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Item 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.Item 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.Item 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.Item Sleep quality and psychological well-being of university students(HSI Journal, 2023) Ahorlu, C.S.; Ainuson-Quampah, J.Item 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.Item 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.Item 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.Item 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.Item 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.Item Consolidation or multiplicity in supply logistics for health commodities?(Exploratory Research in Clinical and Social Pharmacy, 2023) Tetteh, E.K.Public health-sectors of most low- and middle-income countries (LMICs) run a central medical stores (CMS) model that is monopolistic in character. Concerns raised about monopolistic CMS arrangements stress the need to encourage cost reducing efforts and improve service levels (outputs) by having multiple competing logistics institutions. This paper examines the desirability of consolidation or multiplicity in supply logistics by focusing on the task of inventory management (that is, distribution, storage and warehousing). The paper uses theory and historical evidence to describe and suggest a desired form of multiplicity in LMICs. Consolidation shouldn't progress to the point of monopoly and multiplicity doesn't mean having an infinite number of logistics institutions. A limited number (2−10) of logistics institu tions, that are full-line and national in their scope and scale of operations, should be enough to provide choice, support competition and minimize the risk of supply disruptions. Health policy and planning in LMICs should explore ways of turning existing logistics institutions in the public, private and non-governmental sectors into a multiplicity of types that are capable of assuring uninterrupted supplies of health commodities.Item Biopsychosocial analysis of antibiotic use for the prevention or management of COVID-19 infections: A scoping review(Research in Social and Administrative Pharmacy, 2022) Nortey, R.A.; Kretchy, I.A.; Koduah, A.; Buabeng, K.O.Background: The novelty and complexity of the COVID-19 pandemic has resulted in various coping mechanisms adopted by individuals as a means of averting the perceived fatalities of the pandemic. The use of antibiotics in the management of COVID-19 is clinically recommended under specific conditions. However, there are increasing trends of non-adherence to the recommended criteria resulting in the unwarranted use of antibiotics as an adaptative approach to the ongoing pandemic. Objective: The objective was to identify and classify factors associated with the unwarranted use of antibiotics in the management of COVID-19 from published literature and the perspectives of key stakeholders along a Bio psychosocial model. Methods: Literature was searched in the following databases: PubMed/MEDLINE, Scopus, Embase and Google Scholar for studies published between 31st December 2019 and 31st January 2022. The Arskey and O’Malley framework modified by Levac in the six-stage methodological process was adopted for this review and included: a) identification of research questions, b) identification of relevant research articles, c) selection of studies, d) data charting and synthesis, e) summary, discussion and analysis, and f) stakeholder consultations. Results: Out of 10,252 records identified from all sources, 12 studies were selected for inclusion in this scoping review. The selected articles reflected both antibiotic use and COVID-19 whilst capturing the biological (medical) and psychosocial perspectives. Most of the studies reported the overuse or abuse of Azithromycin especially in hospital settings. Common themes across the review and stakeholder consultations included fear, anxiety, media influences and deficits in public knowledge. Conclusion: The findings of the study highlight the complexity of antibiotic control especially in the context of a pandemic. The identified determinants of antibiotic use provide the necessary framework to simulate health emergencies and be better positioned in the future through the development of targeted and comprehensive policies on antibiotic stewardship.Item Implementation of medicines pricing policies in sub-Saharan Africa: systematic review(Systematic Reviews, 2022) Koduah, A.; Baatiema, L.; de Chavez, A.C.; Danso‑Appiah, A.; Kretchy, I.A.; Agyepong, I.A.; King, N.; Ensor, T.; Mirzoev, T.Background: High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA) are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability; however, evidence on the experiences of implementations of these policies in SSA settings appears limited. Therefore, to bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? Methods: We identified policies and examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction, and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines. Results: Of the 5595 studies identified, 31 met the inclusion criteria. The results showed thirteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were limited awareness about policies, lack of regulatory capacity and lack of price transparency in external reference pricing process. Key