Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients with Sickle Cell Disease in Oman.

OBJECTIVES: Many barriers contribute to the underutilization of hydroxyurea (HU) in the treatment of sickle cell disease (SCD), and adherence to its use is often reported to be suboptimal. It is important to have information on the safety of HU in patients with SCD. Our study assessed the pattern of use, patients' adherence to medication, discontinuation of use, and safety of HU in patients with SCD. METHODS: This cross-sectional study was conducted in the department of medicine of a referral hospital in Oman over five months and included a review of patient files and patient interview. Approval was obtained from the Regional Research and Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration. The parameters were compared between groups using the chi-square test. RESULTS: Of 298 patients studied, 128 (43.0%) had used HU at some points. The difference in the prevalence of HU use was statistically significant based only on age (p = 0.014), with younger patients more likely to be currently using HU or used HU in the past. The majority of patients were adherent (82.5%) based on self-reported adherence. The prevalence of discontinuation (temporary or permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR) was the most common reason. Among those who had never used HU, 33.7% of patients had an indication for the initiation of HU. A quarter of patients who used HU developed a suspected ADR, with blood abnormalities being the commonest. The duration of HU use influenced ADR prevalence (p = 0.015). CONCLUSIONS: Among the current users of HU, the majority of the patients were adherent based on self-reported medication adherence. The prevalence of discontinuation of HU use and instances of non-initiation of HU among those indicated were high. A larger study, ideally of a prospective nature, in various governorates of Oman, would provide a wider picture at the national level.

Public's perception and satisfaction on the roles and services provided by pharmacists - Cross sectional survey in Sultanate of Oman.

BACKGROUND AND OBJECTIVES: An important factor that will help in advancement of the pharmacy services in any country would be to understand the public needs, expectation and satisfaction. There are limited published studies conducted in Sultanate of Oman regarding the perception and satisfaction of public on the role and services provided by pharmacists. The present study was conducted to assess the perception and satisfaction of general public in Sultanate of Oman on the roles, and services received from the pharmacists. METHODS: The survey was conducted among public in the Governorates of A'Dahera and Muscat in Oman during 2013. The questionnaire had items to assess two aspects: perception on the roles and responsibilities of pharmacists and satisfaction on the services provided. The responses to the questions marked in a five point Likert scale were assessed using a scoring scheme. Accordingly, the median perception, and satisfaction score and median total score for the participants were estimated. The median scores of the participants were related with the demographics of the participants and frequency of visit to pharmacy. RESULTS: A total of 390 completed questionnaires were obtained. The median total score of the participants based on all the questions was 79 (Inter Quartile Range (IQR), 12) which represents a moderate score. The median perception and satisfaction scores were 44 (IQR 5) and 34 (IQR 7) which represent a good and moderate score, respectively. Perception of the participants differed based on employment status, frequency of visit to pharmacy and governorate represented by participants while satisfaction was influenced by educational qualification and frequency of visit to pharmacy. CONCLUSIONS: Public had a good perception regarding the roles of the pharmacists while they were only moderately satisfied with the services provided. Steps have to be taken to improve the services and relationship of pharmacists, and thereby improve the satisfaction of the customers. An extended study in a broader population involving more governorates will provide an enhanced representation regarding this important aspect.

Knowledge, Beliefs and Behaviours Regarding the Adverse Effects of Medicines in an Omani Population: Cross-sectional survey.

OBJECTIVES: This study aimed to assess the knowledge, beliefs and behaviours of an Omani population with regards to the adverse effects of medicines. METHODS: This cross-sectional survey was conducted between February and June 2012. A 17-item questionnaire was designed to assess three aspects: knowledge, beliefs and behaviours related to medicine safety. A total of 740 questionnaires were distributed in three representative governorates of Oman. Median total scores for the three sections were estimated. Associations with participants' demographic variables and medication histories were also assessed. RESULTS: A total of 618 participants completed the survey (response rate: 83.5%). Many participants (46.4%) believed that side-effects occurred only with high doses of medication and over 30% believed that they did not occur at all with traditional and over-the-counter medicines. The median total score was 19 (interquartile range: 6) out of a maximum of 30. Inadequate knowledge, incorrect beliefs and good behaviours were observed among the participants. There was a significant association between certain demographic parameters (age, educational qualification, history of chronic use of medicines and employment status) and median total scores. Participants reported obtaining additional information on medication safety from various sources, with doctors as the most widely used source. CONCLUSION: Inadequate knowledge and incorrect beliefs among this Omani population indicate a need for interventions to improve public knowledge and address misconceptions regarding medication safety. These interventions could be initiated on both an individual and public scale, with patient interactions by healthcare professionals and mass education activities targeting the larger population.

