Public views of community pharmacy services during the COVID-19 pandemic: a national survey.

OBJECTIVE: To assess public opinion about community pharmacy services in Lebanon during the COVID-19 pandemic. METHOD: A cross-sectional study using an online questionnaire was conducted between April and August of 2021. A link was shared randomly among the Lebanese population using WhatsApp and Facebook. Public perceptions were explored within 3 different indicators: general services (B) dispensing (C), and storage (D). Chi-square, Student's test and ANOVA tests were used. p < 0.05 was considered statistically significant. RESULTS: Out of 491 responses, only 9.6% scored above the 75th percentile (19.3% for the general services, 2.4% for dispensing indicator and 12.6% for storage indicator). The main concerns focused on lack of medication and reduced opening hours; however, 67.1% of respondents preferred consulting the community pharmacist instead of visiting primary health care centers, doctor's private clinic and hospitals. Higher mean values of indicators B, C and in the overall indicator were significantly found in the presence of a pharmacist compared to the support pharmacy workforce. CONCLUSION: The overall public perception was inadequate. Significant difference in terms of quality of services was detected in the presence and absence of a community pharmacist during the crisis. It is recommended that the Order of Pharmacist of Lebanon (OPL) and the Ministry of Public Health (MOPH) undergo further steps mainly to enforce the laws concerning dispensing and storage indicators, improve the services in terms of extending the opening hours, ensure the availability of medicines and increase public awareness.

The current trends and challenges towards good community pharmacy practice and the way forward.

Background: The practice of pharmacy continues to evolve. Comprehensive research to monitor and assess the development of the practice is needed. Good Pharmacy Practices (GPP) have been adopted by many countries to enhance the quality of services. Little information is available concerning how pharmacy practices are being implemented in developing countries. Lebanon being a developing country is a good example where community pharmacy practice doesn't follow clear guidelines and no evidence of good clinical practice. Objectives: This study aims to highlight GPP implementation, to identify obstacles impeding implementation, and to suggest how its application could be facilitated in Lebanon. Methods: The review included studies published in English during the last five years covering aspects of pharmacy practice in relation to GPP standards. The search excluded research related to hospital pharmacy practice and primary health care centers since they have their own quality standards. Results: The research identified 20 recent studies that covered aspects of community pharmacy practice in Lebanon in relation to GPP standards. Eight of the studies related to research and professional development,5 related to the provision of medicines,4 related to interaction and communication,1 related to trainees,1 related to pharmacotherapy monitoring, and 1 related to documentation systems. An additional 6 studies provided insight into factors that affect the pharmacy practice in general. It is apparent that the pharmacy practice would benefit if pharmacists were better supported with financial incentives and a readjustment of their working conditions as this would have a positive impact on their productivity, job satisfaction, and overall well-being. The review indicated that the standard of research and professional development was the most studied topic and it was recommended that pharmacists develop their research capabilities. It was observed that there is a tendency towards implementing Continuous Education for pharmacists and obstacles primarily included work and family commitments, lack of interest, lack of time, difficulties in commuting, and lack of competence in the use of technology. This standard is aligned with the FIP's developmental goal of continuing professional development strategies. The search also identified only one pilot study to assess GGP compliance among community pharmacies in Lebanon. This pilot study was limited and showed low adherence of community pharmacies in Lebanon to GPP standards.Barriers to implementation are lack of enforcing laws,inadequate dissemination of the standards among the community pharmacists, poor public perception, and the financial and soscioeconomically crisis facing Lebanon. Conclusion: Collaborated efforts are needed to implement GPP standards in Lebanon.It is recommended to undergo training and awareness sessions to community pharmacists thus enhancing their commitment and motivation. It is also recommended to establish key performance indicators to monitor the implementation. Indicators should include structure indicators for regulating the storage of medications, process indicators for regulating the dispensing, and outcome indicators for reporting patient safety incidents, measuring public satisfaction and the provision and use of medicines.These recommendations can be used by Health authorities and Pharmacy educational institutions in Lebanon and in all similar low-income countries.

Adherence to international guidelines for the treatment of meningitis infections in Lebanon.

