5(36.7); p = 0.0085]. However, two-way ANOVA showed that dialysis status is the significant contributor to the treatment-burden in the high overall pill-burden group (p < 0.01), the high oral-medication-burden group (p < 0.01), and the high parenteral-medication-burden group (p = 0.004). Conclusions: Patients with advanced CKD experienced a high pill-burden, which increases the treatment burden; however, the dialysis status of the patient is the main factor affecting the overall treatment burden. Future intervention studies should target this population with an aim to reduce polypharmacy, pill-burden, and treatment burden, which may ultimately improve CKD patients' quality of life.

Effect of CYP2C19 genetic variants on bleeding and major adverse cardiovascular events in a cohort of Arab patients undergoing percutaneous coronary intervention and stent implantation.

INTRODUCTION: One-third of patients have clopidogrel resistance that may lead to major adverse cardiac events (MACEs). By contrast, it was found that some clopidogrel-treated patients have hyperresponsive platelets that are associated with higher bleeding risk. Several studies have shown that polymorphisms in the gene encoding the CYP2C19 contribute to the variability in response to clopidogrel. Data on genetic and nongenetic factors affecting clopidogrel response in the Arab population are scarce. In this prospective cohort study, we sought to assess the association between the increased function allele (CYP2C19*17) and bleeding events, and validate the effect of the CYP2C19 genetic variants and nongenetic factors on the incidence of MACEs. METHODS: Blood samples were collected from patients that were undergoing percutaneous coronary intervention and receiving clopidogrel at the Heart Hospital, a specialist tertiary hospital in Doha, Qatar. Patients were followed for 12 months. Genotyping was performed for CYP2C19*2, *3, and *17 using TaqMan assays. RESULTS: In 254 patients, the minor allele frequencies were 0.13, 0.004, and 0.21 for *2, *3, and *17, respectively. Over a 12-month follow-up period, there were 21 bleeding events (8.5 events/100 patient-year). CYP2C19*17 carriers were found to be associated with increased risk of bleeding (OR, 21.6; 95% CI, 4.8-96.8; P < 0.0001). CYP2C19*2 or *3 carriers were found to be associated with increased risk of baseline and incident MACE combined (OR, 8.4; 95% CI, 3.2-23.9; P < 0.0001). CONCLUSION: This study showed a significant association between CYP2C19*17 allele and the increased risk of bleeding, and CYP2C19*2 or *3 with MACE outcomes.

Pharmaceutical care education at pharmacy colleges in the Middle East and North Africa region: A systematic review.

WHAT IS KNOWN AND OBJECTIVE: New pharmacy curricula include content that equip students with a bundle of professional and interpersonal skills that allows the provision of evidence-based patient-centred pharmaceutical care (PC). PC has been adopted as a practise model underpinning these new roles for pharmacists in developed countries. However, anecdotal evidence suggests that countries in the Middle East/North Africa (MENA) region have been relatively slow in including PC in pharmacy education. There seems to be a need to more accurately describe the extent to which PC is included in pharmacy education in the MENA region. The objective of this systematic review was (a) to determine the status of PC education in schools and colleges of pharmacy in the MENA region and (b) to identify pharmacy students' and/or educators' perceptions and attitudes towards PC, preparedness level to PC provision and perceived barriers to implement this practise model in countries of the MENA region. METHODS: A comprehensive literature search was conducted using MEDLINE, EMBASE, SCOPUS, International Pharmaceutical Abstract and ProQuest databases to identify articles published from 2000 to 2021. Selection of studies for inclusion in the review was based on a pre-determined eligibility criterion to retrieve original research articles addressing the review objectives. RESULTS: Nine articles were eligible for inclusion in the review. The majority of the studies (n = 8) employed a survey-based research method. The studies were conducted in Jordan (n = 4), Kuwait (n = 2), Qatar (n = 2), Saudi Arabia (n = 1) and United Arab Emirates (n = 1). The findings suggest that pharmacy students had overall positive attitude and perception towards PC and some studies reported that students expressed good preparedness levels to implement most of the PC aspects. Several barriers to the implementation of PC were reported such as the slow educational reforms in pharmacy programs and a number of organizational and professional barriers. The studies provided recommendations for improvements in the pharmacy curricula to support pharmacy students' preparation to become competent PC practitioners. WHAT IS NEW AND CONCLUSION: The literature describing PC education in the MENA region is limited. Joint efforts among educational institutions and health authorities are needed to support PC implementation. There is a need to conduct further research to explore the status of PC education and practise in the different countries within the MENA region. This can drive future directions of pharmacy education to meet the needs of the pharmacy profession and healthcare systems in these countries.

