Antibiotic use numeracy: Developing the infectious numeracy test (INT).

BACKGROUND: Inadequate numeracy is a barrier to patients' understanding of their health. No measure of numeracy related to antibiotic use is available. OBJECTIVE: to develop and validate a measure of numeracy of antibiotic use, and to make this measure available in the Arabic language and context. METHODS: Best practices for developing, translating and validating scales were consulted to develop an anonymous survey administered on SurveyMonkey. Ten open-ended questions for which participants provided an answer assessed basic numeracy covering fractions, percentages, proportionality, measurement, and estimation, contextualized to real life situations. A panel of five experts, and 10 cognitive debriefings provided face and content validity for the tool. Individuals ≥18 years, who had mastery of Arabic or English were included. Exploratory factor analysis was performed to characterize the psychometric properties of the items, using principal-component analysis. Convergent validity was established by comparing numeracy scores with the antibiotic knowledge scale scores. Differences in numeracy scores according to sociodemographic variables were tested using multivariate analyses of variance. RESULTS: Two hundred fifty-four responses were obtained, giving a response rate of 63.5%. A two-factor structure which explained 44.2% of the variance evolved: "Mathematical knowledge and problem-solving skills" and "Numeracy-related practices and experience". An acceptable reliability of Cronbach's alpha coefficient = 0.713. Higher numeracy scores were significantly correlated with the scores of the antibiotic knowledge (r = 0.205, p < 0.01) and factor one within the tool: "side effects and resistance" (r = 0.162, p = 0.05). Participants with University/College education presented higher levels of numeracy-related practices and experience than those with high-school education. Likewise, participants with medical insurance presented with higher numeracy scores than those without. CONCLUSIONS: A valid and reliable measure of antibiotic numeracy in English and Arabic was created. The tool could identify patients with low numeracy who are candidates for targeted interventions and intensive education on appropriate antibiotic use.

A pseudo-customer cross-sectional study to evaluate the community pharmacist's management of migraine in pregnant women.

Background: To the best of our knowledge few published studies have been conducted to evaluate customer's care services in community pharmacies in the United Arab Emirates (UAE) using the pseudo-customer model. This further indicates that there is a paucity of information available about the current care services provided by the community pharmacists particularly for pregnant women with migraine. Objective: The main objective was to evaluate, the effectiveness of the pseudo-customer method on the care services (counseling, advice, and management) provided by the community pharmacists for migraine during pregnancy. Methods: This was a cross-sectional study conducted in community pharmacies with a cluster sampling of pharmacists. A sample of 200 community pharmacists was recruited from three emirates in the United Arab Emirates. Pregnant woman-related migraine management was assessed using the pseudo-customer model. The used script is not of a real patient but a fake/scripted used to describe the study. Results: No association was found between the gender and nationality of community pharmacists and the ability to be proactive (P =0.5, 0.568) and between the utilization of source of information and gender (P =0.31). The ability to prescribe by community pharmacists without probing or only after a probe was independent of job title (P =0.310); gender (P =0.44) and nationality (P =0.128). The community pharmacists who have offered written information have had significantly higher odds to dispense medication compared to those who have not (OR =45.547, 95% CI: 2.653 - 782.088, P =0.008). Furthermore, the pharmacists who have been reported to ask for precipitating factors of migraine had significantly higher odds to dispense medication compared to those who have not (OR =11.955, 95% CI: 1.083-131.948, P =0.043). The main outcome was the responses of the community pharmacists to the pseudo-customer visit (pregnant woman with migraine). Conclusions: The community pharmacist's care services (counseling, advice, and management) offered to the pseudo-customer visits was effective for dealing with migraine during pregnancy.

A simulated patient study to evaluate community pharmacist assessment, management and advice giving to patients with asthma.

BACKGROUND: Research has shown that there is an increase in the global prevalence of asthma. Pharmacists are well positioned to screen and refer patients for better management of asthma. This study aimed to evaluate community pharmacists' ability to assess the 3 C's (Control, Compliance, Complications) and offer Management and Advice for patients with asthma in the UAE. METHODS: Three fifth year pharmacy students role played a mystery shopper visiting community pharmacies and requesting symptom relief from uncontrolled asthma. Incidence of cough syrup and reliever inhaler supply, physician referral rate, correction of inhaler technique, and counseling on the medications, adherence to the medications and adverse drug reactions were calculated. RESULTS: One hundred, ninety five pharmacies were visited, 27% of pharmacists asked about the need for cough syrup and 60% asked about the need for albuterol inhaler. Only 26% asked about other medications. Less than 20% assessed inhaler technique, only one pharmacist asked about regular use of preventer medications and if the patient was adhering to them and only 16% asked about side effects from medications. Most pharmacists (67%) supplied at least one of the medications, while 65% referred the patient to a physician. Only 21% gave information about correct inhaler technique, the majority (> 60%) being incomplete, only 16 pharmacists gave information about asthma and its triggers; the majority (63%) being incomplete. One third of the pharmacists counselled the patient on the medications with one giving complete information. CONCLUSIONS: The study highlighted suboptimal assessment of control, compliance to preventer medications and complications of asthma and the medications that treat it. It also highlighted suboptimal Management and Advice giving and counseling on medication use by pharmacists. Training pharmacists in all aspects of asthma handling is clearly indicated. Despite the high rate of correct patient referral to a physician noted in this study, there is risk to it, as patients might not actually go to see their physician and continue to depend on symptom relief for the management of their asthma. This study highlighted the importance of improving patient education and information seeking attitude.