A qualitative focus on community pharmacists’ attitudes and barriers toward continuing professional development: implications for professional practice

Background: Continuing professional development and continuing education are important components of professional practice for pharmacists. Mandatory continuing professional development requirements have been introduced in several countries, including Jordan. However, information on the uptake of continuing professional development is lacking, particularly in the Jordanian context. Objective: This study’s principal aim was to investigate community pharmacists’ views of continuing professional development and to explore pharmacists’ perceptions of the most common facilitators and barriers to participation in continuing education. Methods: A series of seven focus group sessions were undertaken with groups of four to seven community pharmacists. Focus group transcripts were thematically analyzed using a qualitative data analysis method. Results: The study included 34 pharmacists out of 95 who received invitation letters. Four key themes were identified: (1) community pharmacists’ attitudes toward continuing professional development; (2) perceived motivating factors for continuing professional development; (3) experienced barriers to continuing professional development; (4) and potential strategies for improving pharmacists’ continuing professional development. In terms of attitudes, participants generally understood the concept of continuing professional development. Motivating factors were mainly attributed to personal, work-related, and service provision-related factors. However, experienced barriers that could prevent community pharmacists from participating in continuing professional development despite their motivation were: barriers pertaining to workload, barriers pertaining to pharmacists, and barriers related to lack of resources. (AU)

Incidence, predictors, clinical outcomes, and economic burden of recurrent acute kidney injury: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the incidence, predictors, mortality, and economic outcomes of recurrent Acute kidney injury (AKI) in Jordan. METHODS: This was a retrospective cohort study that included adult patients who were admitted with AKI to university hospitals in the country from 2010-2019. Recurrent episodes of AKI, laboratory data, baseline medication list, and death dates were retrieved from patient's medical records. The incidence rate of recurrent AKI was estimated. Predictors of recurrent AKI and mortality during the five years post-discharge was evaluated. Total admission charges were described and evaluated in total and by service provided. RESULTS: Among 1162 AKI patients, 57 patients (4.9%) died during the index admission (first admission during the study period), and among the survivors, 220 patients were re-hospitalized with a recurrent AKI during five years of follow-up. Patients with higher discharge serum creatinine level (SCr) at index admission had higher odds of AKI recurrence (OR = 1.001). Patients who were on respiratory, antineoplastic, or anticoagulant medications were also more susceptible to recurrence; ORs were 1.69, 2.77, and 4.16, respectively. Patients who were elderly, with recurrent AKI episodes, or with a more extended hospital stay at index admission were more likely to die during the five years post discharge. The median charge of recurrent admissions was higher than the median charge of the index admissions; 1519.17 JOD ($2142.7) versus 1362.85 JOD ($1922.2), respectively. CONCLUSIONS: Recurrent AKI is associated with increased mortality and health expenditures. Higher discharge SCr levels at index admission, and chronic comorbidities are associated with a higher likelihood of AKI recurrence.

Capacity Building for Health Technology Assessment in Jordan: Institutionalization and Its Use in Pricing and Reimbursement Decisions.

OBJECTIVES: This study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions. HTA CAPACITY BUILDING: University-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA INSTITUTIONALIZATION AND ITS USE IN PRICING AND REIMBURSEMENT DECISIONS: Institutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration's pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet. RECOMMENDATIONS AND FUTURE DIRECTIONS: Over the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.

Feasibility of using simulated patients for onsite structured practice feedback in Jordanian community pharmacy settings.

Simulated patient (SP) visits followed with structured feedback is useful to outline training needs as well as preference for continuing professional education in community pharmacy settings. This study aimed to investigate community pharmacists' management of an over-the-counter (OTC) product request and feasibility of immediate SP feedback in Jordan. Four trained SP visited a sample of pharmacies in three main urban cities in Jordan requesting an antacid. Information request and professional behavior as well as content of information were evaluated. The SP provided structured immediate feedback. The pharmacy staff views on the visit and usefulness of the feedback were collected. A total of 57 visits were conducted. The average duration of SP visits was 1.55 min. The average score (±SD) for information seeking behavior was 16% (±7) and for professional behavior was 56% (±15). The average score for information provision provided spontaneously was 17.1% (±12). Upon demand by the SP; the average score for information improved to 47.6 (±18). Non-pharmacological advice was not offered often; only 6 (10.5%) visits. Written information was provided in 10 (17.5%) visits. Immediate feedback was accepted by all visited pharmacies. Participants expressed positive views about the SP visit and usefulness of the feedback. Community pharmacists supplied OTC drug without carful screening of symptoms and essential information. The SP approach with immediate feedback was shown feasible and well accepted. Further potential for use of SP with feedback formally in practice and professional development should be explored in future studies.

