Association of pharmacy services with patient satisfaction in public and private tertiary care hospitals of Rawalpindi and Islamabad

Background The healthcare system in Pakistan is facing a shortage of human resources and appropriate and sustainable financial measures and therefore fails to provide optimum services to the population of Pakistan. Furthermore, research is limited in the healthcare institutes; therefore, there is a scarcity of information about patient satisfaction with pharmacists and pharmacy services in Pakistan. As evident from the inadequate information in the literature, patients’ opinions about the pharmacy services in Pakistan are important [1]. Therefore, the current study was designed to assess patient satisfaction with the pharmacy performance of the outpatient pharmacy and its variation with socio-demographic characteristics in twin cities of Pakistan (Rawalpindi and Islamabad). Method A cross-sectional study design was used to assess the patient satisfaction through convenience sampling technique. Minimum sample size of 250 respondents who visit pharmacy department of public and private hospital for pharmaceutical care were included in this study. A pre validated tool was used to assess the patient satisfaction. Data was clean coded and import into spss for analysis. Descriptive and inferential statistic was applied to calculate frequency, standard deviation, mean deviation and p value to find the association among different domain of patient satisfaction with different demographic characteristics of respondents. Result Current study shows overall patients were satisfied from pharmacy services provided by government and private hospitals. Furthermore patient satisfaction towards pharmacist medication advice was very good however patient satisfaction towards pharmacist approach was good while patient perception with pharmacy setting, drug availability and cost were underrated. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. No significant difference (p ≥ 0.05) was observed in pharmacy setting drug availability and cost with different gender, age groups and marital status of respondents. However Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with different level of education patients with less education had better satisfaction as compared to highly educated respondents. Furthermore Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with occupation. Self-employee and government employee had low satisfaction score while other had better satisfactory score. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. Females had better satisfactory score as compared to female. Younger age group had better satisfaction as compared to elderly. Patients belong to higher educational groups had better satisfaction toward pharmacist approach as compared to low qualification groups respondents. Furthermore No significant difference (p ≥ 0.05) was observed in pharmacist’s approach with marital status and number of visits Conclusion Current study concluded that overall patient had average satisfaction score. Patients shows a better satisfaction towards pharmacist behavior/ way of handling the patients, information provided by pharmacist regarding medicine. Patient had less satisfaction towards the location of pharmacy, Availability and affordability of medicine. Patient shows negative satisfaction regarding waiting area and counselling area at in door patient pharmacy. It has been observed that educated respondents shows high level of satisfaction towards pharmacist availability and information provided by the pharmacist.

Herbal medicines use and associated factors among pregnant women in Debre Tabor town, north West Ethiopia: a mixed method approach

Background Use of herbal medicines during pregnancy has been increase in many developing and developed countries. In spite of the studies done on herbal medicine, no study has addressed use of herbal medicine among pregnant women in Debre Tabor Town. Hence, the major aim of this study was to assess the prevalence of herbal medicine use and associated factors. Methods A community based explanatory sequential mixed methods was employed. The quantitative method used cross-sectional study design with a sample size of 267 women, also 12 participants in a group for focus group discussion and 6 in-depth interviews from focus group were included for a qualitative part using a purposive sampling technique. The data were coded and entered into Epidata 4.2.0.0 and analysis was done using SPSS version 25, while thematic analysis was used for qualitative data. Bivariate and multivariate logistic analyses were used to assess associations between dependent and independent variables. Results Ninety-five (36.3%) of pregnant women used herbal medicine during pregnancy. Prior use of herbal medicine (AOR: 3.138; 95% CI: 1.375, 7.162), unable to read & write (AOR: 9.316; 95% CI: 2.339, 37.101), presence of health problems (AOR: 3.263; 95% CI: 1.502, 7.090), drug availability (AOR: 9.872; 95% CI: 4.322, 22.551) and distance to the health facilities (AOR 6.153; 95% CI 2.487, 15.226) were significantly associated with use of herbal medicine. Only 5(5.3%) of herbal medicine users disclosed their herbal medicine use to their healthcare providers. Zingiber officinale, Eucalyptus globulus, Rutachalepensis, Linumusitatissimum, and Moringa stenopetala were the most commonly used herbal medicines by pregnant women. Conclusions The use of herbal medicine during pregnancy is a common practice and significantly associated with educational status, prior use of herbal medicine, presence of health problems, drug availability and distance to the health facilities. Since there was high prevalence and low disclosure rate of herbal medicine use, it should be ensured that physicians/midwives establish a good level of communication with pregnant women.

