Access to quality medicines is a universal human right which featured prominently on the agenda o... more Access to quality medicines is a universal human right which featured prominently on the agenda of the World Health Organisation (WHO) over the past decades. Hospital pharmacists play a pivotal role in ensuring that treatment outcomes are optimal. This thesis studied pharmaceutical policies and access to medicines from the perspective of the hospital pharmacist in Ghana. The first theme of this thesis involved the role of hospital pharmacists in improving access to medicines. Here the importance of patient information leaflets (PIL) was discussed; those who read the PIL were more informed about the benefits and risks of their medicines. The patient’s perception of the pharmacists as a member of the health care team was investigated. We noted differential levels of counselling services provided at different pharmacy units and recommended an improvement in this practice. We then studied paediatric medicines and identified that although Ghana has adopted the WHO Children’s medicines list as a working document, some of the medicines are not readily available and are prepared extemporaneously at limited centres in the country leading to problems with acquisition. We also identified the practice of off-label prescribing and suggested the stepping up of surveillance on such products to protect the public from unnecessary harm. The second theme was on adherence to antiretroviral treatment (ART). Data from a historical cohort of a HIV/AIDS treatment unit showed that pragmatic treatment policies based on empirical evidence guided practice; stavudine was substituted with safer alternatives like tenofovir or zidovudine. A subsequent study to ascertain the relationship between adherence and treatment change revealed that overall 88.9% of patients who continued first line treatment compared to 79.9% of patients switching therapy had adherence levels greater than 95%, thus concluding that non-adherence to was associated with treatment change including change to more expensive medicines. In a follow-up study we therefore focused on risk factors associated with non-adherence to ART. WHO stage of disease, low CD4 cell count and presence of symptoms at baseline were the risk factors identified, which could help target adherence counselling. Finally, facilitators of and barriers to ART adherence among adolescents were studied using a qualitative study. Assistance from health care workers and forgetfulness emerged as the most important facilitator and barrier, respectively. The final theme was on the role of hospital pharmacists in safety surveillance during immunization programs. Two prospective studies were conducted, one on adverse events following immunization (AEFI) against 2009 H1N1 influenza and one on signal generation using data from the Food and Drugs Authority in Ghana collected during active surveillance from six immunizations. These studies showed that vaccine safety surveillance can be effectively carried out, also in a low resource setting, if given the right support. This thesis emphasizes the role of the hospital pharmacist in Ghana in access to medicines and pharmaceutical policies. It highlights the importance of medicines information, service provision and delivery of essential medicines to paediatric patients, adherence to antiretroviral therapy, and the monitoring of adverse events following immunization including the detection of signals.
Objectives:The Women’s Health Initiative (WHI) randomized trial identified age differences in the... more Objectives:The Women’s Health Initiative (WHI) randomized trial identified age differences in the benefit-risk profile of estrogen alone (ET) use. However, WHI trial impact on disease-associated medical expenditures attributable to subsequent decreased ET utilization has not been measured. Therefore, the objective of this analysis was to quantify the age-specific disease- associated medical expenditures attributable to reduced ET utilization after the WHI HT trials.Methods:Population-level disease counts and associated expenditures between 2003 and 2015 were compared between an observed ET-user population versus a hypothetical ET-user population assuming absence of the WHI HT trials, constructed by extrapolating ET utilization rates from 1996–2002 assuming pre-WHI HT rates would have continued without publication of the WHI HT trial data (2002–2004). Analyses were stratified by age (50–59, 60–69 and 70–79 years). Input data were extracted from Medical Expenditure Panel Survey (MEPS) and the literature. The primary outcomes were: ET utilization, chronic diseases (breast cancer, stroke, CHD, colorectal cancer, pulmonary embolism and hip fracture) and disease-associated direct medical expenditures.Results:Over 13 years, the decline in ET utilization was associated with $4.1 billion expenditure for excess chronic diseases (37,549 excess events) among women in their 50s, compared to savings of $1.5 billion and $4.4 billion for diseases averted by lower ET utilization among women in their 60s (13,495 fewer events) and 70s (40,792 fewer events), respectively.Conclusion:The decline in ET utilization had differential disease and expenditure consequences by age groups in the US. These results are limited by the lack of inclusion of vasomotor symptom benefit and costs of alternative medications for these symptoms in the analysis.
