Patient Preferences for Pharmacy Services: A Systematic Review of Studies Based on Discrete Choice Experiments

BACKGROUND AND OBJECTIVE

In recent years, the mission of pharmacists has evolved and the model of the caregiver-patient relationship has been challenged by a new patient-centered approach. A challenge to providing personalized care is the assessment of patient preferences. We aimed to systematically identify published discrete choice experiments related to patient preferences for pharmacy services and to assess the quality of the selected articles.

METHODS

A systematic review of the literature was conducted in two databases (PubMed and Embase, until March 2023) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The quality of the selected articles was assessed according to the International Society for Pharmacoeconomics and Outcomes Research conjoint analysis checklist.

RESULTS

Among the 421 articles identified, 16 published studies were included and analyzed. They were mostly published in pharmaceutical (n = 6), economic (n = 4), and public health (n = 4) journals. Only two articles concerned the field of hospital pharmacy. Only five presented the specific pharmacy service studied: filling of prescriptions, management of symptoms, treatment delivery, and components of pharmacist counseling. Five articles focused on pharmacy services related to a specific disease. None fully fulfilled the International Society for Pharmacoeconomics and Outcomes Research checklist, only partially fulfilled.

CONCLUSIONS

According to the identified studies, cost, time, logistics (organizational criteria), and pharmacists' courtesy and skills were consistently cited as factors influencing patient preferences for pharmacy services. The disclosure of patient preferences is a complex and under-researched topic, especially in the field of pharmacy, but interest is growing. As the mission of pharmacists evolves to bring them closer to patients, the better understanding of patient preferences in pharmacy services will allow for better targeting and better integration of patient profiles in patient management.

Aflatoxins and Ochratoxin A in dried fruits from Morocco: Monitoring, regulatory aspects, and exposure assessment

The present study aims to investigate the presence of Aflatoxins (AF) in 180 samples dried fruits and Ochratoxin A (OTA) in 210 samples dried fruits and grape juices collected in Morocco. Mycotoxins were analyzed by high performance liquid chromatography (HPLC) coupled to fluorescence detection and immunoaffinity columns (IAC) cleanup. Contamination levels were compared with the maximum regulatory limits (MRL) recently adopted in the country, and mycotoxin exposure of adult consumers was assessed. Results showed that 13.8% of samples were contaminated with AF, with incidences of 23.3, 23.3, 20, 13.8, and 3.3%, in raisins, figs, nuts, peanuts and pistachio, respectively. There were 12 samples (6.6%) that exceeded the MRL of 2-12 ng/g set for aflatoxin B1 (AFB1). While OTA was detected in 17.1% of samples, with incidences of 3.3, 3.3, 30, 30, and 53.3% in walnuts, pistachios, peanuts, raisins and figs, respectively, and a maximum value of 99.1 in dried raisins, that exceeded the MRL (10 ng/g) set for OTA. The co-occurrence of OTA and AF was observed in 4.7% of total samples. Dietary intake showed that the OTA exposure level was lower than safety guidelines set by The Joint FAO/WHO Expert Committee on Food Additives (JECFA) at 100 ng/kg b.w./week.

The journey of cancer patients and the quest to equity: findings from Morocco

OBJECTIVES

Rapid diagnostic and assessment pathways for cancer patients provide timely and effective care. This study took place in Morocco, where the majority of patients treated in the public sector are diagnosed at an advanced stage. The aim of this study was to determine the duration of different time intervals along the cancer patient pathway and to highlight problem areas so that strategies can be implemented to make the process more equitable and effective.

STUDY DESIGN

Cross-sectional study.

METHODS

Recently diagnosed cancer patients were recruited from four major oncology centres in Morocco; namely, Marrakech, Casablanca, Rabat, and Fez. A questionnaire survey was administered, including sociodemographic and medical information and questions on access to the oncology centre, beliefs, and opinions on the medical staff. The dates of symptom recognition, assessment, diagnosis referral, biopsy, and treatment initiation were collected. Different time intervals (patient, diagnosis, biopsy, and treatment) were estimated and their determinants were investigated.

RESULTS

A total of 812 patients were interviewed. The majority of participants were breast cancer patients. In total, 60% of participants were at stage III-IV. The main facilitators of cancer diagnosis confirmation and treatment initiation were easy access to diagnosis and treatment facilities, financial resources, personal history of cancer, time availability, late stage at diagnosis, advanced age, and private health insurance. The patient interval (i.e., time from symptom recognition to initial healthcare assessment) had a median duration of 30 days. The biopsy and treatment intervals were within the current international recommendations (7 and 28 days, respectively). However, the diagnosis interval (52 days) was twice as long as the recommended timeframes from the UK, Australia, and the World Health Organization (<28 days).

