Effect of educational intervention on medication reconciliation practice of hospital pharmacists in a developing country - A non-randomised controlled trial.

BACKGROUND: Medication reconciliation is an evidence-based practice that reduces medication-related harm to patients. This study evaluated the effect of educational intervention on medication reconciliation practice of pharmacists among ambulatory diabetes and hypertensive patients. METHODS: A non-randomized clinical trial on medication reconciliation practice was carried out among 85 and 61 pharmacists at the intervention site and control site, respectively. Medication reconciliation was carried out among 334 (intervention-183; control-151) diabetes and/or hypertensive patients by the principal investigator to indirectly evaluate pharmacists' baseline medication reconciliation practice at both sites. A general educational intervention was carried out among intervention pharmacists. Medication reconciliation was carried out by the principal investigator among another cohort of 96 (intervention-46; control-50) and 90 (intervention-44; control-46) patients at three and six months postintervention, respectively, to indirectly assess pharmacists' postintervention medication reconciliation practice. Thereafter, a focused educational intervention was carried out among 15 of the intervention pharmacists. Three experts in clinical pharmacy analysed the medication reconciliation form filled by the 15 pharmacists after carrying out medication reconciliation on another cohort of 140 patients, after the focused intervention. Data was summarized with descriptive (frequency, percentage, mean ± standard deviation) and inferential (Pearson product-moment correlations analysis, independent-samples t-test and one-way ANOVA) statistics with level of significance set at p<0.05. KEY FINDINGS: Baseline medication reconciliation practice was poor at both sites. Post-general educational intervention, medication discrepancy was significantly reduced by 42.8% at the intervention site (p<0.001). At the intervention site, a significant increase of 54.3% was observed in patients bringing their medication packs for clinic appointments making medication reconciliation easier (p=0.003), at 6-months postintervention. Thirty-five, 66 and 48 drug therapy problems were detected by 31 (43.1%), 33 (66.0%) and 32 (71.1%) intervention pharmacists at 1-, 3- and 6-month post-general educational intervention, respectively. Post-focused educational intervention, out of a total of 695 medications prescribed, 75 (10.8%) medication discrepancies were detected and resolved among 42 (30%) patients by the 15 pharmacists. CONCLUSIONS: The educational interventions improved pharmacists' medication reconciliation practice at the intervention site. It is expected that this research would help create awareness on medication reconciliation among pharmacists in developing countries, with a view to reducing medication-related patient harm.

Interprofessional education and collaborative practice in Nigeria - Pharmacists' and pharmacy students' attitudes and perceptions of the obstacles and recommendations.

INTRODUCTION: Many countries have implemented interprofessional education (IPE) and interprofessional collaborative practice (IPCP), but there is a dearth of information on the state of IPE in Nigeria. We evaluated the attitude of Nigerian pharmacy students and pharmacists towards IPE and IPCP and the perceived barriers to and recommendations for the implementation of IPE and IPCP. METHODS: A cross-sectional survey of 238 community and hospital pharmacists and 765 pharmacy students in Nigeria was conducted with an online questionnaire using the Interprofessional Attitude Scale. Information on the perceived barriers to and recommendations for implementing IPE was also collected. RESULTS: Two hundred and seven pharmacists (87%) and 629 (82.2%) pharmacy students agreed that it is necessary for health profession students to learn together. Perceived barriers to the implementation of IPE and IPCP included professional pride [pharmacists = 51 (21.42%), pharmacy students = 55 (7.19%)], prejudice against other health professions [pharmacists = 35 (14.7%), pharmacy students = 74 (9.67%)], uni-professional training [pharmacists = 5 (2.1%), pharmacy students = 7 (0.92%)], and government policies that discourage IPE and IPCP [pharmacists = 10 (4.2%), pharmacy students = 20 (2.61%)]. Recommendations proposed were the integration of IPE in undergraduate pharmacy curricula, cooperation among health professionals to curb professional rivalry, and the provision of necessary facilities and resources by the government. CONCLUSIONS: Nigerian pharmacists and pharmacy students had positive attitudes towards IPE and IPCP. The perceived barriers to implementing IPE in Nigeria include discouraging government policies. Deliberate and implementable government policies on IPE are needed.

Impact of pharmacists' training on oral anticoagulant counseling: A randomized controlled trial.

OBJECTIVE: The study evaluated the impact of oral anticoagulant counseling training on the quality of counseling provided by pharmacists. METHODS: A prospective RCT was conducted among 33 pharmacists from 23 pharmacies in Ibadan, Nigeria. Six mystery patients (MPs) who were either warfarin-naïve, experienced adverse drug reaction (ADR), or drug interaction (DI) to warfarin were used to assess pharmacists' oral anticoagulant counseling quality at pre- and post-intervention. A 2-week online oral anticoagulant counseling training was given to the intervention group pharmacists. Quality of counseling was categorized as poor (0-20 %), fair (21-50 %), moderate (51-80 %), and optimal (81-100 %). RESULTS: At pre-intervention, the quality of oral anticoagulant counseling provided to the MPs was poor. Post-intervention, the quality improved among pharmacists in the intervention group, from poor to fair for both warfarin-naïve MP and MP who experienced DI, and from fair to moderate for MP with ADR. CONCLUSION: Short-term online oral anticoagulant counseling training improved the quality of counseling provided by community pharmacists to mystery patients on warfarin. PRACTICE IMPLICATION: Online oral anticoagulant counseling training may be employed by pharmacists' professional bodies intermittently to improve oral anticoagulant counseling.

Prevalence and clusters of modifiable cardiovascular disease risk factors among intra-city commercial motor vehicle drivers in a Nigerian metropolitan city.

BACKGROUND: Commercial motor vehicle drivers (CMVDs) have worst health profiles among different occupations, yet the presence of clusters of cardiovascular disease (CVD) risk factors in this group have not been described in a resource-limited setting. OBJECTIVES: The prevalence of CVD risk factors and the clusters among CMVDs was evaluated. DESIGN: A cross-sectional descriptive study. SETTING: Four motor parks in three local government areas of Ibadan city, Nigeria. PARTICIPANTS: Consented and conveniently sampled 152 intra-city CMVDs aged ≥ 18 years. MAIN OUTCOME MEASURES: Prevalence of CVD risk factors (hypertension, diabetes, high triglyceride, low HDLc, high waist-hip ratio, central obesity, physical inactivity, smoking, alcohol, and overweight/obesity) and their clusters were determined. RESULTS: All participants were male from 20 - 77 years old. Most of the CMVDs were physically inactive (80, 52.6%), take alcohol (78, 51.3%), and few smokes (35, 12.4%). The prevalence of hypertension, diabetes, hypertriglyceridemia, obesity, and central obesity were 36.2%, 5.9%, 23.7%, 4.6%, and 5.3%, respectively. Four clusters of CVD risk factors in the CMVDs with the prevalence of 36.2%. 33.5%, 17.1% and 13.2% were identified with significant differences (p<0.05) in the risk factors. CONCLUSION: The prevalence of diabetes, obesity, central obesity, and smoking was low while the prevalence of hypertension and hypertriglyceridemia was moderate among the CMVDs, but the prevalence of alcohol intake and physical inactivity were high. Four distinct clusters of CVD risk factors were observed among the drivers. FUNDING: The study was self-funded.

Management of uncomplicated gastric ulcer in community pharmacy: a pseudo-patient study.

Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists' questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudo-patient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:-Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists' questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients' minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients' minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.