Validation of the Arabic version of the general medication adherence scale in patients with type 2 diabetes mellitus in Jordan

Background: Medication adherence is a major challenge for patients with diabetes. Adherence rates are often low, and this can lead to poor glycaemic control and increased risk of complications. There are a number of tools available to measure medication adherence, but few have been validated in Arabic-speaking populations. Aim: This study aimed to validate the Arabic version of the General Medication Adherence Scale in patients with type 2 diabetes in Jordan. Methods: A cross-sectional study was conducted for 3 months among patients attending diabetes mellitus outpatient clinic in Irbid, Jordan. The validation procedure included confirmatory factor analysis (CFA) and equation modelling (SEM). Fit indices, namely, goodness of fit index (GFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were observed. Corrected item-total correlation (ITC) was reported. Reliability was assessed using Cronbach's alpha (α) and α value based on item deletion was also carried out. Intraclass correlation coefficient (ICC) was reported. Data were analyzed using IBM SPSS v23 and IBM AMOS v25. Results: Data from 119 participants were gathered. The mean adherence score was 27.5 (±6) ranging from 6 to 33. More than half of the patients were adherent to their therapy (n = 79, 66.4%). The reliability of the scale (n = 11) was 0.907, and ICC ranged from 0.880-0.930: 95% CI. The following values were observed in CFA; χ2 = 62.158, df = 41, χ2/df = 1.516, GFI = 0.913, AGFI = 0.860, TLI = 0.960, CFI = 0.971 and RMSEA = 0.066. A total of 10 out of 11 items had corrected ITC >0.5. The α remained between 0.89-0.92 during item deletion. Conclusion: The results obtained in this study suggest that the scale is valid and reliable in measuring adherence to medications in the studied sample of patients with diabetes. This scale can be used by clinicians in Jordan to assess adherence and may further aide in evaluating interventions to improve adherence rates in persons with type 2 diabetes.

The influence of adverse drug effects on health-related quality of life in chronic obstructive pulmonary disease patients

OBJECTIVES

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Concerns have been raised about the influence of adverse drug effects on patient's health-related quality of life (HRQoL) in COPD patients. This study aimed to evaluate the impact of COPD treatment-related adverse effects on HRQoL in COPD patients.

METHODS

In a cross-sectional study, COPD patients aged 40 years or older were identified and interviewed during their hospital visits. The EuroQol 5 Dimension 5 Level (EQ-5D-5L) questionnaire was used for evaluating HRQoL. Potential treatment adverse effects were evaluated as experienced by participants during the last 2 weeks preceding the interview. The intensity of adverse effects was reported in the following categories: never, mild, moderate and severe. Multivariable linear regression model was performed to evaluate the influence of adverse drug effects on utility scores as an indicator of HRQoL.

KEY FINDINGS

A total of 203 patients diagnosed with COPD were recruited in the current study. The mean utility score of the study sample was 0.68 (SD = 0.36). Moderate-severe constipation, moderate-severe confusion, mild urinary hesitation, moderate-severe urinary hesitation, moderate-severe dry eyes and moderate-severe drowsiness were significant predictors/determinants for the average utility scores (coefficients were -0.099, -0.191, -0.111, -0.157 and -0.144, respectively). In addition, having higher COPD Assessment Test scores and severe disease was negatively associated with average utility scores (coefficients were -0.287 and -0.124, respectively).

CONCLUSIONS

Higher intensity of COPD treatment-related adverse effects has a negative influence on HRQoL in COPD patients. Anticholinergic drug effects are of concern in COPD adults' population.

Direct Medical Cost of Pediatric Asthma in Jordan: A Cost-of-Illness Retrospective Cohort Study

OBJECTIVES

This study aimed to estimate and analyze the direct medical costs of pediatric patients with asthma in Jordan from the provider's perspective.

METHODS

A retrospective analysis of a cohort of pediatric patients with asthma treated during 3 years in a teaching hospital was conducted. The prevalence-based, bottom-up approach has been used to estimate the cost-of-illness of asthma. The total annual direct medical cost was stratified by control status and the severity of asthma.