Hospital unit costs in Jordan: insights from a country facing competing health demands and striving for universal health coverage.

BACKGROUND: Public providers in Jordan are facing increasing health demands due to human crises. This study aimed to benchmark the unit costs of hospital services in public providers in Jordan to provide insights into the outlook for public health care costs. METHODS: The unit costs of hospital services per admission, inpatient days, outpatient visits, emergency visits and surgical operations were estimated using the standard average costing method (top-down) for the fiscal year 2018-2019. The unit costs per inpatient day were estimated for nine specialities and staff in Jordanian dinars (exchange rate JOD 1 = USD 1.41). RESULTS: The average unit cost per admission in Jordan was JOD 782.300 (USD 1101.80), the per inpatient day cost was JOD 236.600 (USD 333.20), the per bed day cost was JOD 172.900 (USD 244.90), the per outpatient visit cost was JOD 58.400 (USD 82.30), the per operation cost was JOD 449.600 (USD 633.20) and the per emergency room visit cost was JOD 31.800 (USD 44.80). The specialities of ICU/CCU and OB/GYN presented the highest unit costs per inpatient day across providers: JOD 377.800 (USD 532.90) and JOD 362.600 (USD 510.70), respectively. The average salaried unit cost of staff depended mainly on year of employment. Nonetheless, the unit costs varied depending on the service utilization, type of service and organizational outlet. CONCLUSIONS: Knowledge of how unit costs vary across public providers in Jordan is essential to outline cost control strategies and inform future research. Institutionalization of the cost information system and high-level governmental support are necessary to generate a routine practice of collecting and sharing cost information.

Assessing content and factors influencing responses to information requests in community pharmacies in Jordan: A simulated patients study.

OBJECTIVES: To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content. METHODS: A cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated. RESULTS: A total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35-39 and those with 6-10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively. CONCLUSIONS: Information provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.

Perceived Public Stress Among Jordanians During the COVID-19 Outbreak.

OBJECTIVES: Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak. METHODS: Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS. RESULTS: The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student's worry regarding their studies/graduation. Perceived stress was decreased if participants' self-rated health status score increased. CONCLUSIONS: In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

Epidemiology of women diagnosed with breast cancer in Jordan: A 5-year survival analysis and patients' characteristics from 2 public hospitals.

OBJECTIVES: To evaluate the epidemiology, prognostic factors, and 5-year overall survival (OS) of females with breast cancer (BC) diagnosed between 2011 and 2014 in Jordan. METHODS: A retrospective medical review of females who were diagnosed with BC between 2011 and 2014 at the 2 leading public health providers in Jordan was performed. The endpoint of the study was 2018. Data were extracted from the medical files between 2011 and 2018, including demographic clinical data on the patient level. Survival by age, laterality, grade, stage, and treatments modes were calculated by the Kaplan Meier method. RESULTS: A total of 877 women were included with median age of 51 years and follow-up duration of 2.4 years. Majority of the patients had ductal carcinoma and estrogen receptor (ER) positive type. The 5-year OS for patients with stage I, II, III, and IV, 94%, 86%, and 46% (p<0.001), respectively. The tumor stage and nodal status were the main prognostic variables affecting the overall survival. CONCLUSION: The incidence in Jordan is increasing, yet survival rates are improving with increased diagnosis during early stages. Therefore, strategies for implementing universal screening programs are advocated to improve clinical outcomes and to reduce the disease burden.

Awareness, knowledge, and attitudes of health professions students toward health economics and pharmacoeconomics education in Jordan.

