Search results for: medicines prescription behavior

Authors: Swanand Pathak, Kiran R. Giri, Reena R. Giri, Kamlesh Palandurkar, Sangita Totade, Rajesh Jha, S. S. Patel

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Background: Population burden, illiteracy, availability of few doctors for larger group of population leads to many unanswered questions left in a patient’s mind. Incomplete information results into noncompliance, therapeutic failure, and adverse drug reactions (ADR). It is very important to establish a system which will provide noncommercial, independent, unbiased source of medicine information. Medicines Info OPD is a concept and step towards safe and appropriate use of medicines. Objective: (1) to assess the present status of knowledge about the medicines in the patients and its correlation with education; (2) to assess the medicine information dispensing modalities, their use and sufficiency from the patients view point; (3) to assess the overall need for Medicines Information OPD in present scenario. Materials and Methods: A pre-validated questionnaire based study was conducted amongst 500 patients of tertiary health care hospital. The questionnaire consisted of specific questions regarding understanding of prescription, knowledge about adverse drug reaction, view about self-medication and opinion regarding the need of Medicines Info OPD. Results: Significantly large proportion of patients opined that doctors do not have sufficient time in current Indian healthcare to explain the prescription and they are not aware of adverse drug reactions, expiry date or use the package inserts etc. Conclusion: Clinically relevant, up to date, user specific, independent, objective and unbiased Medicines Info OPD is essential for appropriate drug use and can help in a big way to common public to address many problems faced by them.

Keywords: information, prescription, unbiased, clinically relevant

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Authors: Lichung Jen, Yi Chun Liu, Kuan-Wei Lee

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Fruitful data has been accumulated in database nowadays and is commonly used as support for decision-making. In the healthcare industry, hospital, for instance, ordering pharmacy inventory is one of the key decision. With large drug inventory, the current cost increases and its expiration dates might lead to future issue, such as drug disposal and recycle. In contrast, underestimating demand of the pharmacy inventory, particularly standing drugs, affects the medical treatment and possibly hospital reputation. Prescription behaviour of hospital physicians is one of the critical factor influencing this decision, particularly irregular prescription behaviour. If a drug’s usage amount in the month is irregular and less than the regular usage, it may cause the trend of subsequent stockpiling. On the contrary, if a drug has been prescribed often than expected, it may result in insufficient inventory. We proposed a hierarchical Bayesian mixture model with two components to identify physicians’ regular/irregular prescription patterns with probabilities. Heterogeneity of hospital is considered in our proposed hierarchical Bayes model. The result suggested that modeling the prescription patterns of physician is beneficial for estimating the order quantity of medication and pharmacy inventory management of the hospital. Managerial implication and future research are discussed.

Keywords: hierarchical Bayesian model, poission mixture model, medicines prescription behavior, irregular behavior

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Authors: A. Shirazibeheshti, T. Radwan, A. Ettefaghian, G. Wilson, C. Luca, Farbod Khanizadeh

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Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature, which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on over 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. To further evaluate the performance of the model, any association between the average risk score within each group and other factors such as socioeconomic status (i.e., Index of Multiple Deprivation) and an index of health and disability were investigated. The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings also show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, indicating that females are more at risk from this kind of multiple medications. The risk may be monitored and controlled in well artificial intelligence-equipped healthcare management systems.

Keywords: anticholinergic medicines, clustering, deprivation, socioeconomic status

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Authors: Joshua Fogel, Rivka Herzog

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Although direct-to-consumer prescription medication advertisements (DTCA) are viewed or heard in many venues, there does not appear to be any research for internet social media DTCA. We study the association of traditional media DTCA and digital media DTCA including internet social media of YouTube, Facebook, and Twitter with three different outcomes. There was one intentions outcome and two different behavior outcomes. The intentions outcome was the agreement level for seeking additional information about a prescription medication after seeing a DTCA. One behavior outcome was the agreement level for obtaining additional information about a prescription medication after seeing a DTCA. The other behavior outcome was the frequency level for obtaining additional information about a prescription medication after seeing a DTCA. Surveys were completed by 635 college students. Predictors included demographic variables, theory of planned behavior variables, health variables, and advertisements seen or heard. Also, in the behavior analyses, additional predictors of intentions and sources for seeking additional prescription drug information were included. Multivariate linear regression analyses were conducted. We found that increased age was associated with increased behavior, women were associated with increased intentions, and Hispanic race/ethnicity was associated with decreased behavior. For the theory of planned behavior variables, increased attitudes were associated with increased intentions, increased social norms were associated with increased intentions and behavior, and increased intentions were associated with increased behavior. Very good perceived health was associated with increased intentions. Advertisements seen in spam mail were associated with decreased intentions. Advertisements seen on traditional or cable television were associated with decreased behavior. Advertisements seen on television watched on the internet were associated with increased behavior. The source of seeking additional information of reading internet print content was associated with increased behavior. No internet social media advertisements were associated with either intentions or behavior. In conclusion, pharmaceutical brand managers and marketers should consider these findings when tailoring their DTCA advertising campaigns and directing their DTCA advertising budget towards young adults such as college students. They need to reconsider the current approach for traditional television DTCA and also consider dedicating a larger advertising budget toward internet television DTCA. Although internet social media is a popular place to advertise, the financial expenditures do not appear worthwhile for DTCA when targeting young adults such as college students.

