Department of Pharmacy Practice and Clinical Pharmacy

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    An exploratory study of the mandate and functions of national pharmaceutical services units: global trends and the cases of Côte d’Ivoire, Kenya, and Nepal
    (Journal of Pharmaceutical Policy and Practice, 2024) Koduah, A.; Kusu, N.; Ahimon, H.; et al.
    Background: National pharmaceutical services units (NPSUs) – organisational units within the central government usually responsible for pharmaceutical services and management – have an increasingly narrow mandate. Anecdotal evidence points to an increasing focus, almost exclusively, on logistics management, while pharmaceutical care and policy oversight have become fragmented. This study examined NPSUs’ current functions and mandates, and proposed what should be the critical functions and roles of these units going forward. Methods: Using case studies of Côte d’Ivoire, Kenya and Nepal, the study relied on a literature review and in-depth interviews. We triangulated and synthesised the findings to identify NPSUs by level in the health ministry’s hierarchy and reporting line, mandate, and function.Results: We identified medicine regulation, procurement and supply chain management, selection and rational use of medicines, and pharmacy practice regulation as four broad sets of functions that NPSUs commonly have as their mandate. A clear position in the Ministry of Health’s hierarchical structure, the legal or administrative framework that mandates an NPSU’s functions, and national pharmaceutical policies and regulations to guide the pharmaceutical sector are three critical factors for effective functioning. It is essential to have a legislative framework that at a minimum identifies one NPSU as responsible for pharmaceutical policy and governance, serving as the steward for the pharmaceutical system. This role encompasses pharmaceutical system coordination and administrative functions, formulating and implementing policies for organising, managing, financing, regulating, monitoring, and evaluating the pharmaceutical system. As such, we recommend that NPSUs should at a minimum have four broad sets of functions: pharmaceutical policy and governance, medicine regulation, pharmacy practice regulation and procurement and supply chain management. Conclusion: The study substantiates the need for a pharmaceutical policy and governance unit that stewards the pharmaceutical system and is empowered to monitor and evaluate system performance and coordinate efforts for system strengthening.
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    Transforming Supply Logistics for Health Commodity Security in Africa
    (Global Health: Science and Practice, 2024) Tetteh, E.K.
    To resolve the problem of ensuring secure supplies of all health commodities, health planners in African countries must first identify arrangements that best serve the public interests of promoting choice and competition in ensuring health commodity security. Investments in inventory management should not be viewed as a one-off exercise but rather as a continuous search for the optimal scale and scope of operations that ensure the availability of essential health commodities most of the time. Without competing alternatives to manage inventory, public-sector logistics monopolies lack adequate incentives to devise ways of reducing costs and improving output. Further, these monopolies make it more difficult to minimize the impact and duration of catastrophic supply disruptions. Current efforts to improve public-sector supply logistics must be extended to include the transformation of existing public and private logistics infrastructure for inventory management into a state of prudent multiplicity—one in which there are at least 2 full-line national logistics institutions competing to serve all government, nongovernmental, and private health facilities. Health planners should consider creating a state of prudent multiplicity in their roadmaps, master plans, and health system strengthening initiatives.
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    Implementation of Medicines Pricing Policies in Ghana: The Interplay of Policy Content, Actors’ Participation, and Context
    (International Journal of Health Policy and Management, 2023) Koduah, A.; Baatiema, L.; Kretchy, I.A.; et al.
    Background: Implementing a medicine pricing policy effectively is important for ensuring equitable access to essential medicines and ultimately achieving universal health coverage. However, published analyses of policy implementations are scarce in low- and middle-income countries (LMICs). This paper contributes to bridging this knowledge gap by reporting analysis of implementation of two medicines pricing policies in Ghana: value-added tax (VAT) exemptions and framework contracting (FC) for selected medicines. We analysed implications of actor involvements, contexts, and contents on the implementation of these policies and the interplay between them. This paper should be of interest, and relevance to policy designers, implementers, the private sector, and policy analysts. Methods: Data were collected through document reviews (n = 18), in-depth interviews (IDIs) (n = 30), and focus group discussions (FGDs) (n = 2) and consultative meetings (n = 6) with purposefully identified policy actors. The data were analysed thematically, guided by the four components of the health policy triangle framework. Results: The nature and complexity of policy contents determined duration and degree of formality of implementation processes. For instance, in the FC policy, negotiating medicines prices and standardizing the tendering processes lengthened implementation. Highly varied stakeholder participation created avenues for decision-making and promoted inclusiveness, but also raised the need to manage different agendas and interests. Key contextual enablers and constraints implementation included high political support and currency depreciation, respectively. The interrelatedness of policy content, actors, and context influenced the timeliness of policy implementations and achievement of intended outcomes. and suggest five attributes of effective policy implementation: (1) policy nature and complexity, (2) inclusiveness, (3) organizational feasibility, (4) economic feasibility, and (5) political will and leadership. Conclusion: Varied contextual factors, active participation of stakeholders, nature and complexity of policy content, and structures have all influenced the implementation of medicine pricing policies in Ghana.
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    Analysis of Hospital Pharmacists’ Interventions in a Covid -19 Isolation Centre of a Tertiary Hospital in Ghana
    (Texila International Journal of Public Health, 2022) Ofei-Palm, C.N.K.; Ekpale, P.; Koduah, A.; et al.