A systematic review on the impact of pharmacist-provided services on patients' health outcomes in Arab countries.

WHAT IS KNOWN AND OBJECTIVE: The pharmacist's role has evolved dramatically over the last few decades and shows considerable impact globally. The aim of this systematic review was to describe the nature and extent of studies evaluating the impact of pharmacist-provided services on clinical, humanistic and economic outcomes in different healthcare settings across the Arab world. METHODS: A systematic literature search was conducted using the following databases from their inception until June 2020: Cochrane, Embase, MEDLINE, PubMed, ScienceDirect and Scopus. Reporting was done according to PRISMA guidelines, and the quality assessment utilized the Mixed Methods Appraisal Tool. RESULTS AND DISCUSSION: Thirty-five eligible studies were included in this review, the majority of which were randomized controlled trials (RCT) (n = 26) conducted in hospital settings (n = 26). Most of the studies involved patients with specific medical conditions (n = 29) and pharmacist's interventions involved mainly medication therapy management (n = 32), counselling and education (n = 29), and medication therapy recommendations (n = 12). Several studies showed a positive impact (i.e., a statistically and/or clinically significant difference in favour of pharmacist-provided care or intervention) of pharmacist-provided services on clinical (n = 28), humanistic (n = 6) and economic (n = 5) outcomes. Conversely, five studies showed neutral or mixed effect of pharmacist interventions on clinical and humanistic outcomes. WHAT IS NEW AND CONCLUSION: The findings of this systematic review demonstrate a positive impact of pharmacist-provided services on clinical, humanistic and economic outcomes across diverse settings in the Arab world. Most of the included studies evaluated clinical outcomes and were from hospital setting. Directed approaches are needed to advance pharmacy practice across various healthcare settings in the Arab world.

Refugee healthcare needs and barriers to accessing healthcare services in New Zealand: a qualitative phenomenological approach.

BACKGROUND: Refuges and asylum seekers have specific healthcare needs; however there has been insufficient attention and effort to address these needs globally. Furthermore, effective communication between healthcare providers and refugees remains poor, further widening the imbalanced power dynamics. The aim of this research project was to examine refugee healthcare needs and current barriers to accessing healthcare services in New Zealand, and to propose solutions by exploring the perceptions, attitudes, beliefs, and opinions of key stakeholders regarding refugee healthcare needs within the scaffold of health and social care systems. METHODS: We conducted semi-structured interviews between September and December 2018 with 18 purposively selected refugee service provider stakeholders in New Zealand using an interview guide that addressed healthcare needs, existing barriers to access healthcare services, and perceived future healthcare delivery solutions. RESULTS: Thematic analysis of emergent themes of this study indicated the need for a national framework of inclusion, mandating cultural safety training of frontline personnel, improving access to interpreters and cultural mediators, and establishing the role of patient navigators. Barriers to accessing health services included entrenched social health determinants such as housing scarcity and disenfranchised community environments; refugee health-seeking behaviour and poor health literacy; along with existing social support networks. We propose that healthcare delivery should focus on capacity building of existing services, including co-design processes with refugees and asylum seekers and increasing funding for refugee-specific health service via the implementation of an overarching national strategy. CONCLUSION: Based on the findings of this study, refugee organisations and their frontline personnel should seek to address the deficiencies identified in order to provide equitable, timely and culturally-accessible healthcare services for refugees in New Zealand and in comparable countries.

Microcredentials training in pharmacy practice and education: an exploratory study of its viability and pharmacists' professional needs.