Keywords: brand managers, direct-to-consumer advertising, internet, social media

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Authors: Zhenzhong Yang

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Herbal medicines are important supplements to chemical drugs and usually consist of a complex mixture of constituents. The current quality control strategy of herbal medicines is mainly based on chemical markers, which largely failed to owe to the markers, not reflecting the herbal medicines’ multiple mechanisms of action. Herein, a bioactive chemical markers based strategy was proposed and applied to the quality assessment and control of herbal medicines. This strategy mainly includes the comprehensive chemical characterization of herbal medicines, bioactive chemical markers identification, and related quantitative analysis methods development. As a proof-of-concept, this strategy was applied to a Panax notoginseng derived herbal medicine. The bioactive chemical markers based strategy offers a rational approach for quality assessment and control of herbal medicines.

Keywords: bioactive chemical markers, herbal medicines, quality assessment, quality control

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Authors: M. Umar Hafeez, Furqan Khursheed Hashmi, Nadeem Irfan Bukhari, Shahzad Ali, Muzammil Ali

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The trend of self-medication is increasing due to various factors and is associated with a large number of complications. A cross-sectional study was aimed to investigate self-medication trend in an urban community and its correlates such as level of education, gender and behavior of using psychoactive medicines. A validated questionnaire was used to collect the data from different locations of Lahore, provincial capital of Punjab, Pakistan. The trend of self-medication was noted in reference to difference in educational level and in gender. This study showed that total 110 respondents, all literate,were found to be self-medicating, and their educational status was as 73.13% primary, 63.15% secondary, 61.12% higher secondary and 62.15% university going. In this sample 74.99% were males and 48.00%were females. Twenty nine (26.36%) of the total sample were found to be using psychoactive agents without consulting the physician. The trend of self-medication was 10% higher in individuals having primary level education, whereas there was not much difference of self-medication trend in other levels of education. The main reasons involved in self-medication trend were socio-economic status, medicine accessibility, religious and cultural beliefs, lack of awareness about risks associated with medicine, non-prescription sale of medicines and previous medication experience. The trend of self-medication of psychotropic agents is quite significant.

Keywords: self-medication, educated community, psychotropic drugs, education levels

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Authors: Ellen Lagast, Melissa Ceuterick, Mark Leys

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Although adolescence is a stressful period with an increased risk for mental illnesses such as anxiety and depression, little in-depth knowledge is available on the determinants of the use of psychotropic drugs (BZD/SSRIs) and the effects. A qualitative research with adolescents in Flanders was performed. Based on indepth interviews, the interviewees indicate feelings of ambiguity towards their medication use because on the one hand the medication helps to manage their mental vulnerability and disrupted lives, but on the other hand they experience a loss of control of their self and their environment. Undesired side-effects and stigma led to a negative pharmaceutical self. The interviewed youngsters also express dissatisfaction about the prescription behavior with regard to psychotropic drugs of their general practitioner (GP). They wished to have received more information about alternative non-pharmaceutical treatment options. Notwithstanding these comments, the majority of the interviewees maintained trust in their GP to act in their best interest. This paper will relate the prescription behavior in primary care to the organization of mental health care to better understand the “phamaceuticalization” and medicalization of mental health problems in Belgium. Belgium implemented fundamental mental health care reforms to collaborate, to integrate care and to optimize continuity of care. Children and adolescents still are confronted with long waiting lists to access (non-medicalized) mental health services. This access to mental health care partly explains general practitioners’ prescription behavior of psychotropics. Moreover, multidisciplinary practices have not pervaded primary health care yet. Medicalization and pharmaceuticalization of mental health vulnerabilities of youth are both a structural and cultural problem.

Keywords: adolescents, antidepressants, benzodiazepines, mental health system, psychotropic drugs

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Authors: Saira Tajdar, Sajad Ahmad

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The pharmaceutical market of Pakistan showed a mixed trend since 1947. In these six decades various local and foreign pharmaceutical companies entered the market with their highly researched based formulas and brands for various diseases. It also created a very competitive market between local and foreign companies and brands. But this intense competition does not clear the picture that whether the customers (Doctors) are preferring/prescribing foreign or local brands more frequently. Previous research has been done in various markets for different brands that whether the customers in that industry prefer foreign or local brands. However, the pharmaceutical industry in this regard has been ignored by the researchers. Generally people don't know that for prescription brands of medicines what the preferences of customers (Doctors) are. Therefore, this study is conducted in two departments of Pharmaceutical industry by selecting the top recommended formulas in those departments that for those formulas whether the customers (Doctors) are prescribing either foreign brands or local brands. Secondary data has been collected from previous studies on the country of origin (COO), ethnocentrism and factors influencing brands preferences from authentic sources. Primary data was also collected through 100 self administered questionnaires from top five hospitals of Peshawar. The results of the study were analyzed through SPSS which shows that in some categories of pharmaceutical products the COO is very important but not for all.

Keywords: customer prescription, country of origin, empirical study, foreign versus local brands, pharmaceutical industry, Pakistan

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Authors: Anton V. Dolzhenko, Tahir Mehmood Khan

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An ability to make an evidence-based decision is a critically important skill required for practicing pharmacists. The development of this skill is incorporated into the pharmacy curriculum. We aimed in our study to estimate perception of pharmacy students regarding herbal medicines and their ability to assess information on herbal medicines professionally. The current Monash University curriculum in Pharmacy does not provide comprehensive study material on herbal medicines and students should find their way to find information, assess its quality and make a professional decision. In the Pharmacy course, students are trained how to apply this process to conventional medicines. In our survey of 93 undergraduate students from year 1-4 of Pharmacy course at Monash University Malaysia, we found that students’ view on herbal medicines is sometimes associated with common beliefs, which affect students’ ability to make evidence-based conclusions regarding the therapeutic potential of herbal medicines. The use of herbal medicines is widespread and 95.7% of the participated students have prior experience of using them. In the scale 1 to 10, students rated the importance of acquiring herbal medicine knowledge for them as 8.1±1.6. More than half (54.9%) agreed that herbal medicines have the same clinical significance as conventional medicines in treating diseases. Even more, students agreed that healthcare settings should give equal importance to both conventional and herbal medicine use (80.6%) and that herbal medicines should comply with strict quality control procedures as conventional medicines (84.9%). The latter statement also indicates that students consider safety issues associated with the use of herbal medicines seriously. It was further confirmed by 94.6% of students saying that the safety and toxicity information on herbs and spices are important to pharmacists and 95.7% of students admitting that drug-herb interactions may affect therapeutic outcome. Only 36.5% of students consider herbal medicines as s safer alternative to conventional medicines. The students use information on herbal medicines from various sources and media. Most of the students (81.7%) obtain information on herbal medicines from the Internet and only 20.4% mentioned lectures/workshop/seminars as a source of such information. Therefore, we can conclude that students attained the skills on the critical assessment of therapeutic properties of conventional medicines have a potential to use their skills for evidence-based decisions regarding herbal medicines.