Objective: The objective of this study was to investigate hypertensive patient beliefs, perceptio... more Objective: The objective of this study was to investigate hypertensive patient beliefs, perception and experience about generic antihypertensive drug substitution and the relationship with adherence. Design and Methods: A prospective cross-sectional study was conducted among 351 hypertensive out-patients at the polyclinic/Family Medicine Department of Korle Bu Teaching hospital using a validated structured questionnaire. Systematic sampling was used to include participants. Patients were 18years and had been on antihypertensive drugs for at least 6 months. Beliefs about generic medicines were collected using an adapted form of the belief about generic medicines scale developed by Figueiras et al and was scored on a 5-point likert scale. Perception about generic substitution was scored using a likert scale. Experiences were measured as experience of side effects. Medication adherence was measured using the Medication Adherence Report Scale-5 (MARS 5). Data were analysed using STATA. ...
International Journal of Current Microbiology and Applied Sciences, 2021
There is evidence that vaccine hesitancy is present among health care workers although various st... more There is evidence that vaccine hesitancy is present among health care workers although various studies on covid-19 vaccination prioritizations conclude that health workers should be prioritized because they are first hand responders. This cross-sectional study audited vaccination status among different categories of pharmacy staff in the largest teaching hospital in Ghana. Vaccination status among staff was ascertained using national vaccination cards after immunization with two doses of Covishield vaccine. A total of 240 workers, representing about 96% of pharmacy staff were captured. It was found that 66% of staff had received two doses and almost 80% had received at least one dose of the Covishield vaccine. Although males were more likely to vaccinate compared to females, this was not significant (OR=1.64, 95% CI 0.91 to 2.99; p=0.104). Independent odds ratios confirmed that compared to dispensing assistants, pharmacist were almost four times as likely to vaccinate (OR=3.89, 95% ...
Introduction many hypertensive patients require two or more anti-hypertensive drugs, but in low- ... more Introduction many hypertensive patients require two or more anti-hypertensive drugs, but in low- and middle-income countries there may be challenges with medication access or affordability. The objective of this study was to determine accessibility and affordability of anti-hypertensive medicines and their association with blood pressure (BP) control among hypertensive patients attending the Korle-Bu teaching hospital (KBTH) polyclinic. Methods a cross-sectional study was conducted among 310 systematically sampled hypertensive patients attending the KBTH Polyclinic in Ghana. A structured questionnaire was used to obtain data on patient demographics and clinical characteristics, prices, availability and mode of payment of generic anti-hypertensive medicines. Results fifty-nine patients (19.4%) made out-of-pocket payments. At the private pharmacy and hospital, 123 (40.5%) and 77 patients (25.3%) respectively could not afford four anti-hypertensive medicines. Medicines availability at KBTH was 60%. Continuous access to BP drugs at KBTH was 14.8%. Overall access was 74.9% (SD ± 41.3). Out-of-pocket affordability of the medicines was positively correlated with BP control (R=0.12, p=0.037). Obtaining medicines via health insurance only was more likely to result in BP control than making any out-of-pocket payments (OR= 2.185; 95% CI, 1.215 - 3.927). Access at KBTH was more likely to result in BP control (OR=1.642; 95% C.I, 0.843 - 3.201). Conclusion there were access challenges although most patients obtained BP medication free. Out-of-pocket affordability is a challenge for some hypertensive patients. Access to affordable BP medication can improve BP control. These findings provide an impetus for urgently evaluating access to affordable anti-hypertensive medicines in other hospitals in Ghana.
AfRIG 2021 Virtual Meeting 10 | Antihypertensive medicine use differs between Ghana and Nigeria S... more AfRIG 2021 Virtual Meeting 10 | Antihypertensive medicine use differs between Ghana and Nigeria Samantha Hollingworth, Seye Abimbola, Yaa Owusu-Agyeman, Jonathon Zobi, Emily Thatcher University of Queensland, School of Pharmacy, Brisbane, Australia; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University of Sydney, School of Public Health, Sydney, Australia; mPharma, Accra, Ghana Background: Non-communicable diseases are a growing burden in many African countries; cardiovascular disease is prevalent. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use. Objective: To describe AHM use in Ghana and Nigeria using a novel data source. Methods: We used data from mPharma a health and pharmaceutical company who distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the Anatomical Therapeutic Chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product. Results: AHM use differed between Ghana and Nigeria. The most commonly used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most commonly used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine, and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria. Conclusion: The differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g., standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community. 15 | Drug related problems among patients with rheumatic diseases and connective tissue disorders at a Kenyan National Referral Hospital Manani Joseph, Sylvia Opanga, Stephen Githinji School of Pharmacy, University of Nairobi, Nairobi, Kenya; Department of Medical Physiology, School of Medicine, University of Nairobi,
Access to quality medicines is a universal human right which featured prominently on the agenda o... more Access to quality medicines is a universal human right which featured prominently on the agenda of the World Health Organisation (WHO) over the past decades. Hospital pharmacists play a pivotal role in ensuring that treatment outcomes are optimal. This thesis studied pharmaceutical policies and access to medicines from the perspective of the hospital pharmacist in Ghana. The first theme of this thesis involved the role of hospital pharmacists in improving access to medicines. Here the importance of patient information leaflets (PIL) was discussed; those who read the PIL were more informed about the benefits and risks of their medicines. The patient’s perception of the pharmacists as a member of the health care team was investigated. We noted differential levels of counselling services provided at different pharmacy units and recommended an improvement in this practice. We then studied paediatric medicines and identified that although Ghana has adopted the WHO Children’s medicines list as a working document, some of the medicines are not readily available and are prepared extemporaneously at limited centres in the country leading to problems with acquisition. We also identified the practice of off-label prescribing and suggested the stepping up of surveillance on such products to protect the public from unnecessary harm. The second theme was on adherence to antiretroviral treatment (ART). Data from a historical cohort of a HIV/AIDS treatment unit showed that pragmatic treatment policies based on empirical evidence guided practice; stavudine was substituted with safer alternatives like tenofovir or zidovudine. A subsequent study to ascertain the relationship between adherence and treatment change revealed that overall 88.9% of patients who continued first line treatment compared to 79.9% of patients switching therapy had adherence levels greater than 95%, thus concluding that non-adherence to was associated with treatment change including change to more expensive medicines. In a follow-up study we therefore focused on risk factors associated with non-adherence to ART. WHO stage of disease, low CD4 cell count and presence of symptoms at baseline were the risk factors identified, which could help target adherence counselling. Finally, facilitators of and barriers to ART adherence among adolescents were studied using a qualitative study. Assistance from health care workers and forgetfulness emerged as the most important facilitator and barrier, respectively. The final theme was on the role of hospital pharmacists in safety surveillance during immunization programs. Two prospective studies were conducted, one on adverse events following immunization (AEFI) against 2009 H1N1 influenza and one on signal generation using data from the Food and Drugs Authority in Ghana collected during active surveillance from six immunizations. These studies showed that vaccine safety surveillance can be effectively carried out, also in a low resource setting, if given the right support. This thesis emphasizes the role of the hospital pharmacist in Ghana in access to medicines and pharmaceutical policies. It highlights the importance of medicines information, service provision and delivery of essential medicines to paediatric patients, adherence to antiretroviral therapy, and the monitoring of adverse events following immunization including the detection of signals.
Objectives:The Women’s Health Initiative (WHI) randomized trial identified age differences in the... more Objectives:The Women’s Health Initiative (WHI) randomized trial identified age differences in the benefit-risk profile of estrogen alone (ET) use. However, WHI trial impact on disease-associated medical expenditures attributable to subsequent decreased ET utilization has not been measured. Therefore, the objective of this analysis was to quantify the age-specific disease- associated medical expenditures attributable to reduced ET utilization after the WHI HT trials.Methods:Population-level disease counts and associated expenditures between 2003 and 2015 were compared between an observed ET-user population versus a hypothetical ET-user population assuming absence of the WHI HT trials, constructed by extrapolating ET utilization rates from 1996–2002 assuming pre-WHI HT rates would have continued without publication of the WHI HT trial data (2002–2004). Analyses were stratified by age (50–59, 60–69 and 70–79 years). Input data were extracted from Medical Expenditure Panel Survey (MEPS) and the literature. The primary outcomes were: ET utilization, chronic diseases (breast cancer, stroke, CHD, colorectal cancer, pulmonary embolism and hip fracture) and disease-associated direct medical expenditures.Results:Over 13 years, the decline in ET utilization was associated with $4.1 billion expenditure for excess chronic diseases (37,549 excess events) among women in their 50s, compared to savings of $1.5 billion and $4.4 billion for diseases averted by lower ET utilization among women in their 60s (13,495 fewer events) and 70s (40,792 fewer events), respectively.Conclusion:The decline in ET utilization had differential disease and expenditure consequences by age groups in the US. These results are limited by the lack of inclusion of vasomotor symptom benefit and costs of alternative medications for these symptoms in the analysis.
Objective: The objective of this study was to investigate hypertensive patient beliefs, perceptio... more Objective: The objective of this study was to investigate hypertensive patient beliefs, perception and experience about generic antihypertensive drug substitution and the relationship with adherence. Design and Methods: A prospective cross-sectional study was conducted among 351 hypertensive out-patients at the polyclinic/Family Medicine Department of Korle Bu Teaching hospital using a validated structured questionnaire. Systematic sampling was used to include participants. Patients were 18years and had been on antihypertensive drugs for at least 6 months. Beliefs about generic medicines were collected using an adapted form of the belief about generic medicines scale developed by Figueiras et al and was scored on a 5-point likert scale. Perception about generic substitution was scored using a likert scale. Experiences were measured as experience of side effects. Medication adherence was measured using the Medication Adherence Report Scale-5 (MARS 5). Data were analysed using STATA. ...
International Journal of Current Microbiology and Applied Sciences, 2021
There is evidence that vaccine hesitancy is present among health care workers although various st... more There is evidence that vaccine hesitancy is present among health care workers although various studies on covid-19 vaccination prioritizations conclude that health workers should be prioritized because they are first hand responders. This cross-sectional study audited vaccination status among different categories of pharmacy staff in the largest teaching hospital in Ghana. Vaccination status among staff was ascertained using national vaccination cards after immunization with two doses of Covishield vaccine. A total of 240 workers, representing about 96% of pharmacy staff were captured. It was found that 66% of staff had received two doses and almost 80% had received at least one dose of the Covishield vaccine. Although males were more likely to vaccinate compared to females, this was not significant (OR=1.64, 95% CI 0.91 to 2.99; p=0.104). Independent odds ratios confirmed that compared to dispensing assistants, pharmacist were almost four times as likely to vaccinate (OR=3.89, 95% ...
Introduction many hypertensive patients require two or more anti-hypertensive drugs, but in low- ... more Introduction many hypertensive patients require two or more anti-hypertensive drugs, but in low- and middle-income countries there may be challenges with medication access or affordability. The objective of this study was to determine accessibility and affordability of anti-hypertensive medicines and their association with blood pressure (BP) control among hypertensive patients attending the Korle-Bu teaching hospital (KBTH) polyclinic. Methods a cross-sectional study was conducted among 310 systematically sampled hypertensive patients attending the KBTH Polyclinic in Ghana. A structured questionnaire was used to obtain data on patient demographics and clinical characteristics, prices, availability and mode of payment of generic anti-hypertensive medicines. Results fifty-nine patients (19.4%) made out-of-pocket payments. At the private pharmacy and hospital, 123 (40.5%) and 77 patients (25.3%) respectively could not afford four anti-hypertensive medicines. Medicines availability at KBTH was 60%. Continuous access to BP drugs at KBTH was 14.8%. Overall access was 74.9% (SD ± 41.3). Out-of-pocket affordability of the medicines was positively correlated with BP control (R=0.12, p=0.037). Obtaining medicines via health insurance only was more likely to result in BP control than making any out-of-pocket payments (OR= 2.185; 95% CI, 1.215 - 3.927). Access at KBTH was more likely to result in BP control (OR=1.642; 95% C.I, 0.843 - 3.201). Conclusion there were access challenges although most patients obtained BP medication free. Out-of-pocket affordability is a challenge for some hypertensive patients. Access to affordable BP medication can improve BP control. These findings provide an impetus for urgently evaluating access to affordable anti-hypertensive medicines in other hospitals in Ghana.
AfRIG 2021 Virtual Meeting 10 | Antihypertensive medicine use differs between Ghana and Nigeria S... more AfRIG 2021 Virtual Meeting 10 | Antihypertensive medicine use differs between Ghana and Nigeria Samantha Hollingworth, Seye Abimbola, Yaa Owusu-Agyeman, Jonathon Zobi, Emily Thatcher University of Queensland, School of Pharmacy, Brisbane, Australia; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University of Sydney, School of Public Health, Sydney, Australia; mPharma, Accra, Ghana Background: Non-communicable diseases are a growing burden in many African countries; cardiovascular disease is prevalent. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use. Objective: To describe AHM use in Ghana and Nigeria using a novel data source. Methods: We used data from mPharma a health and pharmaceutical company who distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the Anatomical Therapeutic Chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product. Results: AHM use differed between Ghana and Nigeria. The most commonly used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most commonly used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine, and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria. Conclusion: The differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g., standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community. 15 | Drug related problems among patients with rheumatic diseases and connective tissue disorders at a Kenyan National Referral Hospital Manani Joseph, Sylvia Opanga, Stephen Githinji School of Pharmacy, University of Nairobi, Nairobi, Kenya; Department of Medical Physiology, School of Medicine, University of Nairobi,
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