- Email: [email protected]
Exploring Associations Between Inhaler Technique and Asthma Control Amongst Asthma Patients using pMDIs and Dry Powder Inhalers
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64 Methods: The study was both retrospective and questionnaire based. A retrospective review of pharmacy intervention book in the outpatient pharmacy department of the Federal medical Centre over a two year period9 From February 18 2010 to June 14, 2012) and that of Niger Delta University teaching hospital from Nov 2 2011 to April 2012. A structured questionnaire was developed, validated and administered to 35 pharmacists in the two hospitals. Results gotten were cleaned up and analyzed using the statistical package for Social Sciences (SPSS, 16).Descriptive statistics and simple percentages were used in presenting the results. Results: The result showed that 371 and 33 drug therapy problems were documented in Federal Medical Centre and Niger Delta University Teaching hospital respectively within the period covered by this study. Under dosage (26.7%) and over dosage (25.6%) were most frequently observed drug therapy problems in Federal medical Centre and the least was adverse drug reaction; While in Niger Delta University Teaching Hospital, over dosage(30.3%) and inappropriate frequency of administration( 27.3%) were the most frequently observed while contraindication was the least(3%). From the questionnaire, it was discovered that Pharmacists take the prescriptions back to the doctor after corrections are made in 71.4% of times and in 17.1% of times, interventions are made without the prescriber’s knowledge. Also, in 71.4% of times, prescriber’s response to pharmacists’ intervention is often positive and occasionally positive in 20%. Conclusion: Pharmacists in the two hospitals carry out interventions on Drug therapy and also document same; though, so many of them agreed that they have not been documenting. It was discovered that some prescribers still insist on their prescription even after the pharmacist’s intervention. Evaluation of understanding on antibiotic resistance among Malaysian pharmacy students of public universities: An exploratory study K. Rajiah1, W.S. Ren1, S.Q. Jamshed2, 1Department of Pharmacy Practice, School of Pharmacy and Health Sciences, International Medical University, Kuala Lumpur, Malaysia, 2Department of Pharmacy Practice, College of Pharmacy, International Islamic University, Pahang, Malaysia Infectious diseases are a great threat to humankind and antibiotic is a viable proposition to numerous pathologies. However, antibiotic resistance is a global concern. Therefore, the aims of this survey were to explore the understanding and attitude of the pharmacy students on antibiotic use and Antibiotic resistance (ABR). Methods: This was a cross-sectional study conducted on final year undergraduate pharmacy students from 5 public universities. A validated, self-administered questionnaire with 45 items written in English was used to collect data. Raosoft software was used to determine the
e23
minimum required sample size. Descriptive and inferential data analyses were carried out using SPSS version 20. Results: Out of 346 students, only 59.5% of them showed a good understanding level regarding antibiotic usage. Students’ level of understanding was divided into 2 categories: average understanding (0-7 correct responses) and good understanding (8-15 correct responses). Overall, 206 (59.5%) of the students were at the category of good understanding, whereas the remaining 140 (40.5%) students were at the category of average understanding. However, it is apparent that majority of the students aware that antibiotics are most commonly prescribed anti-infective agents by public (96.5%, n¼334) and private (84.4%, n¼292) healthcare sector facilities. A majority of the students (n¼295, 85.3%) agreed that educating health professionals on the appropriate antibiotic prescribing can reduce the chances of ABR. More than three quarter of the students (78.3%) believed that the formal teaching on proper usage of antibiotics among healthcare students can minimize the phenomena of ABR. Furthermore, 82.4% responded positively to the statement: antibiotics education is needed to be well received by healthcare practitioners. Conclusions: This survey reveals that the final year pharmacy students of Malaysian public universities have relatively good understanding on the Antibiotic resistance knowledge. However, their attitude did not correlate well with their knowledge. Exploring Associations Between Inhaler Technique and Asthma Control Amongst Asthma Patients using pMDIs and Dry Powder Inhalers F. Darwish Elhajji1, E.A. Qunaibi1, N. Ebedat2, A. BashetiI1, 1Faculty of Pharmacy, Applied Sciences University, Amman, Jordan, 2Jordan University Hospital, Amman, Jordan To investigate associations between