Development and Evaluation of a Turkish Scale to Assess Medication Literacy for Adults.

Objectives: This study aimed to develop a Turkish scale to assess medication literacy and to evaluate its psychometric properties among adults having at least 12 years of education in Türkiye. Materials and Methods: After the composition of a preliminary set of items, the content validity of the scale was assessed by an e-Delphi process and a pilot study. The psychometric properties of the scale were evaluated in 358 participants, who had above 12 years of education: university students, academics and, administrative staff from two faculties (pharmacy and law) in two universities located in two major cities (Istanbul and Ankara) in Türkiye between March and May, 2021. The test-retest validity was assessed by Spearman's rho and Wilcoxon test. Internal consistency was evaluated by Kuder Richardson 20. Principal component analysis was conducted. Results: The last version of the medication literacy scale consisted of 8 items. There was a positive correlation (Spearman's rho: 0.570; p<0.01) and no significant difference (p=0.308) between the scores of the scale at baseline and after a two-week interval. Kuder Richardson 20 coefficient was 0.659. Students and graduates of health sciences and participants with high reading ability of health-related information had significantly higher scores on the medication literacy scale (p<0.001). Conclusion: Turkish version of the Medication Literacy Scale for Adults is a valid tool for evaluate medication literacy among adults, who have above 12 years of education in Türkiye. The generalizability of our findings should be evaluated with caution since this study was conducted in a sample with a significant representation from healthcare professionals. It would be useful to conduct further studies evaluating the psychometric properties of this scale in participants with diverse characteristics.

Potentially Inappropriate Medication Use in Older Adults with Chronic Kidney Disease.

Objectives: This study aimed to identify the prevalence of potentially inappropriate medication use (PIMU) in adults above the age of 65 with chronic kidney disease (CKD) according to the American Geriatric Society Beers Criteria (Beers), Screening Tool of Older People's Potentially Inappropriate Prescriptions Criteria (STOPP) and medication appropriateness index (MAI) 30 criteria and to compare them to justify their use in this specific patient group. Materials and Methods: This was a retrospective and descriptive study conducted between October 1st, 2019 and March 18th, 2020 at Ibni Sina Hospital, Nephrology Department, Faculty of Medicine, Ankara University. Results: Among 269 patients discharged from the hospital during the study period, 100 of them were eligible for the study. The mean age was 73.3 ± 6.9 years and 51.9% of them were male. The prevalence of 35 PIMU was 91%, 42%, and 70% according to the Beers, STOPP, and MAI criteria, respectively. There was a statistically significant difference in terms of prevalence among 3 criteria (p<0.001). Beer detected more PIMU (11.3% vs. 6.4%) and had higher sensitivity among older adults with CKD (0.97 vs. 0.56) compared to the STOPP criteria. Most patients had at least one drug-drug interaction (DDIs) in their discharge prescription (93%) and DDI was one of the main contributors of PIMU. Proton pump inhibitors were the most common medication associated with PIMU in all 3 criteria. Conclusion: The prevalence of PIMU was high among older adults with CKD at discharge according to these criteria. To improve the prescriptions after hospital discharge, it is considered appropriate to use Beers criteria under guidance of a clinical pharmacist.

The first nationwide implementation of pharmaceutical care practices through a continuing professional development approach for community pharmacists.

BACKGROUND: Noncommunicable diseases account for the majority of all deaths and impose a high socioeconomic burden, causing disability and premature deaths. Pharmacists can contribute to the prevention and management of these diseases through the provision of pharmaceutical care services. AIM: The aim of this study was to implement a nationwide practice developed by the Turkish Pharmacists' Association aiming to realize pharmaceutical care provision of standard quality to patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension at community pharmacies through a continuing professional development approach. SETTING: Community pharmacies in Turkey. DEVELOPMENT: A project with the involvement of all community pharmacists who were willing to participate was developed. After piloting, the 'project' turned into a 'practice' with a focus on asthma, chronic obstructive pulmonary disease, diabetes and hypertension management. IMPLEMENTATION: The training process occurred as a peer-training activity. Consultants and academic staff trained the trainer pharmacists during a 3-day course. Community pharmacists (n = 6161) received training regarding pharmaceutical care, asthma, chronic obstructive pulmonary disease, diabetes and hypertension from their peer trainers (n = 341) and began to practice pharmaceutical care and follow-up of patients' outcomes on a regular basis. EVALUATION: Among all community pharmacists in Turkey (n = 26,177), 24% attended training. Among these pharmacists, 21% started to implement practice. With community pharmacists' contribution to patient care, significant improvements in the majority of the outcome parameters regarding asthma, chronic obstructive pulmonary disease, diabetes and hypertension management were noted. CONCLUSION: This first nationwide practice showed us that community pharmacists can help improve the health outcomes of patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension through the provision of pharmaceutical care services.

