An exploratory study of outpatient medication knowledge and satisfaction with medication counselling at selected hospital pharmacies in Northwestern Nigeria.

BACKGROUND: Medication counselling is an important activity that improves patient therapeutic outcomes. After this activity has been carried out, patients should be satisfied with counselling, and possess adequate knowledge about their medications. OBJECTIVES: To describe outpatient/caregiver medication knowledge and satisfaction with medication counselling at the main outpatient pharmacies of eight public secondary and tertiary hospitals located in two states in Northwestern Nigeria. METHODS: Exit interviews were conducted from December 2019 to March 2020 with randomly sampled patients/caregivers who had just been dispensed one or more prescription medications from the main pharmacies of the hospitals. The questionnaire used contained 31 questions in three sections. The first section collected demographic information. The second section assessed respondents' experiences and overall satisfaction with the counselling they had received. The last section evaluated respondents' knowledge of one randomly selected prescription medication that had been dispensed to them. Data collected were coded and analyzed to generate descriptive statistics. To explore associations between respondent characteristics and overall satisfaction, non-parametric tests were used, and statistical significance set at p<0.05. RESULTS: A total of 684 patients/caregivers were interviewed. Majority of respondents agreed that the time spent (97.1%) and quantity of information (99.1%) provided during counselling was adequate. However, over 60% of them also agreed that dispensers did not assess their understanding of information provided or invite them to ask questions. Despite this, their average overall satisfaction with counselling on a 10-point scale was 8.6 ± 1.6. Over 90% of them also correctly identified the routes and frequency of administration of the prescribed medication selected for the knowledge assessment. Although, more than 60% of respondents did not know the duration of therapy or names of these medications. CONCLUSION: Respondents' satisfaction with medication counselling was fairly high even though they did not seem to know much about their medication.

Improving outpatient medication counselling in hospital pharmacy settings: a behavioral analysis using the theoretical domains framework and behavior change wheel.

BACKGROUND: Despite the importance of medication counselling for patients, it is common knowledge that it is often sub-optimally carried out by pharmacy staff. While some interventions have been designed to help improve counselling, no study till date has used the Capability Opportunity and Motivation behavior model (COM-B) or Theoretical Domains Framework (TDF) as a basis for identifying evidence-based intervention strategies to improve medication counselling. OBJECTIVE: To understand barriers/facilitators to optimal medication counselling by conducting a behavioral analysis using the COM-B model and TDF, and use the Behavior Change Wheel (BCW) as a basis for identifying evidence-based intervention strategies and policy categories that could be used to improve outpatient medication counselling by pharmacy staff in hospital settings located within Northwest Nigeria. METHODS: Semi-structured interviews were used to collect data from 25 purposively sampled pharmacy staff working at eight major public hospitals, from January till March 2020. Data from the interviews were then transcribed and deductively coded using the COM-B model and TDF. These findings were then used to identify areas requiring change, as well as the intervention type and policy functions required to support these changes. RESULTS: Findings from the behavioral analysis revealed shortfalls in pharmacy staff capability, opportunity and motivation with respect to outpatient medication counselling. To improve their counselling behaviors, change was identified as necessary in eight TDF domains namely 'knowledge', 'interpersonal skills', 'memory' 'environmental context', 'social influences', 'intentions', 'reinforcement' and 'beliefs about capabilities'. Seven intervention functions including 'education', 'training', 'modelling', 'enablement' and 'environmental restructuring', in addition to three policy categories ('guidelines', 'regulations' and 'environmental/social planning') were also identified as relevant to future intervention design. CONCLUSIONS: Various factors were identified as affecting medication counselling by the pharmacy staff, with several of them requiring changes if counselling was to be improved upon. Multi-component interventions combining several of these intervention functions are recommended for hospital authorities and other relevant stakeholders to improve outpatient medication counselling.

Hospital pharmacy outpatient medication dispensing and counselling practices in North-Western Nigeria: an observational study.

OBJECTIVE: To describe outpatient medication dispensing and counselling processes in pharmacies located in eight hospitals in North-Western Nigeria. METHODS: An observational study was conducted from January to March 2020 in 19 hospital pharmacies located in the eight hospitals. Two types of observations were carried out, structured observations to describe the content of patient medication counselling encounters and general observations of other activities. Quantitative data were generated from the structured observations, whereas qualitative data were collected from field notes and informal discussions with dispensers. Data collected during the structured observations were descriptively analysed, whereas other data collected during the general observation periods were grouped and organized into categories. KEY FINDINGS: A total of 782 patient counselling encounters were observed during the structured observations. The most frequent types of information provided by the dispensers during these encounters included dose (98%) and route of administration (85%). Information about the name(s), indication(s), side effect(s) of medication as well as the importance of adherence were provided in less than 5% of these cases. Dispensers also made attempts to verify ownership of prescriptions to be dispensed in only 35% of these cases. Other issues observed included lack of interventions by dispensing staff during these processes. A total of 100 dispensing errors were observed, and provision of incomplete information (usually about duration of medicines use) was the most common type of dispensing error seen. CONCLUSIONS: Several problems were observed with the medication dispensing and counselling processes for outpatients in the hospital pharmacies observed. Interventions aimed at improving these processes are required if patients are to use their medicines correctly and safely.

Behavioral and anticonvulsant effects of the standardized extract of Ficus platyphylla stem bark.

ETHNOPHARMACOLOGICAL RELEVANCE: Decoctions of Ficus platyphylla Del.-Holl (Family: Moraceae) are used in Nigeria׳s folk medicine for the management of epilepsy and their efficacies are widely acclaimed among the rural communities of northern Nigeria. The aim of the study is to examine the behavioral and anticonvulsant properties of the standardized methanol extract of Ficus platyphylla (FP) stem bark, in order to scientifically describe its potential values in the management of convulsive disorders. MATERIALS AND METHODS: High performance liquid chromatography (HPLC) and preliminary phytochemical analysis of the methanol extract were utilized and the intraperitoneal median lethal dose (LD50) determined in mice. The effects of FP were investigated on some murine models of behavior and its anticonvulsant effects studied on pentylenetetrazole (PTZ)-, strychnine (STN)-, picrotoxin (PCT)-, isoniazid (INH)-, aminophylline (AMI)- and maximal electroshock (MES)-induced seizures in mice. RESULTS: The intraperitoneal oral LD50 of FP was estimated to be 5000mg/kg. FP significantly reduced the locomotor activities including the total distance covered, speed, active time and rearing counts. It shortened the onset and prolonged the duration of diazepam-induced sleep, but had no effect on motor coordination on the rota-rod treadmill or beam-walking assay in mice at the doses tested. The extract protected the mice against PTZ- and STN-induced seizures and significantly delayed the latencies of myoclonic jerks and tonic seizures induced by all the standard convulsant agents (PTZ, PCT, INH, STN and AMI) used in this study, but failed to protect the mice against MES seizures at the doses tested. The HPLC fingerprint of the extract shows a spectrum profile characteristic of Ficus platyphylla, while the preliminary phytochemical screening revealed the presence of saponins, flavonoids and tannins. CONCLUSION: Our study provides scientific evidence that FP may contain psychoactive principles with potential anticonvulsant properties, thus supporting further development of the psychoactive components of this plant as anticonvulsant agents.