Understanding the influence of ethnicity on adherence to antidiabetic medication: Meta-ethnography and systematic review.

INTRODUCTION: A high prevalence of diabetes and diabetes-related complications in people from minority ethnic communities in high income countries is of significant concern. Several studies have indicated low adherence rates to antidiabetic medication in ethnic minority groups. Poor adherence to antidiabetic medication leads to a higher risk of complications and potential mortality. This review aims to qualitatively explore the barriers to and facilitators of adherence to antidiabetic medication among ethnic minority groups in high-income countries. METHODS: A comprehensive search of MEDLINE, Embase, CINAHL, PsycINFO, and Global Health databases for qualitative studies exploring the barriers to or facilitators of adherence to antidiabetic medication in minority ethnic groups was conducted from database inception to March 2023 (PROSPERO CRD42022320681). A quality assessment of the included studies was conducted using the Critical Appraisal Skills Programme (CASP) tool. Key concepts and themes from relevant studies were synthesised using a meta-ethnographic approach. The Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used to assess the Confidence in the review findings. RESULT: Of 13,994 citations screened, 21 studies that included primary qualitative studies were selected, each of which involved people from minority ethnic communities from eight high income countries. This qualitative evidence synthesis has identified three overarching themes around the barriers to and facilitators of adherence to antidiabetic medication among ethnic minority groups.: 1) cultural underpinnings, 2) communication and building relationships, and 3) managing diabetes during visiting home countries. Based on the GRADE-CERQual assessment, we had mainly moderate- and high-confidence findings. CONCLUSION: Multiple barriers and facilitators of adherence to antidiabetic medication among people from minority ethnic communities in high-income countries have been identified. A medication adherence intervention focusing on identified barriers to adherence to antidiabetic medication in these communities may help in improving diabetes outcomes in these groups.

Ethnic disparities in medication adherence? A systematic review examining the association between ethnicity and antidiabetic medication adherence.

OBJECTIVES: Adherence to prescribed medication is an essential component of diabetes management to obtain optimal outcomes. Understanding the relationship between medication adherence and ethnicity is key to optimising treatment for all people with different chronic illnesses, including those with diabetes. The aim of this review is to examine whether the adherence to antidiabetic medications differed by ethnicity among people with diabetes. METHODS: A systematic review was conducted of studies reporting adherence to antidiabetic medication amongst people from different ethnic groups. MEDLINE, Embase, CINAHL, and PsycINFO were searched from their inception to June 2022 for quantitative studies with a specific focus on studies assessing adherence to antidiabetic medications (PROSPERO: CRD42021278392). The Joanna Briggs Institute critical appraisal checklist and a second checklist designed for studies using retrospective databases were used to assess study quality. A narrative synthesis approach was used to summarize the results based on the medication adherence measures. RESULTS: Of 17,410 citations screened, 41 studies that included observational retrospective database research and cross-sectional studies were selected, each of which involved diverse ethnic groups from different settings. This review identified a difference in the adherence to antidiabetic medications by ethnicity in 38 studies, despite adjustment for several confounding variables that may otherwise explain these differences. CONCLUSION: This review revealed that adherence to antidiabetic medication differed by ethnicity. Further research is needed to explore the ethnicity-related factors that may provide an explanation for these disparities.

Pharmacy workforce in Saudi Arabia: Challenges and opportunities: A cross-sectional study.

BACKGROUND: Saudi Arabia has shown rapid growth in its pharmacy workforce and pharmacy education over the last decade. The health indicators demonstrate an increased need for medications and, thus, the accessibility of pharmacies. Since pharmacists are considered the most accessible health care professionals, the country has experienced a continuous demand to produce more pharmacists. OBJECTIVES: The objectives of the study are to evaluate the pharmacy workforce in Saudi Arabia and to identify pharmaceutical manpower issues. METHODS: A retrospective cross-sectional approach was used. Data were obtained from the latest version of the Health Statistical Yearbook-Kingdom of Saudi Arabia, 2016; Saudi Commission for Health Specialties publications, 2018. RESULTS: In general, the exponential increase in the number of pharmacy schools has produced more pharmacists in the rural areas of the country, but inequitable distribution of the workforce still exists. The reliance on nonindigenous pharmacists, especially in the private sector, is substantial. Employed male pharmacists outnumber females, mainly due to the cultural and social factors that limit the participation of women in community pharmacy, which is the largest employment sector. The employment rate shows limited opportunities for Saudi pharmacists at MOH, as they have already Saudised almost all pharmacy positions at their health care facilities. However, the private sector needs to assume responsibility for their share of the renationalisation of the profession in order to provide jobs for local pharmacists. CONCLUSIONS: Regular, more detailed profiling of the pharmacy workforce is an essential step to achieving effective pharmacy workforce planning. Currently, a large gap exists in our knowledge of the country's workforce.

Utilization and adherence to guideline-recommended lipid-lowering therapy at an academic medical center.

BACKGROUND: Clinical guidelines for managing blood cholesterol were updated in November 2013. OBJECTIVE: To evaluate the adherence to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations for statin therapy in the treatment of elevated blood cholesterol in high-risk patients. DESIGN: A single-center, retrospective, observational study. SETTING: A tertiary care academic medical center in Riyadh, Saudi Arabia. PATIENTS: Consecutive adult patients discharged with a prescription for any of the statin medications group between 1 June 2015 and 31 December 2015. MAIN OUTCOME MEASURE(S): Adherence to the 2013 ACC/AHA guidelines for management of cholesterol by statin therapy in high-risk patients. RESULTS: Of 1094 patients, 753 (68.8%) met the inclusion criteria of the study. Of these 753 patients, 53.5% had atherosclerotic cardiovascular diseases; 29.2% had diabetes; 0.9% had an LDL-C level > 190 mg/dL; 10.8% had an estimated 10-year risk > 7.5%; and 4.9% had no risk. Two hundred and eight (27.6%) patients received statin therapy at an inappropriate intensity according to their risk group based on the guideline; 126 (16.7%) received less than the ideal intensity. CONCLUSION: Approximately one-third of patients received statin therapy at an inappropriate intensity according to the guideline recommendation. Wide application of the 2013 ACC/AHA cholesterol guidelines in our practice would optimize the utilization of statin therapy at the ideal intensity in high-risk patients. LIMITATION: Drug-drug interactions and intolerance to statin therapy were not considered when we evaluated adherence among high-risk patients.