RESULTS

The total annual cost for whole the sample (N = 613) in the average of 3 years was Jordanian dinar (JD) 110 874 (US$ 156 382). Pediatrics with uncontrolled asthma had significantly higher annual total direct medical costs than partly controlled and controlled asthma (JD 396 [US$ 558], JD 258 [US$ 364], and JD 150 [US$ 211], respectively) (P < .001). The annual total direct medical cost for severe asthma (JD 455 [US$ 641]) was significantly higher than moderate, mild, and intermittent (JD 176 [US$ 248], JD 35 [US$ 49], and JD 7 [US$ 9.8], respectively) (P < .001). Medications were the most expensive healthcare resource used, accounting for 79.8% of the total cost, followed by outpatient clinic visits and hospitalizations.

CONCLUSIONS

Healthcare sources utilization and direct medical costs of asthma were highly related to disease severity and control status of the disease. Health policies targeting the achievement of better and stricter asthma control will play a crucial role in the reduction of the economic burden of asthma for society and the patient.

Hospital unit costs in Jordan: insights from a country facing competing health demands and striving for universal health coverage

BACKGROUND

Public providers in Jordan are facing increasing health demands due to human crises. This study aimed to benchmark the unit costs of hospital services in public providers in Jordan to provide insights into the outlook for public health care costs.

METHODS

The unit costs of hospital services per admission, inpatient days, outpatient visits, emergency visits and surgical operations were estimated using the standard average costing method (top-down) for the fiscal year 2018-2019. The unit costs per inpatient day were estimated for nine specialities and staff in Jordanian dinars (exchange rate JOD 1 = USD 1.41).

RESULTS

The average unit cost per admission in Jordan was JOD 782.300 (USD 1101.80), the per inpatient day cost was JOD 236.600 (USD 333.20), the per bed day cost was JOD 172.900 (USD 244.90), the per outpatient visit cost was JOD 58.400 (USD 82.30), the per operation cost was JOD 449.600 (USD 633.20) and the per emergency room visit cost was JOD 31.800 (USD 44.80). The specialities of ICU/CCU and OB/GYN presented the highest unit costs per inpatient day across providers: JOD 377.800 (USD 532.90) and JOD 362.600 (USD 510.70), respectively. The average salaried unit cost of staff depended mainly on year of employment. Nonetheless, the unit costs varied depending on the service utilization, type of service and organizational outlet.

CONCLUSIONS

Knowledge of how unit costs vary across public providers in Jordan is essential to outline cost control strategies and inform future research. Institutionalization of the cost information system and high-level governmental support are necessary to generate a routine practice of collecting and sharing cost information.

Factors associated with early nonpersistence among patients experiencing side effects from a new medication

BACKGROUND

Drug discontinuation (i.e., nonpersistence) is often attributed to the emergence of adverse effects. However, it is not known whether other factors increase the risk of nonpersistence when adverse effects occur.

OBJECTIVES

To identify factors associated with early nonpersistence among patients experiencing adverse effects from newly prescribed medications.

METHODS

A questionnaire was mailed to new users of antihypertensive, antihyperglycemic, and lipid-lowering medications in Saskatchewan, Canada, between 2019 and 2020. Only respondents experiencing adverse effects were included. Responses were compared between the nonpersistent group (i.e., people who had discontinued their medication) and the persistent group (i.e., those who were taking their medication at the time of the survey). Statistically significant factors were tested in multivariable logistic regression models. Odds ratios (ORs) and 95% CIs were reported.

RESULTS

Of the 3973 returned questionnaires, 813 respondents experienced adverse -effects from their new medication and were included in the study. Of these, 143 respondents (17.5%) had stopped their medication at the time of survey completion; most discontinuations (72.1%) occurred within 1 month of the first dose. Nonpersistent patients were older, had lower income, and were less likely to be taking an antihyperglycemic medication. After covariate adjustment, 6 factors were independently associated with nonpersistence: age less than 65 years (OR 1.56 [95% CI 1.01-2.41]), female sex (1.67 [1.08-2.59]), health condition not considered dangerous (2.09 [1.25-3.51]), medication not considered important for health (6.90 [4.40-10.84]), failure to expect adverse effects before starting medication (2.67 [1.74-4.10]), and taking 2 or more medications (0.45 [0.27-0.73]).