facilitators were favourable policy environment on essential medicines, strong political will and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines was mixed. Reductions in prices were reported occasionally, and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines. Conclusions: Implementation of medicine pricing policies in SSA shows some mixed evidence of improved avail ability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications, for SSA and potentially other low-resource settings: avoiding a ‘one-size-fts-all’ approach, engaging both private and public sector policy actors in policy implementation and continuously monitoring implementation and effects of policies.Item Assuring health commodity security in resource-poor settings(Elsevier, 2022) Tetteh, E.K.Health planners charged with the task of building or at least maintaining the health of populations within low- and middle-income countries (LMICs) have to find ways of providing steady, predictable supplies of health commodities for unpredictable demands for healthcare and health. To address this issue, this paper emphasizes a focus on aggregate commodity security defined as the continuous interrupted supply of health commodities belonging to all therapeutic categories and not just a selected subset. Given this focus, the paper identifies logistics systems comprising of a set of logistics activities as the machinery for assuring aggregate commodity security. Steady reliable supplies of health commodities, whenever and wherever they are needed, however, means looking beyond logistics systems. Health planners must ask whether there is a healthy supplier base for the commodities needed. The paper notes that a secure supply of health commodities in any LMIC, will remain an illusion without functional logistics systems supported by a healthy supplier base.Item Adherence to Antidiabetic Medications among Women with Gestational Diabetes(Hindawi, 2021) Asiedu-Danso, M.; Kretchy, I.A.; Sekyi, J.K.; Koduah, A.Background. Optimal adherence to prescribed medications in women with gestational diabetes is relevant for perinatal outcomes. Objective. To summarize available information on the prevalence and factors contributing to medication adherence in women with gestational diabetes from the biological and psychosocial perspectives. Methods. A literature search on adherence in gestational diabetes was conducted in PubMed/MEDLINE, CINAHL, Scopus, and the Directory of Open Access Journals for studies published on the topic. The Arksey and O’Malley framework for scoping reviews was used to explore and summarize the evidence. Results. A total of 2395 studies were retrieved of which 13 fully met the eligibility criteria. The studies were reported in Zimbabwe (n = 5), Iran (n = 1), Mexico (n = 1), South India (n = 1), the United States of America (n = 4), and one multinational study covering Australia, Europe, North and South America. The main types of antidiabetic medications used were insulin (n = 6), metformin (n = 4), and glyburide (n = 2). The prevalence of adherence ranged from 35.6% to 97%, with the assessment tool being self-report measures (n = 8). The main factors associated with nonadherence included worsening pregnancy symptoms, side effects of medications, perceived risks, mental health symptoms, poor social support, and socioeconomic status. Recommendations that evolved from the studies to improve adherence included education, counselling, improved support networks, and social interventions, while the main reported interventional study employed continuous education on the impact of adherence on perinatal outcomes. Conclusion. Medication nonadherence in gestational diabetes seems to be influenced by multiple factors with some educational interventions positively impacting adherence behaviours. Thus, future research in women with gestational diabetes could consider interventions from a multifactorial perspective to improve therapeutic outcomes.Item Implementation of medicines pricing policies in sub-Saharan Africa: protocol for a systematic review(BMJ, 2021) Mirzoev, T.; Koduah, A.; de Chavez, A.C.; Baatiema, L.; Danso-Appiah, A.; Ensor, T.; Agyepong, I.A.; Wright, J.M.; Kretchy, I.A.; King, N.Ensuring universal availability and accessibility of medicines and supplies is critical for national health systems to equitably address population health needs. In sub-Saharan Africa (SSA), this is a recognised priority with multiple medicines pricing policies enacted. However, medicine prices have remained high, continue to rise and constrain their accessibility. In this systematic review, we aim to identify and analyse experiences of implementation of medicines pricing policies in SSA. Our ambition is for this evidence to contribute to improved implementation of medicines pricing policies in SSA. We will search: Medline, Web of Science, Scopus, Global Health, Embase, Cairn.Info International Edition, Erudit and African Index Medicus, the grey literature and reference from related publications. The searches will be limited to literature published from the year 2000 onwards that is, since the start of the Millennium Development Goals. Published peer-reviewed studies of implementation of medicines pricing policies in SSA will be eligible for inclusion. Broader policy analyses and documented experiences of implementation of other health policies will be