"Handing out non-prescribed antibiotics is storing up trouble for the next generation!" Unpacking multistakeholder views of drivers and potential solutions in Ethiopia.

BACKGROUND: Antibiotic resistance is a global health crisis, with inappropriate antibiotic use often being linked to non-prescribed antibiotic dispensing practices. This study aimed to examine the perspectives of multiple stakeholders on the drivers and potential solutions for non-prescribed antibiotic dispensing in Ethiopian community drug retail outlets (CDROs). Despite the prescription only use policies, the practice remains prevalent in Ethiopia. Many factors are thought to contribute to this issue, although little research is available for non-urban settings. METHODS: A phenomenological qualitative study was conducted. Pharmacy professionals (owners or employees) working in non-urban towns CDROs were selected through a simulated client study, which identified CDROs that had dispensed antibiotics without a prescription. Some high-level decision makers in the Ethiopian health system were also purposively selected. Interviews were conducted in-person and over the phone or via Zoom. The interview data were transcribed verbatim, translated to English, and thematically analysed. NVivo 12 software was used to assist with coding. RESULTS: CDRO pharmacy professionals (n = 18) and five decision makers were interviewed. Most professionals (61%) were pharmacists working in drug stores, with one to 11 years of work experience. Several contributing factors were identified at the level of patients, CDRO staff, and the healthcare system. These included economic interests, inadequate knowledge and inappropriate attitudes about antibiotic use or supply, and issues within the healthcare system included inaccessibility and insufficient capacity, absence of or a weak enforcement of prescription-only regulations or service supervision. Additionally, patient-related factors included a lack of knowledge and inappropriate attitudes about antibiotics use and their supply, previous successful treatment experience and a culture of seeking out antibiotics. CONCLUSIONS: A complex set of modifiable factors related to patients, CDRO staff and healthcare system were identified that contribute to the non-prescribed supply of antibiotics. Due to this complexity, a single solution will not resolve the issues. Therefore, a range of multifaceted solutions have been suggested, including stricter regulation, increasing availability and accessibility of healthcare services, collaboration, and local consensus-building among CDROs, regular training for CDRO staff, and using community social events to educate the public about responsible use of antibiotics.

Assessment of knowledge, attitude, and practice on substandard and counterfeit pharmaceutical products among pharmacy professionals in Gondar City, North-West Ethiopia.

INTRODUCTION: The circulation of substandard and counterfeit pharmaceutical products on the national and international markets has increased. Different studies revealed that there is limited information about pharmacy professionals' awareness of substandard and counterfeit pharmaceutical products. Therefore; the aim of the present study was to assess the pharmacy professionals' knowledge, attitude, and practice of substandard and counterfeit pharmaceutical products. METHODS: A cross-sectional study was conducted to assess the knowledge, attitude, and practice of pharmacy professionals about substandard and counterfeited pharmaceutical products in Gondar City, North-West Ethiopia. Data were collected through a self-administered, structured questionnaire using the Kobo tool. SPSS version 27 was used for the analysis. To assess the association of factors with pharmacy professionals' practice towards substandard and counterfeit medicines, we conducted univariate and multivariate logistic regression analysis. RESULTS: A total of 170 respondents participated in the study. The highest numbers of participants (71.8%) were in the age group of 18-30 years. Only 10.6% of them reported purchasing medicines regularly. Of total, 31 (18.24%) of respondents had a good knowledge and more than one-third 60 (35.29%) of the respondents had a good level of practice. Multivariate logistic regression analysis results revealed that some socio-demography and attitude (AOR = 0.473 (0.225-0.995) were associated with the practice of pharmacy professionals towards substandard and counterfeit medicines. CONCLUSION: In general, less than one-quarters of the respondents had a good knowledge and more than one-thirds of the respondents had a good level of practice. However, half of the respondents had a positive attitude.