INTRODUCTION: Health economics education (HEe) and pharmacoeconomics education (PEe) in the Middle East and North Africa area is growing, particularly in pharmacy education. Little is known about the awareness, knowledge, and attitudes of health professions students toward health economics (HE) and pharmacoeconomics (PE) and the extent of education they receive before joining the workforce. METHODS: A self-completed validated questionnaire was distributed to students from medical, dental, pharmacy, and nursing schools in Jordan. The questionnaire assessed awareness, knowledge, and attitudes about HE and PE terminologies, applications, and need for training. Chi-square and Kruskal-Wallis H tests were used to outline the differences between students' responses. RESULTS: A total of 2648 questionnaires were analysed, representing 586 medical, 414 dental, 1080 pharmacy, and 568 nursing students. Approximately 65% of respondents reported they had heard of HE or PE. Supportive views about the necessity for economic education in healthcare professions curricula were reported. Nursing students most often expressed desire to undertake training before graduation while dental students showed the least interest. CONCLUSIONS: Students across health professions groups acquire various extents of HEe and PEe before graduation. Pharmacy schools demonstrated leading interest and progress in providing PEe in Jordan, and medical schools appeared to follow. Both dental and nursing schools were lagging. Regional support from the International Society for Pharmacoeconomics and Outcomes Research Arabic Network, accreditation, and regulatory requirements are leading social and contextual contributors to PEe in Jordan.

Role of Pharmacists in COVID-19 Disease: A Jordanian Perspective.

OBJECTIVES: The novel 2019 coronavirus outbreak that first appeared in Wuhan has quickly gained global attention, due to its high transmissibility and devastating clinical and economic outcomes. The aim of this study was to assess the possible roles of Jordanian pharmacists in minimizing the stage of community transmission. METHODS: A cross-sectional survey using Google forms targeting Jordanian pharmacists was conducted during March 2020 and distributed electronically by means of social media. Using the survey tool, we measured the pharmacists' knowledge, the educative activities they perform, and their perceptions regarding undertaking traditional and untraditional roles during the COVID-19 outbreak, as specified by the International Pharmaceutical Federation (FIP). Collected data were analyzed using SPSS version-19. RESULTS: Jordanian pharmacists (n = 449) reported performing various educative activities, and in general, they were knowledgeable about various aspects of the COVID-19 disease (median knowledge score: 20 [range, 13-25]), but certain gaps in knowledge were detected that must be addressed. Pharmacists had positive perceptions about both their traditional and untraditional roles specified by the FIP, the median perceptions score was 4 (range, 1-5). CONCLUSIONS: Jordanian pharmacists can be used to reduce community transmission of the outbreak. However, more actions are required to keep pharmacists knowledgeable with recent disease updates to enable them to perform their tasks effectively during times of crisis.

Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach.

Insomnia is one of the most common minor ailments to which patients seek advice in a community pharmacy setting. Due to the availability of a wide variety of over-the-counter (OTC) products, community pharmacists are in the front line to safe-guard patients looking for self-medication or advice for treatment of insomnia. The purpose of this study was to assess the content of community pharmacists' interactions with patients seeking advice for insomnia in Jordan. A cross-sectional study using a simulated patient methodology was conducted across a stratified convenience sample of community pharmacies in three major cities in Jordan. The visits were evaluated using pre-defined criteria adapted from published literature relating to content and counseling skills. Visits were audio-recorded using a hidden microphone and the simulated patient completed a data collection form immediately after each visit. A total of 67 community pharmacies (response rate = 93.0%) agreed to participate and were all visited once by the simulated patient. The median duration of the visit was 2 minutes (range: 0.2-4 minutes). The majority (86.6%) of visits resulted in the sale of a drug, most commonly a combination product (paracetamol and diphenhydramine) for 30 recommendations (44.8%). This was followed by a natural plant extract combination product, namely valerian and lemon balm (Melissa officinalis L.) for 23 (34.3%). Pharmacists often did not question medical history or other symptoms prior to product sale. Frequently, the recommended dose (49.3%) and administration time (38.8%) were the only information provided to the patient. No information was provided in relation to potential drug interactions or contraindications. No advice was offered on lifestyle or good sleeping hygiene. This study provided evidence that community pharmacists in Jordan in general did not offer adequate counseling for patients seeking advice for insomnia. Exploration of the reasons and factors contributing to this practice and highlighting professional opportunity and responsibility is recommended.