CONCLUSIONS

Interval targets should be defined to encourage health systems to be more equitable and effective and to ensure that cancer patients are treated within a defined timeframe.

COPEDOL: a two-year observational study in pretreated HIV-1-infected patients switching to a dolutegravir-based regimen

OBJECTIVES

Dolutegravir is a second-generation integrase strand transfer inhibitor of particular interest as a rescue treatment for people living with HIV (PLWHIV) who develop resistance to multiple antiretrovirals (ART). We assessed the virological treatment response in patients switched to a dolutegravir-based regimen following failure of previous ART treatment in a real-world treatment setting.

PATIENTS AND METHODS

This was a multicenter, longitudinal, observational study with retrospective patient enrolment. Patients were enrolled between February 2017 and January 2018. Patients starting dolutegravir treatment between February 2014 and September 2016 were retrospectively included. Patients were followed up for 24 months after dolutegravir initiation. During this period, treatment with dolutegravir could be discontinued at any time at the physician's discretion. Treatment failure was either defined as a viral load ≥50 copies/mL at two consecutive blood samples or as clinical or biological safety issues. Overall, 459 patients were enrolled and 329 completed 24 months of treatment. The primary study outcome measures were treatment response and time to treatment response.

RESULTS

346/440 patients (78.6%) achieved a treatment response; 86 patients discontinued dolutegravir treatment (of whom 17 for failure to achieve or maintain viral suppression and 38 for tolerability issues). Acquired dolutegravir-resistance mutations were identified in five patients.

CONCLUSIONS

A sustained treatment response can be obtained with a dolutegravir-based treatment regimen in PLWHIV experiencing treatment failure, even in vulnerable patients with a long history of previous ART failure, infected with multidrug-resistant HIV strains, and with multiple comorbidities.

Associated Factors for Health Quality of Life in Moroccan Women With Breast Cancers

Background: Breast cancer is the most common cancer among women. Breast cancer is ranked the first female cancer (33.4%) in Morocco; and more than 60% cases are diagnosed at stage III or IV. During the last decade, health-related quality of life (HRQOL) has become an important part of breast cancer treatment. Aim: The objective of this study is to describe self- reported HRQOL in patients with breast cancer and to investigate its associations with socio-demographic and clinical variables. Methods: A prospective study was carried out in the main oncology centers in Morocco. Quality of life was measured using the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C 30 (EORTC QLQ C30) and Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). Statistical data analyses were performed using descriptive statistics and multivariate analyses. Results: A total of 1463 subjects were included in the study. The subjects' mean age was 55.6 (SD. 11.2) years, 70% were married. The majority of the subjects had stage II (45.9%) and the few cases had stage IV (12.9%). Participants had a mean score for global health of 68.5. Among functional scales, social functioning scored the highest (mean 86.2, SD = 22.7). The most distressing symptom on the symptom scales was financial difficulties (mean 63.2, SD = 38.2). Using the disease-specific tool, it was found that future perspective scored the lowest (mean 40.5, SD = 37.3). On the symptom scale, arm symptoms scored the highest (mean 23.6, SD = 21.6). Significant mean differences were noted for many functional and symptom scales. Conclusion: Our results emphasize that the general HRQOL of the studied women is fairer than that of the corresponding population in other countries. This study provided baseline information on the quality of life of a large sample of Moroccan women diagnosed with breast cancer.

Evolution of quality of life in patients with breast cancer during the first year of follow-up in Morocco

Background

Quality of life has an important place in the future of patients with breast cancer. The objective of this study is to assess the evolution of the patient’s quality of life with breast cancer in Morocco after a year of follow-up.

Methods

This study involved the patients with breast cancer with all types of treatment as determined by their physicians. Patient’s quality of life was assessed with the Moroccan Arabic version of QLQ- EORTC QLQ C30 and EORTC-BR23 questionnaires. Data were analyzed using SPSS Version 20 software.

