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World Pharmacists Day- What Nigerian Pharmacists can bring to the table

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Adaku Efuribe – A clinical Pharmacist/UN SDGs Advocate

“Safe and effective medicines for all” is the theme of this year’s World Pharmacists Day. (25th September 2019).The theme aims to promote pharmacists’ crucial role in safeguarding patient safety through improving medicines use and reducing medication errors.

“Pharmacists use their broad knowledge and unique expertise to ensure that people get the best from their medicines. We ensure access to medicines and their appropriate use, improve adherence, coordinate care transitions and so much more. Today, more than ever, pharmacists are charged with the responsibility to ensure that when a patient uses a medicine, it will not cause harm”, says FIP President Dominique Jordan.

I believe Nigerian pharmacists are better placed to safeguard patient safety through medicines optimisation and patient centered care. I have observed that this service tends to be lacking in our primary and secondary care facilities because there is a lack of multidisciplinary team approach in some settings. We need to start having these conversations and change the status quo.We need to embrace integrated healthcare. A lot of patients using clinical facilities, do not come in contact with a pharmacist, they do not get their medicines reconciled or reviewed, resulting to exposure to adverse drug-drug interactions and lack of concordance.

As long as we still have some clinicians in Nigeria diagnosing, prescribing, dispensing medication and ‘hiding’ the name of the medicine from the patient; duplication of therapy, adverse drug reactions and drug-drug interactions are inevitable.

Patients have the right to know the medicines they are taking to help achieve concordance and prevent medication errors and overdose.

Pharmacists led medicines review, reconciliation/ optimisation prevents medication errors & adverse drug reactions.

Medicines reconciliation is a process whereby patient’s medicines are reconciled as they move between different stages of healthcare, from primary – secondary care interface. Pharmacists are better placed and equipped to complete the medicines reconciliation process.

Pharmacist led medication review tends to be more in-depth ,capturing all the essence of patient centred care as it offers more time for the patient to ask medicines related questions which enhances concordance.

Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc.

According to the Royal Pharmaceutical Society ‘Medicines optimisation represents that step change. It is a patient-focused approach to getting the best from investment in and use of medicines that requires a holistic approach, an enhanced level of patient centered professionalism, and partnership between clinical professionals and a patient’.

I believe medicines optimisation is about ensuring that patients receive the right kind of medication at the right time. It focuses on making patients get the best out of their medicines. Evidence has shown that a good number of medicines prescribed end up not being taken due to lack of concordance and compliance.

My experience with patient returned medication has shown that patients who do not understand the rationale for prescribed medication are more likely not to use the medication. Also medication used for preventative measures are at a higher risk of non-compliance as patients do not appreciate the benefits of taking such medication.

The gains of patient centered care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into consideration for some elderly patients as well.

In some clinical settings, a lot of patients do not know what regular medicines they are taking or the reason why it has been prescribed, their indication or side effects to expect and they have never had their medication reviewed by a pharmacist since their long term condition was diagnosed.

Part of the role of the pharmacist in a clinical setting is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long term condition like Hypertension, Diabetes, Arthritis, Asthma etc.We need to create the enabling environment for this to be achieved.

For instance, a patent living in Kaduna with a history of hypertension, takes antihypertensive –Calcium channel blocker (CCB) – amlodipine tablets prescribed by his local doctor.

Patient travels to Lagos on official assignment and falls ill, patient gets admitted to a hospital ,diagnosed with very high blood pressure(HBP), patient receives treatment and gets discharged with three other medicines which includes another –CCB-Nifedipine , without being asked about his past medication history  or told what medicines  to stop /continue.

Patient continues to take two CCB –nifedipine and amlodipine at the same time and suffers hypotension (low blood pressure), which makes his condition worse. Patient is re-admitted to hospital in Kaduna, his medication is reviewed by a pharmacist, and he is told to stop Nifedipine and continue taking only Amlodipne.

Learning points- We need to utilise the expertise of pharmacists in all clinical settings.

A medication reconciliation process with a pharmacist during the hospital admission/discharge process in Lagos could have prevented the hypotension resulting from a duplication of therapy.

Evidence has shown that when patients understand the side effects of the medication they take, they are more likely to comply with the dosage regimen.

