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1.  Improving pharmacy practice through public health programs: experience from Global HIV/AIDS initiative Nigeria project 
SpringerPlus  2013;2:525.
The use of medicines is an essential component of many public health programs (PHPs). Medicines are important not only for their capacity to treat and prevent diseases. The public confidence in healthcare system is inevitably linked to their confidence in the availability of safe and effective medicines and the measures for ensuring their rational use. However, pharmacy services component receives little or no attention in most public health programs in developing countries. This article describes the strategies, lessons learnt, and some accomplishments of Howard University Pharmacists and Continuing Education (HU-PACE) Centre towards improving hospital pharmacy practice through PHP in Nigeria.
In a cross-sectional survey, 60 hospital pharmacies were randomly selected from 184 GHAIN-supported health facilities. The assessment was conducted at baseline and repeated after at least 12 months post-intervention using a study-specific instrument. Interventions included engagement of stakeholders; provision of standards for infrastructural upgrade; development of curricula and modules for training of pharmacy personnel; provision of job aids and tools amongst others. A follow-up hands-on skill enhancement based on identified gaps was conducted. Chi-square was used for inferential statistics. All reported p-values were 2-tailed at 95% confidence interval.
The mean duration of service provision at post-intervention assessment was 24.39 (95% CI, 21.70–27.08) months. About 16.7% of pharmacies reported been trained in HIV care at pre-intervention compared to 83.3% at post-intervention. The proportion of pharmacies with audio-visual privacy for patient counseling increased significantly from 30.9% at pre-intervention to 81.4% at post-intervention. Filled prescriptions were cross-checked by pharmacist (61.9%) and pharmacy technician (23.8%) before dispensing at pre-intervention compared to pharmacist (93.1%) and pharmacy technician (6.9%) at post intervention. 40.0% of pharmacies reported tracking consumption of drugs at pre-intervention compared to 98.3% at post-intervention; while 81.7% of pharmacies reported performing periodic stock reconciliation at pre-intervention compared to 100.0% at post-intervention. 36.5% of pharmacies were observed providing individual counseling on medication use to patients at pre-intervention compared to 73.2% at post-intervention; and 11.7% of pharmacies had evidence of monitoring and reporting of suspected adverse drug reaction at pre-intervention compared to 73.3% at post-intervention. The institution of access to patients’ clinical information by pharmacists in all pharmacies at post-intervention was a paradigm shift.
Through public health program, HU-PACE created an enabling environment and improved capacity of pharmacy personnel for quality HIV/AIDS and TB services. This has contributed in diverse ways to better monitoring of patients on pharmacotherapy by pharmacists through access of pharmacists to patients’ clinical information.
PMCID: PMC3824707  PMID: 24255831
Pharmaceutical care; HIV/AIDS; Public health programs; Patients; Nigeria
2.  Obesity Status and Colorectal Cancer Screening in the United States 
Journal of Obesity  2013;2013:920270.
Background. Findings from previous studies on an association between obesity and colorectal cancer (CRC) screening are inconsistent and very few studies have utilized national level databases in the United States (US). Methods. A cross-sectional study was conducted using data from the 2005 Medicare Current Beneficiary Survey to describe CRC screening rate by obesity status. Results. Of a 15,769 Medicare beneficiaries sample aged 50 years and older reflecting 39 million Medicare beneficiaries in the United States, 25% were classified as obese, consisting of 22.4% “obese” (30 ≤ body mass index (BMI) < 35) and 3.1% “morbidly obese” (BMI ≥ 35) beneficiaries. Almost 38% of the beneficiaries had a body mass index level equivalent to overweight (25 ≤ BMI < 30). Of the study population, 65.3% reported having CRC screening (fecal occult blood testing or colonoscopy). Medicare beneficiaries classified as “obese” had greater odds of CRC screening compared to “nonobese” beneficiaries after controlling for other covariates (ORadj = 1.25; 95% CI: 1.12–1.39). Conclusions. Findings indicate that obesity was not a barrier but rather an assisting factor to CRC screening among Medicare beneficiaries. Future studies are needed to evaluate physicians' ordering of screening tests compared to screening claims among Medicare beneficiaries to better understand patterns of patients' and doctors' adherence to national CRC screening guidelines.
