Pharmacists' Attitudes and Role in Diabetes Management in Kuwait.

OBJECTIVES: The objectives of this study were to measure pharmacists' attitudes toward management of diabetes, identify current levels of pharmacy service provided to patients with diabetes, and identify barriers for further provision of diabetes-related services. SUBJECTS AND METHODS: A descriptive, cross-sectional study was conducted on a sample of 198 pharmacists working in primary and secondary health care settings in one health region of Kuwait using a pretested self-administered questionnaire. Descriptive statistics, correlations, and comparative analysis were performed. RESULTS: The response rate was 84.4% (n = 168). Respondents had overall positive attitudes toward management of diabetes. Pharmacists regularly provided their patients with counseling on the appropriate time to administer their medications; however, services related to hypoglycemia and management of comorbid diseases were rarely provided. A negative correlation was found between the positive overall diabetes-related attitudes and pharmacists' involvement in providing the following diabetes-related services: glucose monitoring (r = -0.25, p = 0.001), comorbid disease management (r = -0.243, p = 0.001), and healthy living choices (r = -0.237, p = 0.002). The perception that some physicians and patients have of pharmacists as dispensers only was identified as the most important barrier to providing diabetes-related services. CONCLUSION: Pharmacists have positive diabetes-related attitudes; however, they provide limited diabetes-related services to their patients. Barriers to provision of pharmacy services to patients with diabetes should be addressed to enable optimum patient care delivery.

A medication assessment tool to evaluate prescribers' adherence to evidence-based guidelines in bipolar disorder.

Background The goal of evidence-based clinical practice has led to an increased interest in the development of tools to measure adherence to national guidelines in different diseases. This aids in detecting and measuring inappropriate prescribing to specific patient groups by using quality standards extracted from evidence-based guidelines, and ultimately provide the basis of consistent standardized prescribing. Objective To design and validate a medication assessment tool to assess prescribers' adherence to international guideline recommendations in the management of bipolar disorder (MATBD). Setting Outpatient psychiatry clinic at a secondary healthcare setting in Kuwait. Method International guidelines concerned with the management of bipolar disorder were reviewed in order to develop MATBD. Face and content validity of the developed tool (MATBD) was performed with a research and expert group. A 4-point Likert scale was used to assess the expert group's level of agreement to individual criterion. Content validity ratio (CVR) was calculated for each criterion (n = 54) and the content validity index (CVI) was calculated for each section (n = 5) of the MATBD. Finally, feasibility testing was performed on 19 patient records to confirm the tool's fitness for purpose. Main Outcomes Measure Perceived relevance, utility, and clarity of individual criteria, and reliability of their application to clinical settings. Results Face validity and content validity were achieved with a research and expert group (n = 14). Content validity ratio (CVR) was demonstrated for 54 criteria; criteria with a negative CVR were removed. This resulted in a draft MATBD comprising of 52 criteria (CVI: 0.814). Feasibility testing on 19 patients' records resulted in a final MATBD comprising of 49 criteria divided into 3 sections: initial assessment, acute management and monitoring. Conclusion A medication assessment tool was developed and validated to be used as a means of profiling potential opportunities for medication therapy management optimization, and improving therapeutic interventions regarding the management of bipolar disorder.

Evaluation of adherence to international guidelines for treating patients with type 2 diabetes mellitus in Kuwait.

BACKGROUND: Clinical guidelines derived from scientific evidence provide the basis of consistent standardized prescribing. Despite an alarming increase of diabetes in Kuwait, no studies related to the quality of prescribing in diabetes were found. Before pharmaceutical care can be implemented to improve the quality of care of patients with diabetes, it is important to determine whether prescribers are compliant with comprehensive international guidelines for cardioprevention and glycaemic control. OBJECTIVE: To evaluate the adherence to clinical guidelines for treating patients with type 2 diabetes mellitus in primary care centres and secondary care centres (hospitals) using a developed and validated medication assessment tool with reference to international guidelines. SETTING: Outpatient diabetes clinics in 8 primary care centres and 4 secondary care centres across four healthcare regions in Kuwait. METHOD: A quantitative, cross-sectional study involving a sample of 652 Kuwaiti patients with type 2 diabetes, who were selected using systematic sampling from the study settings. Data were collected retrospectively from the patients' medical records using a validated 43-criterion medication assessment tool (MATKW) designed to assess cardioprevention and treatment in patients with type 2 diabetes. Descriptive and comparative analysis was conducted using SPSS version 17. MAIN OUTCOME MEASURE: Frequency of prescribing adherence to agreed definitions of criteria derived from international guidelines. RESULTS: Overall adherence to prescribing diabetes guidelines was 77.7 % (95 % CI 76.7-78.6 %). Significantly higher prescribing adherence was found in the secondary care facilities, 82.4 % (95 % CI 81.2-83.6 %) compared to primary care 72.5 % (95 % CI 71.0-73.9 %) (p < 0.001). Nineteen criteria out of 43 achieved an adherence >80 % in secondary care compared to ten criteria in primary care. The documentation of patients' records was found to be inconsistent at the study healthcare facilities. Nonoptimal achievement of target goals for HbA1c, blood pressure and BMI was prevalent among the study population. CONCLUSION: A tool such as MATKW highlights areas for review and possible improvement in prescribing adherence. Our findings reveal problem areas in prescribing practices and documentation of patients' records. Cost-effective multifaceted interventions are needed to improve current prescribing practices and documentation.