Pharmacy students' knowledge and practices concerning the storing and disposal of household medication in Saudi Arabia.

INTRODUCTION: Pharmacists, and thus pharmacy students, must participate in promoting awareness about proper storage and disposal of expired or unused medications. This study aimed to determine Saudi Arabian pharmacy students' knowledge and personal practices regarding storing and disposing of household medications. METHODS: This was a descriptive, cross-sectional, questionnaire-based study of pharmacy undergraduates or postgraduates across Saudi Arabia. The online survey was distributed to a convenience sample of participants and supplemented with snowball sampling on social media. RESULTS: Of 807 pharmacy students who viewed the questionnaire, 464 students completed it (response rate 57.5%). Common reasons for keeping medications included having left-over medication (74%) and self-discontinuation of therapy (63.5%). The majority of students (79%) stored their medication in a bedroom or kitchen. Gender-specific variables revealed a gender difference in storing and disposing of these medications. Many students reported previously discarding medicines in the garbage (89%) or giving them to someone else to use (22%). More than half of the sample (60%) had not received any information on how to store or dispose of medications. CONCLUSIONS: The current practice and knowledge of Saudi Arabian pharmacy students regarding storage and disposal of household medications was inappropriate. Concerned authorities (e.g., Ministry of Health, Ministry of Education) should provide proper education to all students on the safe storage and disposal of medications, which may necessitate curriculum reform.

Pharmacists' background, interests, barriers, self-perceived competence and confidence to design and undertake pharmacy practice-based research in the GCC geographic area.

BACKGROUND: The absence of ability and certainty to design and undertake pharmacy practice-based research (PPBR) was a major issue among pharmacists worldwide as reported in previous literature, despite them having an interest in conducting PPBR. Therefore, this study aimed at highlighting the research background of the Gulf Cooperation Council (GCC) pharmacists which are the six Arab states of the Arabian Gulf, and examining barriers to conducting PPBR. In addition, to determine the self-perceived level of competence and confidence when planning and conducting PPBR. METHODS: This is a descriptive, cross-sectional questionnaire-based study, performed among pharmacists working in the GCC countries (i.e. Saudi Arabia, United Arab Emirates, Kuwait, Bahrain, Oman and Qatar). A pre-validated questionnaire was distributed to a convenience sample, via distribution of 500 research participation cards to conference attendees. These cards a quick response (QR) code, which should be scanned via mobile phone, to direct all readers to the online survey. All pharmacist delegates attending the conference (i.e. the Saudi International Pharmaceutical Sciences Annual National Conference (SIPHA) and Dubai International Pharmaceuticals and Technologies Conference and Exhibition (DUPHAT) in 2020 and who are working in one of the GCC co. untries as pharmacists were considered. The data were analysed using the Statistical Package for the Social Sciences (SPSS) and Excel software. RESULTS: Two hundred and fourteen pharmacists were included. Seventy percent of the pharmacists had past PPBR background. Confidence and competence of pharmacists for research skills in regard to employing appropriate inferential statistical test, choosing software for statistical analysis, drafting a comprehensive plan for data analyses and determining appropriate sample size were weak. Highest competence and confidence were seen in preparing a presentation and searching the literature. Pharmacists with previous research experience (K-W: p = 0.001) and training (K-W: p = 0.003) had an overall ability to conduct PPBR. In addition, they had more interest in conducting PPBR (MWU = 3061.500, z = - 4.126, p = 0.000) and in learning about how to do so (MWU = 8698, z = - 1.898, p = 0.050). CONCLUSIONS: Pharmacists practicing in the GCC geographic area realized the importance of planning and conducting PPBR and were more confident and competent to undertake and contribute to PPBR, except for skills related to statistical analysis. Therefore, training programmes especially for biostatistics and data analysis are mandatory to enhance pharmacists' research capabilities.

Act like a warrior to defeat medication counselling barriers: A cross sectional study.