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The gains of patient centered care cannot be overemphasized; all medical needs have to be tailored to the individual patient, considering their personal circumstance. Pharmacists are better placed to undertake this piece of work.

In the course of completing a medication review with one of my patients, It came to light why patient’s chronic obstructive pulmonary disease (COPD) was not well managed .This patient happened to be visually impaired and was unable to read the small typed instructions on the dispensing label and so assumed tiotropium capsules needed to be swallowed whole and not inserted into the inhalation device. After I offered education, guidance and support to this patient, the patient was able to use her inhaler as intended and her COPD symptoms were well controlled eventually. In this case a possible COPD exacerbation or even hospital admission/death was prevented.

Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc.Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.

As we work towards achieving SDG3 and universal health coverage in Nigeria,

The following simple steps could help reduce the risk of medication errors and medicines related deaths in Nigeria:

  • We have to develop and implement a nationwide strategy which will bring about the desired change in the healthcare system.
  • We need to optimise integrated healthcare and patient centred care using a multidisciplinary team approach.
  • We need to begin to put the patient at the centre of care and utilise the pharmacists expertise and input if we must provide safe and effective medicines for all.

The Ministry of health needs to develop and enforce policies around medicines reconciliation and medication reviews especially for patients with long term conditions who need regular medication to improve their quality of life and increase life expectancy and they must ensure that the ‘drug experts’ are given the opportunity to bring their expertise to the table.

Nigerian Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota towards effective healthcare delivery.

The role of the pharmacist in medicines optimisation and patient centred care cannot be overemphasized.

 

Article by Adaku Efuribe- A clinical Pharmacist/UN SDGs Advocate

Health

Reducing the risk of medication related deaths in Nigeria

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‘As long as we have clinicians who hide the name of prescribed medication from their patients; the rate of duplication of therapy, adverse drug reactions and drug-drug interactions will continue to increase. Patients have the right to know the medicines prescribed for them’ Adaku Efuribe

As we clamour for universal health coverage and achieving the UN SDG goal3- Ensure healthy lives and promote wellbeing for all at all ages. There is one simple step we could take to help improve the health and well- being of Nigerians; we need to bridge the gap of lack of integrated healthcare and patient centred care using a multidisciplinary team (MDT) approach. We need to put the patient at the centre of care and utilise pharmacist knowledge and input if we must prescribe legally and safely.

The rate of medication related deaths due to overdose, adverse drug reaction, drug- drug interactions can be reduced through medicines reviews and medicines reconciliation.

‘As long as we have clinicians who hide the name of prescribed medication from their patients; the rate of duplication of therapy, adverse drug reactions and drug-drug interactions will continue to increase. Patients have the right to know the medicines prescribed for them’

Medicines reconciliation/review

Medicines reconciliation is a process whereby patients’ medicines are reconciled as they move between different stages of healthcare, from primary – secondary care interface.

Also Read: Meet Mariatheresa S. Kadushi, Founder of M-afya, A Mobile App Providing Health Information In Native Languages In Africa

Pharmacist led medication review tend to be more in-depth ,capturing all the essence of patient centred care as it offers more time for the patient to ask medicines related questions which enhances concordance.

The role of the pharmacist as a ‘drug expert’ is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long term conditions like Hypertension, Diabetes, Arthritis ,Asthma etc.

In a typical Nigerian Clinical setting (public and private), when a patient has contact with a clinician, most times, the patient does not have any interaction with a pharmacist. Integrated healthcare is a healthcare model where every member of the healthcare team contributes their own quota towards excellent healthcare delivery.

This true-life story about patient X shows the importance of medicines reconciliation:

 Patient X is a 65-year-old man living in Sokoto, with a history of Hypertension; he takes amlodipine 10mg tablets daily. Patient X travelled to Lagos for a business meeting and he suffered a hypertensive crisis, he got admitted in a hospital in Lagos, his blood pressure was adequately controlled and he was discharged with two other antihypertensives. Patient X did not go through the medicines reconciliation process with a pharmacist or another clinician, so when he got back to Sokoto, he continued to take his newly prescribed antihypertensives in addition to the one prescribed by his doctor in Sokoto.Few days later, Patient X suffered hypotension (low blood pressure) and had a fall on the stairway at home, breaking his hip, which made his condition worse.