BACKGROUND: Microcredentials (MCs) are short courses that certify/recognise an individual's achievement of specific skills or knowledge. Schools of pharmacy could be well-placed to contribute to the continuing professional development (CPD) of pharmacists through the inclusion of MCs training in their programs. This study aimed to explore pharmacy professionals' views on the need and viability of MC courses globally. METHODS: Eleven semi-structured telephone interviews were conducted with pharmacy practitioners, policymakers, and academics across seven countries. The participants were selected using purposive sampling to explore information from varying pharmacy disciplines. Interviews were audio-recorded, transcribed verbatim, and analysed using a general inductive approach. RESULTS: Participants regarded MCs in pharmacy as an innovative idea, well-suited to the increasingly technology-driven world. They believe MCs provide easily accessible means of skills and knowledge acquisition that fulfils the needs of the pharmacy profession. MCs were also perceived as an alternative pathway of meeting the requirements of traditional CPD programmes. Many participants believe universities are well-suited to provide MCs; however, numerous challenges such as recognition, time and resources have been identified as potential barriers to enrolment and implementation. CONCLUSIONS: This study provides an insight into the views of pharmacy practitioners and academics on MCs, and their potential utility in pharmacy education and practice. The findings should help in the development of MCs that could be utilised by pharmacy practitioners around the world for CPD purposes. This study comes at a time when alternative models of teaching and learning are being explored as a direct result of the COVID-19 pandemic.

Assessment of an intensive education program for pharmacists on treatment of tobacco use disorder using an objective structured clinical examination: a randomized controlled trial.

BACKGROUND: Tobacco use is one of the major public health threats globally. Community pharmacists are uniquely positioned to offer tobacco cessation services owing to their easy accessibility by the public. To prepare Qatar community pharmacists to develop the competencies and skills required to offer smoking cessation services, an intensive tobacco control education program was designed and implemented. The study aimed to assess the impact of the tobacco education program on the pharmacists' skills and competence. METHODS: A random sample of community pharmacists in Qatar was chosen for participation in the program. Consenting participants were randomly assigned to either intervention or control groups. The intervention group received an intensive education program on treatment of tobacco-use disorder, while a short didactic session on a non-tobacco-related topic was delivered to the control group. The pharmacists' tobacco cessation skills and competencies were assessed using an Objective Structured Clinical Examination (OSCE). RESULTS: A total of 54 and 32 community pharmacists in the intervention group and the control group, respectively, completed the OSCE. The intensive tobacco education group achieved significantly higher total scores than the control group in all the OSCE cases. Specifically, the mean total scores for the intervention group were 15.2, 15.3, 14.2, 14.6, 16.3, and 15.2 compared to 8.8, 6.2, 7.7, 9.2, 8.3, and 11.3 for the control group (p < 0.001) for cases one to six respectively. CONCLUSION: The study demonstrated that an intensive tobacco cessation education program can improve pharmacists' tobacco cessation skills and increase their tobacco cessation counseling abilities. TRIAL REGISTRATION: Clinical Trials NCT03518476 ( https://clinicaltrials.gov/ct2/show/NCT03518476 ) Registration date: May 8, 2018.

Implementation and evaluation of a preceptor educational development programme involving the health cluster colleges at Qatar University.