Results

Regarding EOTRC questionnaires QLQ C-30, there was a significant improvement in global health status and all scales of the functional dimension except the social functional where there was a trend towards improvement and the financial impact of the disease where the situation has deteriorated. Quality of life was improved for most symptom-sized scales dimension of EORTC QLQ- C30 with the exception of diarrhea where it was observed degradation. Most of the EORTC QLQ-scales BR23 questionnaires showed a favorable trend in the quality of life except those of sexual functioning, sexual enjoyment, hair loss and the side effects of systemic therapy.

Conclusion

The quality of life of the patient is significantly improved after 1 year of follow up. Quality of life instruments can be useful in the early identification of patients whose score low on functional scales and symptoms.

The ocean sampling day consortium

Ocean Sampling Day was initiated by the EU-funded Micro B3 (Marine Microbial Biodiversity, Bioinformatics, Biotechnology) project to obtain a snapshot of the marine microbial biodiversity and function of the world’s oceans. It is a simultaneous global mega-sequencing campaign aiming to generate the largest standardized microbial data set in a single day. This will be achievable only through the coordinated efforts of an Ocean Sampling Day Consortium, supportive partnerships and networks between sites. This commentary outlines the establishment, function and aims of the Consortium and describes our vision for a sustainable study of marine microbial communities and their embedded functional traits.

Microbiological impact of treatment lagoons on the economics of water for reuse in agriculture a case study in Morocco (Settat and Soualem regions)

This study was undertaken to enumerate pathogens: fecal coliforms, Escherichia coli, fecal enterococci and Salmonella in the areas irrigated with treated wastewater. The samples were isolated from Settat (33°00'N, 7°37'W) and Soualem regions (34°26'N, 5°53'W). A total of (n= 48) raw water, (n=48) treated water, (n=71) of vegetables samples irrigated by treated water taken from Waste Water Treatment Plant Settat; A total of (n=24) raw water, (n=24) treated water, (n=97) of vegetables samples irrigated by treated water taken from Waste Water Treatment Plant Soualem. The results show the total average in the two stations of raw water 7.9, 6.1 log MPN 100 ml⁻¹ for respectively fecal coliforms and E. coli, 5.4 log CFU 100 ml⁻¹ for fecal enterococci and 5.2 log MPN L⁻¹ for Salmonella; for treated water 4.6, 3.1 log MPN 100 ml⁻¹ for respectively fecal coliforms and E.coli and 3.5 log CFU 100 ml⁻¹ for fecal enterococci. Regarding plants, four types of crops were harvested and analyzed (forage, herbs, cereals and vegetables), the germs charges were found with fecal coliforms, E.coli and fecal enterococci respectively 3.2, 2.8 and 4.1 log CFUg⁻¹. Salmonella was never detected in both treated water and crops samples.

[Mitral commissurotomy during pregnancy]

The physiological hemodynamic changes of the circulation during pregnancy are the main cause of mitral stenosis (MS) decompensation. In pregnant women with MS, the blood volume increase, tachycardia and the obstacle to left ventricular filling are responsible of post-capillary pulmonary hypertension (PF). This hemodynamic stress associated to other conditions can trigger acute pulmonary edema or even cardiogenic shock leading eventually to an unacceptable maternal and fetal death. The percutaneous mitral commissurotomy (PMC) has been tested with success during pregnancy, with excellent short- and mid-term results. We report our experience on seventy patients requiring PMC during the third trimester of pregnancy, between March 1998 and June 2006. The PMC was successful in sixty nine out of seventy patients. All of them improved their NYHA class of that least one stage. None of them kept a residual mitral surface<1.5 cm2. The PMC permitted a spectacular clinical and hemodynamic improvement, and the course of pregnancy until end of term occurred in almost all cases.

[Prevalence of syphilis and HIV infection in female prison population in Morocco]

We studied the prevalence of syphilis and HIV infection in 217 female prisoners at Oukacha prison, Casablanca and associated risk factors. The mean age was 32.0 years and mean length of imprisonment 22.8 months. As regards risk factors, 9% of the women said they used condoms, homosexuality was not admitted, 1.8% were intravenous drug users and the average number of sexual partners was 5.17. Fifty-one women (23%) were positive for syphilis and 4 (2%) were HIV-positive. Multivariate analysis found that being married was protective (OR = 0.75, 95% CI: 0.57-0.97), while high number of partners was a positive risk factor (OR = 2, 95% CI: 1.2-3.51).

Troubles cognitifs dus à l’intoxication oxycarbonée: étude neuropsychologique et IRM de 5 cas

INTRODUCTION

Carbon monoxide (CO) poisoning has been shown to result in cognitive impairments. These disorders have rarely been reported. The present study aimed to evaluate these disturbances in five patients with a neuroanatomical study.