Targeted study to evaluate the cardiovascular risk factor status among patients and efficacy of statins in attaining goal lipid levels in a regional hospital in Sultanate of Oman.

BACKGROUND AND OBJECTIVE: Elevated LDL (Low Density Lipoprotein) cholesterol is a major cause of Coronary Heart Disease (CHD) and LDL lowering therapy reduces the risk for CHD. The study was conducted with the aim of assessing the prescribing pattern of statins based on cardiovascular risk factor category, pattern of lipid monitoring followed among the patients and extent of attainment of goal Low Density Lipoprotein (LDL-C) observed among the patients. METHODS: A group of patient files (among those on statin agent during the year 2011) from the Department of Medicine in Nizwa Hospital were selected for targeted evaluation on the risk factor status of patients and efficacy of statins in attaining goal lipid levels. Goal LDL-C levels were estimated for each patient depending on their risk factor status. Subsequent follow ups of the patients were reviewed from the patient files and accordingly the attainment and maintenance of goal-LDL-C in the patients were evaluated. RESULTS: A total of 183 patients were identified. Mean age of the evaluated patients was 63.6 ± 11.58 years. Evaluating the status of patients on the presence of risk factors, majority (63.9%) of them had presence of CHD. Simvastatin was the most commonly used agent and titration of dose was done in only 3.3% of patients. Mean LDL-C level of the patient before initiation of treatment was 3.74 ± 1.9 mmol/L. Only in 59 (32.2 %) of the total evaluated 183 patients, there was evidence of attaining goal-LDL-C levels. Among them, there was evidence of maintenance of goal LDL-C in 16 (27.1%) of the patients. CONCLUSION: Statins were used less frequently for primary prevention of CHD. Absence of lipid monitoring; base line and follow up in a good number of patients as well as lack of dose titration among the patients were observed. Importance of adequate lipid monitoring and follow up to ensure attainment of goal LDL-C needs to be stressed to serve the objective of use of statins; primary and secondary prevention of CHD.

Statin associated hepatic adverse effects: a retrospective review from a regional hospital in sultanate of oman.

OBJECTIVE: This study aimed at evaluating the prevalence, pattern and predisposing factors for hepatic adverse effects with statins in a regional hospital in Sultanate of Oman. METHODS: A retrospective review of the patient files in Department of Medicine during the year 2011 was done to evaluate any hepatic dysfunction possibly related to statins among the patients. For each case of suspected statin induced hepatic effect, additional details on temporal relationship, pattern of presentation, management, final outcome and any contributing factors were obtained. Difference in the occurrence of hepatic effects based on the patient demographics and drug characteristics was additionally evaluated. RESULTS: A total of 927 patients meeting the inclusion criteria were included for the study. Mean age of the evaluated patients was 63.1 ± 11.37 and median duration of use of statin in months was 22 (IQR, 43.25). In 40 (4%) of the 927 patients, there was presence of a hepatic effect considered to be statin related and only in 12 (1%) patients a significant transaminase rise (>3 times) was observed. Median duration of use of statin among those patients who developed suspected statin induced hepatic effects and those who did not was 45 (IQR,52) and 21 (IQR, 43) months, respectively and the difference observed was statistically significant. A significant difference in the prevalence of hepatic effects was observed only based on the duration of statin use. CONCLUSION: There was an infrequent occurrence of significant hepatic effects associated with statins in the study population. Our results support the latest recommendations including from United States Federal Drug Administration (US FDA) that statins appear to be associated with a very low risk of serious liver injury and that routine periodic monitoring of transaminases does not appear to detect or prevent serious liver injury in association with statins.

Adherence to Medications among Type 2 Diabetes Mellitus Patients in Three Districts of Al Dakhliyah Governorate, Oman: A cross-sectional pilot study.

OBJECTIVES: This pilot study aimed to assess the medication adherence of type 2 diabetes mellitus (T2DM) patients in three wilayats (districts) of the Al Dakhliyah governorate, Oman, and to identify the probable reasons for medication non-adherence. METHODS: A cross-sectional questionnaire-based pilot survey was conducted among T2DM Omani patients between February and June 2012 to assess their medication adherence and the relationship between their socio-demographic characteristics and adherence levels. RESULTS: A total of 158 patients participated in the survey. The majority of the participants were unemployed or were housewives (66.5%). Forgetfulness was the most frequent reason for medication non-adherence (36.4%). Participants demonstrated an excellent level of adherence to their medicines (median total score = 3). No significant difference in median total adherence scores was observed based on the evaluated parameters. CONCLUSION: The medication adherence of T2DM patients in the area under study was good. A larger study in a wider population is warranted to obtain a more representative picture of this important factor which contributes to public health.