Keywords: evidence-based decision, pharmacy education, student perception, traditional medicines

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Authors: Kazunari Ozaki, Mitsuru Kageyama, Kenki Miyazawa, Yoshio Nakamura

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Background: Kampo (Japanese Traditional medicine) is a medicine traditionally practiced in Japan, based on ancient Chinese medicine. Most Kampo doctors have used decoction of crude drug pieces for treatment. 93% of the Kampo drugs sold in Japan are Kampo products nowadays. Of all Kampo products, 81% of them are Kampo extract formulations for prescription, which is prepared in powdered or granulated form from medicinal crude drug extracts mixed with appropriate excipient. Physicians with medical license for Western medicine prescribe these Kampo extract formulations for prescription in Japan. Objectives: Our study aims at presenting a brief history of Kampo extract formulations for prescription in Japan. Methods: Systematic searches for relevant studies were conducted using not only printed journals but also electronic journals from the bibliographic databases, such as PubMed/Medline, Ichushi-Web, and university/institutional websites, as well as search engines, such as Google and Google Scholar. Results: The first commercialization of Kampo extract formulations for general use (or OTC (over-the-counter) Kampo extract formulation) was achieved after 1957. The number of drugs has been subsequentially increased, reaching 148 Kampo extract formulation for prescription currently. Conclusion: We provide a history of Kampo extract formulations for prescription in Japan. The originality of this research is that it analyzes the background history of Kampo in parallel with relevant transitions in the government and insurance systems.

Keywords: health insurance system, history, Kampo, Kampo extract formulation for prescription, OTC Kampo extract formulation, pattern corresponding prescription (Ho-sho-so-tai) system

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Authors: Sarah Saad Alamer, Shujon Mohammed Alazzam, Amjad Khater Alanazi, Mohamed Ahmed Sankari, Jana Sameer Sendy, Saleh Al-Khaldi, Khaled Allam, Amani Badawi

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Background: Self-medication is defined as the selection of medicines by individuals to treat self-diagnosed. There are a lot of concerns about the safety of long-term use of nonprescription ophthalmic drugs, which may lead to a variety of serious ocular complications. Topical steroids can produce severe eye-threatening complications, including the elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage. In recent times, many OTC ophthalmic preparations have been possible without a prescription. Objective: In our study, we aimed to determine the prevalence of self-medication ocular topical steroid practice and associated factors among adult ophthalmic patients attending King Saud medical city. Methods: This study was conducted as a cross-sectional study, targeting participants aged 18 years old or above who had used topical steroids eye drops to determine the prevalence of self-medication ocular topical steroid practice and associated factors among adult patients attending ophthalmology clinic in King Saud Medical City (KSMC) in the central region. Results: A total of 308 responses, 92(29.8%) were using ocular topical, 58(18.8%) with prescription, 5(1.6%) without prescription, 29(9.4%) with and without prescription while 216(70.1%) did not use it. The frequency of using ocular topical steroids without a prescription among participants was 11(12%) once and 33 (35%) many times. 26(28.3%) were having complication, mostly 11(12.4%) eye infection, 8(9%) Glaucoma, 6 (6.7%) Cataracts. Reasons for self-medication ocular topical steroid practice among participants were 14 (15.2%) repeated symptoms, 11(15.2%) had heard an advice from a friend, 11 (15.2%) thought they had enough knowledge. Conclusion: Our study reveals that, even though detecting a high level of knowledge and acceptable practices and attitudes among participants, the incidence of self-medication with steroid eye drops was observed. This practice is mainly due to participants having repeated symptoms and thinking they have enough knowledge. Increasing the education level of patients on self-medication steroid eye drops practice and it is associated complications would help reduce the incidence of self-medication steroid eye drops practice.

Keywords: self-medication, ophthalmic medicine, steroid eye drop, over the counter

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Authors: B.S. Roopa

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Objectives: To investigate the prevalence of concomitant use of GPDs in patients treated with NSAIDs and GPDs in recommended dose and frequency as prophylaxis. And also to know the association between risk factors and prescription of GPDs in patients treated with NSAIDs. Methods: Study was a prospective, observational, cross-sectional survey. Data from patients with prescription of NSAIDs at the out-patient departments of secondary care Hospital, Nilgiris, India were collected in a specially designed proforma for a period of 45 days. Analysis using χ2 tests for discrete variables. Factors that might be associated with prescription of GPD with NSIADs were assessed in multiple logistic regression models. Results: Three hundred and three patients were included in this study, and the rate of GPD prescription was 89.1%. Most of the patients received H2-receptor antagonist, and, to a lesser degree, antacid and proton pump inhibitor. Patients with history of GI ulcer/bleeding were much more likely to be co-prescribed GPD than those who had no history of GI disorders .Compared with patients who were managed in general outpatient clinic, those managed in Secondary care hospital in Nilgrisis, India were more likely to receive GPD. Conclusions: The prescription rate of GPD with NSAIDs is high. Patients were prescribed with H2RA with dose of 150mg twice daily, which are not effective in reducing the risk of NSAIDs induced gastric ulcer. Only the frequency of NSAIDs prescription was considered significant determinant for the co-prescription with GPAs in patients who are < 65 years and ≥ 65 years old.