METHODS

There were two men and three women with an average of 25 years old. Patients were explored several months after acute CO poisoning. Neuropsychological testing was administered to assess memory, intellectual, executive, visual-spatial and constructional functions, language, praxis and gnosis. Cerebral magnetic resonance imaging (MRI) was performed in all patients using axial, sagittal and coronal slides with T1 and T2 weighted and flair images. None of the subjects had hyperbaric oxygen. They received 7, 5 mg bromocriptine per day.

RESULTS

All patients presented cognitive disorders including marked impairment in long term memory with a severe defect in recall performance in comparison to recognition memory. Visual memory was more affected than the verbal one. There were also moderate disturbances in intellectual, executive, visual-spatial and constructional functions. One patient presented alexia agraphia, severe visual disturbances, constructional and dressing apraxia. Four patients had depression and one psychic akinesia. Cerebral MRI studies revealed that all patients had bilateral pallidal necrosis, bilateral hippocampal and moderate cortical atrophy. Fornix atrophy was found in 2 patients and corpus mammillary atrophy in 3 patients. Others lesions were also found: bilateral cerebellar in two cases and cortical in three cases. Treatment with bromocriptine was effective in three cases. There was no improvement in the patients treated 14 months and 5 years following CO poisoning.

CONCLUSION

Neuropsychological impairments in CO poisoned subjects include memory, intellectual, executive, and visuospatial defects. In addition to pallidal necrosis, which is a typical feature of CO poisoning, hippocampal and cortical atrophy are often present. Bromocriptine can improve the cognitive disorders.

[Echocardiographic assessment of cardiac remodeling in the high-level football player]

INTRODUCTION

The aim of this study is to assess the morphological and hemodynamic cardiovascular changes of 24 high-level football players, using Doppler-echocardiography, and compare them to a similar control group.

METHODS AND RESULTS

Twenty-four elite football players were matched to 24 normal subjects according to age, sex, and body surface. All participants had a clinical examination, resting ECG, Doppler-echocardiography and a measurement of maximal oxygen uptake (VO2 max). The echocardiographic variables were compared between two groups by the Student's t-test and other statistical tests, using the SPSS 12 for Windows software. Compared to the control group, the wall thickness (10.49 + 1.04 vs. 7.5 + 2.04 mm, p < 0.05), the LV end-diastolic diameter (57.1 + 3.70 vs. 41.2 + 3.65 mm, p < 0.01) and left atrium surface (20.16 + 2.03 vs. 16.16 + 1.83 cm2, p < 0.01) were significantly more important in football players. The LV and RV ejection fractions were similar in both groups. The RV long-axis diastolic diameter (8 + 0.5 vs. 6.5 + 1.1 mm, p < 0.01) and S-wave using DTI (0.17 + 0.02 vs. 0.14 + 0.02, p < 0.05) were more important among football players.

DISCUSSION

The hemodynamic and morphological changes result from an acquired cardiac adaptation in athletes with important endurance and resistive efforts. The majority of players presented an intermediate-type of remodeling, but the more offensive ones had an endurance-type heart, whereas the defense players had a resistance-type aspect.

CONCLUSION

This study on the cardiac remodeling in high-level athletes permits to have a distinctive approach between physiological and pathological remodeling. This remodeling varies according to the player's post and exercise capacities. In a football player, a correlation between physical level and physical capacity is plausible.

[Orbital cellulitis in children: a retrospective study of 33]

Orbital cellulitis is rare. However the high risk of severe ocular and neurological complications make early diagnosis and adequate therapy essential. The purpose of this retrospective study is to describe 33 cases observed in the pediatric infectious disease department of the Casablanca Children's Hospital in Morocco from 1994 to 2000. Orbital cellulitis was preseptal in 24 patients and retroseptal in 9. Infection occurred in relation with sinusitis in 10 cases, polydermitis in 8, wound infection in 6, ocular infection in 2, and dental abscess in 2. Ages ranged from 40 days to 15 years with a mean age of 5 years. Infants accounted for 25% of cases and always presented preseptal cellulitis. Fever and local edema were noted in all patients. Exophthalmia occurred in six patients and seizures in 2. The 9 cases of retroseptal cellulitis were complicated by empyema in 2 cases, meningitis in 1 case and thrombophlebitis of cavernous sinus with cerebromalacia in 1 case. Bacteriological testing identified micro-organisms in 10 cases, i.e., Staphylococcus aureus in 6 cases, Streptococcus B in 1, Streptococcus pyogenes in 1, Enterobacter Cloacae in land Acinitobacter jejuni in 1 case. Therapy was based on broad-spectrum antibiotics in association with surgery in the patient presenting in intracranial abscess. Ophthalmoplegia-like sequels including blindness, aphasia, and motor deficit occurred in 2 patients. Orbital cellulitis in children are usually preseptal and have a favorable prognosis. However prompt and adequate antibiotherapy is essential due to the risk of retroseptal involvement with inflammatory palpberal edema and possible cerebral extension.