A consultation with a pharmacist during the discharge /admission process could have prevented duplication of therapy, and patient educated/informed about which medication to stop/continue and also side effects to expect. Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc. Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.

Education and support for patients on multiple medicines

Evidence has shown that when patients understand the side effects of the medication they take, they are more likely to comply with the dosage regimen. A lot of work needs to be done in the area of patient education and information provided through medicines use reviews. The gains of patient centred care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into consideration for some elderly patients as well.

There has been a drive for more social prescribing, motivational counselling and interventions for patients who have suffered medical emergencies or patients with long term conditions. Evidence has shown that non-pharmacological interventions have a major role to play in achieving overall general health and wellbeing.

Integrated health care approach will reduce the risk of medication related deaths in Nigeria as well as enhance delivery of outcomes. Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota for effective healthcare delivery. Pharmacists are part of the MDT and their expertise need to be utilised more across clinical settings in Nigeria to help prevent medication related errors and deaths. The role of the pharmacist in medicines optimisation, medicines reconciliation and patient centred care cannot be overemphasized.

Article by Adaku Efuribe: A clinical pharmacist & UN SDG Advocate, Adaku advocates for better healthcare systems. She is also a health and wellbeing coach.

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Providing Affordable Healthcare in Nigeria Should Be Everyone’s Business

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Adaku Efuribe

“It is my greatest desire that we improve the healthcare system in Nigeria and provide affordable healthcare for local communities at the grassroots so that people can have access to the care they need, when they need it, in ways that are user-friendly” –  Adaku Efuribe

The 74th UN General Assembly took place in New York last September; high level meetings were held and Universal Health Coverage (UHC) was a hot topic for the week. As expected, Nigeria had a delegation of Government representatives, NGO’s and individual advocates who are working towards achieving SDG3 and UHC in attendance. So how do we implement new policies and what are the key drivers to providing UHC for all in Nigeria?

As an advocate for UHC/SDGs, I have been lending my voice over the years calling the Nigerian Government to action towards implementing UN SDGs agenda and achieving UHC.I have studied and participated in primary healthcare provision in developed economies and can say for sure healthcare provision is very expensive, but I believe we can up our game towards providing primary health care for everyone at the point of need.

Some developed economies have used the tax system to ensure their national health service does not run out of funds, a percentage of all earnings is taxed and put aside in a ‘pot’ to supplement the health budget. From a lay man’s point of view, just like the banking system, we all bank our money at different times and we withdraw money at different times, so for a contributory  healthcare system, everyone will not fall sick at the same time, some will experience life threatening sickness at some point in their life, some would have long term conditions like CVDs, Diabetes, etc., while others would only go through emergencies or minor ailments/major diseases.

In Nigeria for instance, we have a few HMO schemes covering the organised private and public sector. The ‘common man’ on the street does not have any sort of health insurance whatsoever, which leaves them at the mercy of chance. In an unfortunate event of serious illness like cancer or organ failure, they find themselves in a situation where they cannot pay for medical services hence resorting to luck to stay alive. A lot of unavoidable deaths have occurred due to lack of funds to pay for medical treatment.

The public primary care providers are underfunded and the issue of corruption has eaten deep into the fabric of the healthcare system where funds allocated for medical equipment’s, pharmaceuticals etc. are diverted for personal use.

What plans does the present Government in Nigeria have to provide Universal Health Coverage and in so doing, contribute to the economic growth of the Country?

Sustainability can be defined as meeting the needs of today without compromising the needs of tomorrow.

‘As articulated in SDG 3, health is crucial for sustainable human development, both as an inalienable human right and an essential contributor to the economic growth of society. Health contributes to national development through productive employment, reduced expenditure on illness care and greater social cohesion.

We believe that universal health coverage (UHC), delivered through an adequately-resourced and well-governed health system, will be capable of addressing these and other health challenges. Universal health coverage must ensure equitable access to affordable, accountable, appropriate health services of assured quality to all people.

These must include promotive, preventive, curative, palliative and rehabilitative services. UHC must be supported by policies and services addressing the wider social and environmental determinants of health for individuals and populations’. Sustainable Developments solutions network

Key words for providing health systems that works!