BACKGROUND: In the previous literature, patients' perceptions of medication consultation provided by pharmacists was found to poor, depending upon various factors, which may lead to poor compliance with medication instructions and, therefore, poor health outcomes. In the Kingdom of Saudi Arabia (KSA), this specific area has been overlooked to date, so this study aims to examine patients' perceptions of medication counselling and the factors that influence their likelihood of participating in medication counselling as well as determine the predictors of patients' likelihood to take part in medication counselling delivered by pharmacists in KSA. MATERIALS AND METHODS: A cross-sectional survey was conducted involving people over 18 years of age, who had purchased or collected medicine for their own use from community and/or hospital pharmacies within the past two years and who lived in Saudi Arabia. The data were analysed using IBM SPSS Statistics version 24. Descriptive statistics were applied to each item as well as linear regression and Pearson's correlation. RESULTS: Five hundred and eleven participants (male (n = 101), female (n = 410), the majority of whom were aged 18-24-years-old) were included. Almost an equal number of participants had accessed either community (CP) (n = 228: 45%) or hospital pharmacies (HP) (n = 283: 55%) within the past two years in regards to their condition and/or medication. The perceived susceptibility construct had weak positive correlations with all of the constructs being measured (r < 0.3). Perceived barriers had a weak negative relationship with likelihood (r < 0.3), which means that, as the perceived barriers increase, the perceived benefits and future likelihood to participate in medication counselling decrease. Linear regression analysis found that age (ß = -0.06; P =˃0.05), gender (ß = 0.14; P =˃0.05), education level (ß = -0.01; P =˃0.05) and type of pharmacies accessed (ß = -0.05; P =˃0.05) were non-significant predictors of the participants' likelihood of participating in medication counselling. CONCLUSION: In order to improve the medication consultation provided by pharmacists and, therefore, enhance the patients' experience and care, it is important to understand the public's views, concerns and demands regarding medication consultation, in order to provide the proper interventions and serve as a platform for developing a plan of action for good pharmacy practice.

Employment of Mapping Technology in Antimicrobial Resistance Reporting in Saudi Arabia.

Although Antimicrobial Resistance (AMR) is a worldwide threat, local AMR databases do not exist. Unlike other health disasters, developing containment strategies for AMR cannot be started without a representative, local, updated AMR data. However, Geographical Information Systems (GIS) mapping technology is capable of visualizing AMR data integrated with geographical regions. Due to the absence of AMR databases in Saudi Arabia, we searched Medline and Embase databases from inception until May 28, 2018, including literature that reported AMR data on the most prevalent gram-negative bacterial strains in Saudi Arabia. These data were extracted into Microsoft Excel file and inserted into STATA software, version 13 and ArcMap 10.6 software platform for mapping. We found particularly high levels of AMR in Makkah (Mecca), possibly due to high antibiotic consumption because of the influx of pilgrims, with Pseudomonas aeruginosa isolates showing the highest resistance rate against amikacin, aztreonam, cefepime, ceftazidime, ciprolfloxacin, gentamicin, imipenem, meropenem and pipracillin/tazobactam, and Enterobacteriaceae isolates against cefuroxime, ciprofloxacin, ampicillin, imipenem and ertapenem. The cause is, however, multifactorial since Acinetobacter baumannii isolates showed a variable resistance rate throughout the country. The employment of mapping technology in displaying AMR data extracted from published literature is a practically useful approach, and advanced GIS analyses should help stakeholders create containment strategies and allocate resources to slow down the emergence of AMR.

Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship?

BACKGROUND: Diabetes mellitus (DM) is a major public health problem and one of the most challenging diseases worldwide. According to the World Health Organization (WHO), the Kingdom of Saudi Arabia (KSA) has the second highest rate of diabetes in the Middle East and seventh highest globally. Some diabetic patients may prefer to use alternative approaches such as herbal remedies to control their blood glucose level and this study aims to assess the prevalence of herbal usage and to evaluate users' and doctors' knowledge, attitudes and beliefs about herbal medicine as well as the patient/doctor relationship in this regard. METHOD: A cross-sectional survey was conducted in several hospitals and medical centres in Makkah, KSA, between January and March 2019. Around 289 type II diabetic patients and 105 doctors were interviewed. RESULTS: We found that 68% of the participants were frequent consumers of herbal remedies, especially cinnamon, ginger and fenugreek. Patients' knowledge of herbal usage was mainly gleaned from family and friends as well as social media, and we found that many (71.4%) did not bother to consult or inform their doctors about their choice to self-medicate with herbs. Patients had no concerns regarding the efficacy and safety of herbal usage use in diabetes, as around half of the participants believe that herbal medicine is effective (54%) and safe (46%) for treating symptoms of diabetes. Two-thirds of the doctors (66%) routinely ask patients whether they use herbs for their condition. Although 25% of the doctors took a positive view of herbal medicine in relation to diabetes, others expressed concerns with the rise in herb use and want to see more attention paid to safety aspects. CONCLUSION: The study concludes that herbal remedies are commonly used by diabetic patients and that a gap exists in the relationship between patients and doctors concerning the disclosure of herbal remedy use and views on its safety.