Triadic Distance Models: Axiomatization and Least Squares Representation

Distance models for three-way proximity data, which consist of numerical values assigned to triples of objects that indicate their joint (lack of) homogeneity or resemblance, require a generalization of the usual distance concept defined on pairs of objects. An axiomatic framework is given for characterizing triadic dissimilarity, triadic similarity, and triadic distance, where the term triadic implies that each element of the triple is treated on an equal footing. Two kinds of distance models are studied in detail: the Minkowski-p or Mp model, which is based upon dyadic components and includes the perimeter model as an important special case, and several models based on presence-absence variables. They are shown to satisfy the tetrahedral inequality, a condition that is characteristic for the present axiomatization. Two monotonically convergent algorithms are described that find weighted least squares representations of three-way proximity data under the Euclidean M1 model and the Euclidean M2 model. To enable a scalefree evaluation of the quality of the fit, an additive decomposition of the sum of squares of the dissimilarities is derived. As illustrated in one of the examples, distance analysis of three-way, three-mode tables is possible by a suitable manipulation of the least squares weights.

[Primary Gougerot-Sjogren syndrome. Spontaneous one-year course of clinical, biological and histological signs]

OBJECTIVES

The natural clinical course of primary Sjögren's syndrome was followed in 8 patients to identify the concomitant functional, clinical, biological, scintigraphic and histological manifestations of the disease.

METHODS

The diagnosis of primary Sjögren's syndrome was made on the basis of functional signs (ocular or salivary sicca syndrome) and 2 positive tests among the 3 objective ocular tests (Schirmer's test, break-up time, Rose Bengale). Work-up included recording of functional and clinical signs, ophthalmologic examination and laboratory tests at diagnosis and every 3 months for 12 months. Scintigraphy of the salivary glands was performed together with a biopsy at diagnosis and at 12 months.

RESULTS

No one parameter varied significantly over a 1 year period demonstrating the lack of need for renewed examinations for diagnosis or regular follow-up.

CONCLUSION

This is the first report providing a homogeneous series studied by one team over a determined period of time. It demonstrates that clinical, biological and anatomic criteria for primary Sjögren's syndrome do not show any correlation between functional signs and objective ocular tests.

Entrapment and compartment syndromes of the upper limb in haemophilia

17 patients with haemophilia have been treated for a neurological deficit of the upper limb. Four of the five entrapment neuropathies have been operated upon, and only two patients recovered completely. Only two of the 12 patients with a compartment syndrome have been operated upon, and only two had sequelae. Clotting factor replacement is always indicated as primary treatment. Surgical release is indicated if the condition fails to improve. Late treatment was responsible for incomplete recovery, whatever the cause of the nerve compression.

Hemoglobinopathies in the Dogon Country: presence of beta S, beta C, and delta A' genes

The population of the Dogon, located in Mali, is divided in an endogamic Noble class and two endogamic servant castes (Tanners and Blacksmiths). We find that the polymorphic frequencies of beta c, beta S, and, unexpectedly, a mutation of the delta-chain (delta A'), are geographically (valley vs. plateau) as well as social status dependent.

Two familial cases of malignant Reiter's syndrome

A Cambodian man and his son concomitantly developed malignant Reiter's syndrome soon after their arrival in France. In both cases generalized skin lesions of pustular psoriasis and systemic features were present. The son died after 2 years of unresponsive continuously progressive disease. The father received pulses of high dose immunosuppressants that worked rapidly and prevented a life threatening course. These 2 cases illustrate the pathophysiologic hypothesis of Reiter's syndrome, emphasizing the role of environmental triggering factors and the relationship between spondylarthropathies in B27 positive patients. Fatal cases of Reiter's syndrome are very rare in the review of the literature.