Seguimiento farmacoterapéutico a pacientes polimedicados / Pharmaceutical care to polimedicated patients

Los servicios profesionales farmacéuticos asistenciales contribuyen a un mejor control de los problemas de salud, sobre todo en pacientes polimedicados, y a una optimización de los recursos sanitarios, lo cual conlleva una menor prescripción de medicamentos y un menor número de visitas a los centros sanitarios. Formaron parte de este estudio 78 pacientes, siendo el sexo femenino el más prevalente, con una edad media 72,49 ± 13,92 años; de ellos, 60 pacientes eran mayores de 65 años y, por tanto, considerados pacientes geriátricos. Fueron incluidos en un servicio de sistemas personalizados de dosificación y, posteriormente, se realizó un seguimiento farmacoterapéutico. Se detectaron 450 problemas relacionados con los medicamentos siendo los más frecuentes los asociados al paciente: falta de conocimiento de uso, mala adherencia terapéutica, errores en la administración…, siendo la probabilidad de presentarlos mayor en el sexo masculino. Asociados a estos problemas con los medicamentos se detectaron 160 resultados negativos asociados a la medicación; solo 5 de ellos no fueron resueltos durante la fase estudio, los más frecuentes fueron los de inefectividad no cuantitativa, es decir, aquellos que no se resuelven con una modificación de la dosis farmacológica sino incluyendo o eliminando otros principios activos. En conclusión, el servicio de sistema personalizado de dosificación precisa de una revisión de la medicación como, por ejemplo, el seguimiento farmacoterapéutico, ya que ambos permiten optimizar el tratamiento de los pacientes polimedicados, así como, un aumento del control de los problemas de salud.(AU)

Professional pharmaceutical care services contribute to better health problem control, especially in polymedicated patients, and to the optimization of health resources, which leads to less medication prescription and fewer visits to healthcare centers. This study included 78 patients, with the female sex being the most prevalent, with an average age of 72.49 ± 13.92 years; of these, 60 patients were over 65 years of age and, herefore, considered geriatric patients. They were included in a personalized medication dispensing service and, subsequently, a pharmacotherapeutic follow-up was carried out. 450 medication-related problems were detected, the most frequent of which were associated with the patient: lack of knowledge of use, poor therapeutic adherence, administration errors, etc., with the probability of presenting them being higher in the male sex. Associated with these medication problems, 160 negative medication-related results were detected; only 5 of them were not resolved during the study phase, the most frequent being those of non-quantitative ineffectiveness, that is, those that are not resolved with a modification of the pharmacological dose but by including or eliminating other active ingredients. In conclusion, the personalized medication dispensing service requires a medication review, such as pharmacotherapeutic follow-up, as both allow the optimization of the treatment of polymedicated patients, as well as an increase in the control of health problems.(AU)

Clients' expectations from and satisfaction with medicine retail outlets in Gondar town, northwestern Ethiopia: a cross-sectional study.

PURPOSE: The aim of this study was to assess clients' level of expectation from and satisfaction with medicine retail outlets (MROs) in Gondar town, northwestern Ethiopia. PATIENTS AND METHODS: An institutions-based cross-sectional study was conducted from April 20 to May 5, 2014, by sampling five pharmacies and eight drug stores through simple random sampling. Clients, 424, who came to the MROs during the study period were included in the study. Data were collected using structured questionnaires measuring expectations and satisfaction of clients using a Likert scale of 1-5 through face-to-face interviews. RESULTS: Out of the total 424 interview encounters, 422 (99.5% response rate) questionnaires were included in the analysis, of which 61.1% were of males. The overall mean expectation of respondents toward MRO setting and services was 3.82 and that of satisfaction of the respondents was 3.02. More than three-quarters (76.8%) of the respondents expected medicines in affordable prices from MROs, but nearly half (44.8%) were not satisfied with it. Much more than half (58.5%) of the respondents were dissatisfied with the comfort and convenience of private counseling area. Also, nearly half (47.6%) of the respondents claimed that pharmacy professionals did not provide information regarding the storage condition of medications. There was statistically significant difference in overall expectation (t=2.707, P=0.007) and satisfaction (t=2.260, P=0.024) with the setting and services of MROs between respondents who claimed to know the difference between a pharmacy and a drug store and those who claimed they did not. CONCLUSION: Clients' expectation from MRO services was high, with average satisfaction. The overall expectation and satisfaction of the respondents toward MROs were lower in those who reported they did not know the difference between a pharmacy and a drug store than in those who claimed to know the difference. Supportive supervision by the town's health bureau on the MROs is recommended to help improve clients' satisfaction.