BACKGROUND: 'The Practice Educators' Academy Programme' is an innovative educational intervention developed following a preceptor-focussed needs assessment. The primary aim of this study was to evaluate the programme's effect on self-efficacy and knowledge amongst multi-disciplinary clinical preceptors who precept students across the Health Cluster in Qatar University. The secondary aim was to assess the preceptors' satisfaction with the programme's comprehensiveness, appropriateness, and relevance. METHODS: This is a longitudinal study, with the same participants followed at different time points (i.e., pretest-posttest interventional design). The sample size was calculated to represent 10% of the sample expected for the main study, utilising a stratified convenience sampling technique. Preceptor self-efficacy was assessed using the Preceptor Self-Efficacy Questionnaire, a validated 21-item questionnaire. Preceptor knowledge was assessed through a 25-item multiple-choice question test. Satisfaction with programme content and delivery was assessed through a 14-item questionnaire with open comments. RESULTS: Thirty pretest-posttest respondents for the PSEQ assessment, and 26 pretest-posttest respondents for the knowledge assessment were appropriately matched and analysed. Participation in the self-efficacy questionnaire resulted in a statistically significant increase in their posttest median score (pretest-to-posttest: 3.3-to-3.6, p = 0.001). Participation in the knowledge assessment resulted in a statistically significant increased posttest mean score (pretest-to-posttest: 10.2-to-15.7, p < 0.001). Participants indicated high levels of satisfaction with the programme (average score = 4.42/5). CONCLUSIONS: Our findings suggest the programme is effective as demonstrated through a significant improvement in preceptors' self-efficacy and knowledge. Recommendations for future iterations include placing greater focus on active learning strategies, and inter-disciplinary interactions.

Assessment of Qatar community pharmacists' competence and practices related to renal and gastrointestinal adverse effects of nonprescription NSAIDs.

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently dispensed nonprescription drugs in community pharmacies. However, inappropriate use of NSAIDs by consumers has been associated with development of gastrointestinal (GI) injuries and renal injuries. Community pharmacists' education of consumers on proper use of NSAIDs and their associated adverse effects has been shown to reduce the GI and renal injuries. In Qatar, no studies have been done to assess the community pharmacists' knowledge, attitude, and practices related to renal and GI adverse effects of NSAIDs. Therefore, this study aimed to assess Qatar community pharmacists' knowledge, attitude, and practices on the safe use of nonprescription NSAIDs to reduce the risk of kidney and GI injuries. Methods: A cross-sectional web-based survey was conducted among community pharmacists in Qatar. A pre-tested 28-item questionnaire that was developed through a multi-phase iterative process was administered to a convenient sample of community pharmacists in Qatar. Data were analyzed using descriptive and inferential statistics with statistical significance set at p < 0.05. Results: Overall, 114 community pharmacists responded to the online questionnaire (response rate 15.2%). Approximately 90% of the community pharmacists demonstrated from good to excellent knowledge on the renal and GI adverse effects of NSAIDs, with none of their sociodemographic and professional characteristics having a significant effect on their knowledge scores. More than half of the pharmacists reported that they always or usually educated patients on the dosage (98.6%), administration (95.8%), side effects and precautions (78%), and contraindications (71.2%) of NSAIDs during their routine practices. The majority of the pharmacists had positive attitude towards educating patients about adverse effects of NSAIDs, as well as identifying high-risk patients who should avoid nonprescription NSAIDs. However, 45.7% of the pharmacists strongly agreed or agreed that educating patients about NSAIDs can be time consuming. Conclusion: Community pharmacists in Qatar demonstrated good knowledge of the renal and GI adverse effects of NSAIDs with some obvious areas of improvement, and this can be reinforced through continuing professional development. They also showed positive attitudes towards protecting patients against the renal and GI adverse effects of NSAID. However, a significant proportion of the pharmacists admitted that educating patients on NSAIDs was time consuming, which is a cause of concern warranting further investigation. Community pharmacy managers should provide community pharmacists adequate time and support to educate individuals at risk of renal and GI injuries who obtain NSAIDs from their pharmacies. Also, the Ministry of Public Health of Qatar should consider making counseling on high-risk medications (e.g., NSAIDs and insulin) by community pharmacists mandatory so that measures can be put in place in the pharmacies to free the pharmacist for education and counseling.

The Association Between Religiosity, Spirituality, and Medication Adherence Among Patients with Cardiovascular Diseases: A Systematic Review of the Literature.

