Implications of failure on students who have repeated a class in a faculty of pharmacy

INTRODUCTION

Academic failure is a major contributor to attrition in pharmacy education, and this attrition is also associated with other effects that are secondary fallouts of academic failure. This study sought to assess the emotional implications and overall psychological impact of academic failure among students who repeated at least one class in the pharmacy program at Obafemi Awolowo University (OAU), Ile-Ife, Nigeria.

METHODS

The study involved 177 students from the 200 level to 500 level at the School of Pharmacy, OAU who had repeated at least one class. A pretested questionnaire was administered using a random sampling method. The questionnaire was divided into four sections assessing demographics, the academic emotions caused by academic failure, the psychological effects of failure, and the possible effects of academic failure on subsequent performance.

RESULTS

Results indicated that the most common emotions among students who had repeated a class included shame (80%), anger (77.4%), anxiety (61%), and boredom (61%), which are all negative academic emotions. The repurposed Impact of Event Scale gave a median score of 41 out of a possible 42. Respondents also agreed that feelings of boredom, anger, anxiety, and shame subsequently impacted class attendance, learning, and test preparation.

CONCLUSIONS

The study showed that students who had repeated at least one class experienced negative academic emotions and may have suffered symptoms typical of post-traumatic stress disorder. These emotional effects of academic failure were also noted to impact subsequent academic performance.

Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria

BACKGROUND

Non-adherence to recommended therapy remains a challenge to achieving optimal clinical outcome with resultant economic implications.

OBJECTIVE

To evaluate the effect of a pharmacist-led intervention on treatment non-adherence and direct costs of management among patients with type 2 diabetes (T2D).

METHOD

A quasi-experimental study among 201-patients with T2D recruited from two-tertiary healthcare facilities in southwestern Nigeria using semi-structured interview. Patients were assigned into control (HbA1c < 7%, n = 95) and intervention (HbA1c ≥ 7%, n = 106) groups. Baseline questionnaire comprised modified 4-item Medication Adherence Questions (MAQ), Perceived Dietary Adherence Questionnaire (PDAQ) and International Physical Activity Questionnaire, to assess participants' adherence to medications, diet and physical activity, respectively. Post-baseline, participants were followed-up for 6-month with patient-specific educational intervention provided to resolve adherence discrepancies in the intervention group only, while control group continued to receive usual care. Subsequently, direct costs of management for 6-month pre-baseline and 6-month post-baseline were estimated for both groups. Data were summarized using descriptive statistics. Chi-square, McNemar and paired t-test were used to evaluate categorical and continuous variables at p < 0.05.

RESULTS

Mean age was 62.9 ± 11.6 years, and 160(79.6%) were females. Glycated haemoglobin (HbA1c) was 6.1 ± 0.6% (baseline) and 6.1 ± 0.8% at 6-month post-baseline (p = 0.094) for control group, and 8.7 ± 1.5% (baseline) versus 7.8 ± 2.0% (6-month), p < 0.001, for the intervention. Post-baseline, response to MAQ items 1 (p = 0.017) and 2 (p < 0.001) improved significantly for the intervention. PDAQ score increased significantly from 51.8 ± 8.8 at baseline to 56.5 ± 3.9 at 6-month (p < 0.001) for intervention, and from 56.3 ± 4.0 to 56.5 ± 3.9 (p = 0.094) for the control group. Physical activity increased from 775.2 ± 700.5 Metabolic Equivalent Task (MET) to 829.3 ± 695.5MET(p < 0.001) and from 901.4 ± 743.5MET to 911.7 ± 752.6MET (p = 0.327) for intervention and control groups, respectively. Direct costs of management per patient increased from USD 327.3 ± 114.4 to USD 333.0 ± 118.4 (p = 0.449) for the intervention, while it decreased from USD 290.1 ± 116.97 to USD289.1 ± 120.0 (p = 0.89) for control group, at baseline and 6-month post-baseline, respectively.

CONCLUSION

Pharmacist-led intervention enhanced adherence to recommended medications, diet and physical activity among the intervention patients, with a corresponding significant improvement in glycaemic outcome and an insignificant increase in direct costs of management. There is a need for active engagement of pharmacists in management of patients with diabetes in clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04712916 . Retrospectively-registered.

Assessing community pharmacists’ involvement and clients’ opinion on HIV/AIDS services in community pharmacies in Nigeria: a cross-sectional survey

The World Health Organization is promoting community-based services to end HIV/AIDS by 2030. In Nigeria, studies on community pharmacists’ involvement in HIV testing services (HTS) and antiretroviral (ARV) medication therapy management (MTM) are scarce, and no study had evaluated the clients’ opinion on community pharmacy HTS. We assessed the community pharmacists’ involvement in HIV/AIDS services and clients’ opinions of community pharmacy HTS. Semi-structured questionnaires on a five-point Likert scale were administered to 701 selected community pharmacists and 5840 clients in southwest Nigeria in 2019. Data were analyzed with descriptive and inferential statistics. Response rates were 68.6% and 69.8% for community pharmacists and clients, respectively. Only 18.5% of community pharmacists offered rapid HTS and 30% refills of ARV. The total score of their involvement on the HTS was 20.94 ± 17.521 (range 8–40; midpoint 24) and on ARV/MTM was 22.98 ± 19.61 (range 9–45; midpoint 27), while 91% were willing to participate in training. Barriers to integrating services into practice were lack of clinical tools (46.8%), lack of collaboration with other healthcare professionals (39.1%), and lack of training on HIV/AIDS services (36.2%) among others. Also, 77% of the clients were willing to participate in community pharmacy HTS, and about 83% of them responded that knowing their HIV status will help them to take necessary precautionary actions. Community pharmacists’ involvement in HIV/AIDS services was low. However, they showed willingness to participate in training to improve services. Also, clients were willing to receive community pharmacies HTS to know their status.

Effect of providing feedback and prescribing education on prescription writing: An intervention study

Background/Objective:

Accurate medication prescribing important to avoid errors and ensure best possible outcomes. This is a report of assessment of the impact of providing feedback and educational intervention on prescribing error types and rates in routine practice.

Methods:

Doctors’ prescriptions from selected wards in two tertiary hospitals in central Nigeria were prospectively reviewed for a 6-month period and assessed for errors; grouped into six categories. Intervention was by providing feedback and educational outreach on the specialty/departmental level at one hospital while the other acted as the control. Chi-squared statistics was used to compare prescribing characteristics pre- and post-intervention.

Results:

At baseline, error rate was higher at the control site. At the intervention site, statistically significant reductions were obtained for errors involving omission of route of administration (P < 0.001), under dose (P = 0.012), dose adjustment in renal impairment (P = 0.019), ambiguous orders (P < 0.001) and drug/drug interaction (P < 0.001) post intervention though there was no change in mean error rate post intervention (P = 0.984). Though House Officers and Registrars wrote most prescriptions, highest reduction in prescribing error rates post intervention was by the registrars (0.93% to 0.29%, P < 0.001).

Conclusion:

Writing prescriptions that lacked essential details was common. Intervention resulted in modest changes. Routinely providing feedback and continuing prescriber education will likely sustain error reduction.

Cost implications of treatment of diabetes mellitus in a secondary healthcare facility in Ibadan

BACKGROUND

Diabetes and its complications remain a major health challenge in Nigeria.

AIM

To evaluate the economic cost of type 2 diabetes mellitus in a secondary healthcare facility in Ibadan, Nigeria.

METHODS

The study was carried out in Oyo state general hospital Ibadan, Nigeria using two methods of data collection. A retrospective study design in which data were extracted from case files of diabetic patients using a pre-designed data form and secondly with an Open-ended, Affirmation, Reflective listening and Summaries (OARS) method. Data was analysed using frequencies mean and correlation statistical tools.

RESULTS

Majority of the patients (73%) earned less than $125 per month. Hypertension was the most common (98.08%) co-morbid disorder with diabetes mellitus and the most common complication noted was neuropathy (48.10%). Metformin was the most widely prescribed oral hypoglycemic agent (90.40%). The annual cost of diabetes mellitus was $20,827.37. for the 52 patients while the average annual cost of diabetes per patient was $400.52 but higher in age group 60-69 years. There was a significant correlation (p < 0.05) between age (at onset of diabetes and at registration at the healthcare facility) and total cost of drugs used.

CONCLUSION

The study demonstrated that type 2 diabetes mellitus and its complications imposed significant economic burden on the patients. There is need for the policy maker of health sector in the country to plan towards reducing the financial burden of diabetes on the society.

Assessment of the knowledge and attitudes of intern doctors to medication prescribing errors in a Nigeria tertiary hospital

CONTEXT

Junior doctors are reported to make most of the prescribing errors in the hospital setting.

AIMS

The aim of the following study is to determine the knowledge intern doctors have about prescribing errors and circumstances contributing to making them.

SETTINGS AND DESIGN

A structured questionnaire was distributed to intern doctors in National Hospital Abuja Nigeria.

SUBJECTS AND METHODS

Respondents gave information about their experience with prescribing medicines, the extent to which they agreed with the definition of a clinically meaningful prescribing error and events that constituted such. Their experience with prescribing certain categories of medicines was also sought.

STATISTICAL ANALYSIS USED

Data was analyzed with Statistical Package for the Social Sciences (SPSS) software version 17 (SPSS Inc Chicago, Ill, USA). Chi-squared analysis contrasted differences in proportions; P < 0.05 was considered to be statistically significant.

RESULTS

The response rate was 90.9% and 27 (90%) had <1 year of prescribing experience. 17 (56.7%) respondents totally agreed with the definition of a clinically meaningful prescribing error. Most common reasons for prescribing mistakes were a failure to check prescriptions with a reference source (14, 25.5%) and failure to check for adverse drug interactions (14, 25.5%). Omitting some essential information such as duration of therapy (13, 20%), patient age (14, 21.5%) and dosage errors (14, 21.5%) were the most common types of prescribing errors made. Respondents considered workload (23, 76.7%), multitasking (19, 63.3%), rushing (18, 60.0%) and tiredness/stress (16, 53.3%) as important factors contributing to prescribing errors. Interns were least confident prescribing antibiotics (12, 25.5%), opioid analgesics (12, 25.5%) cytotoxics (10, 21.3%) and antipsychotics (9, 19.1%) unsupervised.

CONCLUSIONS

Respondents seemed to have a low awareness of making prescribing errors. Principles of rational prescribing and events that constitute prescribing errors should be taught in the practice setting.

A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria in-patient setting

AIMS

The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them.

MATERIALS AND METHODS

A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria, from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical, pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed, and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses.

RESULTS

Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual, team, environment, and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience, absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient, and supervision was inadequate.

CONCLUSIONS

To reduce the risk of prescribing errors, a number of strategies addressing individual, task, team, and environmental factors such as training of junior doctors, enforcing good practice in prescription writing, supervision, and reviewing the workload of junior doctors must be established.

An assessment of the rate, types and severity of prescribing errors in a tertiary hospital in southwestern Nigeria

BACKGROUND

Accurate medication prescribing is an important process in ensuring the best possible outcomes in patient care. Worldwide literature is replete with studies reporting high prevalence of prescribing error which are the most common type of avoidable medication errors and hence are an important target for improvement.

OBJECTIVES

This study assessed types and prevalence of prescribing errors, their clinical significance, when in the prescribing process they occurred and the medications commonly associated with prescribing errors.

METHODS

A retrospective review of 2010 in-patients' records from medical and paediatric specialties of a tertiary hospital in South West Nigeria was undertaken. Prescriptions that met the standard as enumerated in the Nigeria Standard Treatment Guideline (STG) were assessed. Prescription error rates for potentially clinically serious and total errors were determined.

RESULTS

The total prescribing error rate was 40.9% (95% CI 37.8 to 41.4) with 1.3% (95% CI -1.1 to 3.7) being clinically serious. Omitting to write an ending date or duration for therapy and unsafe abbreviations were the most common errors. Prescriptions involving antimicrobials produced the bulk of errant prescriptions.

CONCLUSION

Prescribing errors were found to be common. There was poor compliance with the Nigeria Standard Treatment Guidelines which outline the essential elements of a prescription. Continuing prescriber education on proper prescription writing and rational drug use is recommended as a way to reduce prescribing errors.

Pharmacist medication history interview of elderly patients in a teaching hospital in Nigeria

Objective

To explore communication patterns between hospital pharmacists and elderly patients during medication history interviews.

Method

Medication history interviews conducted by four hospital pharmacists were audiotaped and videotaped. A transcript was constructed for each interview comprising the words spoken, supplemented by noted observations of non-verbal behaviour from the videotapes. Twenty transcripts were coded and analysed using the socio-linguistic model of communication.

Results

Misconception of speech events was found to be an important source of conflict in the pharmacist-patient relationship. Miscommunication occurred most frequently in the acoustic, lexicon and conception areas.

Conclusion

Pharmacists' communication skills with the elderly must be developed for effective interaction about medication use.

Legal issues in prescription writing: A study of two health institutions in Nigeria

Objectives

This study examined the degree of deviation (from both World Health Organization (WHO) specifications and the particular institution's specifications) on the part of prescribers in adequately filling prescription forms and the legal implications of such deviations for the prescriber and the institution.

Methods

The study was carried out at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) and Obafemi Awolowo University Health Centre, Ife-Ife, Nigeria. The Teaching Hospital is a 1000-bed tertiary health care facility that serves as a training centre for health professionals. The Health Centre is a 25-bed health care facility. A random sample of prescriptions received from the Pharmacy Department of the OAUTHC and the Obafemi Awolowo University Health Centre were analysed.

Key findings

For the Teaching Hospital, the prescriber's name and signature were on 80 and 96% of the prescriptions, respectively, whereas all prescriptions from the Health Centre contained this information. For the Teaching Hospital, 100, 1.8, 93.8 and 98.4% of prescriptions contained the patient's name, address and age, and the date, respectively, whereas 99.6, 86.4 and 99.9% of prescriptions from the Health Centre contained patient code number, age and the date respectively. The precentages of completely filled prescriptions for the Teaching Hospital and the Health Centre were 1.3 and 85.9% respectively. Prescription patterns for the major drug classes in both institutions were compared and related to the level of deviation from the ideal prescription-writing specifications of the WHO.

Conclusions

The legal implications of non-compliance with WHO standards in prescription writing are discussed, with appropriate recommendations.

Legal issues in prescription writing: a study of two health institutions in Nigeria

OBJECTIVES

This study examined the degree of deviation (from both World Health Organization (WHO) specifications and the particular institution's specifications) on the part of prescribers in adequately filling prescription forms and the legal implications of such deviations for the prescriber and the institution.

METHODS

The study was carried out at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) and Obafemi Awolowo University Health Centre, Ife-Ife, Nigeria. The Teaching Hospital is a 1000-bed tertiary health care facility that serves as a training centre for health professionals. The Health Centre is a 25-bed health care facility. A random sample of prescriptions received from the Pharmacy Department of the OAUTHC and the Obafemi Awolowo University Health Centre were analysed.

KEY FINDINGS

For the Teaching Hospital, the prescriber's name and signature were on 80 and 96% of the prescriptions, respectively, whereas all prescriptions from the Health Centre contained this information. For the Teaching Hospital, 100, 1.8, 93.8 and 98.4% of prescriptions contained the patient's name, address and age, and the date, respectively, whereas 99.6, 86.4 and 99.9% of prescriptions from the Health Centre contained patient code number, age and the date respectively. The precentages of completely filled prescriptions for the Teaching Hospital and the Health Centre were 1.3 and 85.9% respectively. Prescription patterns for the major drug classes in both institutions were compared and related to the level of deviation from the ideal prescription-writing specifications of the WHO.

CONCLUSIONS

The legal implications of non-compliance with WHO standards in prescription writing are discussed, with appropriate recommendations.

Positive benefits of a pharmacist-managed hypertension clinic in Nigeria

OBJECTIVE

The aim of this study was to determine whether the provision of further practice-based support by pharmacists will bring about improved outcomes for blood pressure (BP) control in middle-aged and elderly Nigerian hypertensive patients managed with combination diuretics (amiloride hydrochloride 5 mg+hydrochlorothiazide 50 mg) and/or methyl dopa at the primary care level.

DESIGN AND SETTING

This was a 1-year prospective, randomized cohort study of the outpatients of a state comprehensive health centre in South-western Nigeria. Free primary health services including free drugs were provided for all patients.

PATIENTS AND METHOD

The study population comprised 51 Nigerian patients with uncomplicated hypertension aged 45 years or more, with a 0.2-3.0-year history of hypertension, registered at the Comprehensive Health Centre, Ife between October 2002 and March 2003. They were invited into the pharmacist-managed hypertension clinic and followed for the study period. Participating pharmacists counselled for current medication, personalized goals of lifestyle modification stressing weight loss and/or increased activity, increased patient awareness by providing relevant education about hypertension and associated/related diseases, adjusted drug therapy to optimize effectiveness and minimize adverse events, utilized treatment schedules that enhanced patients' adherence to therapy, and monitored treatment outcomes between enrollment and return visits. Patient satisfaction and the number of treatment failures within 6 months post enrollment were compared with retrospective data from our earlier study involving physician-managed patients under a similar setting.

RESULTS

Uncontrolled BP reduced from 92 to 36.2% by 10.15+/-5.02 days after enrollment. Treatment failures were observed at 5.9% of the total return visits (n=184) within 6 months.

CONCLUSION

Pharmacist-managed hypertension clinics can improve BP control, reduce treatment failure and increase patient satisfaction.

Managing Hypertension with Combination Diuretics and Methyldopa in Nigerian Blacks at???the???Primary Care Level

OBJECTIVE

To gain insight into the control of hypertension and to suggest possible interventions within a selected black population treated with combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) and/or methyldopa for uncomplicated essential hypertension.

DESIGN AND SETTING

A 2-year retrospective cohort review of the outpatient medical records of a State Comprehensive Health Center in southwestern Nigeria. Free primary health service, including free drugs, is provided in the health facility for all patients.

PATIENTS AND METHODS

The study population included outpatients continuously registered at the health centre between June 1999 and June 2002, aged >/=36 years, with 2-6 months' history of hypertension or newly diagnosed hypertension and followed for 6 months after diagnosis. They were managed with methyldopa 250mg and/or combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) or a combination in two different regimens for at least 6 months. Participating physicians measured patients' blood pressure with a validated device and recorded demographics and medical history. Patients were considered to have hypertension if systolic blood pressure was >140mm Hg and diastolic blood pressure was >90mm Hg.

RESULTS

Bivariate regression analysis revealed that systolic blood pressure contributed moderately to the variances of drug and regimen decisions. Among the 128 hypertensive patients with average and modal ages of 57.2 +/- 11.1 and 60 years, respectively, only 37.5% had controlled blood pressure after the first treatment; with 10.2% and 4% of the study population needing, respectively, three and five re-treatments within 6 months to achieve target blood pressure levels.

CONCLUSION

A high percentage of uncontrolled blood pressure and re-treatment rates were observed within the study population. A more aggressive management strategy that individualises diuretic therapy by titrating dose to systolic blood pressure and prioritises lifestyle modification in middle-aged and elderly black hypertensive patients is suggested.