Prevalence, Associated Risk Factors, and Adverse Cardiovascular Outcomes of Statins Discontinuation: A Systematic Review.

PURPOSE: Statins are widely prescribed for cardiovascular diseases (CVD) prevention; however, a significant proportion of users discontinue the medication for various reasons. This review aimed to determine the prevalence of statin therapy discontinuation, its associated factors, and adverse cardiovascular outcomes within the first year of discontinuation. METHODS: The PubMed, EMBASE, ScienceDirect, SCOPUS, and Google Scholar databases were systematically searched from their inception to December 2022. Manual searches were also conducted on the bibliographies of relevant articles. Studies were included for qualitative data synthesis and assessed for methodological quality. RESULTS: Fifty-two studies, predominantly cohort studies (n = 38), involving 4 277 061 participants were included. The prevalence of statin discontinuation within the first year of statin initiation ranged from 0.8% to 70.5%, which was higher for primary prevention indications. Factors frequently associated with an increased likelihood of statin discontinuation included male sex, nonWhite ethnicity, smoking status, and being uninsured. Conversely, discontinuation was less likely in patients with CVD who received secondary prevention statin therapy and in patients with polypharmacy. Furthermore, age showed diverse and inconsistent relationships with statin discontinuation among various age categories. Five studies that reported the cardiovascular risk of statin discontinuation within the first year of initiation showed significantly increased risk of discontinuation, including all-cause mortality (hazard ratio: 1.36-3.65). CONCLUSION: Our findings indicate a high prevalence of statin discontinuation and an increased likelihood of adverse cardiovascular outcomes within the first year of discontinuation, despite wide variability across published studies. This review highlights the importance of addressing the modifiable risk factors associated with statin discontinuation, such as smoking and lack of insurance coverage.

Pharmacy Students' Perception of the Content and Delivery of Drug Information Training: A Mixed-Methods Study.

OBJECTIVE: To explore the pharmacy students' perception of the content and pedagogical strategies used for the delivery of drug information (DI) training. METHODS: An explanatory sequential mixed-methods study was conducted among BSc Pharmacy and PharmD students at the College of Pharmacy, Qatar University. The first phase consisted of a quantitative cross-sectional survey using a 34-item pretested questionnaire. The Donabedian framework guided the development of the questionnaire. This was followed by a phenomenological qualitative phase that was conducted based on the result of the first phase. Descriptive statistics and thematic content analysis were used for data analyses. RESULTS: The completion and usable rates were 88.7% (102 of 115) and 91.2% (93 of 102) respectively. The online resources used for the delivery of DI and the progressive structuring from year 1 to 4 were reported to be adequate by a majority of the respondents (93.55%). Ninety percent of the students opined that the use of simulation-based assessments improved their integration of the theoretical and practical aspects, and their preparedness to apply the DI concepts in practice. However, 20% of the participants reported inconsistency of the DI curricular content with some practices encountered during their experiential learning exposures. The themes identified from the focus group discussion included the perceived value and skills acquired from the DI content, availability and currency of DI resources, students' preparedness, curricular structuring of DI content, and reflection on and recommendations to improve DI coverage and delivery. CONCLUSION: The curricular structuring of the DI content across varieties of relevant undergraduate pharmacy courses from the lower to higher professional years and its focus on the progressive development of DI-related competencies appeared to have enhanced the students' perception of the relevance, appropriateness, and utility of the content, resources, and pedagogical strategies used for the delivery of DI education at the undergraduate level.

Pharmaceutical care education at pharmacy colleges in the Middle East and North Africa region: A systematic review.

WHAT IS KNOWN AND OBJECTIVE: New pharmacy curricula include content that equip students with a bundle of professional and interpersonal skills that allows the provision of evidence-based patient-centred pharmaceutical care (PC). PC has been adopted as a practise model underpinning these new roles for pharmacists in developed countries. However, anecdotal evidence suggests that countries in the Middle East/North Africa (MENA) region have been relatively slow in including PC in pharmacy education. There seems to be a need to more accurately describe the extent to which PC is included in pharmacy education in the MENA region. The objective of this systematic review was (a) to determine the status of PC education in schools and colleges of pharmacy in the MENA region and (b) to identify pharmacy students' and/or educators' perceptions and attitudes towards PC, preparedness level to PC provision and perceived barriers to implement this practise model in countries of the MENA region. METHODS: A comprehensive literature search was conducted using MEDLINE, EMBASE, SCOPUS, International Pharmaceutical Abstract and ProQuest databases to identify articles published from 2000 to 2021. Selection of studies for inclusion in the review was based on a pre-determined eligibility criterion to retrieve original research articles addressing the review objectives. RESULTS: Nine articles were eligible for inclusion in the review. The majority of the studies (n = 8) employed a survey-based research method. The studies were conducted in Jordan (n = 4), Kuwait (n = 2), Qatar (n = 2), Saudi Arabia (n = 1) and United Arab Emirates (n = 1). The findings suggest that pharmacy students had overall positive attitude and perception towards PC and some studies reported that students expressed good preparedness levels to implement most of the PC aspects. Several barriers to the implementation of PC were reported such as the slow educational reforms in pharmacy programs and a number of organizational and professional barriers. The studies provided recommendations for improvements in the pharmacy curricula to support pharmacy students' preparation to become competent PC practitioners. WHAT IS NEW AND CONCLUSION: The literature describing PC education in the MENA region is limited. Joint efforts among educational institutions and health authorities are needed to support PC implementation. There is a need to conduct further research to explore the status of PC education and practise in the different countries within the MENA region. This can drive future directions of pharmacy education to meet the needs of the pharmacy profession and healthcare systems in these countries.

The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students' and recent alumni's perceptions using mixed-methods approach.

BACKGROUND: The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students' perspective towards the utilization of SPs in Qatar and to identify areas that require improvement. METHODS: An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases. RESULTS: The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs' roles, communication and language barriers, simulations of real-life case scenarios, SPs' competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria. CONCLUSION: This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.

Evidence of community pharmacists' response preparedness during COVID-19 public health crisis: A cross-sectional study.

INTRODUCTION: Community pharmacists are often the first point of contact for the public, especially during pandemics. As outlined by the International Pharmaceutical Federation, community pharmacists have an important public health role during this Coronavirus Disease 2019 (COVID-19) public health emergency. We therefore investigated the current practices, response preparedness and professional development needs of community pharmacists in Qatar. METHODOLOGY: A descriptive cross-sectional online 38-item questionnaire-based survey constructed on evidence-based public health roles of pharmacists was conducted between 28 May and 18 June 2020. Questions related to current practices required responses on a 5-point Likert-type scale ranging from "always" to "never". The questionnaire was evaluated for validity and the reliability analysis showed a Cronbach's alpha coefficient of 0.921. RESULTS: The response (n = 311) rate for the survey was 34.2%. More than 75% of pharmacists "always" encouraged and practiced hygiene and social distancing measures. On the other hand, the proportion of pharmacists "always" involved in patient assessment, education or providing information related to COVID-19 and application of evidence-based protocol ranged from 32 to 73%. The vast majority (87-96%) of pharmacists indicated that they needed professional development related to COVID-19. Overall, 77% of pharmacists either "strongly agreed" or "agreed" that they have all the necessary COVID-19 related emergency response preparedness and training. Country from which pharmacists obtained their first degree, and the type of pharmacy where they practice influenced their overall perception toward emergency response preparedness. CONCLUSIONS: Community pharmacists in Qatar are willing to receive additional training related to COVID-19 public health crisis despite being prepared to engage with patients.