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Year : 2022  |  Volume : 1  |  Issue : 3  |  Page : 79-87

The 2nd International Annual Conference of the SSCP Accepted Abstract: Clinical Pharmacy; Healthcare Professionals Theme

Date of Web Publication30-Sep-2022

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/WKMP-0249.357710

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How to cite this article:
. The 2nd International Annual Conference of the SSCP Accepted Abstract: Clinical Pharmacy; Healthcare Professionals Theme . Saudi J Clin Pharm 2022;1:79-87

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. The 2nd International Annual Conference of the SSCP Accepted Abstract: Clinical Pharmacy; Healthcare Professionals Theme . Saudi J Clin Pharm [serial online] 2022 [cited 2022 Dec 2];1:79-87. Available from: http://www.sjcp.org/text.asp?2022/1/3/79/357710

  Theme 1: Clinical Pharmacy; Healthcare Professionals Top

Assessment of Adherence to Statin Recommendations for People with Diabetes Mellitus Attending Family and Community Medicine Clinics, Riyadh, Saudi Arabia

Fatimah Aljohan, Khalid Alyahya, Huda Aldossari, Bedor Alomari, Ali Ruwyani

Background: Patients with diabetes mellitus who have poor glycemic control have a higher risk of developing cardiovascular disease (CVD). Furthermore, mortality due to CVD among patients with diabetes is 2–4-fold higher than those with non-diabetes. According to the AHA, 68% of the people with diabetes older than 65 years die from the consequences of CVD. Therefore, maintaining controlled glycemic value and cholesterol levels reduces CVD risk. This study aims to assess the level of adherence to ADA guideline recommendations for statin therapy and to evaluate the therapeutic response of statin therapy.

Methods: This is a retrospective cross-sectional study conducted at a family and community medicine clinic in Riyadh, which included type 2 diabetes mellitus patients. The study inclusion criteria are adult patients with type 2 diabetes mellitus seen at family and community medicine clinics and patients who have their lipid profile checked within a year. Descriptive statistics were used for this study. Continues data were reported as mean ± standard deviation. Categorical data were reported as frequencies and percentages.

Results: A total of 361 patients were included in this study. Two hundred twenty patients were male (61%). The mean age was 56 ± 11 years. Patients with multiple comorbidities represent 56% (205). A total of 287 patients received statin therapy. Moderate-intensity statin therapy was most frequently prescribed for 68.7% (248) of the patients. Of those, 54.8% (136) of the patients achieved the target low-density lipoprotein-cholesterol (LDL-C). High-intensity statin therapy was prescribed for 10.8% (39) of the patients; however, only 43.6% (17) of the patients have their LDL-C within the target. Ezetimibe in combination with a statin was prescribed for six patients, although the target LDL-C was achieved in four of them. The overall success rate of achieving the guideline-suggested percentage reduction in the baseline LDL-C level was 53.4%.

Conclusion: Our study provided an overview of the utilization of statin therapy among family and community medicine clinics. Statin therapy needs to be improved and thus can be achieved by developing strategies to optimize statin prescribing to reduce the risk of cardiovascular consequences.

Prevalence of Early Vascular Thrombosis After Kidney Transplantation in Relation to Early Chemo-thromboprophylaxis Use: A Retrospective Cross-sectional Study

Rawan Al Ghamdi, Bassem Al Malki

Background: Renal transplant is recommended for defined chronic kidney disease patients with end-stage kidney disease. However, renal transplant recipients have an 8-fold more risk of thrombo-embolic events when compared with the general population. However, there are no consensus wither to initiate chemo-thromboprophylaxis (CTP) within 7 days post-kidney transplantation. The study aims to investigate the prevalence of vascular thrombosis in renal transplant recipients within 7 days post-operatively with or without CTP and to evaluate the risk of bleeding with CTP use in this population.

Methods: A retrospective cross-sectional study was carried out at a tertiary hospital from January 2017 to December 2021 on adult renal transplant recipients. The primary outcome was the prevalence of thrombo-embolic events within 7 days post-operatively. Secondary outcomes were bleeding, patients, and graft survival.

Results: A total of 210 renal transplant recipients were screened, 84 of them matched the inclusion criteria. One (1.19%) developed deep vein thrombosis on day 3 post-transplant. From the total number of patients analyzed, the mean age was 45 ±15.9 years; 60 (71%) were male, and 65 (77%) were on hemodialysis pre-transplant. Regarding the use of CTP, within the 7 days post-operatively, 10 (12%) received anticoagulant only, 15 (18%) received antiplatelet only, and 7 (8%) received both anticoagulant and antiplatelet simultaneously. Bleeding occurred in seven (8%) of the patients, and a comparative analysis revealed no significant difference (P=0.96) in risk of bleeding between those who received only anticoagulant or antiplatelet or those who received both simultaneously. Regarding patients and graft survival, there were no patient deaths or graft losses in the 7 days post-transplant.

Conclusion: This study showed a low prevalence of thrombo-embolic events in renal transplant recipients within 7 days post-operatively. Bleeding was not significantly associated with the use of any CTP.