Use of secret simulated patient followed by workshop based education to assess and improve inhaler counseling in community pharmacy in Jordan

OBJECTIVES: To assess inhaler technique demonstration skills of community pharmacists located in Amman, Jordan via incorporating the trained secret simulated patient (SSP) approach. Secondly, to evaluate the effectiveness of a 2-hour educational workshop focused on SSP feedback. METHODS: This cross-sectional study involved community pharmacies located in Amman, Jordan. Initially, a trained SSP was involved to enact baseline visits requesting advice on how to use Ventolin(R) (a pressurized metered-dose inhaler; pMDI) and Pulmicort(R) (a Turbohaler inhaler, TH). Immediately after each visit, the SSP completed an inhaler technique evaluation form with inhaler checklists based on previously published checklists (consisting of 9 and 10 items for pMDI and TH respectively). The SSP invited all participating pharmacists to a 2-hour workshop that included feedback on their demonstration skills, and the second evaluation of their inhaler technique. The workshop included a summary of the initial visits' results highlighting pharmacists' performance. RESULTS: Sixty pharmacies were visited and 120 inhaler assessments were completed. During baseline assessment, pharmacists scored an average of 4.5 out of 9 for pMDI and 4.9 out of 10 for TH. Only 11 pharmacists (18.3%) attended the workshop. During the workshop, inhaler technique demonstration skills significantly improved, as scores improved from 5.4 (SD 1.6) to 7.8 (SD 0.9) (p = 0.008) and from 4.6 (SD 2.5) to 9.9 (SD 0.6) (p = 0.003) for pMDI and TH respectively. CONCLUSIONS: The SSP approach revealed a lack of ability to demonstrate correct inhaler technique for pMDI and TH inhalers by community pharmacists in Amman, Jordan. A focused educational workshop based on SSP feedback improved inhaler technique significantly

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Patients' attitude and willingness to pay for pharmaceutical care: An international message from a developing country.

BACKGROUND: Since patients are essential partners in determining priorities and resource allocation in the healthcare system, considerable efforts have been made to shift the focus of pharmacy profession from drug dispensing to patient-oriented care. Accordingly, the assessment of patient-oriented care has become a prominent method to evaluate the quality of the healthcare services delivered and willingness to pay (WTP) to receive them. OBJECTIVE(S): To determine patients' attitude towards pharmaceutical care services among general population in Jordan and their WTP for this service. METHODS: A cross-sectional study was conducted in a teaching hospital in Jordan over a period of six months. A contingent valuation method was used, with closed-ended questions to elicit participants' attitudes and WTP for pharmaceutical care services. RESULTS: A total of 223 participants were interviewed. Most of the participants showed a positive attitude towards pharmaceutical care services, with an average attitude score of 0.82 (±0.19). Almost 96.0% of participants believed that pharmacists must be committed to more counseling roles than dispensary activities. The majority of participants (194, 87.0%) expressed their interest in pharmacists checking their medications at least once per month. Most of the participants (212, (95.1%) believed that the pharmacist should be reimbursed for providing a pharmaceutical care service that would potentially reduce medication-related problems (MRPs) by 50%. Of these, 208 (93.3%) participants were willing to pay out of their pockets an average maximum amount of $3.95 (±4.23) for the pharmaceutical care services they may receive to reduce 50% of the risk of MRPs. CONCLUSIONS: This study revealed that Jordanian people have a supportive attitude regarding pharmacists' abilities in providing pharmaceutical care services in addition to dispensing. Majority of participants in this study were willing to pay for pharmaceutical care services that would reduce the risk of MRPs.

Use of secret simulated patient followed by workshop based education to assess and improve inhaler counseling in community pharmacy in Jordan.

OBJECTIVES: To assess inhaler technique demonstration skills of community pharmacists located in Amman, Jordan via incorporating the trained secret simulated patient (SSP) approach. Secondly, to evaluate the effectiveness of a 2-hour educational workshop focused on SSP feedback. METHODS: This cross-sectional study involved community pharmacies located in Amman, Jordan. Initially, a trained SSP was involved to enact baseline visits requesting advice on how to use Ventolin® (a pressurized metered-dose inhaler; pMDI) and Pulmicort® (a Turbohaler inhaler, TH). Immediately after each visit, the SSP completed an inhaler technique evaluation form with inhaler checklists based on previously published checklists (consisting of 9 and 10 items for pMDI and TH respectively). The SSP invited all participating pharmacists to a 2-hour workshop that included feedback on their demonstration skills, and the second evaluation of their inhaler technique. The workshop included a summary of the initial visits' results highlighting pharmacists' performance. RESULTS: Sixty pharmacies were visited and 120 inhaler assessments were completed. During baseline assessment, pharmacists scored an average of 4.5 out of 9 for pMDI and 4.9 out of 10 for TH. Only 11 pharmacists (18.3%) attended the workshop. During the workshop, inhaler technique demonstration skills significantly improved, as scores improved from 5.4 (SD 1.6) to 7.8 (SD 0.9) (p=0.008) and from 4.6 (SD 2.5) to 9.9 (SD 0.6) (p=0.003) for pMDI and TH respectively. CONCLUSIONS: The SSP approach revealed a lack of ability to demonstrate correct inhaler technique for pMDI and TH inhalers by community pharmacists in Amman, Jordan. A focused educational workshop based on SSP feedback improved inhaler technique significantly.

