ABSTRACT
INTRODUCTION: In the context of the continuous quest to improve the care of the neonates especially the critically ill premature infants, the extended role of pharmacists in the process of parenteral nutrition order writing and effective participation in decision-making especially in the neonatal population is increasingly important. This review aims to present results from the literature review of available evidence on the pharmacist role in neonatal parenteral nutrition therapy. MATERIAL AND METHODS: Key medical, clinical, and review databases were searched; relevant articles were retrieved and evaluated. RESULTS AND DISCUSSION: A total of 19 papers out of 7127 searched papers met the criteria for inclusion, discussing the review topic. The main focus of the selected papers was on parenteral nutrition practice as related to the pharmacy practice. The overall quality of studies was mixed. CONCLUSION: Overall, the review presents the up-to-date status of the most recent analysis being undertaken on the topic of pharmacist involvement in the parenteral nutrition order writing practices and more specific in the neonatal population over the period from 1979 to 2013. The overall impression is that the practice of pharmacist writing neonatal parenteral nutrition orders already exists, but still limited if compared with the practice of pharmacist writing adult parenteral nutrition orders which is much more established in many countries. There was no single clinical study evaluating this practice, as we were able to retrieve only two surveys, which make it difficult to evaluate the pharmacist role in this area. Nevertheless, despite the wide variation in literature types, characteristics and quality, there are consistent patterns across all the reviewed literatures that competencies of the pharmacist in this field are well represented, which make it very important to carry out good quality clinical studies in this field. Finally, we are currently conducting a prospective clinical study to evaluate the impact of clinical pharmacist as a neonatal PN prescriber, this impact will be judged through the study outcomes as reducing the metabolic and electrolyte complications and increasing the mean daily weight gain during PN therapy and reducing the average number of days of PN till enteral feeding is achieved.
ABSTRACT
BACKGROUND: Type 2 diabetes is a major risk factor for cardiovascular disease and microvascular complications. Approximately 20.5% of adults between the ages of 20-79 are diagnosed with type 2 diabetes in Saudi Arabia. Nonadherence with type 2 diabetes medications is an established contributor to higher prevalence in other countries. No published studies have used a theoretical framework to explain or predict medication-taking behavior in Saudi Arabian type 2 diabetes (T2D) patients. OBJECTIVE: The purpose of this study was to investigate type 2 diabetes medication adherence using a theoretical framework, the Health Belief Model (HBM). The specific objectives were to 1) assess self-report of medication-taking in a Saudi T2D convenience sample; 2) investigate self-reported HBM constructs for T2D, its complications, and medication-taking in this sample, and 3) test the ability for self-reported health beliefs to predict specific medication-taking behaviors among the sample. METHODS: A cross-sectional study was conducted in a convenience sample at an outpatient pharmacy in Saudi Arabia. Adult type 2 diabetes patients on at least one prescribed diabetes medication, who were cognitively capable, and came themselves for prescription pickup, were eligible to participate. Patients completed a questionnaire or were interviewed. Data were collected for demographics, medical history, self-reported medication adherence, and type 2 diabetes medication-taking HBM items. Three measures collected self-report of medication adherence: new multi-dimensional adherence measure (MDAM), previously validated stage of change, and medication-taking recall- 7days (MTR-7). Descriptive statistics were generated and regression analyses were used to explain self-report of adherence. RESULTS: Just over half (54%) of the 220 participants were male, mean age was 52 ± 11.2 years, and most (59%) had less than high school education. Approximately 58% were on oral medications only and the rest were on either insulin alone or a combination of oral and insulin; 16.7% reported knowing their hemoglobin A1C (A1C). For adherence, most reported taking the prescribed dose every time taken; however, 60% were not taking it the prescribed number of times per day and 50%, not the prescribed time of day (interval). Over 40% reported low adherence on stage of change and MTR-7. Perceived susceptibility, perceived medication benefits, and self-efficacy were significant HBM predictors for medication adherence (R2 = 0.42). CONCLUSIONS: The MDAM has research and practice potential because it evaluates sub-behaviors of medication-taking separately and as a score. Patient perceptions and beliefs should be assessed as part of a patient-centered medication adherence intervention.