A cross sectional pilot study on assessing the knowledge, attitude and behavior of community pharmacists to adverse drug reaction related aspects in the Sultanate of Oman.

BACKGROUND AND OBJECTIVES: Adverse drug reaction (ADR) monitoring and reporting requires a multidisciplinary approach and pharmacists have a major role to play in it. The present pilot study was conducted to assess the knowledge, attitude and behavior of community pharmacists to ADR related aspects in the Sultanate of Oman. METHODS: A self-administered questionnaire comprising of 21 questions were distributed to a random sample of pharmacists in two Governorates in the Sultanate of Oman. It assessed the knowledge of pharmacists on some of the selected basic aspects of drug safety. Further, the knowledge and attitude of community pharmacists toward ADR reporting and their behavior on ADR related aspects were assessed. A scoring scheme was used to estimate the median total score of participants for various parameters. Obtained scores were correlated with the demographics of the respondents. RESULTS: A total of 107 community pharmacists participated in the survey giving a response rate of 72.3%. The responses of the pharmacists to the questions on the drug safety of individual drugs were incorrect for some important and practical questions. Consequently, total median score corresponding to these questions was 5 (Inter Quartile Range, IQR 2) out of a possible maximum score of 9, which was below the acceptable score. Total median score based on knowledge, attitude and behavior was 38 (IQR 8) out of a possible maximum of 50 which shows a moderate score. Lack of awareness on how to report an ADR and concern that the report may be wrong were the most common factors discouraging pharmacists from reporting ADRs. Qualification as well as years of experience were the only demographic parameters which had an influence on the score obtained by the pharmacists. CONCLUSIONS: Even though the pharmacists had an acceptable knowledge, attitude and behavior on ADR reporting and related aspects, a good number of them had below than acceptable knowledge on drug safety related aspects of specific drugs. Educational programs have to be continued to generate awareness on how to report ADR and stimulate pharmacists' more active participation in the pharmacovigilance program. There is a genuine need to have training programs to improve the knowledge of pharmacists on ADR related aspects which are of benefit on a daily basis which could greatly have an impact on patient safety.

A study assessing public knowledge, belief and behavior of antibiotic use in an omani population.

OBJECTIVE: This study was aimed to assess public knowledge, belief and behavior towards antibiotics use in a general population in the Sultanate of Oman. METHODS: A 12-item self-administered questionnaire was distributed to 850 prospective participants by researchers using quota sampling in two governorates of Oman. The data obtained were evaluated to assess the responses to individual questions related to knowledge, belief and behavior of antibiotic use. Median score of the respondents was correlated with participant demographics and status on use of antibiotics. RESULTS: A total of 718 completed questionnaires were obtained giving a response rate of 85%. The median total score of the participants was 16 (Interquartile range: 6) out of a possible maximum score of 24. A moderate knowledge and behavior score was observed, while the belief score of the participants was low. A significant difference was observed in the median total score based on age group, educational qualification and employment status. CONCLUSION: Antibiotics are frequently used by the public. An inappropriate belief on antibiotic related aspects was observed and inappropriate behavior was noticed, which are reflections of insufficient knowledge and wrong beliefs. Interventions must be put in place to educate the public on appropriate antibiotic use.

Patient medication adherence: measures in daily practice.

Adherence to therapies is a primary determinant of treatment success. Failure to adherence is a serious problem which not only affects the patient but also the health care system. Medication non adherence in patients leads to substantial worsening of disease, death and increased health care costs. A variety of factors are likely to affect adherence. Barriers to adherence could be addressed as patient, provider and health system factors, with interactions among them. Identifying specific barriers for each patient and adopting suitable techniques to overcome them will be necessary to improve medication adherence. Health care professionals such as physicians, pharmacists and nurses have significant role in their daily practice to improve patient medication adherence.

A survey on the knowledge, beliefs and behaviour of a general adult population in Malaysia with respect to the adverse effects of medicines.

OBJECTIVE: The aim of the study was to explore, in the Malaysian general population: knowledge and beliefs of the characteristics in general of medication-related side effects and side effects associated with different types of medicines; behaviour related to the safe use of drugs before and after taking a medication; and behaviour in the event of a medication-related side effect. METHODS: A 24-item self-administered questionnaire was developed and used to survey the general public living or working in suburban Kuala Lumpur, Malaysia. Eight hundred questionnaires were distributed, face to face, by researchers using quota sampling. Respondents' knowledge, belief and behaviour were analysed and correlated with demographics, medical history and experience of side effects. KEY FINDINGS: Six hundred and ten respondents completed the questionnaire giving a response rate of 76.3%. The mean knowledge score for the respondents was 18.4±3.6 out of the maximum possible score of 26. Educational level and experience of side effect had an influence on the knowledge score obtained. Respondents had misconceptions regarding the safety of complementary and alternative medicines (CAMs) and over-the-counter medications. Medication history and previous experience with side effects had a significant influence on the higher behaviour score obtained. CONCLUSION: The survey has shown moderate results with regard to the knowledge of public regarding safety of medications, and there was evidence of under-estimating the risk of medications, especially CAMs. The misconceptions among the public, and inappropriate behaviour on drug safety-related aspects, is a concern which needs to be addressed in the interventions designed.