Pharmaceuticals Wastage and Pharmaceuticals Waste Management in Government-sector Health Facilities at Saudi Arabia

Sami Alajlan, Waleed Al-Romi, Eyad Alkhodiri, Menyfah Alanazi

Background: Globally, medication wastage is a serious public health problem and negatively impacts on economic and environmental factors. Accumulation of unused inventory in warehouse government sectors causes unnecessary expenditure on the government, resulting in interruption and poor quality of health services and increased expenses. Limited studies have been conducted on the causes and economic impacts of unused inventory in warehouses of medical facilities. This study aims to estimate the prevalence of waste medication (expired and non-moving) in medical facilities at MoNGH in the central region which identified the cost impact of unused inventory and to identify the type of unused medication by using the ABC-VEN matrix analysis. In addition, the study aimed to assess new strategy to minimize the waste of inventory.

Methods: A cross-sectional study design was used to review logistic data retrospectively from Health Enterprise Resource Management, over 7 years starting from May 2015 through June 2022 in health facilities of the Ministry of National Guard at Riyadh. The unused and expired inventory is classified based on the monetary value and quantity as follows: ABC analysis: based on monetary value and VED analysis: vital (V), essential (E), and desirable (D) categories. This classification is based on user’s experience and perception. Also, turnover will be used to identify the rate of consumption inventory. Descriptive and inferential statistics were made using Statistical Package for Social Sciences, version 20.

Results: The overall prevalence of wastage medication during the study period was 3% of all formulary drugs (42 out of 1400). The monetary value was 0.7% of total pharmaceutical expenditures in the central region: non-moving representing 5% and expired was 95%. The majority of the expired category of medication was antineoplastic, biological, anti-infective, and vaccines, which represent two-thirds of monetary value. The top expired drug was hepatitis B immunoglobulin. Using the VEN analysis, an average of 26% of the items was vital and 34% essential.

Conclusion: This research will help decision-makers to design an appropriate system for the improvement of the whole supply chain productivity and to minimize the wastage of inventory. Also, this will be used as baseline data for future studies in logistic field.

Impact of Educational Intervention on Adverse Drug Reaction Reporting in a Tertiary Care Hospital, Pakistan

Fizza Afzal, Rehan Anjum, Arsh Zafar

Background: Drug research has resulted in tremendous benefits for patients, but at the same time, the prevalence of adverse drug reactions (ADRs) has risen dramatically. ADRs are a substantial cause of illness and death all over the world. It not only jeopardizes the patients’ safety but also has a substantial impact on their quality of life and dramatically increases healthcare costs. One of the obstacles is the underreporting of ADRs by healthcare professionals (HCPs), which has influenced the medication’s safety. The ADRs go undetected until they cause harm to the patients. All types of ADRs should be reported by physicians, nurses, and pharmacists no matter how minor they are. The pharmacist plays an important role in reducing this underreporting through pharmacovigilance and educational intervention. Lack of knowledge is a key factor in underreporting. HCPs are reluctant to disclose ADRs due to a lack of motivation and training. Educational activities improve knowledge as well as good practice, so this study is to identify the impact of the educational intervention by pharmacists on HCPs’ ADR reporting in a tertiary care hospital.

Methods: In a tertiary care hospital in Pakistan, observational retrospective research on ADR reporting was conducted. The data were analyzed for 3 years (2019–2021). As part of their educational intervention, pharmacists held ADR reporting awareness events, campaigns, seminars, and training over the years. The hospital portal was updated, and pharmacists went on ward rounds to distribute ADR reporting leaflets. After that, the impact of activities on HCPs was evaluated. Throughout the sessions, all HCPs were urged to report any adverse events, no matter how slight. Every month’s ADR report was examined to see how the educational intervention was improving ADR reporting.

Results: In 2019, a total of 99 ADRs were reported (23.47%). Doctors reported 2, pharmacists reported 66, and nursing personnel reported 31. Following more campaigns and sessions, the number of ADRs climbed to 121 in 2020 (28.67%), with doctors and pharmacists reporting 6 and 100 ADRs, respectively. However, the nursing staff reported 15 ADRs. A continuous emphasis on ADR reporting through educational initiatives has resulted in a massive increase in reporting. In 2021, a total of 202 ADRs (47.86%) were recorded, including contributions from all healthcare teams. Doctors reported 16 ADRs, pharmacists recorded 126, and nurses reported 60. In comparison to 2019, the educational intervention appears to have raised ADR reporting by 5.22% in 2020 and 24.41% in 2021. So, the general approach to ADR reporting was positive, with a steady increase in reporting.

Conclusion: Educational interventions have been shown to be beneficial in enhancing HCPs’ knowledge and attitude toward ADR reporting. Our research showed that increasing HCPs’ knowledge increases ADR reporting. There is a need to adopt this practice on a national level so that everyone should know their role and play their part in enhancing medication safety.

Evaluation of Risk Factors Associated with Clostridioides difficile Infection (CDI) in Security Forces Hospital

Roaa Alosaimi

Background:Clostridium difficile is a Gram-positive spore-forming anaerobic bacterium that causes C. difficile infection (CDI), one of the most common causes of diarrhea in healthcare facilities. CDI remains an important nosocomial infection with attendant morbidity, mortality, and increased healthcare cost. Data from the Centers for Disease Control and Prevention (CDC) indicate that almost half a million cases of CDIs were reported annually in the USA. In Saudi Arabia, data on risk factors for CDI and disease epidemiology are limited. Therefore, more studies are needed to identify patients at high risk of CDI in our community. This study aims to identify the risk factors associated with developing C. difficile among the Security Forces Hospital (SFH) population.