This systematic review aimed to summarize the literature on the relationship between religiosity or spirituality (R/S) and medication adherence among patients with cardiovascular diseases (CVDs) and to describe the nature and extent of the studies evaluating this relationship. Seven electronic databases (PubMed, MEDLINE, EMBASE, Scopus, the Cochrane Central Library, ProQuest Theses and Dissertations, and Google Scholar) were searched with no restriction on the year of publication. The Crowe Critical Appraisal Tool was used to evaluate the methodological quality of the eligible studies. Due to the heterogeneity observed across the included studies, data synthesis was performed using a narrative approach. Nine original studies published between 2006 and 2018 were included in the review. Only a few quantitative studies have examined the relationship between R/S and medication adherence among patients with CVDs. Most studies were conducted in the USA (n = 7) and involved patients with hypertension (n = 6). Five studies showed a significant correlation between R/S (higher organizational religiousness, prayer, spirituality) and medication adherence and revealed that medication adherence improved with high R/S. The other four studies reported a negative or null association between R/S and medication adherence. Some of these studies have found relationships between R/S and medication adherence in hypertension and heart failure patients. This review showed a paucity of literature exploring the relationship between R/S and medication adherence among patients with other CVDs, such as coronary artery diseases, arrhythmia, angina and myocardial infarction. Therefore, the findings suggest that future studies are needed to explore the relationship between R/S and medication adherence among patients with other types of CVDs. Moreover, there is a need to develop interventions to improve patients' medication-taking behaviors that are tailored to their cultural beliefs and R/S.

Clinical outcomes of high-intensity doses of atorvastatin in patients with acute coronary syndrome: A retrospective cohort study using real-world data.

AIMS: To compare the effectiveness and safety of 2 high-intensity atorvastatin doses (40 mg vs 80 mg) among acute coronary syndrome (ACS) patients. METHODS: This retrospective observational cohort study using real-world data included patients admitted with ACS to the Heart Hospital in Qatar between 1 January 2017 and 31 December 2018. The primary endpoint was a composite of cardiovascular disease-associated death, nonfatal ACS and nonfatal stroke. Cox proportional hazard regression analysis was used to determine the association between the 2 high-intensity atorvastatin dosing regimens and the primary outcome at 1 month and 12 months postdischarge. RESULTS: Of the 626 patients included in the analyses, 475 (75.9%) received atorvastatin 40 mg, while 151 (24.1%) received atorvastatin 80 mg following ACS. Most of the patients were Asian (73%), male (97%) with a mean age of 50 years and presented with ST-elevation myocardial infarction (60%). The incidence of the primary effectiveness outcome did not differ between the atorvastatin 40-and 80-mg groups at 1 month (0.8 vs 1.3%; adjusted hazard ratio = 0.59, 95% confidence interval 0.04-8.13, P = .690) and at 12 months (3.2 vs 4%; adjusted hazard ratio = 0.57, 95% confidence interval 0.18-1.80, P = .340). Similarly, the use of the 2 doses of atorvastatin resulted in comparable safety outcomes, including liver toxicity, myopathy and rhabdomyolysis with an event rate of <1% in both groups. CONCLUSION: The use of atorvastatin 40 mg in comparison to atorvastatin 80 mg in patients with ACS resulted in similar cardiovascular effectiveness and safety outcomes.

Health-related quality of life and its predictors among adults living with HIV/AIDS and receiving antiretroviral therapy in Pakistan.

BACKGROUND: Health-related quality of life (HRQoL) is considered to be the fourth 90 of UNAIDS 90-90-90 target to monitor the effects of combination antiretroviral therapy (ART). ART has significantly increased the life expectancy of people living with HIV/AIDS (PLWHA). However, the impact of chronic infection on HRQoL remains unclear, while factors influencing the HRQoL may vary from one country to another. The current study aimed to assess HRQoL and its associated factors among PLWHA receiving ART in Pakistan. METHODS: A cross-sectional descriptive study was conducted among PLWHA attending an ART centre of a tertiary care hospital in Islamabad, Pakistan. HRQoL was assessed using a validated Urdu version of EuroQol 5 dimensions 3 level (EQ-5D-3L) and its Visual Analogue Scale (EQ-VAS). RESULTS: Of the 602 patients included in the analyses, 59.5% (n = 358) reported no impairment in self-care, while 63.1% (n = 380) were extremely anxious/depressed. The overall mean EQ-5D utility score and visual analogue scale (EQ-VAS) score were 0.388 (SD: 0.41) and 66.20 (SD: 17.22), respectively. Multivariate linear regression analysis revealed that the factors significantly associated with HRQoL were: female gender; age  > 50 years; having primary and secondary education;  > 1 year since HIV diagnosis; HIV serostatus AIDS-converted; higher CD 4 T lymphocytes count; detectable viral load; and increased time to ART. CONCLUSIONS: The current findings have shown that PLWHA in Pakistan adherent to ART had a good overall HRQoL, though with significantly higher depression. Some of the factors identified are amenable to institution-based interventions while mitigating depression to enhance the HRQoL of PLWHA in Pakistan. The HRQoL determined in this study could be useful for future economic evaluation studies for ART and in designing future interventions.