  • Well Governed Systems- Are there systems and policies in place that can be retained and continued
  • Promotive- Do we have health promotion strategies in place to promote good health and wellbeing
  • Preventative- Are we taking preventative measures seriously, screening, vaccination, reducing CVD risk through lifestyle management?
  • Curative- When we fall ill or in times of emergency, do we have access to affordable healthcare, or does sickness lead to poverty?
  • Palliative and rehabilitative services- For terminally ill patients, do we have plans for social prescribing and support? For people engaged in substance misuse, do we have plans for treatment, rehabilitation and integration back into the society

WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in countries: Where does Nigeria rank in the indicators?

Reproductive, maternal, newborn and child health:

  • Family planning
  • Antenatal and delivery care
  • Full child immunization
  • Health-seeking behaviour for pneumonia

Infectious diseases:

  • Tuberculosis treatment
  • HIV antiretroviral treatment
  • Hepatitis treatment
  • Use of insecticide-treated bed nets for malaria prevention
  • Adequate sanitation.

Noncommunicable diseases:

  • Prevention and treatment of raised blood pressure
  • Prevention and treatment of raised blood glucose
  • Cervical cancer screening
  • Tobacco (non-)smoking.

Service capacity and access:

  • Basic hospital access
  • Health worker density
  • Access to essential medicines
  • Health security: compliance with the International Health Regulations.

Also Read: Meet Mariatheresa S. Kadushi, Founder of M-afya, A Mobile App Providing Health Information In Native Languages In Africa

The Nigerian Government can do more to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services. We can subsidise the payment for health services and provide emergency health care at the point of need by ensuring we are constantly reviewing our health policies and implementing proven international strategies. The Health budget does not in any way reflect the health needs of Nigerians, this needs to be reviewed.

As Individuals, if we take health promotion seriously, and change our lifestyle habits, then we can make changes that would reduce the cost of health as well.

Adaku Efuribe is an SDGs/UHC Advocate & Clinical Pharmacist with expertise in medicines management, integrated healthcare and health promotion.

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GE Healthcare Launches Versana Ultrasound Machines to Drive Access to Affordable and Quality Healthcare in Uganda

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GE Healthcare team displaying the Versana Premier and Versana Essential Ultrasound machines during the Uganda Society for Advancement of Radiology and Imaging Conference (USOFARI).

This innovative system is well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care

KAMPALA, Uganda, November 11, 2019- GE Healthcare has announced the launch of Versana Premier and Versana Essential for the first time in Uganda. The launch was announced during the Uganda Society for Advancement of Radiology and Imaging Conference (USOFARI).

Versana Premier is a world-class ultrasound designed for peace of mind, easy to use and easy to own. The Versana Premier ultrasound system can help deliver high-quality, personalized care, patient after patient, day after busy day. This innovative system is well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care. It also comes with local product and clinical training to help healthcare professionals gain comfort and proficiency with the system to enhance patient care.

Versana Essential is a complete ultrasound solution that healthcare professionals can learn to use quickly and productively. It enables confident clinical decision making for quick referrals and immediate clinical correlation to help scan a wide range of patients. The machine is designed with the growing medical center in mind, to provide the clinical capability and support they want without compromising the quality, reliability, and affordability needed.

Both Versana Premier and Versana Essential are part of the Versana ultrasound family, which comprises of solutions that help to empower care without compromise, balancing capability, affordability, and reliability. These innovative systems found within the GE Healthcare Primary Care Ultrasound Segment are well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care.

“We are excited to participate in this year’s USOFARI conference together with other private and public partners in an effort to continue providing the latest imaging solutions to enhance early detection of diseases and ultimately the most appropriate treatment for patients,” said Andrew Waititu, General Manager, GE Healthcare East Africa. “The launch of Versana Premier and Versana Essential is a testament of our continuous investment in innovations that help to drive access to affordable and quality healthcare for all across Uganda.”

Also Read Meet Mariatheresa S. Kadushi, Founder of M-afya, A Mobile App Providing Health Information In Native Languages In Africa

Universal Health Coverage (UHC) is part of the United Nations sustainable development goals, to ensure that every person, everywhere, should have access to quality healthcare. As part of its vision 2040 and the health sector development plan, Uganda seeks to accelerate movement towards UHC with among others, essential health and related services needed for promotion of a healthy and productive life. 

GE Healthcare

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