Methods: This retrospective observational study was conducted at the SFH. The study involved reviewing the medical records of patients with age ≥18 years who were admitted between January 2016 and December 2020 and were diagnosed with C. difficile. Patients with positive polymerase chain reaction of C. difficile or positive stool test of C. difficile toxin were included. Demographics and clinical data of patients were collected and then analyzed using the SPSS program.

Results: The study included 586 participants: 293 were involved in the control group and 293 were involved in the case group. A total of 22 factors were investigated; there were only seven risk factors identified and they included proton pump inhibitor (P=0.05), using antibiotics (P=0.02), diabetes mellitus (P=0.01), immune deficiency (P=0.01), hospital-acquired (P=0.02), stroke (P=0.01), and cardiovascular disease (P=0.01).

Conclusion: There were seven risk factors that could be identified to be associated with C. difficile. Patients with diabetes, stroke, immune deficiency, and cardiovascular disease are more prone to infection. Also, those using proton pump inhibitors and antibiotics as well as hospital-acquired were more vulnerable to infection with C. difficile.

Fluid De-resuscitation Among Critically Ill Patients Requiring Intravenous Fluid Administration

Reham Alharbi, Namareq Aldardeer, Hassan Hawa, Ahmad Alabbasi, Amjad Albuqami, Emily Heaphy

Background: Intravenous fluid might carry significant risks to critically ill patients. Several studies have shown that a positive fluid balance negatively impacts intensive care unit (ICU) patients. A study conducted on septic patients found that every 1-l increase in fluid balance at 72 h was associated with hospital mortality; however, it is unclear whether percent fluid overload could guide fluid de-resuscitation among ICU patients.

Methods: A prospective cohort study was conducted in a tertiary care hospital in Saudi Arabia. The study included adult critically ill patients, 18 years of age and older, and those who were started on intravenous fluid. The primary outcome is the percent fluid accumulation on the day of fluid de-resuscitation or ICU discharge, whatever comes first. Patients who were de-resuscitated with diuretics and/or renal replacement therapy were compared with those who were not de-resuscitated.

Results: Three hundred eighty-eight patients were screened between August 1, 2021 and April 30, 2022. One hundred patients were included with a mean age of 59.8 ± 16.2 years. The mean APPATCHI II score was 15.4 ±8.0. Sixty-one patients required fluid de-resuscitation, whereas 39 patients did not require it. Median percent fluid accumulation on the day of de-resuscitation or ICU discharge was 3.8% (1.2–8.6) and 5.3% (2.7–8.6) in patients requiring de-resuscitation and those who did not, respectively (P-value = NS). Hospital mortality was found in 25 (80.7%) patients with de-resuscitation and in 6 (19.4%) who did not require it (P-value = NS).

Conclusion: The mean percent fluid accumulation on the day of fluid de-resuscitation or ICU discharge was not statistically different between patients who required fluid de-resuscitation and those who did not. A larger sample size is needed to confirm these findings.

Impact of Nausea and Vomiting of Pregnancy on Quality of Life and Day-to-Day Function Among Women in Saudi Arabia

Rana Almohaimeed, Nora Alkhudair, Ziyad Alrabiah

Background: Despite the fact that nausea and vomiting of pregnancy (NVP) is a frequently reported medical condition during pregnancy, no studies have evaluated its impact on women’s ability to perform acts of daily living in the Saudi population. Hence, this study aimed to explore the impact of NVP on quality of life and daily functioning among pregnant women in Saudi Arabia.

Methods: This cross-sectional study was conducted using a validated survey instrument. The survey covered demographic information, symptoms of NVP, and quality of life measured by the Quality-of-Life Scale instrument. Pregnant females and new mothers were asked to complete an anonymous online questionnaire. A message relating to the survey was shared with friends, communities, and family members with a URL link to the survey.

Results: A total of 591 women with NVP participated in the study. Of these, 233 (39.4%) were pregnant at the time of the survey, and 358 (60.6%) were new mothers who had a child under the age of 1 year. A majority [556 (94.1%)] of the respondents reported experiencing NVP symptoms at some time during their pregnancies. NVP symptoms were most predominant during the first trimester, as experienced by 420 (75.5%) women. NVP severely affected daily activities in 45.4% of the working or studying mothers. About 58% of the respondents reported that they might never consider getting pregnant again because of NVP.

Conclusion: The majority of the women suffer from NVP at some time during their pregnancies. This study also shows that NVP has an impact on women’s daily life functioning and their desire to become pregnant again. Future studies are needed to explore the efficacy of current therapeutic interventions among women with NVP.

