Evaluation and implementation of behavioral and educational tools that improves the patients' intentional and unintentional non-adherence to cardiovascular medications in family medicine clinics.

OBJECTIVE: There are limited number of studies describing the reasons and interventions of non-adherence to cardiovascular medications in United Arab Emirates (UAE). We aimed to implement and evaluate the behavioral and educational tools that indicate the reasons of non-adherence in patients with cardiovascular diseases and improve patient's adherence to their cardiovascular medications. METHODS: In this prospective interventional study, we recruited patients (n = 300) with cardiovascular diseases from three family medicine clinics in Al Ain, UAE in 2010. We assessed patients' responses to a validated brief medication questionnaire (BMQ). RESULTS: At the end of the study, we observed a significant improvement in adherence. When we compared pre- and post-interventions, the mean (± standard deviation, SD) score for non-adherence to current regimen were 4.1 ± 0.2 vs. 3.0 ± 0.3 (p = 0.034); indication of negative believes or motivational barriers scores was 1.8 ± 0.4 vs. 0.9 ± 0.1 (p = 0.027); the indication of recall barrier scores was 1.6 ± 0.1 vs. 0.8 ± 0.1 (p = 0.014); and the indication of access barrier scores was 1.6 ± 0.2 vs. 0.7 ± 0.2 (p = 0.019). Mean blood pressure, fasting blood glucose, glycosylated hemoglobin, low density lipoprotein and postprandial blood glucose decreased significantly (p < 0.01) post-intervention. CONCLUSION: We reported that implemented multifaceted tools targeting patients, provider and healthcare system have improved the adherence to cardiovascular medications. Our interventions managed to improve patients' clinical outcome via improving adherence to prescribed cardiovascular medications.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries.

BACKGROUND: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. METHODS: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs' intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. RESULTS: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. CONCLUSIONS: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

A comparative study between prescribed and over-the-counter antibiotics.

OBJECTIVE: To examine the influence of pharmacists` demographic characteristics on dispensing antibiotics purchased with and without a prescription in the community pharmacies. METHODS: This cross-sectional study was conducted in 24 randomly-selected community pharmacies located in Abu Dhabi, United Arab Emirates between March and September 2009. Data were collected through a closed-structured questionnaire and analyzed using the Statistical Package for Social Sciences Version 17. Descriptive statistics, odds ratios, significance and 95% CI and logistic regression analyses were then used to analyze the resulting data. RESULTS: Participating pharmacists conducted a total of 1645 antibiotic transactions (1211 [73.6%] dispensed with prescriptions versus and 434 [26.4%] without). Gender and socioeconomic status of the patients had a significant effect in acquiring antibiotics without prescription (p=0.012, p=0.001). Clarithromycin (91.5%), cefuroxime (91.3%), and co-amoxiclav (66.4%) were dispensed with prescription. Ceftriaxone (53.3%), amoxicillin (47.8%) and co-amoxiclav (33.6%) were dispensed without prescription. Dispensing of antibiotics with prescription were frequently given a 5, 7, or 10 day regimen, while those without prescription were frequently given 3-7 days duration. Co-amoxiclav for sore throat was commonly dispensed without prescription. Ceftriaxone for sexually transmitted diseases was dispensed at a similar rate, both with and without prescription. CONCLUSION: Dispensing antibiotic without prescription is illegal and alarming. Patient interviews and interventions to improve the current prescribing pattern for both prescribers and pharmacists are highly warranted.

Self-medication with antibiotics by the community of Abu Dhabi Emirate, United Arab Emirates.

BACKGROUND: Self-medication with antibiotics may increase the risk of inappropriate use and the selection of resistant bacteria. The objective of the study was to estimate the prevalence of self-medication with antibiotics in Abu Dhabi. METHODOLOGY: A validated, self-administered questionnaire was used to collect data. Data were analysed using descriptive statistics, and the chi-square test when applicable. One thousand subjects were invited to participate in the study. RESULTS: Eight hundred sixty questionnaires were completed, with a respondent rate of 86%, consisting of 66% males and 34% females. Among the 860 participants, 485 (56%) reported the use of antibiotics within the last year. Amoxicillin was the antibiotic most commonly used (46.3%). The survey showed a significant association between antibiotics used and age group (p < 0.001). Of the participants surveyed, 393 (46%) stated that they intentionally use antibiotics as self-medication without a medical consultation, a behavior that is significantly affected by educational levels (p<0.001). Two hundred forty-five (28%) participants stored antibiotics at home. These antibiotics were mostly acquired from community pharmacies without prescriptions (p<0.001). CONCLUSIONS: The results of this study confirm that antibiotic self-medication is a relatively frequent problem in Abu Dhabi. Interventions are required in order to reduce the frequency of antibiotic misuse.