inhaler technique mean scores for pMDI and DPIs and asthma control variables (reliever use and Asthma Control Test (ACT) scores. Methods: This observational study was conducted in 2011, and ethics approval was obtained from the Jordanian Ministry of Health. Patients using the pMDI and DPI (Turbuhaler (TH) and Accuhaler (ACC)), were recruited by a clinical pharmacist and their inhaler technique assessed against published inhaler technique checklists. Patients’ reliever use (puffs/day) and ACT scores (out of 25, the higher the score the better the control) was also assessed at the same visit. Data was entered into SPSS and correlations between the mean scores were completed. Results: 130 patients were enrolled into the study (41 TH, 54 ACC, and 35 pMDI). No significant difference in demographic information was found between the groups. Inhaler technique scores (out of 9 for all devices)
e24
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
were low for TH (4.40.9) and ACC (5.41.0) as compared to the pMDI (8.10.9) (p!0.001, Independent Sample T test). Beside type of inhaler, higher inhaler technique scores were significantly associated with more recent diagnosis of asthma, older patient age (above 31), and lower reliever use (p¼0.019, one way ANOVA). Results showed no significant association between inhaler technique and ACT scores (meanSD), which were very low for all inhaler groups, with no significant differences between them (TH: 13.13.9, ACC: 13.33.9 and pMDI: 12.84.2, pO0.05). Conclusion: Patients in Jordan are using the pMDI inhalers more correctly than the newer DPIs. Significant association between higher inhaler technique scores and lower reliever use was found, but no significant association with ACT scores was detected.
Conclusions: Our vision is to better understand and improve statin adherence via promotion or prevention tailored messages and interventions, according to each patient’s regulatory focus. We envision pharmacists and other healthcare professionals being trained to communicate with their patients using specific tailored messages that match the patients’ regulatory focus. This communication may then strengthen the patient-provider relationship, enhance patient adherence to medications, and ultimately improve health outcomes.
Factors Influencing Statin Medication Adherence: Regulatory Focus and Fit A.I. Iaconi1, K.B. Farris1, R. Bagozzi1, S. Erickson1, J. Piette2, M. Dorsch2, 1Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, USA, 2University of Michigan School of Public Health University of Michigan, Ann Arbor, Michigan 48109, USA
Feeding Back Pharmacy Staff on their OTC Dispensing Performance: An Exploratory Study P. Veiga1, L.V. Lapa˜o2, A.M. Cavaco1,3, M.P. Guerreiro4, 1Instituto de Investigac¸a˜o do Medicamento (iMed.ULisboa), Faculdade de Farma´cia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal, 2WHO Collaborating Center for Health workforce policy and planning, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal, 3Faculdade Farma´cia Universidade de Lisboa (FFUL), Lisbon, Portugal, 4Instituto Superior de Cieˆncias da Sau´de Egas Moniz (ISCSEM), Monte da Caparica, Portugal j Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal
Statin medication non-adherence is as low as 25 to 40% and few theory-based approaches have been examined to improve it. Regulatory focus and fit have been used to explain health behaviors, but not medication-taking. Health communication regarding statin medications may be improved by understanding these concepts and their relationship to medication adherence. The objective of the proposed study is to examine how a person’s regulatory focus and fit affect statin medication adherence by testing the conditional indirect relationships with behavioral intentions and motivational intensity serving as mediators and self-efficacy, outcome expectancies, and optimism serving as moderators. Methods: We will use a psychological field experiment with a randomized design that consists of two manipulations and two QualtricsÒ internet surveys. A letter describing the study will be mailed to 3,000 qualified University of Michigan Health System participants. Survey one participants will randomly receive either promotion or prevention manipulations for both regulatory focus and implementation intentions. Participants will provide self-reported medication adherence 7 days later in the second survey. Pre-paid and promised incentives will be offered for completing both surveys. The relationship between regulatory focus/fit on statin medication adherence will be determined via the conditional process modeling analysis. Results: We expect that a person’s self-efficacy, outcome expectancies and optimism will moderate the mediated relationship by behavioral intentions/motivational intensity between regulatory focus/fit and statin medication adherence.