The Appropriateness of Using Non-steroidal Anti-inflammatory Drugs Among Cardiovascular Patients in a Tertiary-Care Hospital

Sarah Altamimi, Amal Alotaibi, Fatima Aldwisan, Haifa Alhenaki, Malak Alshammari, Waad Alayyaf, Noura Albuhairan, Abdulrazaq Aljazairi, Edward De Vol

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used among patients worldwide for different indications. The risk of cardiovascular (CV) events associated with using NSAIDs has been very well documented. Yet, utilizing NSAIDs in CV disease (CVD) patients remains an area of concern that needs be assessed, and the adherence to the ACC/AHA and ESC guidelines recommendation in Saudi Arabia is unknown.

Methods: This is a retrospective cohort study conducted at King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh, Saudi Arabia. This study included adults at the age of 18 years or above with CVD (i.e., heart failure, hypertension, stroke, coronary artery disease, ST-elevation acute chest syndrome, non-ST-elevation acute chest syndrome, supraventricular tachycardia, non-sustained ventricular tachycardia, and transient ischemic attack) on NSAIDs from 2014 to 2016 to allow a 2-year follow-up. The calculated sample size was 1683 subjects with 99% confidence interval and 3% margin of error. Descriptive statistics were used and presented as mean ± standard deviation and frequency for patient demographics, clinical characteristics, medication-related data, appropriateness of using NSAIDs, and safety of NSAIDs use. For inferential statistics, paired sample T-test was used for the comparison of serum creatinine level and creatinine clearance pre/post-NSAIDs use. The analysis of variance was used to compare creatinine clearance between patients with normal kidney function and patients with renal impairment.

Results: Inappropriateness of using NSAIDs was found in 89.4%. The most frequent NSAIDs prescribed in CVD patients was meloxicam at 47% followed by ibuprofen at 29%. Majority (97.14%) of the NSAIDs prescribed was made by non-cardiology specialist physicians. The mean decline in creatinine clearance was from 109.5 ± 45.1 to 105.4 ± 46.2 with a P-value of 0.0001. However, for patients with renal impairment at baseline, the reduction was significantly higher by −5.094 mL/min when compared to those with normal function (mean difference −3.962).

Conclusion: Among patients with CVD, the majority of NSAIDs prescribed were inappropriate and against the ACC/AHA and ESC guidelines recommendations. Further assessment needs to be considered in utilizing NSAIDs for CVD patients. More physicians’ encouragement for appropriate prescribing of NSAIDs is needed. The study limitations include that data were collected retrospectively, it was not applied in multi-center, non-prescription NSAIDs not included, and the patients may follow-up with other healthcare facilities that prescribe NSAIDs. Adding an alert in the electronic systems and connecting all the pharmacies prescriptions together in one system applied all over the country are recommended.

Prevalence, Appropriateness, and Cost for the Treatment of Acute Otitis Media in the Emergency Department of a Tertiary Care Hospital in Saudi Arabia

Menyfah Alanazi

Background: Acute otitis media (AOM) is a serious health problem affecting millions of people every year. Inappropriate antibiotic prescriptions put patients at risk and lead to bacterial resistance and elevated costs. This study aims to assess the prevalence and antibiotic-treatment pattern for otitis media, prevalence and types of antibiotic-prescribing errors, and the cost of inappropriate antibiotic use.

Methods: This was a retrospective cross-sectional study conducted over a 3-month period in an emergency department in Saudi Arabia.

Results: During the study period, 652 patients were diagnosed with AOM, including pediatrics 66.4% and adults 33.4%. The overall prevalence of AOM was 4.5% of total visits, and 10% of the patients experienced more than one episode of AOM. The percent was found to be higher among young children less than 2 years (32%) and lower in the age group more than 60 years (3.4%). The males had a slightly higher rate of AOM when compared with females (1% and 0.8%), respectively (P < 0.01). Broad-spectrum antibiotics were prescribed for 82% of the patients. Three main antibiotics were prescribed: Augmentin (45%), Cefpozil (24%), and Amoxicillin (16.6%). The overall prevalence of inappropriate antibiotic prescription with at least one type of error was 57% (pediatrics 67% and adults 36%). Errors were dose (26%), duration (42%), and frequency (2.8%). Dose error and duration were significantly greater in pediatric patients (P=0.001). Significantly more inappropriate Augmentin prescriptions were seen in adults (P=0.001), whereas Cefpozil had significantly higher errors in pediatric patients. Positive ear culture was seen in 2.3% of the patients, and the most common microorganism was Streptococcus (53%). Treatment of AOM was more costly in males (56% of the total cost), pediatric patients (59.2%), and those using broad-spectrum antibiotics (80%). There were statistically significant associations among sex, age, spectrum of antibiotics, category of antibiotics, and inappropriate cost.

Conclusion: The results revealed a significant level of inappropriate use of antibiotics in the treatment of AOM in the emergency department.

Prescribing Behavior in Patients with Multiple Sclerosis in Saudi Arabia: Mixed-methods

Nada Alsowaida, Hussain Alomar, Lama Aldosari, Ahmed Mayet, Mohammad Aljumah

Background: Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system with variable degrees of demyelination, axonal loss, and gliosis. Healthcare providers face challenges in a treatment approach to MS with efficacy, safety, availability, and cost. Selecting the appropriate medication, starting with highly effective medication, or using the escalation is arising challenge with the large number of available medications. Definition for treatment failure and response remains a dilemma, and medications are switched for reasons of inadequate response and adverse and drug reactions. The aim of this study is to explore the local practice, physicians’ view, and their behavior in treating MS patients in Saudi Arabia.