Career Choices and Preferences of Saudi Pharmacy Undergraduates: A Cross Sectional Study.

BACKGROUND: Despite the increasing number of pharmacy schools and their graduates, the healthcare workforce shortage has increased in Saudi Arabia's pharmacy sector, especially with the opening of new retail pharmacies, industries and pharmaceutical companies, which means that more pharmacist positions have been created with expanded working hours. However, very limited data are available regarding the views and preferences of pharmacy students regarding their future job choices in Saudi Arabia, which may create concerns for licensing organizations, employers and institutions and also gaps between what students want and the vacancies for pharmacists. Therefore, this study aims to identify pharmacy students' career choices and examine the factors that influence their choices across different pharmacy schools in Saudi via a cross-sectional survey. MATERIALS AND METHODS: A cross-sectional survey was carried out of undergraduates at all education levels at different colleges of pharmacy across Saudi Arabia from October 2017 to March 2018. The questionnaire gathered students' characteristics and covered the importance of general job considerations for students, their choices and the factors influencing their future career choices and finally the students' opinions regarding different work settings. The data were analysed using the Statistical Package for the Social Sciences (SPSS). RESULTS: Hospital pharmacies were the preferred area of practice (n = 212: 51.6%), followed by academia and research centres (n = 102: 24.8%), while the pharmaceutical industry and community pharmacies were the least preferred, at 7% and 2%, respectively. Based on the respondents' characteristics and preferred future career, a multivariate logistic regression revealed that the pharmD students were 4 times more likely to prefer hospital pharmacy posts (odds ratio (OR) = 4.554, p = 0.033) compared with the B-pharm students. Among the factors that influenced the students' choices were personal interest, in addition to training experience and organizational reputation. The most important job considerations, according to the students, was moving up the job ladder (n = 346; 84.2%), and job openings in a certain field (n = 341; 83%). The Kruskal-Wallis test for nonparametric ordinal data declared detected several significant differences among different pharmacy settings for each item measuring the pharmD and B-pharm students' attitudes and opinions. CONCLUSION: By identifying these gaps and pharmacy students' goals and needs, we aim to draw the government's attention to these to ensure a future balance between supply and demand and effective pharmacy workforce planning, which is mandatory.

"You could lose when you misuse" - factors affecting over-the-counter sale of antibiotics in community pharmacies in Saudi Arabia: a qualitative study.

BACKGROUND: The sale of antibiotics without a prescription poses a global public health concern. Antibiotics dispensed without a prescription are largely recognised as a cause of antibiotic misuse and overuse which may result in antibiotic resistance, recurrent infection, increased cost and adverse effects of treatment. There have been no qualitative studies to explore the reasons for over-the-counter (OTC) sale of antibiotics, despite the fact that non-prescription sale of antibiotics are increasing in Saudi Arabia. METHODS: Qualitative interviews were conducted with community pharmacists living in the Eastern Province of Saudi Arabia using face-to-face, open-ended questions. Interviews were audio-recorded and transcribed verbatim. The interview transcripts were analysed using thematic analysis and NVivo 10 software. RESULTS: All participants declared that antibiotics were frequently sold without a medical prescription on an OTC basis. The main reasons for OTC sale of antibiotics were found to be related to the ease of access to community pharmacies compared to other healthcare services, expertise and knowledge of pharmacists and patients' trust, misconceptions and inappropriate practices of the public towards antibiotic use, customer pressure, pharmacists' need to ensure business survival and weak regulatory enforcement mechanism. These are presented in more detail below by using illustrative quotes from participants' transcripts. CONCLUSIONS: The non-prescribed sale of antibiotics is still a common practice in Saudi Arabia, despite being a problem. The results of this study highlight the need to design interventions to promote rational use of antibiotics.

The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Adverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events. OBJECTIVE: To update the previous assessment of pharmacist-led medication reconciliation by restricting the review to randomized controlled trials (RCTs) only. METHODS: Six major online databases were sifted up to 30 December 2016, without inception date (Embase, Medline Ovid, PubMed, BioMed Central, Web of Science and Scopus) to assess the effect of pharmacist-led interventions on medication discrepancies, preventable adverse drug events, potential adverse drug events and healthcare utilization. The Cochrane tool was applied to evaluate the chances of bias. Meta-analysis was carried out using a random effects model. RESULTS: From 720 articles identified on initial searching, 18 RCTs (6,038 patients) were included. The quality of the included studies was variable. Pharmacists-led interventions led to an important decrease in favour of the intervention group, with a pooled risk ratio of 42% RR 0.58 (95% CI 0.49 to 0.67) P<0.00001 in medication discrepancy. Reductions in healthcare utilization by 22% RR 0.78 (95% CI 0.61 to 1.00) P = 0.05, potential ADEs by10% RR 0.90 (95% CI 0.78 to 1.03) P = 0.65 and preventable ADEs by 27% RR 0.73 (0.22 to 2.40) P = 0.60 were not considerable. CONCLUSION: Pharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization.

"Your Health Essential for Your Hajj": Muslim pilgrims' knowledge, attitudes and practices regarding Middle East respiratory syndrome coronavirus (MERS-CoV) during Hajj season.

BACKGROUND: Up to date, there have been no studies to evaluate pilgrims' knowledge, attitude and practices regarding MERS-CoV during the annual Hajj pilgrimage in order to see whether there is a need for these aspects to be improved. METHODS: A cross-sectional survey study was conducted with a convenience sampling. Participants were pilgrims, aged over 18, and able to speak Arabic or English. A self-administered structured questionnaire was distributed during Hajj season in Mecca. Descriptive and multiple linear regression analysis were used in data analysis. RESULTS: Two hundred and fifty-seven participants completed the study, 80% of whom were female, and the median (IQR) age was 35 (24.5-43.5) years. Pilgrims had moderately correct knowledge and accurate attitudes about MERS-CoV with median scores of 5 (IQR 4-7) and 6 (IQR: 5-7) respectively. Educational level and employment status were significantly associated with knowledge whereas gender and age were significantly associated with attitude and practices respectively (P < 0.05). The correlation between knowledge, attitude and practices was significant (correlation coefficient: 0.207; P < 0.05). Better knowledge was found to be a predictor for positive practice. CONCLUSIONS: These findings will provide insight when designing future interventions to promote specific messages to enhance knowledge, change attitude and improve practice regarding MERS-CoV.

Self-medication and self-prescription with antibiotics in the Middle East-do they really happen? A systematic review of the prevalence, possible reasons, and outcomes.

OBJECTIVES: There has been no review on the prevalence, possible causes, and clinical outcomes of self-medication with antibiotics (SMA) in the Middle East. METHODS: Databases were searched (January 2000 through June 2016) for articles on SMA among adults aged ≥18 years living in the Middle East. A hand search for relevant citations and key journals was also performed. RESULTS: Twenty-two studies were found. The prevalence of SMA ranged from 19% to 82%. Age, sex, and educational and income levels were the main determinants of SMA. Socio-cultural, economic, and regulatory factors were the most commonly cited reasons for SMA. Penicillins were the antibiotics most commonly used; the antibiotics were obtained mainly via stored leftover drugs, pharmacies without prescriptions, and friends/relatives. SMA was mainly for upper respiratory tract problems. The primary sources of drug information included relatives/friends and previous successful experience. Inappropriate drug use such as wrong indication, short and long duration of treatment, sharing of antibiotics, and storing antibiotics at home for use at a later time were reported. Negative and positive outcomes of SMA were identified. CONCLUSIONS: It is important to understand the links between different factors promoting SMA and to assess the changing trends in order to derive strategies aimed at reducing drug-related health risks.

Knowledge, Attitudes and Practices (KAP) Relating to Dietary Supplements Among Health Sciences and Non-Health Sciences Students in One of The Universities of United Arab Emirates (UAE).