To explore pharmacy staff’s perspectives on OTC visits. Methods: A purposively selected community pharmacy was subjected to mystery shopper visits, using four symptom-based (SbS) and three product-based scenarios (PbS). Ethical approval was granted and participants signed an informed consent. Performance data were collected by means of a previously tested checklist containing both interpersonal and technical criteria, completed by trained mystery shoppers immediately after each visit. Data were converted into two composite scores (technical and interpersonal performance), and analyzed with SPSSÒ v.18. The perspectives of pharmacy staff (one pharmacist, one pharmacy-technician and three counter-assistants) on their performance were collected using audiotaped semi-structured interviews. During the interviews participants received general feedback on standards met and scores. Analysis of verbatim transcripts followed the framework approach based on an attitudinal model (i.e. cognitive, affective and behavioral components). Results: Ten mystery shopper visits were considered for analysis. Overall, the mean technical performance score was 50.4% and the mean interpersonal performance score was 77.7%; the former was higher for SbS (63.2%) than for PbS (31.3%). Cognitive and behavioral dimensions were predominant. Inadequate patient evaluation and counselling (written instructions) were found. Most participants expressed disappointment about unmet standards and provided justifications for their suboptimal performance. Reasons included perceiving some questions as irrelevant, believing the person was already informed, considering counselling for cold medicines unnecessary (as they are commonly used),
e23
minimum required sample size. Descriptive and inferential data analyses were carried out using SPSS version 20. Results: Out of 346 students, only 59.5% of them showed a good understanding level regarding antibiotic usage. Students’ level of understanding was divided into 2 categories: average understanding (0-7 correct responses) and good understanding (8-15 correct responses). Overall, 206 (59.5%) of the students were at the category of good understanding, whereas the remaining 140 (40.5%) students were at the category of average understanding. However, it is apparent that majority of the students aware that antibiotics are most commonly prescribed anti-infective agents by public (96.5%, n¼334) and private (84.4%, n¼292) healthcare sector facilities. A majority of the students (n¼295, 85.3%) agreed that educating health professionals on the appropriate antibiotic prescribing can reduce the chances of ABR. More than three quarter of the students (78.3%) believed that the formal teaching on proper usage of antibiotics among healthcare students can minimize the phenomena of ABR. Furthermore, 82.4% responded positively to the statement: antibiotics education is needed to be well received by healthcare practitioners. Conclusions: This survey reveals that the final year pharmacy students of Malaysian public universities have relatively good understanding on the Antibiotic resistance knowledge. However, their attitude did not correlate well with their knowledge. Exploring Associations Between Inhaler Technique and Asthma Control Amongst Asthma Patients using pMDIs and Dry Powder Inhalers F. Darwish Elhajji1, E.A. Qunaibi1, N. Ebedat2, A. BashetiI1, 1Faculty of Pharmacy, Applied Sciences University, Amman, Jordan, 2Jordan University Hospital, Amman, Jordan To investigate associations between inhaler technique mean scores for pMDI and DPIs and asthma control variables (reliever use and Asthma Control Test (ACT) scores. Methods: This observational study was conducted in 2011, and ethics approval was obtained from the Jordanian Ministry of Health. Patients using the pMDI and DPI (Turbuhaler (TH) and Accuhaler (ACC)), were recruited by a clinical pharmacist and their inhaler technique assessed against published inhaler technique checklists. Patients’ reliever use (puffs/day) and ACT scores (out of 25, the higher the score the better the control) was also assessed at the same visit. Data was entered into SPSS and correlations between the mean scores were completed. Results: 130 patients were enrolled into the study (41 TH, 54 ACC, and 35 pMDI). No significant difference in demographic information was found between the groups. Inhaler technique scores (out of 9 for all devices)
e24
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
were low for TH (4.40.9) and ACC (5.41.0) as compared to the pMDI (8.10.9) (p!0.001, Independent Sample T test). Beside type of inhaler, higher inhaler technique scores were significantly associated with more recent diagnosis of asthma, older patient age (above 31), and lower reliever use (p¼0.019, one way ANOVA). Results showed no significant association between inhaler technique and ACT scores (meanSD), which were very low for all inhaler groups, with no significant differences between them (TH: 13.13.9, ACC: 13.33.9 and pMDI: 12.84.2, pO0.05). Conclusion: Patients in Jordan are using the pMDI inhalers more correctly than the newer DPIs. Significant association between higher inhaler technique scores and lower reliever use was found, but no significant association with ACT scores was detected.