Methods: A sequential explanatory mixed-method approach was used to achieve the study aims. The quantitative arm of the study consisted of patient data extracted from the Saudi MS registry from 2015 to 2018. The qualitative study consisted of in-depth semi-structured interviews with physicians using a validated interview topic guide comprising 25 open-ended questions.

Results: We extracted data of 2516 patients from 20 different hospitals across Saudi Arabia. Patients’ mean age was 34±10 years; two-thirds (n=1668) were female. Ninety-two percent (n = 2290) had relapsing–remitting MS, and 5% (n=126) had secondary-progressive MS. Overall, patients with MS received at least one drug as the DMT or DMTs and corticosteroids for those with relapse, with a total of 4536 patients receiving therapy. During disease exacerbation, almost all patients with MS (n=2222, 99%) received corticosteroid therapy, mostly intravenous prednisone. Qualitatively, nine physicians agreed to participate in the interviews. Of them, five (55%) were males and four were females from different regions. Thematic analysis yielded three main themes: practice, views, and challenges.

Conclusion: MS prevalence and management in Saudi Arabia is similar to those worldwide. A national MS guideline is needed to streamline diagnosis and treatment criteria, avoid any treatment delay, and guide physicians who are providing care for patients with MS.

Assessment of Chemotherapy-induced Nausea and Vomiting in Hematopoietic Stem Cell Transplant Patients

Ahmed Alanazi, Fouad Alnajjar, Abdullah Alrajhi

Background: Chemotherapy-induced nausea and vomiting (CINV) is a prevalent and potentially treatment-limiting side effect of chemotherapy. (1) CINV is frequent and can significantly affect cancer patients’ daily functioning and health-related quality of life if not treated properly. (2) Patients who experience nausea and vomiting have been shown to be affected by worse physical, cognitive, social functioning, and global quality of life in comparison to patients who do not have nausea and vomiting. (3) Poor control of CINV could lead to serious clinical symptoms such as dehydration, electrolyte disturbance, malnutrition, and possibly stopping chemotherapy, which in turn can impact treatment outcomes. It can also lead to increased ER admissions and length of stay burdening the health system.

Methods: We conducted a prospective cohort observational study to assess the complete response (CR) and risk factor associated with nausea and vomiting among hematopoietic stem-cell transplantation patients at King Fahad Medical City. All adult patients who underwent bone morrow transplant were included in the study. Data were collected prospectively during treatment with the conditioning regimen. Patients were interviewed by clinical pharmacists and assessed using MASCC Antiemesis Tool© to assess the effectiveness of our regimens used to prevent nausea and vomiting during the acute phase (24 h post-chemotherapy) and delayed phase (72 h after the acute phase ends). CR was defined as no vomiting, no nausea, and no usage of breakthrough medications for nausea and vomiting.

Results: A total of 18 patients were enrolled in the study from May to October 2021. A preliminary data analysis was done and revealed the following: out of 18 patients enrolled, 11 (61.1%) were females and 7 (38.9%) were males. Lymphomas (non-Hodgkin and Hodgkin) were the most common diagnoses among patients [11 (61.6%)]. The BEAM (Carmustine, Etoposide, Cytarabine, and Melphalan) protocol was the most common conditioning regimen used [7 (38.9%)]. CR was achieved in 8 (44.1%) patients during the acute and delayed phases of nausea and vomiting, whereas 10 (55.6%) of the patients were not able to achieve CR. There was no association among gender, conditioning regimen, type of transplant, and achievement of CR among patients (P > 0.05).

Conclusion: Among hematopoietic stem cell transplant patients, CR in the prevention of chemotherapy-induced vomiting was achieved in about 50% of the patients with current antiemetic regimens used at our institution. At the current number of participants, we could not find any specific risk factor for CR failure.

Metformin Use Among Obese Patients with Pre-diabetes in Saudi Arabia: A Retrospective Cohort Study

Osamah Alfayez, Sumaia Alfuraih, Basmah Alsalamah, Hadeel Almendeel, Omar Alkhezi, Saad Alharbi, Naief Alwohaibi

Background: Preventing diabetes is a critical national health concern, especially as the prevalence of diabetes continues to rise. Metformin, in addition to lifestyle modifications, has been found to reduce the chance of developing type 2 diabetes. However, previous research indicates that metformin use among patients with pre-diabetes remains low in real practice. Thus, the aim of our study was to determine the prevalence of metformin use for diabetes prevention among obese patients.

Methods: A retrospective cohort study was conducted after obtaining approval from the Research Ethics Committee of the Ministry of Health. Data were collected from the electronic medical records of patients registered at two hospitals in Saudi Arabia from 2017 to 2021. The inclusion criteria were patients with pre-diabetes [glycated hemoglobin (HbA1c) from 5.7% to 6.4%] and obesity [body mass index (BMI) 30 kg/m2] who received metformin for diabetes prevention. Patients with chronic kidney disease and those using metformin for other purposes such as treating polycystic ovary syndrome were excluded. The primary outcome of interest was the rate of metformin use according to clinical guidelines criteria (HbA1c from 5.7% to 6.4%, age <60, and BMI ≥ 35 kg/m2). The second outcome was the prevalence of metformin use among obese patients with pre-diabetes. Descriptive statistics were used to report the primary and secondary outcomes. Data are presented as percentages, means, standard deviations (SDs), medians, and interquartile ranges as appropriate. All analyses were conducted using Stata version 16.1 (Stata Corp., College Station, TX, USA).