    Coronavirus disease 2019 (Covid-19) is a global pandemic that was first identified in the city of Wuhan, China, and declared On January 30, 2020, by the World Health Organization (WHO) as a Public Health Emergency of International Concern. In Ghana, the Korle Bu Teaching Hospital became one of the designated sites for the management of Covid-19 patients, and the pharmacists were part of the task force. This study aims to analyze hospital pharmacists’ interventions in a Covid 19 isolation center and to identify the evidence that supports the effect of such interventions. This was a retrospective study carried out by collecting and collating the interventions and recommendations made by the hospital pharmacists who worked at the isolation center from May 2020 to August 2020 at the peak of the pandemic. A total of 145 pharmacists’ interventions (PIs) were captured from the medication reviews of 53 patients: resulting in an average PI rate of 3 interventions per patient. Women accounted for 58.5% (31/53) of positivity in the study. The mean (SD) for age was 47.1(17.9). Physicians’ acceptance rate of PIs for Covid-19-positive patients was 95.2% (138/145). The most prevalent type of PIs was discharge counseling; 32.4 % (47/145), followed by untreated indication 10.3% (15/145), drug /dose omission 9% (13/145), and drug shortage/refill 9% (13/145) respectively. This study highlights the clinical relevance of pharmacists’ interventions in the Covid-19 era and the importance of teamwork to prevent medication errors.
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    Sleep quality and psychological well-being of university students
    (HSI Journal, 2023) Ahorlu, C.S.; Ainuson-Quampah, J.
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    Advanced pharmacy practice of a doctor of pharmacy student at an allied surgical ward in a hospital in Africa
    (Heliyon, 2023) Ofei-Palm, C.N.K.; Gbadago, D.; Tetteh, R.; Koduah, A.; Ankrah, D.; Buabeng, K.O.
    Introduction: The pharmacy profession is undergoing transformational change in Ghana. The role of pharmacists has become more patient-focused with increased accountability and responsibility. Aim: This study is aimed at reporting the experiential learning on the clinical interventions made and documented at the Allied Surgical Wards of Korle-Bu Teaching Hospital (KBTH). This involves a review of patient’s medical records during the Advanced Pharmacy Practice Experience (APPE) learning. One case each from Eye, Ear, Nose, Throat, (ENT) and Dental units’ subspecialty were reviewed from October 7, 2019 to November 15, 2019 b y a Pharm D student. Conclusion: The student was able to make prompt clinical interventions that contributed to patient care in clinical wards assigned during her clinical clerkship.
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    Advanced pharmacy practice of a doctor of pharmacy student at an allied surgical ward in a hospital in Africa
    (Elsevier Ltd, 2023) Koduah, A.; Ofei-Palm, C.N.K.; Gbadago, D.; et al.
    A B S T R A C T Introduction: The pharmacy profession is undergoing transformational change in Ghana. The role of pharmacists has become more patient-focused with increased accountability and responsibility. Aim: This study is aimed at reporting the experiential learning on the clinical interventions made and documented at the Allied Surgical Wards of Korle-Bu Teaching Hospital (KBTH). This involves a review of patient’s medical records during the Advanced Pharmacy Practice Experience (APPE) learning. One case each from Eye, Ear, Nose, Throat, (ENT) and Dental units’ subspecialty were reviewed from October 7, 2019 to November 15, 2019 b y a Pharm D student. Conclusion: The student was able to make prompt clinical interventions that contributed to patient care in clinical wards assigned during her clinical clerkship.
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    Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertension
    (Heliyon, 2023) Baah-Nyarkoh, E.; Alhassan, Y.; Dwomoh, A.K.; Kretchy, I.A.
    Background: Medication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication related burden among patients with co-morbid T2DM and hypertension and to evaluate the as sociation between the perceived burden and adherence to medication therapy. Methods: A cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model. Results: The total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93–113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), fre quency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20–5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13–8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14–4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25–0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30–0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16–0.69, p = 0.003) were associated with lower odds of medication adherence. Conclusion: These findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care nterventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended.
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    Viewing the global health system as a complex adaptive system – implications for research and practice [version 1; peer review: 1 approved]
    (F1000 Research, 2023) Borghi, J.; Ismail, S.; Koduah, A.; et al.
    The global health system (GHS) is ill-equipped to deal with the increasing number of transnational challenges. The GHS needs reform to enhance global resilience to future risks to health. In this article we argue that the starting point for any reform must be conceptualizing and studying the GHS as a complex adaptive system (CAS) with a large and escalating number of interconnected global health actors that learn and adapt their behaviours in response to each other and changes in their environment. The GHS can be viewed as a multi-scalar, nested health system comprising all national health systems together with the global health architecture, in which behaviours are influenced by cross-scale interactions. However, current methods cannot adequately capture the dynamism or complexity of the GHS or quantify the effects of challenges or potential reform options. We provide an overview of a selection of systems thinking and complexity science methods available to researchers and highlight the numerous policy insights their application could yield. We also discuss the challenges for researchers of applying these methods and for policy makers of digesting and acting upon them. We encourage application of a CAS approach to GHS research and policy making to help bolster resilience to future risks that transcend national boundaries and system scales.
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    Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertensio
    (Heliyon, 2023) Baah-Nyarkoh, E.; Alhassan, Y.; Dwomoh, A.K.; Kretchy, I.A.
    Background: Medication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication related burden among patients with co-morbid T2DM and hypertension and to evaluate the as sociation between the perceived burden and adherence to medication therapy. Methods: A cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model. Results: The total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93–113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), fre quency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20–5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13–8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14–4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25–0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30–0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16–0.69, p = 0.003) were associated with lower odds of medication adherence. Conclusion: These findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care interventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended.