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.

"Don't Let Medicines Go to Waste"-A Survey-Based Cross-Sectional Study of Pharmacists' Waste-Reducing Activities Across Gulf Cooperation Council Countries.

OBJECTIVES: Medication waste has a negative environmental and economic impact. From avoiding unnecessary supply to recycling medicines that are no longer needed, pharmacists are placed in an advantageous position to minimise medication waste. Thus, the aim of this study was to detect waste-minimising activities undertaken by pharmacists to limit medication waste and to evaluate their importance for medication waste minimisation and feasibility for implementation. METHODS: A cross-sectional survey of 277 participants, conveniently selected from six Gulf countries. The eligibility criteria were pharmacists or pharmacy technicians, Arabic- or English-speaking individuals, aged ≥18 years, and living in the Gulf countries. An online self-administered survey was distributed during December 2019 and February 2020, via e-mail and social networks; it included the purpose of the study with a link to the webpage that hosted the questionnaire. Data were collected through the online survey site QuestionPro.com. All analyses were performed in SPSS Version 23 and Microsoft Excel. RESULTS: The majority of participants were female (175/277; 63%), hospital pharmacists (206/277; 74%), and had more than 10 years of work experience (100/277; 36%). This study indicates that most of the suggested activities (14/21) were implemented by the majority of pharmacists for minimising medication waste, except four activities in the dispensing stage and three activities in the leftover stage. Activities performed at the prescribing, dispensing and leftover stages were considered very important or important for reducing medication waste and very feasible or feasible for implementation in practice. CONCLUSIONS: Many waste-minimising activities were undertaken by pharmacists in the prescribing, dispensing, and leftover stages. However, although waste-minimising activities were perceived as important for reducing waste and feasible for implementation in practice, not all activities were implemented in daily 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.

'Sharing may not be caring' - Prescription medication sharing among adults in Saudi Arabia.

OBJECTIVES: The aim of the current study was to describe prescription medication sharing behaviours (i.e. borrowing and lending) among adults living in Saudi Arabia. METHODS: This cross-sectional survey was conducted in Saudi Arabia during December 2018. The eligibility criteria were an ability to communicate in Arabic or English and aged ≥18 years. An online survey was distributed to a convenience sample, supplemented by snowballing, by email and social media via an Internet link leading to a web-based survey platform in QuestionPro to assess their medication sharing behaviours. Bivariate and multivariate analyses were used to assess the associations. KEY FINDINGS: A total of 667 completed the questionnaire. The prevalence of borrowing and lending prescription medication was found to be 14% and 16% in 2018 (past year), respectively. Twenty per cent of participants revealed that they had given a medication prescribed for one child to another child in their care, and 75% reported having leftover prescription medicine at home. The majority (90%) had borrowed or lent on one to three occasions. A wide range of medications were borrowed and lent mainly between immediate family members. Different reasons have been identified for medicine borrowing or lending behaviours. CONCLUSIONS: Borrowing and lending prescription medications are a common practice in the Saudi population. Further research is warranted into the development of successful approaches or interventions to reduce medication sharing behaviour.

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.

"Antibiotics kill things very quickly" - consumers' perspectives on non-prescribed antibiotic use in Saudi Arabia.

BACKGROUND: In recent decades, the Kingdom of Saudi Arabia has seen an exponentially growing antibiotic resistance, which is exacerbated by the use of antibiotics without a prescription and other various factors. However, no published data are available on factors influencing non-prescription use of antibiotics among the general public in Saudi Arabia using an in-depth interview technique. METHODS: Semi-structured interviews were carried out with 40 Saudi participants from the Eastern Province of Saudi Arabia, selected via snowball sampling technique. Participants were enrolled based on the following inclusion criteria: 18 years of age or older and had self-medicated themselves with antibiotics in the past two years. Data collection was continued until data saturation was attained. Interviews were audiotaped, transcribed verbatim and analysed using NVivo 10 software. RESULTS: Participants (80% female) had a mean (SD) age of 30 years (10.2). Self-medication with antibiotics was associated with various inappropriate antibiotic use behaviours and negative outcomes such as antibiotic resistance, treatment failures and adverse events. Interviews revealed that different reasons contribute to the rise of self-medication with antibiotics, ranging from difficulty accessing healthcare services, participant's cultural beliefs and practices, lack of knowledge about antibiotics and antibiotic resistance, and weak regulatory enforcement. CONCLUSIONS: The findings of the present study will aid in generating data that may provide an insight when designing future interventions to promote public health awareness regarding safe and effective use of antibiotics.