Drug safety reports on complementary and alternative medicines (ayurvedic and homeopathic medicines) by a spontaneous reporting program in a tertiary care hospital.

OBJECTIVES: The objectives of this study were to initiate a pharmacist-coordinated program to improve the adverse drug reaction (ADR) reporting on complementary and alternative medicines (CAM) in a tertiary care hospital and to evaluate the pattern of the reported ADRs. DESIGN: A targeted approach was taken in increasing the ADR reporting to CAM in a tertiary care hospital in South India. Suspected ADRs to CAM spontaneously reported over a period of 24 months were selected for evaluation. Reported ADRs were evaluated for patient demographics, reaction and drug characteristics, causality, severity, and outcome. RESULTS: A total of 12 ADRs to CAM were reported, which included 9 to Ayurvedic and 3 to homeopathic medicines, which accounted for 1.5% of the ADRs reported to the ADR reporting unit. ADR resulted in hospitalization in 5 patients. The system organ class most commonly involved included skin and appendage disorders (58.3%). Only four of the reactions were previously reported in the literature. The mean time for onset of the ADR after the administration of the drug was 27.8 +/- 36.1 days. The suspected drug was withdrawn in all the reports that resulted in recovery, with mean time for recovery 5.9 +/- 3.6 days. The majority (66.6%) were moderate in severity and 2 were severe in nature. On causality assessment, 6 were probable in nature and the remaining were possible. CONCLUSIONS: Even though there were fewer ADRs reported by this spontaneous reporting system, it gave valuable information regarding the potential for adverse effects with these agents. The study has reinstated the potential role of spontaneous reporting in identifying lesser reported ADRs, including those to CAM. Such hospital-based programs can contribute much in increasing the safety-related data of these agents.

Acute interstitial nephritis related to lansoprazole administration.

Acute interstitial nephritis (AIN) is a rare but serious adverse effect reported with proton pump inhibitors (PPIs). Only one report (2 cases) of AIN with lansoprazole is published in literature. A case of lansoprazole induced interstitial nephritis (biopsy supported) was reported in an elderly female patient admitted to the hospital with non specific symptoms after 45 days of treatment with the drug. A recovery was noticed upon withdrawal of the drug and treatment with corticosteroids. We consider this report as a valuable addition to the existing literature on this rare adverse effect with lansoprazole. This potentially serious adverse effect with PPIs including lansoprazole has to be given due consideration, especially taking into account the wide spread use of this group of agents.

Short communication: pattern of adverse drug reaction related queries received by the drug information centre of a tertiary care teaching hospital.

Accurate information about safety of drugs is very essential for health care professionals in identifying, preventing and managing Adverse Drug Reactions (ADRs), thereby ensuring safe use of medications. The objective of the present study was to assess the pattern of drug information (DI) queries related to ADRs received by the Drug Information Center (DIC) of a tertiary care teaching hospital. Retrospective evaluation of the DI queries received in the DIC over a period of three and a half years (January 2002-July 2005) was done for various parameters such as purpose and type of query, characteristics of the drugs and reactions involved, and references used. Out of 2312 DI queries received, 600 (25.9%) were related to ADRs. Majority of the queries were from the department of medicine (80.5%) and was received during ward rounds (76%). In most of the queries, the information was sought for better patient care (66.3%) and the enquirer wanted the information immediately (59.5%). The category of ADR queries most commonly asked was regarding identification of an ADR (54.3%). Considering the reaction characteristics, the organ system most commonly involved in the queries was nervous system (14.7%) and the reaction was fever and skin rash (14%). Most of the queries were on uncommon reactions. Drug class most commonly involved in the queries were antibacterials for systemic use (18.6%) and the most frequently involved drug was phenytoin (35%). MICROMEDEX system was used as the reference in answering most (57.1%) of the queries. Information on ADRs is among the most sought information on drugs by the health care professionals. Evaluation of pattern of these queries could reveal opportunities for educational and other interventions in promoting safer drug use in a health care setting. DICs could play a major role in promoting drug safety and it needs to be well equipped to respond to these needs.