CONCLUSION

Despite the strong link between the emergence of adverse effects and early nonpersistence, our findings confirm that this association is highly influenced by several factors external to the physical experiences caused by the new medication.

Clinical and economic impact of telemedicine in the management of pediatric asthma in Jordan: a pharmacist-led intervention

OBJECTIVE

Pediatric asthma is a major public health concern, considering its chronic nature and negative effects on quality of life of affected children. Telemedicine is efficacious in providing pharmaceutical care for patients with several chronic diseases, including asthma. This approach allows habitants of sparsely populated rural Jordanian areas to remotely access high-quality healthcare services. Pharmacist-provided asthma counseling has proven benefits in improving patient adherence rates and their understanding. This study evaluated clinical and economic impacts of pharmacist-led, interactive synchronous telemedicine counseling of pediatric asthma patients in Jordan.

METHODS

A randomized, controlled, 12-week pre-post interventional study was conducted. Ninety patients with uncontrolled asthma aged 5-11 years were recruited and randomly assigned to two groups: intervention or control. Inhaler use was checked for both groups at baseline, along with assessment of clinical and economic measures. Counseling on proper inhaler use was provided by pharmacists. Telemedicine sessions for the intervention group were scheduled every 4 weeks, whereas the control group received standard care. Pertinent measures reflecting the level of disease control and relapse were tracked monthly.

RESULTS

The intervention group showed more significant improvement in clinical and economic outcomes than the control group (the Childhood Asthma Control Test mean scores [P = 0.0134], decreased parental loss of wages [P = 0.0015], and decreased economic burden [P < 0.001]). Additionally, overall improvement in quality of life and satisfaction with the telemedicine sessions were reported.

CONCLUSION

Pharmacist-led telemedicine counseling could be a promising approach to deliver distant pharmaceutical care for patients with childhood asthma.

Assessment of Extrapyramidal Symptoms Associated with Psychotropics Pharmacological Treatments, and Associated Risk Factors

BACKGROUND

Extrapyramidal Symptoms (EPS) are unwanted symptoms commonly originating from the use of certain medications. The symptoms can range from minimal discomfort to permanent involuntary muscular movements. The aims of the study were to examine the incidence of drug-induced extrapyramidal symptoms (di-EPS), associated risk factors, and clinical characteristics.

METHODS

This is a retrospective, observational study of di-EPS conducted in outpatient clinics of Jordan using the longitudinal health database (Hakeem®) for data collection. Patients who received drugs with the risk of EPS during the period 2010-2020 were included and followed. Patients with any of the known underlying conditions that may cause EPS or were currently taking drugs that may mask the symptoms were excluded. Gender and age-matched control subjects were included in the study. The Statistical Package for Social Science (SPSS®) version 26 was used for data analysis.

RESULTS

The final dataset included 34898 exposed patients and 69796 matched controls. The incidence of di-EPS ranged from 9.8% [Amitriptyline 25mg] to 28.9% (Imipramine 25mg). Baseline factors associated with a significantly higher risk of developing di-EPS were age {HR: 1.1 [95%CI: 0.8-1.2, p=0.003], smoking {HR: 1.7 (95%CI: 1.3-2.2), p=0.02}, tremor history {HR: 7.4 (95%CI: 5.9-8.3), p=.002} and history of taking antipsychotics {HR: 3.9, (95% CI: 2.5-4.6), p=0.001}. Patients taking paroxetine {HR: 8.6 [95%CI: 7.4-9.8], p=.0002},imipramine {HR: 8.3, [7.1-10.5], p=0.01}, or fluoxetine {HR: 8.2 (95%CI: 6.8-9.3), p=.006} had a significantly higher risk of developing di-EPS compared to patients taking citalopram. Myoclonus, blepharospasm, symptoms of the basal ganglia dysfunction, and organic writers' cramp were reported among participants.

