Consensus methodology to investigate the crucial referral criteria to pharmacist-led counseling clinics in Makkah City.

Aim: Identifying and prioritizing criteria for referring patients to a counseling clinic managed by hospital pharmacists in the tertiary care setting in Saudi Arabia (SA). Method: A two-phase consensus Delphi methodological approach was adopted in this study. Data was collected from physicians and pharmacists from different specialties working in different hospitals in Makkah City. In Phase 1, semi-structured interviews were conducted with physicians and pharmacists to discuss and develop the initial list of potential referral criteria for post-discharge counseling. Phase 2 consisted of two rounds of online surveys where participants were asked to independently rank the referral criteria using a 5-point Likert Scale. Results: In Phase 1, four participants undertook the interviews (two physicians and two pharmacists). Overall, no major comments were given on the suggested criteria. In Phase 2, most suggested referral criteria to the counseling clinic reached participants' consensus agreement of >70 % in both rounds for all three domains. Among all criteria that achieved consensus agreement, two demographic criteria were top-ranked by the participants; the elderly patients (100 %) and those who needed help with their devices (96 %). These were followed by five medication-related criteria, which are medication-related problems, polypharmacy, medication that needs monitoring, high-risk medication, and medication with special formulations. All had a consensus agreement of 96 %. Conclusion: This study suggests that a counseling clinic led by pharmacists is particularly advisable for the elderly, individuals requiring assistance with their devices, and those encountering medication issues. It is essential to prioritize specific patient demographics when contemplating the extensive establishment and integration of such clinics across various hospitals in SA.

The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis.

Background: The existence of Type 2 Diabetes Mellitus (DM) in tuberculosis (TB) patients is very dangerous for the health of patients. One of the major concerns is the emergence of MDR-TB in such patients. It is suspected that the development of MDR-TB further worsens the treatment outcomes of TB such as treatment failure and thus, causes disease progression. Aim: To investigate the impact of DM on the Emergence of MDR-TB and Treatment Failure in TB-DM comorbid patients. Methodology: The PubMed database was systematically searched until April 03, 2022 (date last searched). Thirty studies met the inclusion criteria and were included in this study after a proper selection process. Results: Tuberculosis-Diabetes Mellitus patients were at higher risk to develop MDR-TB as compared to TB-non-DM patients (HR 0.81, 95% CI: 0.60-0.96, p < 0.001). Heterogeneity observed among included studies was moderate (I2 = 38%). No significant change was observed in the results after sub-group analysis by study design (HR 0.81, 95% CI: 0.61-0.96, p < 0.000). In the case of treatment failure, TB-DM patients were at higher risk to experience treatment failure rates as compared to TB-non-DM patients (HR 0.46, 95% CI: 0.27-0.67, p < 0.001). Conclusion: The results showed that DM had a significant impact on the emergence of MDR-TB in TB-diabetes comorbid patients as compared to TB-non-DM patients. DM enhanced the risk of TB treatment failure rates in TB-diabetes patients as compared to TB-non-DM patients. Our study highlights the need for earlier screening of MDR-TB, thorough MDR-TB monitoring, and designing proper and effective treatment strategies to prevent disease progression.

Home infusion services in Saudi Arabia: Where are we standing?

Diseases management has reached the highest level of complexity and cost in history, worldwide, and in Saudi Arabia in particular, which led to prolonged, unnecessary hospital stays. There have been many recent innovative measures to reduce these issues. One is to provide home infusion services. Hence, this narrative review emphasizes the expected benefits and challenges of such services and the applicability of their implementation in Saudi Arabia. A literature search was conducted via PubMed database, involving all published studies from inception until March 24th, 2023. Many studies showed positive impacts of home infusion on reducing the length of hospital stays, increasing cost-saving, and leading to high patient satisfaction.

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic.

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

Qualitative investigation of barriers to providing an electronic hospital to community pharmacy referral service for discharged patients.