Keywords: gastro protective agents, non steridol anti inlfammatory agents

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Authors: Mera Ababneh, Sayer Al-Azzam, Karem Alzoubi, Abeer Rababa'h

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Background: Medication errors are among the most common medical errors. Their occurrences result in patient’s mortality, morbidity, and additional healthcare costs. Continuous monitoring and detection is required. Objectives: The aim of this study was to compare medication errors in outpatient’s prescriptions in two different hospitals (paper system vs. electronic system). Methods: This was a cross sectional observational study conducted in two major hospitals; King Abdullah University Hospital (KAUH) and Princess Bassma Teaching Hospital (PBTH) over three months period. Data collection was conducted by two trained pharmacists at each site. During the study period, medication prescriptions and dispensing procedures were screened for medication errors in both participating centers by two trained pharmacist. Results: In the electronic prescription hospital, 2500 prescriptions were screened in which 631 medication errors were detected. Prescription errors were 231 (36.6%), and dispensing errors were 400 (63.4%) of all errors. On the other side, analysis of 2500 prescriptions in paper-based hospital revealed 3714 medication errors, of which 288 (7.8%) were prescription errors, and 3426 (92.2%) were dispensing errors. A significant number of 2496 (67.2%) were inadequately and/or inappropriately labeled. Conclusion: This study provides insight for healthcare policy makers, professionals, and administrators to invest in advanced technology systems, education, and epidemiological surveillance programs to minimize medication errors.

Keywords: medication errors, prescription errors, dispensing errors, electronic prescription, handwritten prescription

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Authors: Josiah Damisa, Michelle Louise Richardson, Morenike Adewuyi

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Lower back pain is a significant cause of disability worldwide and associated with great implications in terms of the well-being of affected individuals and society as a whole due to its undeniable socio-economic impact. With its prevalence on the increase as a result of an aging global population, the need for novel forms of pain management is ever paramount. This review aims to provide further insight into current research regarding a role for the endocannabinoid signaling pathway as a target in the treatment of chronic pain, with particular emphasis on its potential use as part of the treatment of lower back pain. Potential advantages and limitations of cannabis-based medicines over other forms of analgesia currently licensed for medical use are discussed in addition to areas that require ongoing consideration and research. To evaluate the efficacy of cannabis-based medicines in chronic pain, studies pertaining to the role of medical cannabis in chronic disease were reviewed. Standard searches of PubMed, Google Scholar and Web of Science databases were undertaken with peer-reviewed journal articles reviewed based on the indication for pain management, cannabis treatment modality used and study outcomes. Multiple studies suggest an emerging role for cannabis-based medicines as therapeutic agents in the treatment of chronic back pain. A potential synergistic effect has also been purported if these medicines are co-administered with opiate analgesia due to the similarity of the opiate and endocannabinoid signaling pathways. However, whilst recent changes to legislation in the United Kingdom mean that cannabis is now licensed for medicinal use on NHS prescription for a number of chronic health conditions, concerns remain as to the efficacy and safety of cannabis-based medicines. Research is lacking into both their side effect profiles and the long-term effects of cannabis use. Legal and ethical considerations to the use of these products in standardized medical practice also persist due to the notoriety of cannabis as a drug of abuse. Despite this, cannabis is beginning to gain traction as an alternative or even complementary drug to opiates, with some preclinical studies showing opiate-sparing effects. Whilst there is a paucity of clinical trials in this field, there is scope for cannabinoids to be successful anti-nociceptive agents in managing chronic back pain. The ultimate aim would be to utilize cannabis-based medicines as alternative or complementary therapies, thereby reducing opiate over-reliance and providing hope to individuals who have exhausted all other forms of standard treatment.

Keywords: endocannabinoids, cannabis-based medicines, chronic pain, lower back pain

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Authors: S. Vinotha, I. Thabrew, S. Sri Ranjani

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Hot aqueous and methanol extracts of the two selected herbal medicines such are Vellarugu Chooranam (V.C) and Amukkirai Chooranam (A.C) were examined for total phenolic and flavonoid contents and in-vitro antioxidant activity using four different methods. The total phenolic and flavonoid contents in methanol extract of V.C were found to be higher (44.41±1.26 mg GAE⁄g; 174.44±9.32 mg QE⁄g) than in the methanol extract of A.C (20.56±0.67 mg GAE⁄g;7.21±0.85 mg QE⁄g). Hot methanol and aqueous extracts of both medicines showed low antioxidant activity in DPPH, ABTS, and FRAP methods and Iron chelating activity not found at highest possible concentration. V.C contains higher concentrations of total phenolic and flavonoid contents than A.C and can also exert greater antioxidant activity than A.C, although the activities demonstrated were lower than the positive control Trolox. The in-vitro antioxidant activity was not related with the total phenolic and flavonoid contents of the methanol and aqueous extracts of both herbal medicines (A.C and V.C).

Keywords: activity, different extracts, herbal medicines, in-vitro antioxidant

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Authors: Prabha Rohatgi

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To obtain an efficient control over a huge amount of inventory of drugs in pharmacy department of any hospital, generally, the medicines are categorized on the basis of their cost ‘ABC’ (Always Better Control), first and then categorize on the basis of their criticality ‘VED’ (Vital, Essential, desirable) for prioritization. About one-third of the annual expenditure of a hospital is spent on medicines. To minimize the inventory investment, the hospital management may like to keep the medicines inventory low, as medicines are perishable items. The main aim of each and every hospital is to provide better services to the patients under certain limited resources. To achieve the satisfactory level of health care services to outdoor patients, a hospital has to keep eye on the wastage of medicines because expiry date of medicines causes a great loss of money though it was limited and allocated for a particular period of time. The objectives of this study are to identify the categories of medicines requiring incentive managerial control. In this paper, to minimize the total inventory cost and the cost associated with the wastage of money due to expiry of medicines, an inventory control model is used as an estimation tool and then nonlinear programming technique is used under limited budget and fixed number of orders to be placed in a limited time period. Numerical computations have been given and shown that by using scientific methods in hospital services, we can give more effective way of inventory management under limited resources and can provide better health care services. The secondary data has been collected from a hospital to give empirical evidence.

Keywords: ABC-VED inventory classification, multi item inventory problem, nonlinear programming technique, optimization of EOQ

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Authors: M. Y. Achouri, O. A. Alleg, M. C. L. Moulai, M. A. Selka

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This study aims to assess the perception and attitudes of community pharmacists in Sidi-Bel-Abbes (Algeria) towards generic drugs. This is a descriptive cross-sectional prospective survey and quantitative, conducted over a period of two months from April to May 2014. The target population consisted of 118 pharmacists practicing in pharmacies in Sidi-Bel-Abbes. Data collection was conducted through a questionnaire consisting of thirteen (13) items. Fifty six (67%) of community pharmacists in the town of Sidi-Bel-Abbes in the survey believe that generics have a lower quality compared to brand name medicines Only 42% of respondents viewed locally manufactured generic medicines as equal in quality compared to the imported generic medicines, and 63% believe that the generics substitution has led to change the relationship between a pharmacist and patient. In order to promote the practice of generic medicines in Algeria, an educational program should be implemented.

Keywords: generic drugs, perception, attitudes, community pharmacists

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Authors: Aliyu Umar, Mohammed Yau, Faruruwa M. Dahiru, Saed Garba

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Evaluation of heavy metals in twelve commonly consumed herbal medicines/preparations in Kano State, Nigeria, was carried out. The samples comprised of five unregistered powdered medicines, namely, Zuwo, (ZW); Rai Dorai, (RD); Miyar Tsanya, (MTS); Bagaruwar Makka, (BM); and Madobiya, (M); five unregistered liquid herbal medicinal concussions for pile (MB), yellow fever (MS), typhoid (MT), stomach pain (MC), sexually transmitted diseases (STDs); and two registered herbal medicines; Alif Powder (AP) and Champion Leaf (CL). The heavy metals evaluation was carried out using Atomic Absorption Spectroscopy (AAS) and the result revealed the concentrations (ppm) ranges of the heavy metals as follows: Cadmium (0.0045 – 0.1601), Chromium (0.0418 – 0.2092), Cobalt (0.0038 – 0.0760), Copper (0.0547 – 0.2465), Iron (0.1197 – 0.3592), Manganese (0.0123 – 1.4462), Nickel (0.0073 – 0.0960), Lead (0.185 – 0.0927) and Zinc (0.0244 – 0.2444). Comparing the results obtained in this work with the standards of the World Health Organization (WHO), the Food and Agricultural Organization (FAO) and permissible limits of other countries, the concentrations of heavy metals in the herbal medicine/preparations are within the allowed permissible limits range in herbal medicines and their use could be safe.

Keywords: Kano state, herbal medicines, registered, unregistered

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Authors: Adeyemi A. Ajisebiolola

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This study examined people’s responses to demand and consumption of herbal medicines in Nigeria. It also assessed people’s evaluation of the effectiveness of the existing medicines on the treatment of ailments and encouraging forest products utilization for greener future in terms of healthcare delivery. Two Local Government Areas, namely Ido and Ibadan Northwest were adopted for the study; Ido is characterized by rural populace and Ibadan Northwest by urban populace. Out of 500 questionnaires randomly administered to the households in the two local government areas of study, 481 (96.2%) were recovered. Statistical analysis employed showed that people were beginning to understand the importance of herbal medicines in Nigeria as majority of the households use herbal medicines to treat various ailments. Among the major problems encountered by the respondents are lack of precise dosage and adequate preservation methods. It was recommended that Forestry Research Institutes in Nigeria should be deeply involved in the findings on medicinal plants, package them into products and make them available to the society for sustainable healthcare management and greener future of the nation.

Keywords: demand and consumption, forest products, herbal medicines, Nigeria

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Authors: Prashant Neupane, Asmi Pandey, Mumna Ehsan, Katie Davies, Richard Lowsby

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Introduction/Background & aims: Safe and effective prescribing in hospitals, directly and indirectly, impacts the health of the patients. Even though digital prescribing in the National Health Service (NHS), UK has been used in lots of tertiary centers along with district general hospitals, a significant number of NHS trusts are still using paper prescribing. We came across lots of irregularities in our daily clinical practice when we are doing paper prescribing. The main aim of the study was to assess how safely and effectively are we prescribing at our hospital where there is no access to digital prescribing. Method/Summary of work: We conducted a prospective audit in the critical care department at Mid Cheshire Hopsitals NHS Foundation Trust in which 20 prescription charts from different patients were randomly selected over a period of 1 month. We assessed 16 multiple categories from each prescription chart and compared them to the standard trust guidelines on prescription. Results/Discussion: We collected data from 20 different prescription charts. 16 categories were evaluated within each prescription chart. The results showed there was an urgent need for improvement in 8 different sections. In 85% of the prescription chart, all the prescribers who prescribed the medications were not identified. Name, GMC number and signature were absent in the required prescriber identification section of the prescription chart. In 70% of prescription charts, either indication or review date of the antimicrobials was absent. Units of medication were not documented correctly in 65% and the allergic status of the patient was absent in 30% of the charts. The start date of medications was missing and alternations of the medications were not done properly in 35%of charts. The patient's name was not recorded in all desired sections of the chart in 50% of cases and cancellations of the medication were not done properly in 45% of the prescription charts. Conclusion(s): From the audit and data analysis, we assessed the areas in which we needed improvement in prescription writing in the Critical care department. However, during the meetings and conversations with the experts from the pharmacy department, we realized this audit is just a representation of the specialized department of the hospital where access to prescribing is limited to a certain number of prescribers. But if we consider bigger departments of the hospital where patient turnover is much more, the results could be much worse. The findings were discussed in the Critical care MDT meeting where suggestions regarding digital/electronic prescribing were discussed. A poster and presentation regarding safe and effective prescribing were done, awareness poster was prepared and attached alongside every bedside in critical care where it is visible to prescribers. We consider this as a temporary measure to improve the quality of prescribing, however, we strongly believe digital prescribing will help to a greater extent to control weak areas which are seen in paper prescribing.

Keywords: safe prescribing, NHS, digital prescribing, prescription chart

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Authors: Ananda Perera

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Diet therapy has a positive impact on many diseases in General Practice. If a meal plan can be generated as easily as writing a drug prescription for dyspepsia, then the evidence and practice gap in nutrition therapy can be narrowed. Meal plans of 50 diet prescriptions were compared with the criteria for a healthy diet given by Australian authorities. The energy value of each meal plan was compared with the recommended daily energy requirements of the authorities for Diet Prescription Generator (DPG) accuracy. Meal plans generated were within the criteria laid down by the Australian authorities for a healthy diet.

Keywords: dieting, obesity, diabetes, weight loss, computerized decision support systems, dieting software, CDSS, meal plans

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Authors: Jean-michel Sahut, Lubica Hikkerova, Wissal Ben Arfi

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The Internet of Things (IoT) emerged over the last few decades in many fields. Healthcare can significantly benefit from IoT. This study aims to examine factors influencing the adoption of IoT in eHealth. To do so, an innovative framework has been developed which applies both the Technology Acceptance Model (TAM) and the United Theory of Acceptance and Use of Technology (UTAUT) model and builds on them by analyzing trust and perceived-risk dimensions to predict intention to use IoT in eHealth. In terms of methodology, a Partial Least Approach Structural Equation Modelling was carried out on a sample of 267 French users. The findings of this research support the significant positive effect of constructs set out in the TAM (perceived ease of use) on predicting behavioral intention by adding the effects identified for UTAUT variables. This research also demonstrates how perceived risk and trust are significant factors for models examining behavioral intentions to use IoT. Perceived risk enhanced by the trust has a significant effect on patients’ behavioral intentions. Moreover, the results highlight the key role of prescription as a moderator of IoT adoption in eHealth. Depending on whether an individual has a prescription to use connected devices or not, ease of use has a stronger impact on adoption, while trust has a negative impact on adoption for users without a prescription. In accordance with the empirical results, several practical implications can be proposed. All connected devices applied in a medical context should be divided into groups according to their functionality: whether they are essential for the patient’s health and whether they require a prescription or not. Devices used with a prescription are easily accepted because the intention to use them is moderated by the medical trust (discussed above). For users without a prescription, ease of use is a more significant factor than for users who have a prescription. This suggests that currently, connected e-Health devices and online healthcare systems have to take this factor into account to better meet the needs and expectations of end-users.

Keywords: internet of things, Healthcare, trust, consumer acceptance

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Authors: Mario M. J. Musonda

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Access to health care is a human right, which includes having timely access to affordable and quality essential medicines at the right place and in sufficient quantity. However, inefficient public sector supply chain management contributes to constant shortages of essential medicines at health facilities. Literature review involved a desktop study of published research studies and reports on risk management, supply chain management of essential medicines and their integration to increase the efficiency of the latter. The research was conducted on a sample population of offices under Ministry of Health Headquarters, Lusaka Provincial and District Offices, selected health facilities in Lusaka, Medical Stores Limited, Zambia Medicines Regulatory Authority and Cooperating Partners. Individuals involved in study were selected judgmentally by their functions under selection and quantification, regulation, procurement, storage, distribution, quality assurance, and dispensing of essential medicines. Structured interviews and discussions were held with selected experts and self-administered questionnaires were distributed. Collected and analysed data of 35 returned and usable questionnaires from the 50 distributed. The highest prioritised risks were; inadequate and inconsistent fund disbursements, weak information management systems, weak quality management systems and insufficient resources (HR and infrastructure) among others. The results for this research can be used to increase the efficiency of the public sector supply chain of essential medicines and other pharmaceuticals. The results of the study showed that there is need to implement effective risk management systems by participating institutions and organisations to increase the efficiency of the entire supply chain in order to avoid and/or reduce shortages of essential medicines at health facilities.