PMCID: PMC3649664  PMID: 23691289
3.  Association between Lifestyle Factors and Metabolic Syndrome among African Americans in the United States 
Background. Although there is a reported association between lifestyle factors and metabolic syndrome, very few studies have used national level data restricted to the African Americans (AAs) in the United States (US). Methods. A cross-sectional evaluation was conducted using the National Health and Nutrition Examination Survey from 1999 to 2006 including men and nonpregnant women of 20 years or older. Multiple logistic regression models were constructed to evaluate the association between lifestyle factors and metabolic syndrome. Results. AA women had a higher prevalence of metabolic syndrome (39.43%) than AA men (26.77%). After adjusting for sociodemographic factors, no significant association was found between metabolic syndrome and lifestyle factors including alcohol drinking, cigarette smoking, and physical activity. Age and marital status were significant predictors for metabolic syndrome. With increase in age, both AA men and AA women were more likely to have metabolic syndrome (AA men: ORadj = 1.05, 95% CI 1.04–1.06, AA women: ORadj = 1.06, 95% CI 1.04–1.07). Single AA women were less likely to have metabolic syndrome than married women (ORadj = 0.66, 95% CI 0.43–0.99). Conclusion. Lifestyle factors had no significant association with metabolic syndrome but age and marital status were strong predictors for metabolic syndrome in AAs in the US.
PMCID: PMC3572645  PMID: 23431427
4.  Long-Term Effect of the Women's Health Initiative Study on Antiosteoporosis Medication Prescribing 
Journal of Women's Health  2010;19(5):847-854.
To describe long-term prescribing patterns of osteoporosis therapy before and after the Women's Health Initiative (WHI) publication.
We conducted a time-series analysis from 1997 to 2005 using nationally representative data based on office-based physician and hospital ambulatory clinic visits. Bivariate and multivariable analyses were conducted using chi-square tests and logistic regression, respectively, and trends in the prevalence of osteoporosis therapies were evaluated per 6-month (semiannual) intervals. Linear regression and graphic techniques were used to determine statistical differences in the prevalence trends between the two periods.
Overall prevalence of therapeutic or preventive osteoporosis therapy was similar between the WHI periods. However, a significant decrease in estrogen therapy and increases in bisphosphonates, calcium/vitamin D were observed in the period after the WHI publication (p < 0.05). Multiple logistic regression analysis showed older age and white race were associated with a higher likelihood of antiosteoporosis medication (AOM) prescription, and Medicaid insurance type was associated with a lower likelihood of an AOM prescription. Excluding calcium/vitamin D, nonestrogen therapy was more likely to be prescribed in the after-WHI period (office-based physician clinic: [adjusted OR, aOR] 2.49 [2.04–4.04]; hospital-based clinic: aOR 2.42 [1.67–7.50]) Nonestrogen therapy was more prevalent in visits made by older women, women of white race, women with contraindicated conditions for estrogen therapy, and women from the Northeast region.
After the WHI publication, the overall prevalence of osteoporosis therapy did not change; however, a shift from estrogen to nonestrogen therapy was observed after the WHI publication. Black women were less likely to receive nonestrogen antiosteoporosis therapy in hospital-based clinics.
PMCID: PMC2875952  PMID: 20459329
5.  Application of Regression-Discontinuity Analysis in Pharmaceutical Health Services Research 
Health Services Research  2006;41(2):550-563.
To demonstrate how a relatively underused design, regression-discontinuity (RD), can provide robust estimates of intervention effects when stronger designs are impossible to implement.
Data Sources/Study Setting
Administrative claims from a Mid-Atlantic state Medicaid program were used to evaluate the effectiveness of an educational drug utilization review intervention.
Study Design
Quasi-experimental design.
Data Collection/Extraction Methods
A drug utilization review study was conducted to evaluate a letter intervention to physicians treating Medicaid children with potentially excessive use of short-acting β2-agonist inhalers (SAB). The outcome measure is change in seasonally-adjusted SAB use 5 months pre- and postintervention. To determine if the intervention reduced monthly SAB utilization, results from an RD analysis are compared to findings from a pretest–posttest design using repeated-measure ANOVA.
Principal Findings
Both analyses indicated that the intervention significantly reduced SAB use among the high users. Average monthly SAB use declined by 0.9 canisters per month (p<.001) according to the repeated-measure ANOVA and by 0.2 canisters per month (p<.001) from RD analysis.
Regression-discontinuity design is a useful quasi-experimental methodology that has significant advantages in internal validity compared to other pre–post designs when assessing interventions in which subjects' assignment is based on cutoff scores for a critical variable.
PMCID: PMC1702511  PMID: 16584464
Regression discontinuity; drug utilization review; quasi-experimental design
6.  National patterns of dementia treatment among elderly ambulatory patients. 
PURPOSES: To assess patterns of dementia/Alzheimer's disease (AD) management and to investigate predictive factors of cholinesterase inhibitor prescriptions. METHODOLOGY: A cross-sectional study was conducted using a national survey among the elderly aged >60 from 2000 to 2002. Visit characteristics and cholinesterase inhibitor prescriptions associated with dementia/AD status were evaluated. MAIN FINDINGS: A total of 25,561 visit records were identified. Of the total visits, only 0.6% had dementia/AD records. Most of the dementia/AD visits were made by women (60.6%) and white patients (93.5%). Of the dementia/AD visits, about half (46.5%) were prescribed with one or more cholinesterase inhibitors. Donepezil was the most prevalent agent (68.0%) followed by rivastigmine (26.0%). Logistic regression analyses indicated that the physician's specialty was a strong predictor for cholinesterase inhibitor prescription; psychiatrists [odds ratio (OR)=5.5; p<0.01] and neurologists (OR=2.6; p<0.03) were more likely to prescribe cholinesterase inhibitor than other physicians. Other characteristics including race did not show significant association. CONCLUSIONS: The study findings suggest that physicians who specialized in psychiatry and neurology predominantly provided ambulatory care services for dementia patients. More efforts should be given to detect and to treat dementia patients with cognitive-enhancing agents after the formal diagnosis in the ambulatory care setting.
PMCID: PMC2576124  PMID: 16573310
7.  Prostate cancer education in the Washington, DC, area. 
Pharmacists are key members of the healthcare team, especially in minority and urban communities. This study was developed to assess pharmacists' ability and willingness to counsel the public on prostate cancer in the community pharmacy setting. A mail survey was sent to all 192 community pharmacies in Washington, DC, and Prince George's County, Maryland. A total of 90 pharmacists responded to the questionnaire, providing a 46.9% response rate. One third of the pharmacists indicated a willingness to participate in a prostate cancer training program. Perceived benefits and perceived barriers were each measured through five questionnaire items using Likert-style statements with responses ranging from "strongly agree" to "strongly disagree." The most significant predictor of perceived benefits of providing prostate cancer information was gender; male pharmacists perceived greater benefits for providing prostate cancer information than female pharmacists. Similarly, black pharmacists perceived greater benefits of providing prostate cancer information to their patients than non-black pharmacists. Also, pharmacists in stores that offered disease state management programs had a significantly lower perceived benefit of providing prostate cancer information. These findings indicate that gender and race may play a role in health promotion in health disparities. There were no significant barriers to providing prostate cancer information. Thus, many pharmacists are willing to participate in health education on prostate cancer.
PMCID: PMC2594186  PMID: 12442999
8.  The Incidence and Types of Medication Errors in Patients Receiving Antiretroviral Therapy in Resource-Constrained Settings 
PLoS ONE  2014;9(1):e87338.
This study assessed the incidence and types of medication errors, interventions and outcomes in patients on antiretroviral therapy (ART) in selected HIV treatment centres in Nigeria.
Of 69 health facilities that had program for active screening of medication errors, 14 were randomly selected for prospective cohort assessment. All patients who filled/refilled their antiretroviral medications between February 2009 and March 2011 were screened for medication errors using study-specific pharmaceutical care daily worksheet (PCDW). All potential or actual medication errors identified, interventions provided and the outcomes were documented in the PCDW. Interventions included pharmaceutical care in HIV training for pharmacists amongst others. Chi-square was used for inferential statistics and P<0.05 indicated statistical significance.
Of 6,882 participants, 67.0% were female and 93.5% were aged ≥15years old. The participants had 110,070 medications filling/refilling visits, average (±SD) of 16.0 (±0.3) visits per patient over the observation period. Patients were followed up for 9172.5 person-years. The number of drug items dispensed to participants was 305,584, average of 2.8 (±0.1) drug items per patient. The incidence rate of medication errors was 40.5 per 100 person-years. The occurrence of medication errors was not associated with participants’ sex and age (P>0.05). The major medications errors identified were 26.4% incorrect ART regimens prescribed; 19.8% potential drug-drug interaction or contraindication present; and 16.6% duration and/or frequency of medication inappropriate. Interventions provided included 67.1% cases of prescriber contacted to clarify/resolve errors and 14.7% cases of patient counselling and education; 97.4% of potential/actual medication error(s) were resolved.
The incidence rate of medication errors was somewhat high; and majority of identified errors were related to prescription of incorrect ART regimens and potential drug-drug interactions; the prescriber was contacted and the errors were resolved in majority of cases. Active screening for medication errors is feasible in resource-limited settings following a capacity building intervention.
PMCID: PMC3904988  PMID: 24489899

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