A simulated patient study assessing over the counter supply and counseling in Jordan: responding to headache complaints.

Background Community pharmacists are the most accessible health professionals for patients seeking advice on minor ailments and over the counter supply. Objectives To assess the management of patients seeking advice for headache in community pharmacies in Jordan. Method A cross-sectional study was conducted using simulated patient in three cities in Jordan. A trained simulated patient enacted an advice-seeking scenario for the treatment of a headache. The visits were evaluated using pre-defined criteria relating to content and communication skills. Results Of 72 community pharmacies invited, 50 (69.4%) agreed to participate. Of these, 38 (76%) pharmacies were visited. The median duration of the visit was 2 min (20 s-4 min). All visits resulted in selling a drug. Paracetamol combinations often with caffeine were recommended in over 50% of visits. Drug sale recommendations were often made without obtaining essential information about symptoms or patient medical history. Only brand names and doses were often highlighted to the simulated patient. No written information was offered. Conclusion Community pharmacies in Jordan appear not to offer adequate counseling for patients seeking advice for headache. Both counseling and communication skills are suboptimal. Exploration of factors and reasons of suboptimal practice is recommended.

The impact of clinical pharmacists in improving Jordanian patients' health outcomes.

OBJECTIVES: To assess the impacts of clinical pharmacists on Jordanian patients' health outcomes. Methods: A systematic review was conducted until July 2016 within EBSCO, Pubmed, Cochrane database, and ISI Web of Knowledge. Published studies evaluating the benefit of clinical pharmacy services on therapeutic, safety, humanistic, and economic outcomes in hospital or community settings in Jordan were targeted. Two reviewers independently extracted and assessed risk of bias using a pre-published validated tool. The literature search identified 130 publications of which 21 full texts met predetermined inclusion criteria. Results: Studies were of moderate quality. Pharmacist interventions resulted in an average reduction (95% CI) in systolic blood pressure of 5.45 mm Hg (2.95-7.92) and diastolic blood pressure of 3.03 mm Hg (1.09-4.96). The mean reduction in glycosylated hemoglobin was 0.75% (-0.49-1.99) and fasting blood sugar was 36.73 mg/dl (-19.7-93.1). The average reduction in low-density lipoprotein cholesterol was 2.36 (1.8-16.62) mg/dl and triglycerides was 20.16 (6.14-46.47). There was a minimal increase in the level of high-density lipoprotein cholesterol of 1.24 (1.64-4.11) mg/dl. Effects on safety along with humanistic and economic outcomes and long term effects remained unclear.  Conclusion: Published evidence from Jordan highlights service opportunities for clinical pharmacists. Favorable but not always statistically significant impacts were found on therapeutic outcomes. More studies are needed to understand safety, humanistic, economic, and long-term outcomes. Therefore, the add-on benefits of this service to the health system are not well understood. Future studies of higher rigor and multi-perspective outcomes are mandated.

Pharmacist provided medicines reconciliation within 24†hours of admission and on discharge: a randomised controlled pilot study.

BACKGROUND: The UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken. METHOD: Patients were recruited 7 days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay (LOS), quality of life (EQ-5D-3L), unintentional discrepancies (UDs) and emergency readmission (ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention-associated resources was determined. RESULT: 200 patients were randomised to either intervention or control. Groups were comparable at baseline. 95 (99%) patients in the intervention received MR within 24 hours, while 62 (60.8%) control patients received MR at some point during admission. The intervention resolved 250 of the 255 UDs identified at admission. Only 2 UDs were identified in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%, respectively. Assuming 5% loss to follow-up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3-month ER rates. CONCLUSIONS: The results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted. TRIAL REGISTRATION NUMBER: ISRCTN23949491.

