Management of potentially inappropriate medication use among older adult's patients in primary care settings: description of an interventional prospective non-randomized study.

BACKGROUND: The management of inappropriate medication use in older patients suffering from multimorbidity and polymedication is a major healthcare challenge. In a primary care setting, a medication review is an effective tool through which a pharmacist can collaborate with a practitioner to detect inappropriate drug use. AIM: This project described the implementation of a systematic process for the management of potentially inappropriate medication use among Lebanese older adults. Its aim was to involve pharmacists in geriatric care and to suggest treatment optimization through the analysis of prescriptions using explicit and implicit criteria. METHOD: This study evaluated the medications of patients over 65 years taking a minimum of five chronic medications a day in different regions of Lebanon. Descriptive statistics for all the included variables using mean and standard deviation (Mean (SD)) for continuous variables and frequency and percentage (n, (%)) for multinomial variables were then performed. RESULTS: A total of 850 patients (50.7% women, 28.6% frail, 75.7 (8.01) mean age (SD)) were included in this study. The mean number of drugs per prescription was 7.10 (2.45). Roughly 88% of patients (n = 748) had at least one potentially inappropriate drug prescription: 66.4% and 64.4% of the patients had at least 1 drug with an unfavorable benefit-to-risk ratio according to Beers and EU(7)-PIM respectively. Nearly 50.4% of patients took at least one medication with no indication. The pharmacists recommended discontinuing medication for 76.5% of the cases of drug related problems. 26.6% of the overall proposed interventions were implemented. DISCUSSION: The rate of potentially inappropriate drug prescribing (PIDP) (88%) was higher than the rates previously reported in Europe, US, and Canada. It was also higher than studies conducted in Lebanon where it varied from 22.4 to 80% depending on the explicit criteria used, the settings, and the medical conditions of the patients. We used both implicit and explicit criteria with five different lists to improve the detection of all types of inappropriate medication use since Lebanon obtains drugs from many different sources. Another potential source for variation is the lack of a standardized process for the assessment of outpatient medication use in the elderly. CONCLUSION: The prevalence PIDP detected in the sample was higher than the percentages reported in previous literature. Systematic review of prescriptions has the capacity to identify and resolve pharmaceutical care issues thus improving geriatric care.

Evaluating the influence of a 3-min online video on the community knowledge of stroke in four Arab countries.

Introduction: Studies from developed and developing countries showed that the knowledge levels of stroke need improvement. Educational campaigns varied and were of limited influence predominantly because of their short duration and the need for financial support. The study aims to test the impact of a 3-min online video on the knowledge of stroke and factors influencing the knowledge score in four Arab countries. Methods: A cross-sectional web-based pre-post study was conducted in Egypt, Jordan, Lebanon, and the United Arab Emirates. The data were collected using the snowball technique. Participants were adults aged 18 years and above. The questionnaire sequence was conducting a pretest, followed by the educational video explaining stroke occurrence, types, risks, warning signs, preventive measures, and treatment, and finally, a posttest to evaluate the differences in knowledge from baseline. Statistical analysis included paired t-tests comparing pre-post-education stroke knowledge scores, while repeated measures ANOVA, adjusting for covariates, assessed mean changes. Results: The total number of participants was 2,721, mainly younger than 55 years. The majority had a university degree and were not healthcare professionals. A significant improvement was noted in the total knowledge score in all countries from a mean average (Mpretest = 21.11; Mposttest = 23.70) with p < 0.001. Identification of the stroke risks (Mpretest = 7.40; Mposttest = 8.75) and warning signs (Mpretest = 4.19; Mposttest = 4.94), understanding the preventive measures (Mpretest = 5.27; Mposttest = 5.39) and the importance of acting fast (Mpretest = 0.82; Mposttest = 0.85) improved from baseline with (p < 0.001) for all score components. Conclusion: The educational tool successfully enhanced public understanding of stroke risks, the identification of stroke signs, and the critical need for emergency action. The advantages of this video include its short length, free online access, use of evidence-based content in lay language, and reflective images. The ultimate goal remains the long-term improvement of sustainability by mandating full-scale trials.

Moderating effect of work fatigue on the association between resilience and posttraumatic stress symptoms: a cross-sectional multi-country study among pharmacists during the COVID-19 pandemic.

