Recruitment of participants and data collection
hypertensive, intervention-46, 140 diabetes, hypertension, diabetes
HYPERTENSION, DISEASES, DIABETES
Sequel to acquiring ethics approval from each hospital review board, the approvals of heads of different units/departments where the study was undertaken were also secured. Total sampling of the entire pharmacists at the control and intervention sites was adopted for the study. The purpose of the study was explained to all the pharmacists and consulting physicians in each hospital. Thereafter, pharmacists were visited in their different units and the questionnaire administered to those who gave informed consent. The study, which was a mixed-method non-randomised clinical trial utilised self-administered questionnaire (Q2) among 146 pharmacists (intervention site-85; control site-61) to directly evaluate their medication reconciliation practice. Ambulatory diabetes and/or hypertensive patients were visited on their respective clinic days during which the purpose of the study was explained in English and Yoruba (local language), as required. Interviewer-administered semi-structured questionnaires (Q1 and Q3) were employed to carry out medication reconciliation for a total of 660 ambulatory patients (Q1 for 520 and Q3 for 140 diabetes and/or hypertension patients) throughout the study in different cohorts to indirectly evaluate the pharmacists’ medication reconciliation practice, at both sites. Patients with diabetes and/or hypertension were targeted because of the prevalence of the two diseases in Nigeria (5.77% for diabetes and 30.6% for hypertension) [Baseline medication reconciliation practice of the pharmacists was indirectly evaluated as the principal investigator carried out medication reconciliation among a cohort of 334 (intervention-183; control-151) out of the 660 patients. Thereafter, a general educational intervention was carried out among the 85 pharmacists, hereafter referred to as intervention pharmacists, in the intervention group to address the medication reconciliation practice gaps observed at baseline. The semi-structured questionnaire (Q2) was administered to pharmacists at the intervention site at one, three and six months to assess their medication reconciliation practice of the pharmacists after the general educational intervention. The effect of the intervention on pharmacists’ medication reconciliation practice was also indirectly evaluated using Q1 as the principal investigator carried out medication reconciliation among cohorts of 96 (intervention-46; control-50) patients at three months and 90 (intervention-44; control-46) at six months postintervention. This was followed by a focused educational intervention for 15 pharmacists (a subset of the initial 85 intervention pharmacists) at the Geriatric Center of the intervention site. The data collected by the 15 pharmacists after carrying out medication reconciliation for a cohort of 140 patients was independently reviewed by three experts, who were faculties at the Department of Clinical Pharmacy and Pharmacy Administration of the University of Ibadan. The three experts in this study were faculties at the Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Nigeria. They were selected based on their competence in the core areas of medication reconciliation, which includes comprehensive medication history taking, documentation of clinical care activities, identification and resolution of drug therapy problems as well as medication discrepancies. The criteria to define them as experts in clinical pharmacy includes the fact that they have several years of teaching and research experience in Clinical Pharmacy. The three experts comprised an Associate Professor and two Senior Lecturers who are well versed in intervention studies aimed at improving the quality of care provided by pharmacists for patients. They have also made extensive contributions in Clinical Pharmacy with several articles published in both local and international peer-reviewed journals. Outcomes measured included identification and resolution of drug therapy problems, medication discrepancies and patients who brought their medication packs for clinic appointment.