INTRODUCTION: The use of Dietary Supplements (DS) has increased substantially in the United Arab Emirates (UAE) in recent years, despite the fact that the efficacy and safety of these supplements are not proven yet. In addition, the practices of supplement users in the UAE remain undocumented. AIM: To determine the usage of DS in health sciences and non-health sciences students; and to determine their knowledge, attitudes and practices (KAP) regarding these supplements. MATERIALS AND METHODS: A descriptive, cross-sectional, questionnaire-based study was conducted among university students. Based on the Raosoft online calculator, it was anticipated that the sample of 383 students would enable us to achieve the study objectives. Students were recruited from Ajman University of Science and Technology and identified by the academic staff through students' records. All students who were registered at Ajman University of Science and Technology - including medical (i.e. dental, pharmacy and health sciences) and non-medical colleges (i.e. engineering, business administration, law, information technology, mass communications and humanities) - were invited to participate, after obtaining the approval of the Institutional Ethics Committee (IEC), (during the period of January-February 2015). This study used quantitative method approach. Therefore, data were analysed quantitatively using SPSS version 22.0. RESULTS: More than one-third of participants (39%) were found to consume DS. The most common reasons for consuming supplements were to maintain good health (58,21%) and ensure adequate nutrition (43,15%). Almost two-thirds of participants (65%) perceived that the best way to obtain nutrients is through food and DS together (49%), or DS alone (16%). Therefore, there was a relatively high amount of DS intake among participants in this study. With regard to medical and non-medical students' use of DS, there were no significant differences in the use (p=0.139). However, other findings suggest that there are significant differences in the knowledge of health sciences and non-health sciences students pertaining to the health benefits and safety of these supplements (p<0.001), what they are (p=0.040) and the source of help that should be sought when using them (p<0.001). CONCLUSION: There is a relatively high prevalence of DS consumption among students, which they reported as using to maintain good health and ensure adequate nutrition. However, findings suggest that there are significant differences in the knowledge of health sciences and non-health sciences students pertaining to the health benefits and safety of these supplements. Therefore, awareness of DS usage and information should be integrated into everyday practice.

How effectively are your patients taking their medicines? A critical review of the Strathclyde Compliance Risk Assessment Tool in relation to the 'MMAS' and 'MARS'.

RATIONALE, AIMS AND OBJECTIVES: A useful assessment tool that can support health care professionals in anticipating elderly patients' care needs regarding additional support in managing their own medicines is essential, but currently lacking. Thus, the aim of the study was to assess whether the 13-item Strathclyde Compliance Risk Assessment Tool (SCRAT) is an appropriate instrument for identifying community-dwelling elderly people who may be at risk of medication non-adherence. METHOD: An 8-week survey was performed from October to November 2009. Patients were ≥65 years old, receiving ≥3 medications and were either using multi-compartment compliance aids or receiving social care support, or both. The data were collected in 45 face-to-face structured interviews using the 13-item SCRAT, 5-item Medication Adherence Rating Scale (MARS) and 8-item Modified Morisky Adherence Scale (MMAS) in sheltered housing complexes in Glasgow, Scotland. Interviews were analysed quantitatively using SPSS version 21 software. RESULTS: The SCRAT instrument showed substantial inter-rater reliability (Cohen's kappa of 0.730 for the 13-item scale). There was a significant strong negative correlation between the 13-item SCRAT total risk score and 8-item MMAS (r = -0.654; P = 0.0036), and the 13-item SCRAT total risk score and 5-item MARS (r = -0.481; P = 0.0084). The SCRAT instrument showed satisfactory internal consistency (Cronbach's alpha of 0.853 for the 13-item scale). The area under the receiver operator characteristic curve (AUC ± standard error; 95% confidence interval) showed that the SCRAT had good discriminatory capacity and was able to distinguish between adherent and non-adherent participants on the MARS (0.729 ± 0.17; 0.39, 1.00). The best cut-off (sensitivity, specificity) was <3 (75%, 45%). In the sub-analyses, there was a significant difference in total risk score (3 vs. 2, P = 0.011) between users and non-users of multi-compartment compliance aids. CONCLUSION: The study shows that the 13-item SCRAT has the potential to be used in identifying elderly participants who may have problems managing their own medicines and it may help to determine the level and type of assistance that patients require to manage their medicines.