Results: After screening medical records of 1789 patients, a total of 304 patients were included. The average age was 40 years, and the majority was female (72%). The average BMI was 39.4 kg/m2 (SD 6.95), and the average HbA1c was 5.8% (SD 0.2%). The number of comorbidities among the sample ranged from 0 to 3 with an average of one medication used at home. Regarding the primary outcome, 19 patients (8.7%) received metformin according to the clinical guidelines. Among the entire sample, 25 (8.22%) received metformin for diabetes prevention. The total daily dose of metformin ranged from 750 to 1500 mg. A total of 11 patients received 1000 mg, 10 received 750 mg, and 3 received 1500 mg of metformin.

Conclusion: This study revealed that metformin is under-used for diabetes prevention despite clinical recommendations. More effort is needed to address the reasons behind the hesitancy of healthcare providers in prescribing metformin for diabetes prevention.

A Strategy to Improve Adherence to Guideline-Directed Medical Therapy and the Role of the Clinical Pharmacist in a Heart Failure Program

Fakhr Alayoubi, Ahmed Hayajenh, Waleed Alhabeeb

Background: The role of clinical pharmacists has been demonstrated in several aspects, which has showed improvements in patients’ care massively. In our hospital, we have established a multi-disciplinary program for patients with heart failure (HF) in order to improve patient care. Furthermore, we think that having a clinical pharmacist will improve the adherence to the Guideline-Directed Medical therapy (GDMT) which by itself improves the HF patient care.

Methods: A retrospective study evaluating the adherence of HF team to the GDMT was conducted prior to the presentation of clinical pharmacists (from January to December 2019) and after (from January to December 2020) on patients with HF at King Fahad Cardiac Center in Riyadh, Saudi Arabia. This was assisted by applying a local checklist form to measure, in particular, the utilization of angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, re-admission within 30 days of discharge, and vaccination if needed.

Results: The results demonstrate the use of ACEIs/angiotensin receptor blockers, beta-blockers, and immunization use 1 year prior to the start of the program. About 81.17% of the patients were receiving ACEI/ARBA in 2019 at discharge and 75.59% in 2020. The difference between the two groups is 5.58 with a P-value of 0.249. In addition, 87.83% of the patients received beta-blockers in 2019 at discharge and 94.53% in 2020 with a difference of 6.70% between the 2 years. For the flu vaccine, 48.24% received it in 2019 and 75.13% received it in 2020, with a difference of 26.89% with a P-value of 0.001. For the pneumococcal vaccine, 44.22% of the patients received it in 2019 and 75.13% received it in 2020 with a difference of 30.91% and a P-value of 0.001.

Conclusion: Our data showed that the role of a clinical pharmacist has significantly improved the adherence to the GDMT in 1 year, which has positively reflected on our patient care. However, a longer period of time with dose–response target is still needed.

Medication Errors in a Military Healthcare Facility in Eastern Province of Saudi Arabia

Saleh Almekhloof

Background: The purpose of this study was to identify medication errors at King Abdulaziz Hospital in Al Ahsa City, in the Eastern province of Saudi Arabia.

Methods: This is a retrospective analysis of 2021 medication errors reported by healthcare professionals at King Abdulaziz Hospital via Safety Reporting System (SRS).

Results: A total of 209 incidences were reported during the study period. In terms of NCC-MERP person-affected outcome, class A accounted for 29% of all the events; class B 34%; class C 7%; class D 3%; classes E and F < 1%; and the remaining events 3% were “person not applicable.” Regarding the medication process stage, 59% of the medication errors were related to physician prescribing, broken down in terms of events as follows: ordered a medication the patient is allergic to (4); contraindicated prescription (6); laboratory or diagnostic test missing for monitoring (8); medication duplication (17); prescription for a wrong patient (1); prescribed incorrect medication (11); dosage form (4); dose or infusion rate (50); dose frequency (2); duration of therapy (2); route of administration (1); ineligible or inappropriate prescribing (11); and incomplete prescription (6). Other incidences accounted for 41% of all the events, which were related to other reasons such as medication delivery delays 12%; incorrect medication dispensed 1%; and expired medication dispensed 1%.

Conclusion: The majority of the medication errors happened during the prescribing process. Physician education programs and development of electronic order sets are keys to minimize prescribing errors. Moreover, close loop medication administration with barcoding system could prevent administration errors.