Conclusions: Our vision is to better understand and improve statin adherence via promotion or prevention tailored messages and interventions, according to each patient’s regulatory focus. We envision pharmacists and other healthcare professionals being trained to communicate with their patients using specific tailored messages that match the patients’ regulatory focus. This communication may then strengthen the patient-provider relationship, enhance patient adherence to medications, and ultimately improve health outcomes.
Factors Influencing Statin Medication Adherence: Regulatory Focus and Fit A.I. Iaconi1, K.B. Farris1, R. Bagozzi1, S. Erickson1, J. Piette2, M. Dorsch2, 1Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, USA, 2University of Michigan School of Public Health University of Michigan, Ann Arbor, Michigan 48109, USA
Feeding Back Pharmacy Staff on their OTC Dispensing Performance: An Exploratory Study P. Veiga1, L.V. Lapa˜o2, A.M. Cavaco1,3, M.P. Guerreiro4, 1Instituto de Investigac¸a˜o do Medicamento (iMed.ULisboa), Faculdade de Farma´cia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal, 2WHO Collaborating Center for Health workforce policy and planning, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal, 3Faculdade Farma´cia Universidade de Lisboa (FFUL), Lisbon, Portugal, 4Instituto Superior de Cieˆncias da Sau´de Egas Moniz (ISCSEM), Monte da Caparica, Portugal j Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal
Statin medication non-adherence is as low as 25 to 40% and few theory-based approaches have been examined to improve it. Regulatory focus and fit have been used to explain health behaviors, but not medication-taking. Health communication regarding statin medications may be improved by understanding these concepts and their relationship to medication adherence. The objective of the proposed study is to examine how a person’s regulatory focus and fit affect statin medication adherence by testing the conditional indirect relationships with behavioral intentions and motivational intensity serving as mediators and self-efficacy, outcome expectancies, and optimism serving as moderators. Methods: We will use a psychological field experiment with a randomized design that consists of two manipulations and two QualtricsÒ internet surveys. A letter describing the study will be mailed to 3,000 qualified University of Michigan Health System participants. Survey one participants will randomly receive either promotion or prevention manipulations for both regulatory focus and implementation intentions. Participants will provide self-reported medication adherence 7 days later in the second survey. Pre-paid and promised incentives will be offered for completing both surveys. The relationship between regulatory focus/fit on statin medication adherence will be determined via the conditional process modeling analysis. Results: We expect that a person’s self-efficacy, outcome expectancies and optimism will moderate the mediated relationship by behavioral intentions/motivational intensity between regulatory focus/fit and statin medication adherence.
To explore pharmacy staff’s perspectives on OTC visits. Methods: A purposively selected community pharmacy was subjected to mystery shopper visits, using four symptom-based (SbS) and three product-based scenarios (PbS). Ethical approval was granted and participants signed an informed consent. Performance data were collected by means of a previously tested checklist containing both interpersonal and technical criteria, completed by trained mystery shoppers immediately after each visit. Data were converted into two composite scores (technical and interpersonal performance), and analyzed with SPSSÒ v.18. The perspectives of pharmacy staff (one pharmacist, one pharmacy-technician and three counter-assistants) on their performance were collected using audiotaped semi-structured interviews. During the interviews participants received general feedback on standards met and scores. Analysis of verbatim transcripts followed the framework approach based on an attitudinal model (i.e. cognitive, affective and behavioral components). Results: Ten mystery shopper visits were considered for analysis. Overall, the mean technical performance score was 50.4% and the mean interpersonal performance score was 77.7%; the former was higher for SbS (63.2%) than for PbS (31.3%). Cognitive and behavioral dimensions were predominant. Inadequate patient evaluation and counselling (written instructions) were found. Most participants expressed disappointment about unmet standards and provided justifications for their suboptimal performance. Reasons included perceiving some questions as irrelevant, believing the person was already informed, considering counselling for cold medicines unnecessary (as they are commonly used),