INTRODUCTION: In the context of the COVID-19 pandemic, pharmacists, despite their vital contributions, have faced significant challenges that have impacted their mental well-being, potentially leading to the development of Post-Traumatic Stress symptoms (PTSS). The aim of this study was to investigate the role of work-related fatigue as a potential moderator in the relationship between pharmacists' resilience and their likelihood of experiencing PTSS during the COVID-19 pandemic. METHODS: A cross-sectional survey was conducted online in eight countries from January to December 2021, including Brazil, Lebanon, Nigeria, Pakistan, Poland, Serbia, and Tunisia. The mediation analysis was conducted using PROCESS MACRO (an SPSS add-on) v3.4 model 1, taking work fatigue as a moderator in the association between resilience and PTSS. RESULTS: A total of 442 pharmacists were enrolled in this study (mean age = 33.91 ± 10.36 years) with 59.5% of them being females. The results were adjusted over country, gender, working in contact with COVID-19, working patients, working mandatory hours, working voluntary hours, age, household crowding index and number of months engaged in COVID-19. The interactions resilience by physical (Beta = 0.02; p = .029), mental (Beta = 0.02; p = .040) and emotional (Beta = 0.03; p = .008) work fatigue were significantly associated with PTSS; for pharmacists with low to moderate levels of physical (Beta = - 0.33; p < .001 and Beta = - 0.21; p = .001), mental (Beta = - 0.29; p < .001 and Beta = - 0.18; p = .006) and emotional (Beta = - 0.31; p < .001 and Beta = - 0.17; p = .008) work fatigue, higher resilience was significantly related to lower PTSS levels. However, for pharmacists with high levels of physical/mental/emotional work fatigue, the association between resilience and PTSS became non-significant. CONCLUSION: This study highlights the complex relationship between work-related fatigue, resilience, and PTSS in pharmacists. It emphasizes the need to address work-related fatigue for pharmacists' psychological well-being during crises, offering insights for tailored support and interventions.

Knowledge and Awareness of Stroke among the Elderly Population: Analysis of Data from a Sample of Older Adults in a Developing Country.

Background and Objectives: Stroke prevention has traditionally concentrated on research to improve knowledge and awareness of the disease in the general population. Since stroke incidents increase with age, there is a need to focus on the elderly, a high-risk group for developing the disease. This study aimed to examine the level of stroke awareness and knowledge, their predictors, and their source of information. Materials and Methods: A prospective cross-sectional study targeted Lebanese senior citizens aged 65 years and above. A total of 513 participants enrolled in the study through a self-administered survey distributed using a snowball sampling technique. Results: Most participants had appropriate baseline knowledge (more than 75% correct answers) of stroke, including risk factors, alarming signs, and preventive measures. Better knowledge of disease risks was significantly associated with having a university degree (ORa = 1.609; p = 0.029). Participants who had previous ischemic attacks showed significantly lower knowledge of the alarming signs (ORa = 0.467; p = 0.036) and prevention measures (ORa = 0.427; p = 0.029). Those suffering from depression had better knowledge of stroke alarming signs (ORa = 2.060.; p = 0.050). Seeking information from pharmacists, physicians, or the internet was not significantly associated with better knowledge of stroke risks, alarming signs, and preventive measures. Conclusions: The present study showed that seniors had fair knowledge of stroke, despite gaps in stroke prevention measures. Healthcare providers could play a leading role in improving public health by educating seniors to enhance awareness about prevention measures, detecting alarming signs, and acting fast to save a life.

Impact of pharmacist-led interventions on patient care in ambulatory care settings: A systematic review.

BACKGROUND: In an era of rapid evolution in healthcare delivery, major changes have occurred within the profession of pharmacist. Because the impact of pharmacist-led interventions in the hospital setting has been well-studied and showed mixed findings on drug-related readmissions, all-cause emergency department visits and mortality, this systematic review focused on services provided by pharmacists in the community or ambulatory care setting without being limited to a specific intervention or outcome. OBJECTIVE: To investigate the impact of pharmacist-led interventions, categorised into clinical medication review (CMR), adherence review (AR), and prescription review (PR) on various aspects of patient care (clinical, behavioural, economic and humanistic outcomes in ambulatory care setting) and understand which particular intervention makes the greatest contribution. METHODS: A literature search was conducted using MEDLINE, Embase and the Cochrane Library for publications from 2000 onwards. FINDINGS AND INTERPRETATION: A total of 31 relevant publications corresponding to 27 controlled trials (CTs) and 4 observational studies were selected. CMR was the most studied pharmacist-led intervention (n = 19, 61.29%), followed by AR (n = 6, 19.3%). CMR demonstrated a favourable effect on different clinical outcomes mainly the management of drug-related problems and adverse events, and it also contributed the most to the reduction of healthcare costs. AR was the most effective intervention to improve patient's adherence. CMR alone or combined with AR both raised equally the patient's satisfaction. CONCLUSION: Our results showed that CMR can play a major role in the management of drug-related problems and economic issues. AR can significantly improve patient compliance. Larger, standardised and rigorously designed intervention studies are needed to help decision-makers to select appropriate interventions leading to meaningful improvements in patient care.