excluded. The team will collaboratively screen titles and abstracts, then two reviewers will independently screen full texts, extract data and assess quality of the included studies. Disagreements will be resolved by discussion or a third reviewer. Data will be extracted on approaches used for policy implementation, actors involved, evidence used in decision making and key contextual influences on policy implementation. A narrative approach will be used to synthesise the data. Reporting will be informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline. No ethics approvals are required for systematic reviews. Results will be disseminated through academic publications, policy briefs and presentations to national policymakers in Ghana and mode widely across countries in SSA.Item Utilization of complementary and alternative medicine for the prevention of COVID-19 infection in Ghana(Preventive Medicine Reports, 2021) Kretchy, I. A.Complementary and alternative medicine (CAM) use is widespread and has played critical roles in preventing infections, including previous coronaviruses. This study sought to document current practices in the use of CAM for the prevention of COVID-19 disease in Ghana. An anonymous electronic survey was conducted from February 1, 2021 to April 30, 2021. Data on demographic characteristics, basic clinical information, illness perceptions about COVID-19, and CAM use during the pandemic period were generated. While about 82.5% (986/1195) of the participants used CAM during the COVID-19 period, 69.1% (681/986) of CAM users intented it for COVID-19 infection prevention. Vitamin supplements (88.1%, 869/986), spiritual healing/prayer (23.3%, 230/986), mineral supplements (22.3%, 220/986), botanical/herbal medicines (22.2%, 219/986), and diet therapy (19.4%, 191/986) were the main types of CAM used. From the adjusted binary logistic regression model, current age (aOR: 1.03, 95%CI: 1.01–1.05), sex (aOR: 1.41, 95%CI: 1.02–1.95), participants’ perceptions of consequences (aOR: 1.10, 95%CI: 1.04–1.17), identity (aOR: 1.15, 95%CI: 1.06–1.25) and concerns about COVID-19 (aOR: 0.91, 95%CI: 0.85–0.97) were statistically significant predictors of CAM use. These results suggest the need for appropriate public health policy on COVID-19 and CAM use in addition to directing further research initiatives toward an optimized COVID-19 prevention scheme using clinically validated CAM treatments. Research to validate the clinical efficacy of these products, especially the herbs, for COVID-19 prevention while isolating lead compounds that could be optimized and used for the treatment and prevention of COVID-19 is also recommended.Item Psychotropic medicine beliefs, side efects and adherence in schizophrenia: a patient–caregiver dyad perspective(International Journal of Clinical Pharmacy, 2021) Kretchy, I.A.; Appiah, B.; Agyabeng, K.; Kwarteng, E.M.; Ganyaglo, E.; Aboagye, G.O.Background Medication adherence is essential in the management of schizophrenia. Yet poor treatment uptake has nega tive consequences on patients and their primary caregivers. Objective To examine the association among beliefs about psychotropic medications, side efects and adherence from a patient-caregiver dyad perspective. Setting This study was conducted in a public psychiatric hospital setting in Accra, Ghana. Methods A cross-sectional study was conducted among 121 patient-caregiver dyads using an interviewer-administered data collection approach.Main outcome measure Beliefs about medicines, side-efects and medication adherence. Results The patient and caregiver-reported level of medication adherence was 28.1%. Using the Kappa index, the level of agreement between the responses of patients and their caregivers ranged from slight to moderate. Both patients and caregivers rated necessity higher than concern (patients: 1.67±0.84, caregiver: 1.79±0.96). Signifcant positive relations between specifc-necessity, necessity–concerns diferential and medication adher ence were recorded while specifc–concern, general harm and side-efects correlated negatively with medication adherence from the dyad. The odds of adhering to medications increased by 58 and 64% for each unit increase in specifc-necessity and general overuse scores respectively. However, a unit increase in specifc–concern score and high side-efects scores were associated with lower odds of adherence. Conclusions This study highlights the need for patient-caregiver collaborations in decision-making relating to medication adherence in schizophrenia. Thus, in clinical practice, there is the need to recognize that caregivers are essential partners, and patient-caregiver views about psychotropic medications are critical in enhancing adherence for positive mental health outcomes.Item Pharmacy premises licensing policy formulation: experience from Ghana(Health Research Policy and System, 2021) Koduah, A.; Sekyi-Brown, R.; Nyoagbe, J.K.N.; Danquah, D.A.; Kretchy, I.Background: Licences to operate pharmacy premises are issued by statutory regulatory bodies. The Health Institu- tions and Facilities Act (Act 829) and Health Professions Regulatory Bodies Act (Act 857) regulate pharmacy premises and the business of supplying restricted medicines by retail, respectively, and this could create a potential regulatory overlap for pharmacy practice in Ghana. We theorise that the potential overlap of