The Prescribing Pattern of Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors and Glucagon-like Peptide-1 (GLP-1) Receptor Agonists in Patients with Type 2 Diabetes Mellitus: A Two-Center Retrospective Cross-Sectional Study

Albandari Alghamdi, Ghazwa Korayem, Omar Alshaya, Shahad Alanazi, Renad Almutib, Mahdi Alsaileek, Abdulrahman Alrashidi, Nasser Aldosar, Nader Alshraim, Majed Alyami, Omar Almohammed

Background: Despite the proven cardioprotective and renoprotective effects of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes mellitus (T2DM), their use in real practice remains limited. Limited data are available about the effective prescribing of SGLT-2i and GLP1-RA in T2DM patients regardless of the presence of established cardiovascular diseases. Thus, this study aims to describe the appropriateness of prescribing GLP1-RA and SGLT-2i in patients with T2DM.

Methods: This is a multi-center retrospective cross-sectional study that included adult patients aged ≥ 18 years diagnosed with T2DM. Patients were classified into four groups depending on the eligibility and the reception of GLP1-RA or SGLT-2i. The medications were considered to be used appropriately if patients were eligible and prescribed them or non-eligible and did not receive them. Statistical analyses included descriptive statistics and logistic regression.

Results: A total of 1217 patients were included; most were females (57%). Among the included patients, only 18% received either SGLT-2i or GLP1-RA. These medications were appropriately used in 35% of the patients. Among the eligible patients (n=509), 84% were not prescribed SGLT-2i or GLP1-RA, whereas 20.6% were prescribed SGLT-2i or GLP1-RA when they were not eligible. These medications were mostly prescribed by endocrinologists (58.9%), followed by internalists (11.6%) and then cardiologists (10.3%).

Conclusion: This highlights the underutilization of GLP1‐RA and SGLT-2i in patients with T2DM. However, it also raises some concerns about over-prescribing GLP1‐RA and SGLT-2i. Both under-prescribing and over-prescribing can lead to negative consequences. Thus, increasing the prescriber’s awareness about the appropriate use of GLP1‐RA and SGLT-2i is essential. Future larger studies are needed to investigate the appropriateness of their use, including indication and dose.

Outcomes of Antimicrobial Stewardship Program in Prevention of Antibiotics Misuse in Patients with Spinal Cord Injury Undergoing Minor Urologic Procedures

Nourah Alrashidi, Lina Alnajjar, Omar Khan, Njoud Almutairi, Noura Alshamrani, Amira Yousef, Reem BinSuwaidan

Background: Antimicrobial Stewardship Program (ASP) is an internationally recognized strategy for reducing antimicrobial resistance while maintaining patients’ safety. This study aimed to determine whether the implementation of stewardship practice improved antibiotics prescribed by urologists in spinal cord injury (SCI) patients undergoing minor urological procedures at a tertiary hospital in Saudi Arabia.

Methods: A retrospective cohort study included hospitalized patients (aged ≥18 years) between January 1, 2012 and December 31, 2020, to compare antibiotics prescribed in the SCI unit before and after implementation of the ASP. This study was conducted at the Sultan Bin Abdulaziz Humanitarian City in Riyadh, Saudi Arabia.

Results: There is a significant reduction in patients who received antimicrobial prophylaxis pre-procedure in the post-implementation group when compared with the pre-implementation group (24.46% vs. 45.9%, P<0.0001), respectively. Patients who did not receive antimicrobial prophylaxis pre-procedure were significantly higher with post-implementation group (75.5%) compared with patients in the pre-implementation group (54.08%) (P<0.0001). There is a highly significant reduction (P<0.0001) in the post-implementation group (1.2%) when compared with the pre-implementation group (16.7%) in receiving post-operative prophylaxis.

Conclusion: The ASP implementation for surgical prophylaxis in SCI patients in a rehabilitation hospital is an example of one setting in which it is highly needed to improve the appropriate use of antimicrobial therapy. It will also promote acceptance rate of prescribers to the guidelines, thus reducing related costs and antimicrobial consumption. Further studies should examine the generalizability of these findings to other patient population groups with similar conditions to neurogenic bladder and the need to assess long-term clinical benefits for patients of all diseases. These studies can ensure allocation of further resources which are crucial to support the expansion of ASP programs, as ASP becomes increasingly accepted as a standard of care in many advanced hospital settings.

Developing Competent Entry-level Pharmacists Using Competency-based Training During Internship

Luma Ameer, Nousheen Hamid, Zahraa Almoussa, Safyah Asfour, Sherihan Ghosn, Manal Suroor

Background: In line with Vision 2030 Healthcare Transformation Program, Mohammed Al-Mana College for Medical Sciences (MACHS) will introduce Competency-based Training (CBT) for Bachelor of Pharmacy interns to produce more competent entry-level pharmacists.

Methods: The MACHS Pharmacy Department Training Unit developed a CBT framework based on the FIP Global Competency Framework. The CBT includes pharmaceutical public health, pharmaceutical care, and professional/personal competencies. Students were prepared for CBT through a 2–3-day orientation by the training unit before training, followed by baseline assessments. Assignments were set throughout training as a form of scaffolding to support competency development. Assessment methods used for the evaluation were site preceptor evaluation, college-based assessments, and student portfolio. End-of-training results were compared with baseline to determine the effectiveness of CBT in terms of improvement of skills. Successful completion of CBT required a final mark of 80%. Unsuccessful interns had an opportunity to improve their weak competency(ies) and re-assessment.