CONCLUSION

Patients treated with paroxetine, imipramine, fluoxetine, or clomipramine had a higher risk of developing di-EPS than patients treated with citalopram. The difference in gender was not significantly related to di-EPS development. Whereas age, smoking, and history of taking antipsychotics were significantly associated with di-EPS development.

KEY FINDINGS

• High incidence of drug-induced extrapyramidal symptoms (di-EPS) was reported• Age, smoking, tremor history, and history of taking antipsychotics were risk factors of drug-induced extrapyramidal symptoms.• Patients taking paroxetine, imipramine or fluoxetine had a significantly higher risk of developing di-EPS compared to patients taking citalopram.

Evaluation of a medication safety and adherence program within a First Nations community in Saskatchewan, Canada

OBJECTIVE

The objective of this mixed methods report was to describe a pharmacist intervention to support medication adherence of patients living with chronic health conditions in a First Nations community.

SETTING

The intervention took place in a First Nations community health center.

PRACTICE DESCRIPTION

Multidisciplinary primary care clinic.

PRACTICE INNOVATION

A pharmacist was integrated into the weekly primary care clinics to regularly monitor patients and address any medication-related issues.

EVALUATION

The pharmacist intervention was evaluated qualitatively by using focus groups and interviews, and quantitatively by analyzing medication refill claims.

RESULTS

The entire health care team believed that the support provided by the pharmacist encouraged the patients to take control of their health conditions and was beneficial to increasing patient self-management behaviors, including improved medication adherence. All staff appreciated the team-based model because it optimized appointment times and promoted better patient care. The patients valued having a pharmacist they trusted and with whom they had a relationship to address their concerns. In the 6 months after the date of the initial visit with the pharmacist, the median number of refill claims increased in comparison with the 6 months before.

CONCLUSION

A clinical pharmacist contributes to improved satisfaction and medication adherence when integrated into a primary care team providing care in a First Nations community.

Direct medical costs for stage-specific breast cancer: a retrospective analysis

Aim: To analyze the direct medical costs of breast cancer (BC) patients in the north of Jordan. Patients: A cohort of BC patients treated during 2015 at King Abdullah University Hospital. Methods: A retrospective analysis of 119 patients, where all records including age, sex, treatment processes and costs were extracted from the patients’ profiles and examined. Results: The mean age of patients was 50.8 (±10.2) years. The total sample cost was Jordanian dinar 1,393,325 (US$1,963,560). The mean cost per patient from stage I to IV was Jordanian dinar 6696, 9183, 11,970 and 15,073, respectively. Medications were the most expensive resource used. Stage IV had the highest cost and largest number of patients. Conclusion: Direct medical costs associated with BC are considerable. Three-quarters of the cost were devoted to medications.

Drug and therapeutics committees in Jordanian hospitals: a nation-wide survey of organization, activities, and drug selection procedures

Background

Drug and Therapeutics Committees (DTCs) were founded about a century ago as a guide for dealing with drugs in hospitals. Since then, it has shown a vital role in rational drug use in terms of regulatory and educational activities.

Objective

To describe structures, functions, and activities of hospital DTCs.

Methods

A questionnaire was developed based on previous studies. Questions consisted of information on respondents' demographics; structures, functions, and activities of DTCs; drug selection process and resources used, and factors and criteria used in drug selection.

Results

The overall response rate was 95%. DTCs were mainly present in most large hospitals (45%). All DTCs had hospital pharmacists in their structure and most of them (66%) met monthly. The main responsibilities of DTCs were related to general prescribing policies. The number, frequency, and severity of adverse drug reactions were the most reported criteria for the drug selection process. Legal implications for practical, economic, and organizational factors were the most important factors that were reported for drug selection.

Conclusions

DTCs are mainly present in most large hospitals. The main responsibilities of the DTC in Jordanian hospitals are general prescribing policies, drug selection, hospital formulary editing, and reporting of ADR to external authorities.