There has been a sustained interest in transfer of care (ToC) services, from hospital to home, in the past twenty years. In England, an electronic referral (e-referral) service from hospital to community pharmacy has been provided since 2014. However, to date, there has been little information about service implementation and delivery. This study investigates the barriers to this referral process in hospital and community pharmacy settings, and barriers to providing subsequent community pharmacy interventions from the perspectives of the service leaders (SLs), hospital pharmacy staff (HPS) and community pharmacists (CPs). Semi-structured face-to-face or telephone interviews were conducted with the key informants from two tertiary hospitals and nine pharmacies. The Consolidated Framework for Implementation Research (CFIR) tool informed the data collection tools and data analysis. A total of three SLs, ten HPS and nine CPs were interviewed. Data analysis identified various barriers to the provision of the e-referral service. Some were related to (1) patient engagement, e.g., patients' awareness/acceptance of the service, (2) the SLs and other National Health Service hospitals, e.g., lack of monitoring of the service progress, (3) the HPS, e.g., resource limitations, or (4) the CPs, e.g., lack of understanding/appreciation of the service. In-depth understanding of barriers related to the provision of e-referral service are essential to drive improvement and facilitate wider diffusion and adoption. The use of implementation science and behaviour change model as a lens to assess this service enables the identification of certain behaviours that can be modified to produce the required change to drive better implementation and delivery.

Interventions developed to reduce secondary care utilisation in patients with type 2 diabetes mellitus: a narrative review.

OBJECTIVES: To identify, describe and critically appraise the quality of studies of interventions developed to reduce the rate of secondary care utilisation and investigate interventions' impact on patients with type 2 diabetes mellitus (T2DM). METHOD: Using a systematic approach, five databases were searched between 01 January 1995 and 01 February 2021 (MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane database). Inclusion criteria were studies (published in English) in adults with T2DM offered intervention(s) involving medicines/services/educational programmes in any country or setting, with investigated outcomes including the rate of hospital admission/re-admission/accident and emergency visits. Validated tools were used to assess the quality and accuracy of reporting the interventions. A narrative synthesis was used to frame the findings. KEY FINDINGS: A total of 4670 papers were identified, which yielded a final 53 studies after screening against the inclusion criteria. Identified interventions were complex interventions (n = 21) including at least two interventions (e.g. improving medication adherence and patient education), medication management (n = 15), patient education programmes (n = 8), lifestyle interventions (n = 5) and other interventions (n = 4; e.g. dental care). After assessing for quality and effectiveness of interventions, 15 studies remained; 7 were medication management interventions (e.g. use of insulin pen) and 8 were complex interventions (e.g. pharmaceutical care and telehealth systems). Complex interventions showed significant improvement in clinical outcomes and reduction in secondary care utilisation. CONCLUSIONS: This narrative review identified potential elements of an effective complex intervention to reduce healthcare utilisation in patients with T2DM. These results could inform the development of interventions to be tested for feasibility, before piloting to assess for outcomes that improve diabetic care, reduce diabetes-related complications and minimise healthcare utilisation.

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention.

BACKGROUND: Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention. METHODS: The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach. RESULTS: Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity. CONCLUSIONS: This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.

Association between medication adherence and quality of life of patients with diabetes and hypertension attending primary care clinics: a cross-sectional survey.

PURPOSE: To evaluate the association between medication adherence and quality of life (QoL) of patients with diabetes and/or hypertension attending primary care clinics. METHODS: In this cross-sectional study, patients with at least one long-term condition (hypertension or diabetes mellitus) meeting the eligibility criteria were recruited from five primary care clinics in Saudi Arabia. Arabic version of Morisky Medication Adherence Scale (MMAS-8) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool were used to assess medication adherence and QoL, respectively. Patients' sociodemographic, medical and medication data were collected using a structured, pilot-tested data collection form. RESULTS: Three hundred patients with a mean (± SD) age of 56.79 (12.8) years participated in the study. Fifty-eight had hypertension only, 96 had diabetes (Type 1 or 2), and 146 had both hypertension and diabetes. After adjusting for socioeconomic characteristics, multiple linear regression analysis found that adherent patients had significantly higher mean overall perception of QoL and health scores by 14.6 (P = 0.001) and 17.2 (P = 0.001) points, respectively, compared to non-adherent patients. In addition, irrespective of the type of long-term condition, adherence status was found to be an independent predictor of all QoL domains. CONCLUSION: There is an association between medication adherence and QoL among patients with diabetes and/or hypertension attending primary care clinics. Medication adherence should be assessed and emphasised during routine clinical consultations in primary care in order to achieve the desired clinical outcomes and overall well-being of patients.

Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study.

PURPOSE: To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia. PATIENTS AND METHODS: Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data. RESULTS: Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score < 6). Binary regression analysis showed that highly adherent patients (MMAS score = 8) were about five times (OR 4.91 [95%CI: 1.85-12.93; P = 0.01]) more likely to have controlled blood pressure compared to low adherent patients. Female gender (OR 0.40 [95% CI: 0.20-0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04]) were found to be independent predictors of medication adherence. CONCLUSION: Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.