Pharmacy led medicine reconciliation at hospital: A systematic review of effects and costs.

BACKGROUND: Transition of patients care between settings presents an increased opportunity for errors and preventable morbidity. A number of studies outlined that pharmacy-led medicine reconciliation (MR) might facilitate safer information transfer and medication use. MR practice is not well standardized and often delivered in combination with other health care activities. The question regarding the effects and costs of pharmacy-led MR and the optimum MR practice is warranted of value. OBJECTIVES: To review the evidence for the effects and costs/cost-effectiveness of complete pharmacy-led MR in hospital settings. METHODS: A systematic review searching the following database was conducted up to the 13th December 2015; EMBASE & MEDLINE Ovid, CINAHL and the Cochrane library. Studies evaluating pharmacy-led MR performed fully from admission till discharges were included. Studies evaluated non-pharmacy-led MR at only one end of patient care or transfer was not included. Articles were screened and extracted independently by two investigators. Studies were divided into those in which: MR was the primary element of the intervention and labeled as "primarily MR" studies, or MR combined with non-MR care activities and labeled as "supplemented MR" studies. Quality assessment of studies was performed by independent reviewers using a pre-defined and validated tool. RESULTS: The literature search identified 4065 citations, of which 13 implemented complete MR. The lack of evidence precluded addressing the effects and costs of MR. CONCLUSIONS: The composite of optimum MR practice is not widely standardized and requires discussion among health professions and key organizations. Research focused on evaluating cost-effectiveness of pharmacy-led MR is lacking.

Costs of hospital services in Jordan.

BACKGROUND: Policy makers are on quest for estimates of health costs to achieve maximum efficiency and sustainability. In Jordan, there is a scarcity of information on hospital service costs. AIM: The purpose of this study was to estimate the direct cost of hospital services in one of the biggest public hospitals in Amman, Jordan. METHODS: A retrospective analysis forms a 400-bed public urban hospital. Costs were estimated in Jordanian dinars (JD) (exchange rate was US$1.41). RESULTS: Inpatient costs contributed to 50% of all costs whilst outpatient clinics consumed 17%. Average cost per admission was JD 481.6 (US$674.2), JD 106.7 (US$149.3) per inpatient day and JD 63.1 (US$88.3) per bed day. The average cost per visit to emergency room was JD 14.1 s (US$19.7). Cost per visit to ambulatory care services ranged between JD 37.3 and 473 (US$52.6-662.2). The average cost per surgery was JD 322.1 (US$454.2). CONCLUSIONS: With high health costs, areas for improvements in efficiency and cost savings must be identified and discussed with managers and policy makers. A larger-scale study is advocated to understand the costs of various health providers such as military, teaching and private hospitals.

Active educational intervention as a tool to improve safe and appropriate use of antibiotics.

Misconception about antibiotics use among the public has been widely outlined to be a main reason for inappropriate use of antibiotics including failure to complete treatment, skipping of doses, re-use of leftover medicines and overuse of antibiotics. The study was devised to evaluate whether education might be a potential strategy to promote safer use of antibiotics and reducing self-medication. Two hundred seventy one adults were asked to complete two questionnaires; a pre and posteducation. The questionnaires comprised of three parts consisting of 17 statements assessing the knowledge on: appropriate use, safe use and resistance of antibiotics. Knowledge score was estimated by calculating the percentage of correct responses. The mean (SD) knowledge score pre-education was 59.4% (20.3). However, posteducation the score was 65.9% (17.9), p < 0.001(t-test). Knowledge scores were classified as poor, adequate and good. Posteducation, participants within poor and adequate knowledge categories were significantly shifted to the good category describing better knowledge, McNemar-χ2 = 28.7, df = 3, p < 0.001. It is concluded that using tailored education material targeting antibiotic need and use with a major aim of improving the public knowledge about antibiotics can be an effective and feasible strategy. This pilot study could be considered as the starting point for a wider scale public educational intervention study and national antibiotic campaign. However, the improvement in participant's knowledge might not reflect an actual change in antibiotics-seeking behaviour or future retention of knowledge. Future research should seek to assess the impact of education on participant's behaviour.