Evaluation of patient safety culture in community pharmacies in Qatar.

INTRODUCTION: Patient safety culture is a key contributor to medication safety globally. However, the perspective of pharmacists and other personnel in community pharmacy regarding patient safety culture may vary from one country to another. OBJECTIVE: The aim of this study was to determine the perspectives of community pharmacy personnel in Qatar about patient safety culture in community pharmacy setting. METHODS: A cross-sectional web-based survey utilising the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was conducted. Participants included community pharmacy personnel practicing in Qatar. Both descriptive and inferential statistics were applied for data analyses, with statistical significance set at ≤ 0.05. RESULTS: Two hundred and forty participants completed the survey. A large proportion of the respondents (52.5%) reported an "excellent" overall rating of patient safety in their respective community pharmacies. Patient counselling and teamwork composites of patient safety culture were associated with the highest positive responses (95% and 93.7%, respectively). The "staffing, work pressure and pace" composite demonstrated the lowest positive response (50.6%) among the 11 composites. Inferential analysis revealed that working in chain pharmacies was significantly associated with positive responses related to "teamwork" (P = .019). Furthermore, working for more than 40 hours per week had a significant positive influence on the overall perceptions of patient safety (P = .025). CONCLUSION: There was an overall positive perception towards patient safety culture among the surveyed community pharmacy personnel in Qatar. Superiority was observed with patient counselling and teamwork, while staffing, work pressure and pace were judged poorly, warranting further investigations and potential targeting for interventions.

Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service.

BACKGROUND: Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion. METHODS: Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach. RESULTS: Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system. CONCLUSIONS: The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.

The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students' and recent alumni's perceptions using mixed-methods approach.

BACKGROUND: The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students' perspective towards the utilization of SPs in Qatar and to identify areas that require improvement. METHODS: An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases. RESULTS: The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs' roles, communication and language barriers, simulations of real-life case scenarios, SPs' competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria. CONCLUSION: This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.

Insights from healthcare academics on facilitating interprofessional education activities.

Facilitators are of paramount importance to the success of interprofessional education (IPE) activities; hence, it is crucial to explore their perspectives and experiences in delivering IPE in Qatar. Using an exploratory case study approach, semi-structured interviews were conducted, in 2018, among faculty members, who had facilitated at least one IPE activity in Qatar, from healthcare professional education programs at Qatar University Colleges of Pharmacy, Medicine, and Health Sciences, Weill Cornell Medicine in Qatar, the University of Calgary in Qatar, and the College of North Atlantic. Interviews were recorded and transcribed verbatim. Inductive thematic content analysis was implemented. Twenty-one interviews were conducted with the following professions represented: medicine (n = 6), pharmacy (n = 5), nursing (n = 4), biomedical science (n = 3), respiratory theory (n = 2) and public health (n = 1). Four main themes emerged from the interviews: drivers to facilitator involvement that included interest and commitment to IPE and awareness of collaborative practice benefits; facilitator participation which was based on facilitator attributes and preparedness and readiness for IPE facilitation; the organizational support in terms of dedicated structure for IPE and IPE design and delivery and; student participation in terms of group dynamics and student engagement. Some key recommendations include having a dedicated unit for IPE, scheduling protected time for IPE, and organizing facilitators' training and debriefing workshops. The facilitators valued and appreciated IPE in preparing students for future collaborative practice. These findings can inform the development of quality and sustainable IPE activities in the future.