The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources

Background Primary healthcare (PHC) is an essential component of an effective healthcare system. The Kingdom of Saudi Arabia’s (KSA) health reforms prioritize tackling the increasing noncommunicable disease burden by prioritizing PHC, centering it as the core of the newly proposed Model of Care. To identify challenges and opportunities to scale up PHC capacity, understanding the current capacity of primary health care centers (PHCC) is critical. A limited number of publications review PHC capacity in KSA, focusing on specific regions/sectors; this paper is a first to examine PHC capacity on a national level. Methods The study uses a countrywide Facility Survey that collected data in 2018 from 2319 PHCCs, generating information on their characteristics, number of health workers, services provided, and capacity elements captured through the Service Availability and Drug Availability constructed indices. Descriptive analysis was performed by rural-urban classification. Ordinary Least Squares (OLS) regressions were used to understand correlates to health workers and equipment availability. Finally, a logistic regression was fitted for selected services. Regressions controlled for various measures to determine correlates with facilities’ capacity. Results On a national level, there are 0.74 PHCCs per 10,000 population in KSA. There are variations in the distribution of PHCCs across regions and within regions across rural and urban areas. PHCCs in urban areas have more examination rooms but lower examination room densities. Offering 24 × 7 services in PHCCs is infrequent and dependency on paper-based medical recording remains common. More urban regions are more likely to offer general services but less likely to offer burn management and emergency services. PHCCs are mostly staffed with general medicine, family medicine, and obstetrics & gynecology physicians, whose numbers are more concentrated in urban areas; however, their densities are higher in rural areas. Finally, psychiatrists and nutritionists are rare to find in PHCCs. Conclusions Decision-makers need to consider several factors when designing PHC policies. For instance, PHC accreditation needs to be prioritized given its positive correlation with service provision and health workers availability. PHC 24 × 7 operation also needs considerations in rural areas due to the high dependency on PHCCs. Finally, there is a substantial need for improvements in e-health.

Hydroxychloroquine availability during COVID-19 crisis and its effect on patient anxiety

ObjectiveTo report the results of a survey exploring the experience of patients with SLE facing hydroxychloroquine (HCQ) shortage that occurred during the early phases of the COVID-19 pandemic.MethodsA survey was designed by Lupus Europe’s patient advisory network and distributed through its social media, newsflash and members' network. People with lupus were asked about their last HCQ purchases and their level of anxiety (on a 0–10 scale) with regard to not being able to have access to HCQ, once in April 2020 (first wave) and after 11 August (second wave). The results were compared.Results2075 patients responded during the first wave; 1001 (48.2%) could get HCQ from the first place they asked, 230 (11.1%) could get the drug by going to more than one pharmacy, 498 (24.0%) obtained HCQ later from their usual pharmacy and 126 (6.1%) from other sources. 188 (9.1%) could not get any; 32 (1.5%) did not respond to this question. All countries showed significant improvement in HCQ availability during the second wave. 562 (27.4%) patients reported an extremely high level of anxiety in wave 1 and 162 (10.3%) patients in wave 2; 589 (28.7%) and 268 (17.1%) patients reported a high level of anxiety in wave 1 and wave 2, respectively.ConclusionsThe HCQ shortage had a significant impact on patients with SLE and has been responsible for psychological consequences including anxiety. Indeed, despite an objective improvement in drug availability, the event is leaving significant traces in patients’ mind and behaviours.

Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study

Background Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). Methods Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n = 22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. Results Barriers to improving antimicrobial prescribing included prohibitively expensive antimicrobials, limited antimicrobial availability, resistance to changing current practices regarding antimicrobial prescribing, and limited diagnostic capabilities. The most frequent of these barriers in all three locations was limited drug availability. Many physicians in all three sites had not heard of ASPs before the interviews. Improved education was a suggested component of ASPs at all three sites. The creation of guidelines was also recommended, without prompting, by interviewees at all three sites. Although most participants felt microbiological results were helpful in tailoring antibiotic courses, some expressed distrust of laboratory culture results. Biomarkers like erythrocyte sedimentation rate and c-reactive protein were not felt to be specific enough to guide antimicrobial therapy. Despite limited or no prior knowledge of ASPs, most interviewees were receptive to implementing protocols that would include documentation and consultation with ASPs regarding antimicrobial prescribing. Conclusions Our study highlighted several important barriers to implementing ASPs that were shared between three tertiary care centers in LMICs. Improving drug availability, enhancing availability of and trust in microbiologic data, creating local guidelines, and providing education to physicians regarding antimicrobial prescribing are important steps that could be taken by ASPs in these facilities.

Therapeutic Hydrogel Lenses and the Antibacterial and Antibiotic Drugs Release

The aim of this research was to evaluate the effects of different lens types on the availability and efficacy of anti-inflammatory and antibiotic drugs. Three lens types were examined: (1) nonionic hydrogel lenses; (2) ionic hydrogel lenses; and (3) silicone hydrogel lenses. The lenses were incubated with (a) dexamethasone; (b) betamethasone; (c) bromophenacyl bromide; and (d) chloramphenicol. Drug availability was quantified by gradient HPLC, and chloramphenicol antibacterial activity was quantified by testing the inhibition of Salmonella typhimurium growth on agar. The lens allowing the most abundant passage of betamethasone was the ionic hydrogel lens, followed by the silicone hydrogel lens and nonionic hydrogel lens. The lens allowing the most abundant passage of dexamethasone was the ionic hydrogel lens, but only at 0.5 h and 1 h. Regarding chloramphenicol, the ionic hydrogel lens and silicone hydrogel lens allowed more abundant passage than the nonionic hydrogel lens. These results highlight the relevance of adapting lenses to anti-inflammatory therapy, thus allowing a personalized medical approach.

Deconstructing and Historicizing Access to Medicines: The Changing Priority of Pharmaceutical Governance in China

Securing access to medicines (ATM) is critical for improving public health outcomes. Existing research has long identified and analyzed various barriers that may impede ATM at the global, national, or local levels. However, it tends to adopt a normative perspective to prescribe what infrastructures, resources, and measures should be put in place to improve ATM. Little scholarship has explored how and why countries may prioritize certain dimensions of ATM over others in pharmaceutical governance within specific historical contexts. This article fills that gap by deconstructing and historicizing the concept of ATM. The author aims to make two arguments. First, tensions easily arise between different dimensions of ATM, and prioritizing certain dimensions in pharmaceutical policy may impede improvements in others (e.g., availability vs. affordability). Second, which dimension(s) of ATM might be prioritized in the state’s pharmaceutical policy hinges upon social, economic, and political forces. To substantiate these arguments, the author draws on interview and archival evidence from China. Specifically, the author provides a historical account of how and why the priorities of pharmaceutical governance in China changed over time: 1) 1949—late 1970s: pursuing both drug availability and affordability through socialist planning; 2) early 1980s—2015: priority shifting from availability (before the mid-1990s) to affordability (after the mid-1990s); 3) 2015—present: striving for a rebalance between drug availability and affordability.