regulation duties stems from how law-makers framed issues and narratives during the formulation of these Acts. Objective: To describe the policy actors involved, framing of narratives and decision-making processes relating to pharmacy premises licensing policy formulation. Methods: A qualitative study was conducted and data gathered through interviewing eight key informants and reviewing Hansards, reports, bills, memoranda and Acts 829 and 857. Data were analysed to map decision-making venues, processes, actors and narratives. Results: The Ministry of Health drafted the bills in July 2010 with the consensus of internal stakeholders. These were interrogated by the Parliament Select Committee on Health (with legislative power) during separate periods, and decisions made in Parliament to alter propositions of pharmacy premises regulations. Parliamentarians framed phar- macies as health facilities and reassigned their regulation from the Pharmacy Council to a new agency. The Pharmacy Council and the Pharmaceutical Society of Ghana could not participate in the decision-making processes in Parlia- ment to oppose these alterations. The laws’ contents rested with parliamentarians as they made decisions in venues restricted to others. Legislative procedure limited participation, although non-legislative actors had some level of influence on the initial content. Conclusion: Implementation of these laws would have implications for policy and practice and therefore under- standing how the laws were framed and formulated is important for further reforms. We recommend additional research to investigate the impact of the implementation of these Acts on pharmacy practice and business in Ghana and the findings can serve as bargaining information for reforms.Item Pharmacy premises licensing policy formulation: experience from Ghana(Health Research Policy and Systems, 2021) Koduah, A.; Sekyi‑Brown, R.; Nyoagbe, J.K.N.; Danquah, D.A.; Kretchy, I.Background: Licences to operate pharmacy premises are issued by statutory regulatory bodies. The Health Institutions and Facilities Act (Act 829) and Health Professions Regulatory Bodies Act (Act 857) regulate pharmacy premises and the business of supplying restricted medicines by retail, respectively, and this could create a potential regulatory overlap for pharmacy practice in Ghana. We theorise that the potential overlap of regulation duties stems from how law-makers framed issues and narratives during the formulation of these Acts. Objective: To describe the policy actors involved, framing of narratives and decision-making processes relating to pharmacy premises licensing policy formulation. Methods: A qualitative study was conducted and data gathered through interviewing eight key informants and reviewing Hansards, reports, bills, memoranda and Acts 829 and 857. Data were analysed to map decision-making venues, processes, actors and narratives. Results: The Ministry of Health drafted the bills in July 2010 with the consensus of internal stakeholders. These were interrogated by the Parliament Select Committee on Health (with legislative power) during separate periods, and decisions made in Parliament to alter propositions of pharmacy premises regulations. Parliamentarians framed pharmacies as health facilities and reassigned their regulation from the Pharmacy Council to a new agency. The Pharmacy Council and the Pharmaceutical Society of Ghana could not participate in the decision-making processes in Parliament to oppose these alterations. The laws’ contents rested with parliamentarians as they made decisions in venues restricted to others. Legislative procedure limited participation, although non-legislative actors had some level of influence on the initial content. Conclusion: Implementation of these laws would have implications for policy and practice and therefore understanding how the laws were framed and formulated is important for further reforms. We recommend additional research to investigate the impact of the implementation of these Acts on pharmacy practice and business in Ghana and the findings can serve as bargaining information for reforms.Item Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from low-and middle-income countries(Research in Social and Administrative Pharmacy, 2020-04-15) Kretchy, I.A.; Asiedu-Danso, M.; Kretchy, J-P.The current coronavirus disease 2019 (COVID-19) pandemic is placing a huge strain on health systems worldwide. Suggested solutions like social distancing and lockdowns in some areas to help contain the spread of the virus may affect special patient populations like those with chronic illnesses who are unable to access healthcare facilities for their routine care and medicines management. Retail pharmacy outlets are the likely facilities for easy access by these patients. The contribution of community pharmacists in these facilities to manage chronic conditions and promote medication adherence during this COVID-19 pandemic will be essential in easing the burden on already strained health systems. This paper highlights the pharmaceutical care practices of community pharmacists for patients with chronic diseases during this pandemic. This would provide support for the call by the WHO to maintain essential services during the pandemic, in order to prevent non-COVID disease burden on healthcare systems particularly in low-and middle-income countries