Association of smoking with direct medical expenditures of chronic diseases in north of Jordan: a retrospective cohort study

OBJECTIVE

This study aimed to estimate the association of smoking with the direct medical expenditures for chronic disease management in north of Jordan.

DESIGN, SETTING AND PARTICIPANTS

Retrospective cohort study using hospital database. Patients who were diagnosed with at least one chronic disease,were aged 18 years or older and had attended King Abdullah University Hospital for disease management and procedures from 1 July 2015 through 30 June 2016 were included in the study.

MAIN OUTCOME MEASURES

The outcome of interest was the direct medical expenditures for chronic disease management according to smoking status.

RESULTS

Data were collected from 845 patients having at least one chronic disease (mean age of 61±10.7 years). Smokers formed 22% of total patients. The back transformed mean total expenditure per patient of smokers, former smokers and non-smokers was 875 JD, 928 JD and 774 JD, respectively. Drugs were the most expensive healthcare resource used, accounting for 43% of total expenditure, followed by inpatient-related and outpatient-related services (19%). Smokers and former smokers were associated with the highest inpatient expenditures and inpatient-related and outpatient-related services expenditures. However, smokers were associated with the lowest outpatient and medication expenditures.

CONCLUSIONS

Smokers and former smokers presented with higher statistically significant inpatient-related and outpatient-related services expenditures and higher transformed mean total expenditures compared to non-smokers; highlighting this economic burden is useful for promoting tobacco control policies.

Evaluating intensive care unit medication charges in a teaching hospital in Jordan

Background: Intensive Care Unit (ICU) medication costs contribute to a large portion of the total ICU costs. Evaluating ICU drug expenditures is essential for optimal resource use especially in countries with limited resources. Considering the dearth of data regarding ICU medication expenses in the Middle East, we sought to evaluate ICU medication charges at a large academic hospital in Jordan. Methods: ICU drug charges were extracted from the hospital administration database at King Abdullah University Hospital for 2014-2015 fiscal years (FYs). ICU drug charges were compared to non-ICU drug charges that were incurred during the same patient admissions. ICU medications with the most significant charges were identified. The most frequent diagnoses with the highest ICU medication charges were described. Results: Average ICU medication charges per day were approximately twice that of non-ICU medication charges ($121.5 versus $55.7 in 2014 and $100.2 versus $52.2 in 2015; p < 0.001 in both FYs). Meropenem and human albumin were the most expensive ICU medications. Drug charge allocation was most expensive for sepsis, motor vehicle accidents and respiratory failure. Conclusion: Drug charges in the ICU are considerably higher than non-ICU drug charges, thus requiring more vigilant cost containment approaches. Further research is needed to evaluate the appropriateness of expensive ICU medications.

Factors affecting hypertensive patients' compliance with healthy lifestyle

Purpose: This study aimed to identify factors correlating with hypertensive patients' compliance with lifestyle recommendations in north of Jordan. Patients and methods: A cross-sectional survey and face-to-face interview methods were used to collect the data from 1000 adult Jordanian hypertensive patients (>18 years old). A questionnaire was developed based on previous literature and professional consultation. Results: Only 23% of the patients were fully compliant with healthy lifestyle behaviors. About 95% were knowledgeable on hypertension and 86% had positive beliefs about the management protocols of their disease. Gender, physician counseling on a healthy lifestyle, patients' beliefs about hypertension management, and their knowledge on hypertension and its management have an independent effect on compliance with lifestyle recommendations. Conclusion: Patients' compliance with lifestyle recommendations was low. Receiving counseling from physicians about healthy lifestyle and self-care; being informed about hypertension and its management; and having positive beliefs about managing this disease are significant predictors of patients' compliance with lifestyle recommendations.

Availability, prices and affordability of selected essential medicines in Jordan: a national survey

BACKGROUND

Free access to essential medicines is a fundamental right. Governments should provide accessible and affordable medicines to people. The purpose of this study was to evaluate medicines' prices, availability and affordability in Jordan.

METHOD

Data was collected from 30 public sectors and 30 private sectors in 6 regions in Jordan. At each institution, the availability and prices data of 50 originator brand (OB) medicines and lowest-price generic (LPG) equivalent medicines were collected. Medicines' prices were compared with international reference prices (IRPs) to obtain a median price ratio (MPR). Availability of medicines was determined on the day of data collection. Affordability was calculated with regards to the daily income of the lowest-paid unskilled government employee.

RESULT

Availability of medicines in public and private sectors was 72% and 76% for LPGs, respectively. Median MPRs of procurement prices for OBs and LPGs in the public sector were 1.1 and 5.5 times the IRPs, respectively. Private sector OB medicines were priced 4.8 times higher than IRPs, whereas LPGs were 3.8 times higher. OBs cost 14% more than LPGs in private sector. The median MPRs of patient prices for LPGs in the public sector were lower than in the private sector (1.1 versus 7.6). Generally, medicines' prices are affordable in public sector that the lowest paid unskilled government employee need less than a 1 day income to purchase the LPGs. While in private sector, the medicine prices are not affordable. For example, the treatment of hypertension either by LPGs or OBs needs more than 1 day income by lowest paid unskilled government employee.

CONCLUSION

This study showed good availability of LPGs in the public sector. In private sector, it showed good availability of LPGs and OBs with higher patient prices. The procurement prices in the public sector were reasonable in comparison to IRPs. Policy evaluation efforts must be directed to cut medicines prices and to improve affordability in private sector.

Direct medical cost associated with colorectal cancer in north of Jordan

Colorectal cancer (CRC) is mainly characterized as the malignant and impaired growth of rectal cells in the intestinal region. Direct medical cost is related to resources, which are directly used in treating the patient, that mainly includes the cost of drugs, diagnostic, treatment, follow-up, rehabilitation, and hospital admission. The objective of this study is to estimate and analyze direct medical costs attributable to CRC in Jordan. A retrospective analysis of a cohort patients treated for CRC data has been performed to determine direct medical costs attributable to CRC in Jordan. The prevalence-based approach has been used in addition to the "bottom up" approach to accumulate 1-year time costs of CRC. Demographic, clinical, and economic data have been collected and analyzed using SPSS for windows. Costs were estimated by a bottom-up approach, in which each service component was identified and valued at the most detailed level, to provide greater transparency and reliability in economic evaluation of health care services. This study quantified the economic burden associated with CRC by Jordanian patients in King Abdullah University Hospital from the perspective of health care providers (public sector). Total CRC cost in the year 2014 was estimated to JD 695,608, and the most expensive stage for all sites was stage 4 reaching a cost of JD 5147. Advanced disease stages were associated with an increase in total cost and chemotherapy costs. In conclusion, results of this study propose that direct medical costs associated with CRC are considerable. Most of the cost was devoted for medications, primarily chemotherapy. Advanced stages were associated with higher cost and largest number of patients.

Pharmacy education in Jordan: updates

Objective

To describe the increasing number of pharmacy schools in Jordan.

Method

A review for numbers of schools and their curricula was conducted.

Key findings

To date, there are 18 pharmacy schools in Jordan. PharmD program is offered by two public schools. PhD program is offered by one school; while MSc program is offered by seven schools. Public pharmacy schools have two similar programs in terms of curricula, ‘regular’ and ‘parallel’. The ratio of pharmacists to 1000 population was 2.1 in 2012. Substantial increase in pharmacists’ integration is needed in public and private primary care settings.

Conclusions

Number of pharmacy schools and pharmacy graduates in Jordan seems to be ‘high’. If the schools are to remain on a track of growth, let the emphasis shift to PharmD expansion.

Evaluation of the types and frequency of drug-related problems and the association with gender in patients with chronic diseases attending a primary health care center in Jordan

BACKGROUND

Drug-related problems (DRPs) can be defined as any event that is drug related that results in harm or in providing less than optimum medical care to patients. The aim of this study is to determine the types and frequency of each type of DRP in selected outpatient settings in Jordan, with emphasis on gender as a grouping variable.

METHODS

This study was a non-randomized controlled trial, carried out over 3 days, at Alsarih Medical Health Center in the north of Jordan. Clinical pharmacists conducting the research interviewed a randomly selected population, assessed their DRPs, proposed appropriate clinical interventions to physicians and provided appropriate patient counseling.

RESULTS

The study included a total of 258 patients (mean age 54.4±12.1; male ratio 37.6%). The most frequently encountered DRPs in our study were patients' need for counseling and education (83.8%), and life style modifications (80%). This study also revealed that 71.8% of patients required additional and/or more frequent monitoring, and 53% of patients had untreated conditions that required pharmacological and/or non-pharmacological interventions. Gender did not affect the frequency of DRPs among patients.

CONCLUSION

Certain types of DRPs are the most common among outpatient settings. Therefore, measures should be taken to specifically tackle these types of DRPs.

Translation and validation of the Arabic version of generic medicines scale

BACKGROUND

Generic drugs are considered the best alternative for the originator brand drugs because they have the same quality, safety, and efficacy yet offered at considerbaly lower cost. Prior research has developed instrumentation to assess patients' perceptions of generic drugs; however, little has been done to translate these measures in other languages.

OBJECTIVES

This study's aim was to translate and validate an Arabic version of the generic drug scale (GMS) in a Jordanian sample. This was a cross-sectional study.

METHODS

The English version of the GMS was translated to an Arabic version using the standard "forward-backward" procedure of translation. The questionnaire was distributed to 225 patients. The translated version was then validated in a sample of patients. Face validity of the translated GMS was confirmed with pilot testing. Content validity of the translated GMS was evaluated by a number of pharmacists and academicians. Confirmatory factor analysis (CFA) was used to test a pre-specified relationship of observed measures.

RESULTS

The GMS consisted of two subscales: efficacy, and similarity of generic drugs to originator brand drugs. The efficacy subscale consisted of ten items while the similarity subscale consisted of six. The responses to the items were framed on five-point, Likert-type scales. The instrument demonstrated good internal consistency (Cronbach's alpha = 0.83). The range model fit was good for some fit indices. The RMSEA value was 0.08, which indicates good fit. Also, CMIN/DF indicated a good fit model with a value of 2.7, as well as GFI and CFI values of 0.95 and 0.91, respectively. NFI and CFI values were 0.92 and 0.93, respectively. Factor loadings were over 0.30 for all items, which means the scale has CFA validity indictors.

CONCLUSIONS

The Arabic version of GMS was proved to be a reliable and valid measure to investigate patients' belief regarding generic drugs as it showed acceptable, internal consistency reliability, face and content validity.

Drug-related problems in a sample of outpatients with chronic diseases: a cross-sectional study from Jordan

Optimization of drug therapy and preventing drug-related problems (DRPs) are major factors to improve health care, reduce expenditure, and potentially save lives. This study aimed at describing the types, numbers, and frequencies of DRPs in the outpatient settings of a group of hospitals in Jordan. The study was set in the cardiology, endocrine, and respiratory outpatient clinics of five major hospitals in Jordan. Patients who visited the above clinics during the period from September 2012 to December 2013, were candidates for this study. Each included subject was fully assessed for DRPs by clinical pharmacists according to a specially designed and validated pharmaceutical care manual. The main outcome measures were the number and types of DRPs. Data were collected from 2,898 patients (mean age ± standard deviation: 56.59±13.5 years). The total number of identified DRPs was 32,348, with an average of 11.2 DRPs per patient. The most common DRPs were a need for additional or more frequent monitoring, a problem in patients' adherence to self-care activities or nonpharmacological therapy, and that the patient was not given instruction in or did not understand nonpharmacological therapy or self-care advice. The numbers of DRPs per patient in our sample were associated with older age (>57 years), being unmarried, having an education level of high school or less, not having health insurance, and the presence of certain clinical conditions, including hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, cardiac catheterization, heart failure, and gout. In conclusion, implementation of clinical pharmacy services is a strategy to limit DRPs. Certain patient populations are more vulnerable to DRPs.