OBJECTIVES: To assess meningitis treatment in Lebanon's compatibility with the Infectious Diseases Society of America (IDSA) guidelines and the effect of non-compliance on mortality. Methods: This is a retrospective study, conducted in 5 Lebanese hospitals, and enrolling all patients diagnosed with meningitis who presented to the involved hospitals from January 2008 to December 2016.  Results: A total of 252 participants were enrolled in the study. Of these patients, 205 (82.7%) were diagnosed with viral meningitis and 47 (17.3%) with bacterial meningitis, which was confirmed using laboratory tests. For patients with viral meningitis, 128 (62.4%) remained on the initial prescribed antibiotics despite the negative cerebrospinal fluid (CSF) and blood culture results. For bacterial meningitis patients, 30.8% received treatment regimen incompatible with the IDSA guidelines. The most common reason for the treatment incompatibility was the definitive drug choice after the culture results (49.1%) and the least common reason was inappropriate hospital stay days (25.9%). The mortality rate was 13.5%. Having low proteins values in the CSF (odds ratio=0.095) was associated with lower mortality compared to patients with normal protein values. Conclusion: This study shows a high percentage of inappropriate treatment in Lebanese hospitals despite these hospitals having adopted international treatment guidelines. This inappropriate management was associated with an increasing rate of mortality and neurological complications.

Self-medication misuse in the Middle East: a systematic literature review.

Regulations usually distinguish between prescription-only (POM) and over-the-counter (OTC) medicines. The former requires medical prescription; the latter are available for SM of common minor or easily treated ailments. However, in the Eastern Mediterranean countries, theoretical prescription medicines can easily be purchased without a prescription, as self-medication (SM) resulting in potential misuse and unnecessary risk for patients. The magnitude of this activity is uncertain. The aim of this article, therefore, is to undertake a comprehensive review to identify the different types of medicines that can easily be purchased as SM in Middle East and recognized as misused. An extensive review of the published literature (1990-2015) was conducted using Pubmed, web of science, Cochrane, and Google Scholar databases, for OTC medicine misuse in the Middle East. A total of 72 papers were identified. Medicines involved in misuse included: codeine containing products, topical anesthetics, topical corticosteroids, antimalarial, and antibiotics. Self-medication misuse of medicines seemed widespread. Individual treatment patterns were not clearly identified. Studies were not standardized, limiting the comparability between studies and the estimation of the scale of misuse. Pharmacists, friends, or parents were found to be the main sources of SMs. Knowledge and attitudes are an important contributing factor in the misuse of these medications. Strategies and interventions to limit misuse were rarely identified in literature. In conclusion, a massive problem involving a range of medicines was found in Middle East. Standardization of studies is a prerequisite to the understanding and prevention of misuse of self-medication.

Growth charts and obesity prevalence among Lebanese private schools adolescents.

INTRODUCTION: The objectives of this study were to establish weight, height and body mass index curves and to calculate the prevalence of obesity by sex and age groups in Lebanese adolescents of private schools. MATERIAL AND METHODS: Body weight, height and body mass index (BMI) were measured among 12299 adolescents aged 10 to 18 years from Lebanese private schools. Adolescents' growth charts were established. Obesity and at risk of obesity individuals were identified according to International Obesity Taskforce thresholds, and our numbers were compared to those of other countries. RESULTS: Curves of weight, height and BMI were drawn. In boys, 10.1% were obese and 28.8% at risk of obesity. In girls, 4.2% were obese and 19.0% were at risk of obesity. CONCLUSION: Lebanese private schools adolescents, particularly boys, present high prevalences of obesity and risk of obesity. Pediatricians should identify early adolescents at greater risk, in order to achieve a more favorable prognosis.

Chronic bronchitis and pesticide exposure: a case-control study in Lebanon.

OBJECTIVE: Pesticides are widely used toxics. The objective of the study is to evaluate the odds of exposure to pesticides in chronic bronchitis patients. METHODS: Using the American Thoracic Society standardized questionnaire confirmed by medical diagnosis of chronic bronchitis, a case-control study was performed in Lebanon. Pesticide exposure was estimated and between groups comparison was made. RESULTS: The study involved 262 controls and 110 chronic bronchitis outpatient subjects from 10 medical centers. Any exposure to pesticides was associated to chronic bronchitis (OR = 2.46 [1.53-3.94]; p < 10(-4)). Occupational use presented the highest association (15.92 [3.50-72.41]; p < 10(-4)), followed by regional exposure (3.70 [2.05-6.70]; p < 10(-4)). Results were confirmed by multivariate and subgroup analysis. CONCLUSION: Pesticide exposure was associated with chronic bronchitis in Lebanese adults. Pesticides toxicological effects may explain chronic respiratory effects associations found with all exposure types.

[Clinical pharmacy in lebanon: a pilot study regarding health care professionals' opinion]. / Une étude pilote concernant l'opinion du personnel hospitalier.

INTRODUCTION: In Lebanon, clinical pharmacy is not professionally applied, despite being taught and required by the accreditation system of hospitals established by the Ministry of Health. The objective of our study is to evaluate the knowledge and attitude of medical professionals regarding the concept of clinical pharmacy. METHODS: It is a descriptive cross-sectional study, conducted in hospitals with doctors, nurses and administrators. Standardized self-filling questionnaires were distributed. RESULTS: The majority of physicians and of nurses found a clinical pharmacist intervention beneficial. All administrators were ready to accept a clinical pharmacist in their institution, since his/her presence would contribute to the reduction of hospitalization costs, mortality and morbidity. DISCUSSION: Medical professionals have a clear and positive idea regarding clinical pharmacy. CONCLUSION: Different steps are necessary in order to integrate clinical pharmacy in the Lebanese health care system.

Adolescent obesity in Lebanese private schools.

BACKGROUND: Obesity has become a public health problem worldwide. Our objective was to calculate the prevalence of overweight and obesity. METHODS: It is a cross sectional study of adolescents in private Lebanese schools, aged 10-18 years. Gender, birth date and measures of weight and height were recorded. RESULTS: In 12,299 adolescents, we found high prevalence of obesity (7.5%) and at risk of obesity (24.4%). In girls, risk of obesity and obesity prevalence decrease with increasing age (P < 10(-4)) as compared with that in boys. CONCLUSION: Early recognition of obesity should become routine in paediatric ambulatory care settings.

Symptoms and acute pesticide intoxication among agricultural workers in Lebanon.

Pesticides are known for their toxicity and are still widely used, especially in agriculture. Increasing attention is being focused on the health effects affecting humans occupationally exposed to pesticides, particularly agricultural workers. The objective of this study was to assess the association between occupational exposure to pesticides with recurrent symptoms and acute intoxications, in comparison with other workers in Lebanon. A cross-sectional study was undertaken, where a standardized questionnaire was administered to 89 exposed and 88 non exposed workers. Subjects exposed to pesticides reported more upper respiratory tract infections (PR = 9.39 ; p < 10(-4)), anorexia (PR = 3.63 ; p = 0.03), epistaxis (PR = 2.97; p = 0.02), immunoallergic (PR = 1.58 ; p = 0.01) and gastrointestinal (PR = 2.13 ; p < 10(-4)) symptoms. Acute pesticide intoxications requiring hospitalization were also more common (PR = 4.26; p = 0.01). Adjustment over potential confounding did not change the results, except for the appearance of an association of central (PR = 1.50 ; p = 0.04) and autonomic nervous systems symptoms (PR = 3.92 ; p = 0.01) with agricultural work in Mount Lebanon. Our results suggest that agricultural workers have a higher prevalence of multiple symptoms, which may be due to subacute intoxications by pesticides that did not need hospitalization. In addition, these workers have a higher risk of having an acute intoxication due to pesticides, exposing them to life-threatening situations.

Pesticides in Lebanon: a knowledge, attitude, and practice study.

Pesticides, despite their known toxicity, are widely used in developing countries. Evaluating the pattern of their use would be interesting to assess the appropriateness of adequate intervention. Using a standardized questionnaire, a knowledge, attitude, and practice study was performed in two Lebanese regions, in which a group of agricultural workers was compared to workers of the general population and a third group of pesticide distributors. Agricultural workers were exposed to pesticides during cropping, mixing, loading, and application (100%). They had low pesticide knowledge scales compared to pesticide distributors and to the general population workers (P<10(-7)). The preventive measures they took were low, and the lower their knowledge was, the lower were the preventive measures applied (P<10(-3)). Pesticide safety education is necessary in order to induce protective behavior among agricultural workers. The general population may also benefit from increasing their awareness regarding pesticides.