"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.

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.

South Asian and Middle Eastern patients' perspectives on medicine-related problems in the United Kingdom.

BACKGROUND: There has been little research which specifically examines medicine use among South Asian (SA) and Middle Eastern (ME) groups, although evidence suggests that medicine-related needs may be poorly met for these groups. OBJECTIVE: To describe medicine-related problems (MRPs) experienced by SA and ME patients from their perspectives and identify possible contributory factors that may be specific to their cultures. SETTING: The data were collected in seven pharmacies in London, United Kingdom (UK). METHOD: The study was a qualitative study. Patients were from SA and ME origins, aged over 18 and prescribed three or more regular medicines. Patients were identified when presenting with a prescription. The data were collected in 80 face-to-face semi-structured interviews using Gordon's MRPs tool. Interviews were audiotaped, transcribed verbatim and analysed thematically using Gordon's coding frame and Nvivo 10 software. MAIN OUTCOME MEASURE: Describing MRPs experienced by SA and ME patients from their perspectives and identifying possible contributory factors that may be specific to their cultures. Results Eighty participants (61 % male) had mean (SD) age 58 (13.4) years and a mean (SD) of 8 (4) medicines. Interviews revealed that several factors contributed to the development of MRPs; some appeared to be specific to SA and ME cultures and others were similar to the general population. The factors that were reported to be specific to SA and ME groups comprised religious practices and beliefs, use of non-prescription medicines, extent of family support, and travelling abroad--to patient's homeland or to take religious journeys. Illiteracy, language and communication barriers, lack of translated resources, perceptions of healthcare providers, and difficulty consulting a doctor of the same gender may also contribute to the problems. Many of these factors could be expected to influence patient's safety, adherence, and informed decision-making. CONCLUSION: This study demonstrated that SA and ME patients have their own problems and needs regarding both medicine use and service access. By uncovering particular problems experienced by these groups, the study can inform healthcare professionals to support SA and ME patients in the use of their medicines.

Medicine use and medicine-related problems experienced by ethnic minority patients in the United Kingdom: a review.

OBJECTIVE: The aim of this review was to establish type(s) and possible cause(s) of medicine-related problems (MRPs) experienced by ethnic minorities in the UK and to identify recommendations to support these patients in the effective use of medicines. METHODS: A systematic search of studies related to problems with medicine use experienced by ethnic minorities in the UK was performed using the following databases: PubMed, Embase, International Pharmaceutical Abstract and Scopus from 1990 to 2011. A hand search for relevant citations and key journals was also performed. KEY FINDINGS: Fifteen studies were found. The MRPs identified across studies included lack of information, problems with not taking medicines as advised, concern of dependency or side effects, lack of regular monitoring and review, risk of adverse drug reactions, adverse events and problems in accessing healthcare services. Many problems are common in other groups, however, studies examining possible explanatory factors discussed how the cultural and religious beliefs, previous experiences, different expectations, language and communication barriers, lack of knowledge of the healthcare services and underestimating patients' desire for information may contribute to the problems. Some of the recommendations were made based on the problems that were found, but these have not been evaluated. CONCLUSIONS: Little evidence is known of what influences MRPs among ethnic minorities, despite the increased diversification of populations in countries throughout the world. To support their entire populations in the use of medicines, we have to ensure that we understand their different perspectives and needs regarding the effective use of medicines.