Keywords: essential medicine, risk assessment, risk management, supply chain, supply chain risk management

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Authors: Naila Awan, Shahrukh Inam

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This study was conducted to highlight the role of basic health units in district Swabi, which provides primary health services to the people of district Swabi having four tehsils. Tehsil Swabi was selected purposively for the study. Three villages were purposively selected from district Swabi. A sum of 110 respondents was randomly selected for interview i.e., 27 from Botakaa, 39 from Gulatee, and 44 from Darra Cham, using proportion allocation sampling technique. A pretested and well-designed interview schedule was used to collect as per the objective and Chi square test was applied to find an association between the quality of medicines and health improvement. The output of the test shows that the government was doing its best and providing enough facilities to the individuals at the healthcare units, and they were utilizing them. These resources were easily accessible to the people of the community. Medicines provided by the government were of good quality and quantity. There were also school health sessions and community health sessions (SHS/CHS) to deliver useful information and awareness regarding health problems and diseases were conducted. The staff of the BHU was present at work time and was performing their duties. The respondents seemed satisfied with their behavior and the duty of the staff. However, there were no emergency resources existing at the BHU after the working hours of the medical staff. It is recommended that government should provide appropriate quantity and quality of medicines to the basic health units so that these healthcare units don’t have to face any shortages regarding medicines at the end of the month. In addition, laboratory and blood testing facilities need to be provided in the basic health units, and also the infrastructure should be made suitable, satisfactory, and more functional.

Keywords: community health session, basic health units, outpatient department, tuberculosis

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Authors: Asma A. Ben Ahmed, Hajer M. Alborawy, Alaa A. Mashina, Pradeep K. Velautham, Abdulmonem Gobassa, Emhemmed Elgallal, Mohamed N. El Attug

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Generic medicines are those where patent protection has expired, and which may be produced by manufacturers other than the innovator company. Use of generic medicines has been increasing in recent years, primarily as a cost saving measure in healthcare provision. Generic medicines are typically 20 – 90 % cheaper than originator equivalents. Physicians often continue to prescribe brand-name drugs to their patients even when less expensive pharmacologically equivalent generic drugs are available. Because generics are less expensive than their brand-name counterparts, the cost-savings to the patient is not the only factor that physicians consider when choosing between generic and brand-name drugs. Unfortunately Physicians in general and Libyan Physicians in particular tend to prescribe brand-name drugs, even without evidence of their therapeutic superiority, because neither they nor their insured patients bear these drugs’ increased cost with respect to generic substitutes. This study is to compare the quality of five different prednisolone tablets of the same strength from different companies under different trade names: Julphar, October pharma, Akums, Actavis, Pfizer compared them with pure prednisolone reference (BPCRS).

Keywords: quality control, pharmaceutical analysis, generic medicines, prednisolone

Procedia PDF Downloads 474

Authors: Richa Sinha, Mohammad Irfan Javed, Sanjay Singh

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Introduction: Good antimicrobial prescribing reduces length of stay in hospital, risk of adverse events, antimicrobial resistance, and unnecessary hospital expenditure. The aim of this prospective audit was to identify any problems with antimicrobial prescribing including documentation of the relevant aspects as well as appropriateness of antibiotics use. The audit was conducted on the surgical wards in a teaching hospital in the UK. Methods: Standards included the indication, duration, choice, and prescription of antibiotic should be in line with current Regional Guidelines and should be clearly documented on the prescription chart. There should be an entry in each patients’ medical record of the diagnosis and indication for each acute antibiotic prescription issued. All prescriptions should clearly document the route, frequency and dose of antibiotic. Data collection was done for 2 weeks in the month of March 2014. A proforma including all the questions above was completed for all the patients. The results were analysed using Excel. Results: 35 patients in total were selected for the audit. 85.7% of patients had indication of antibiotic documented on the prescription chart and 68.5% of patients had indication documented in the notes. The antibiotic used was in line with hospital guidelines in 45.7% of patients, however, in a further 28.5% of patients the reason for the antibiotic prescription was microbiology approved. Therefore, in total 74.2% of patients had been prescribed appropriate antibiotics. The duration of antibiotic was documented in 68.6% of patients and the antibiotic was reviewed in 37.1% of patients. The dose, frequency and route was documented clearly in 100% of patients. Conclusion: Overall, prescribing can be improved on the surgical wards in this hospital. Only 37.1% of patients had clear documentation of a review of antibiotics. It may be that antibiotics have been reviewed but this should be clearly highlighted on the prescription chart or the notes. Failure to review antibiotics can lead to poor patient care and antimicrobial resistance and therefore it is important to address this. It is also important to address the appropriateness of antibiotics as inappropriate antibiotic prescription can lead to failure of treatment as well as antimicrobial resistance. The good points from the audit was that all patients had clear documentation of dose, route and frequency which is extremely important in the administration of antibiotics. Recommendations from this audit included to emphasize good antimicrobial prescribing at induction (twice yearly), an antimicrobial handbook for junior doctors, and re-audit in 6 months time.

Keywords: prescribing, antimicrobial, indication, duration

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Authors: Nedjar Abdelhadi

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The pharmaceutical industry is one of the most important structures and foundations for the management and development of the modern world, especially the advanced part of it, meaning that there are some exceptions for third-world countries. The world today has witnessed radical transformations and changes, some of which made it better and some of which affected the path of its growth. At the beginning of my research, there was a detailed presentation overview of the current situation of the world in terms of growth and development, and it proceeded through that overview as the introduction to my research. The first chapter had divided into three sections; each topic was unique to one of the new methods of manufacturing, deducing and developing medicines Several examples of various recently developed medicines were used The second chapter dealt with the defects and shortcomings that pioneers and drug makers at various levels, as well as various regions and major companies, suffer from on the basis that they are international, especially those specialized in the manufacture of medicines related to viruses and chronic diseases, as well as incurable. As for the third chapter, it was devoted to marketing methods, methods of achieving sales, as well as the basics of spreading medicines and preparing the minds of consumers. Through my research, the one concluded that the current world has become completely different from the world we used to know, and it means by saying the field of manufacturing, selling and marketing medicines. It was noted that one of the biggest factors that affected the change in the field of medicine was the corona disaster. At the end of my research, I was left with nothing but to show the importance and necessity of the pharmaceutical industry and its effective role, not only in the development of mankind, but its main role is in the survival of mankind.

Keywords: health, diseases, medicine, epidemics

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Authors: Syed Asif Hassan, Tabrej Khan, Ibrahim Manssor Al Najar, Mohammed Nasser

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The incredible accomplishment achieved by e-commerce in consumer durable area encouraged us to implement the online e-commerce model to tap the business benefits of electronic pharmacy in Saudi Arabia. The Kingdom of Saudi Arabia is famous for traditional herbal medicine. The rich heritage of traditional medicine has helped the mushrooming of regional pharmaceutical industries manufacturing drugs and other therapeutic against various diseases. However, the implementation of e-commerce in pharmacy has not been employed in the Kingdom of Saudi Arabia. The electronic pharmacy (E-Pharm) is an important sector that is flourishing across the globe and providing benefits of E-Pharm to the customers and suppliers all around the world. In this context, our web-based application of electronic pharmacy is the one of its kind in the Kingdom of Saudi Arabia. Surveys and personal interviews were used to identify key objectives of the proposed web-based portal. As per the findings of the surveys and personal interviews, following key objectives were identified: (a) The online platform will be used for ordering of prescription based medications for consumers. (b) The e-portal will provide space for pharmaceutical retailers who do not have an electronic platform to upload and sell their therapeutic products in an organized way. (c) The web portal will provide a tracking system to track the customer’s behavior like choice, offer, order, shipment, payment, etc. The web-based e-pharmacy portal will be developed using MySQL and PHP. The development of e-pharmacy web portal and e-prescription practices will not only improve the growth of electronic pharmacy but would also decrease the possibility of prescription alteration thus providing safety and improving the quality of service provided to the patient or consumers.

Keywords: e-commerce, E-Pharm, MySQL, PHP

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Authors: Marcelus U. Ajonina, Deodata B. Ngonga, Kenric B. Ware, Carine K. Nfor

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Background: Lack of knowledge of rational use of antimalarial drugs among dispensers is a serious problem, especially in areas of intense transmission, thus increasing the risk of resistance and adverse drug reactions. This study was aimed at assessing the knowledge of malaria as well as perception and dispensing practices of antimalarials among vendors in Buea community. Methods: A community-based cross-sectional survey of a random sample of 140 drug vendors living within the Buea community was conducted between March and June 2017. A questionnaire was designed to obtain information from drug vendors on the general knowledge of malaria as well as dispensing practices. Data were analyzed using SPSS Statistics 20.0 and were considered significant at p ≤ 0.05. Results: Knowledge of malaria symptoms, transmission, and prevention was reasonable among 55.8% (77) of the respondents. Only 33.6% (47) of the respondents could attribute the cause of malaria to protozoan of genus Plasmodium species. Of the 140 vendors, 115 (82.7%) prescribe antimalarial drugs. The knowledge of the national protocol was malaria case management among dispensers was 35.0%. Vendors in hospital/community pharmacies were 2.4 times (OR = 3.14, 95% CI: 4.14 - 8.74, p < 0.001) more knowledgeable about malaria treatment protocol than those of in drugstores. The prevalence of self-prescription of antimalarials was 39.3%. Self-prescription was significantly higher in drugstores than hospital/community pharmacies (p=0.004). In all, 56 (40.6%) of vendors showed good practices regarding antimalarial drug dispensing with the majority (51.7%) from community pharmacies (OR=2.27,95% CI: 1.13-4.56). Conclusion: Findings reveal moderate knowledge of malaria but poor prescription and dispensing practices of antimalarial drugs among vendors, thus indicating a need for routine monitoring and evaluation to prevent the emergence of resistant strains to current efficacious antimalarials.

Keywords: antimalarials, drug retail outlets, dispensing, drug resistance, prescription

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Authors: H. Chabalala, A. Grootboom, M. Tang

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The innovative development, production, and clinical utilisation of African natural medicines requires frameworks from systematisation, innovation, registration. Afrika faces challenges when it comes to these sectors. The opposite is the case as is is evident in ancient Asian (Traditional Chinese Medicine and Indian Ayurveda and Siddha) medical systems, which are interfaced into their respective national health and educational systems. Afrikan Natural Medicines (ANMs) are yet to develop systematisation frameworks, i.e. disease characterisation and medicines classification. This paper explores classical medical systems drawn from Afrikan and Chinese experts in natural medicines. An Afrikological research methodology was used to conduct in-depth interviews with 20 key respondents selected through purposeful sampling technique. Data was summarised into systematisation frameworks for classical disease theories, patient categorisation, medicine classification, aetiology and pathogenesis of disease, diagnosis and prognosis techniques and treatment methods. It was discovered that ancient Afrika had systematic medical cosmologies, remnants of which are evident in most Afrikan cultural health practices. Parallels could be drawn from classical medical concepts of antiquity, like Chinese Taoist and Indian tantric health systems. Data revealed that both the ancient and contemporary ANM systems were based on living medical cosmologies. The study showed that African Natural Healing Systems have etiological systems, general pathogenesis knowledge, differential diagnostic techniques, comprehensive prognosis and holistic treatment regimes. Systematisation models were developed out of these frameworks, and this could be used for evaluation of clinical research, medical application including development of curriculum for high-education. It was envisaged that frameworks will pave way towards the development, production and commercialisation of ANMs. This was piloted in inclusive innovation, technology transfer and commercialisation of South African natural medicines, cosmeceuticals, nutraceuticals and health infusions. The central model presented here in will assist in curriculum development and establishment of Afrikan Medicines Hospitals and Pharmaceutical Industries.

Keywords: African Natural Medicines, Indigenous Knowledge Systems, Medical Cosmology, Clinical Application

Procedia PDF Downloads 91