Results: Since its implementation, three cohorts have been trained through CBT. The results showed that between 74% and 87% of trainees successfully passed the CBT on their first attempt, whereas between 13% and 26% were required to improve a weak competency and reassessed. Training activities and assessments were reviewed and developed. The students scored better in the portfolio and site preceptor evaluation when compared with the college-based assessment. Student feedback toward the assignments was positive.

Conclusion: CBT is effective in augmentation of the necessary pharmacist skills, to provide competent health care to patients and community. More FIP competencies and evaluation strategies could be added to the Intern framework in the future. Discrepancies between site preceptor evaluations also need to be addressed through preceptor training programs. A national approach toward implementation of CBT should be used to ensure the competency of pharmacists.

Evaluation of Adherence to Chemotherapy-induced Nausea and Vomiting (CINV) Guideline in Adult Saudi Oncology Centers

Aisha Sabbagh, Yousef ALOlah, Ghada AL Yousef

Background: It is essential for cancer patients to be clinically supported by management of cancer treatment side effects. Moreover, there are several antiemesis guidelines for preventing and managing chemotherapy-induced nausea and vomiting (CINV) including the American Society of Clinical Oncology (ASCO) guidelines, Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) guidelines, and National Comprehensive Cancer Network (NCCN) guidelines. These guidelines are mainly similar with minor differences, and they are regularly updated and the consistency with these guidelines is important to prevent CINV. Although the adherence rate to antiemetic guidelines for the prevention of CINV has been studied extensively in the medical literature, there is lack of adequate information about adherence to the guidelines for antiemetic prophylaxis in cancer patients in oncology centers in Saudi Arabia.

Methods: It is cross-sectional study that tends to evaluate the use of antiemetic guidelines in different oncology centers in Saudi Arabia by doing survey that will be filled by three different professionals (senior hematology/oncology physician, senior pharmacist, and senior nurse) in each oncology center in Saudi Arabia. The study inclusion criterion is that all adult oncology centers are located in Saudi Arabia, and the exclusion criteria are oncology centers that do not agree to complete the questionnaire and pediatric oncology centers. The data obtained from the data collection sheet will be entered in Microsoft Office Excel, and the report will be generated. Simple statistic (i.e., average, mean, etc.) will be reported.

Results: Twenty-five of 45 (55.55%) respondents from 14 of 15 (93.3%) centers from all over the place in Saudi Arabia participated in the survey. About 52% of the participants were pharmacists, 28% were nurses, and 20% were physicians. About 44% of the participants had less than 5 years of experience in Hematology/Oncology field and 32% had 10–20 years of experience in this field. Around 64% of the respondents use an international guideline and 24% use their own CINV guidelines. About 40% of the respondents vote to update the guideline every 2 years, and 40% of the respondents vote that their centers incorporated the CINV guideline in each chemotherapy protocol in their Electronic Medical Record System. Approximately 28% incorporated the guideline in each preprinted chemotherapy protocol and 28% relied on physician memory to adapt the CINV guidelines. About 72% of the participants were satisfied with patients’ outcome of their CINV guidelines; however, 12% reported more than 50 incidents and 40% reported less than 10 incidents of nausea and vomiting in their respected centers. About 52% of the respondents rate their center’s adherence to CINV guidelines as usually adhered.

Conclusion: Based on the results observed from this survey, the following points are recommended to improve CINV prophylaxis in different centers in Saudi Arabia: availability of one NK1I in all hematology/oncology centers and all hematology/oncology teams should collaborate to develop the standard national CINV guideline in all regions of Saudi Arabia.

Telemedicine-based Medical Care Compared to In-person Medical Care for Warfarin Follow-up: A Retrospective Propensity Score-matched Cohort Study

Fahad Alkhuzaee, Sahar Ayoup, Murooj Shukry

Background: Telemedicine is underutilized in Saudi Arabia and is a matter of concern, especially since previous literature showed its equivalence with office visits, providing access to care and convenience for patients while reducing safety-related complications when appropriate measures are followed. The purpose of this study is to analyze the efficacy of telehealth-based care compared with in-person visit care for dose adjustment of warfarin. The secondary objective is to measure the safety outcomes including major or minor bleeding events, any thrombo-embolic events, extreme INR values, and re-admission rate within 30 days.

Methods: The authors will conduct a retrospective chart review comparing the mean percentage of time in therapeutic range (TTR) in King Faisal Specialist Hospital and Research Center—Jeddah Branch. Patients will be enrolled if warfarin was prescribed between July 2019 and November 2020. A subcohort analysis for both telemedicine group and in-person group will be performed using propensity score matching. Descriptive analysis will be done for all entries.

Results: A total of 350 patient records were included in this retrospective study. Matched analysis using propensity score matching showed that the mean percentage of TTR was 62.82 (±19.46) and 70.61 (±19.83) in telemedicine-based and in-person-based groups, respectively (P = 0.017). There was no statistical correlation in the incidence of major or minor bleeding events, thrombo-embolic events, and re-admission rates between the two groups.

Conclusion: Based on the results of this study, managing patients on oral anticoagulation therapy through a telemedicine method showed a lower overall TTR percentage when compared with in-person anticoagulant clinic visits in matched groups, thus demonstrating that using a telemedicine approach alone for warfarin follow-up did not help patients to maintain their INR target level.


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