The point prevalence and inappropriateness of antibiotic use at hospitals in Turkey: a systematic review and meta-analysis.

Inappropriate antimicrobial use is a key problem causing antimicrobial resistance and increased health care costs. Although global point prevalence surveys on antimicrobial prescribing in hospitals were described, there is lack of data from Turkish hospitals. Here, we aimed to perform systematic review and meta-analysis for the point prevalence surveys on antimicrobial prescribing in Turkish hospitals. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline was used to identify studies for the review. Articles published between January 2004 and September 2020 by Turkish investigators were included if they used the point prevalence survey method. The Joanna Briggs Institute's critical appraisal tool and the World Health Organization's point prevalence survey tool were used to the evaluate studies. Results were combined using random effects meta-analysis. The pooled point prevalence of antimicrobial use in Turkish hospitals was 48% (95% confidence interval 43-54). There was considerable heterogeneity in prevalence among the studies (I2= 98.75 %, 95 % CI 98.49-98-97). The most commonly prescribed antimicrobial and indication for antimicrobial use were third generation cephalosporins (36%) and respiratory tract infections (88%), respectively. More than two thirds of the antimicrobials were prescribed empirically (median: 71% [interquartile range: 56-80]) in hospitals. The point prevalence and inappropriateness of antimicrobial use are high in Turkish hospitals. Turkey is one of the biggest consumers of antimicrobials. There is an urgent need for antimicrobial stewardship programmes at Turkish hospitals to improve antimicrobial prescribing. Our study findings can contribute to improving antimicrobial prescribing, and thereby control antimicrobial resistance.

A Point Prevalence Study of Antimicrobial Use and Practice Among Nursing Homes in Singapore.

BACKGROUND: Inappropriate antimicrobial use is a major cause for the development of antimicrobial resistance in nursing homes (NHs); however, little is known about antimicrobial use at NHs in Singapore compared with NHs in other countries. OBJECTIVES: The aim of this study was to determine the prevalence, practice and challenges of antimicrobial prescribing in Singapore NHs compared with those in other countries. METHODS: A point prevalence survey (PPS) was conducted from August to October 2017. Data on antimicrobial use and the quality of documentation were retrieved from medical and/or medication records of NH residents. Informed consent was obtained from the NH management. RESULTS: Nine of 73 NHs in Singapore, with a total of 1760 residents, participated in the PPS. The prevalence of oral antibiotic and topical antimicrobial use was 2% and 11%, respectively, and the worldwide point prevalence of antimicrobial prescribing in NHs ranged from 1-17% (median 8%). The key challenges identified locally were different from those of overseas NHs, including incomplete documentation of antimicrobial duration and indication of use, as well as the high prevalence of topical antimicrobial use. CONCLUSIONS: The prevalence of oral antibiotic use in NHs in Singapore was lower, while topical antimicrobial use was higher, compared with NHs in other countries. Variability in antimicrobial prescribing and challenges in practice among local and overseas NHs implied that a comprehensive PPS could be beneficial to aid in the design of effective and practicable antimicrobial stewardship strategies appropriate for the NH.

Antimicrobial use and drug-drug interactions among nursing home residents in Singapore: a multicentre prevalence study.

Background With the Ministry of Health's projected increase in nursing home beds and optimization of antimicrobial use in health care settings, it is therefore timely to consider baseline prevalence and patterns of antimicrobial use at nursing homes in Singapore as well as to evaluate the prevalence of potential clinically significant drug-drug interactions involving antimicrobials. Objective The primary objective was to determine the prevalence and patterns of antimicrobial use at nursing homes in Singapore. The secondary objective was to evaluate the prevalence of potential clinically significant drug-drug interactions involving antimicrobials. Setting Four nursing homes in Singapore. Method A retrospective cross-sectional study was conducted among nursing home residents. The antimicrobial prevalence, defined daily doses, days of therapy, and potential drug-drug interactions were determined using data from archived resident medication prescribing and administration records. Main outcome measure Prevalence and patterns of antimicrobial use, drug-drug interactions involving antimicrobials. Results Among 707 residents (mean age: 80.7 ± 8.8 years, female: 57.1%), 10% used antimicrobials during the study month, with a 1-day point prevalence of 3%. The utilization rates of antimicrobials were 28.9 defined daily doses/1000 resident-days and 24.8 days of therapy/1000 resident-days. Potential drug-drug interactions involving antimicrobials were identified among 32 of the 70 (46%) residents who were prescribed antimicrobials. Of these, 26 (81%) residents had 43 potential clinically significant drug-drug interactions. Conclusions The prevalence and utilization rates of antimicrobial use in Singapore nursing homes appear to be low. Yet, potential clinically significant drug-drug interactions are prevalent.