Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Candidate PharmDr. Abobakr Abasaeed Elhag Supervisor prof. RNDr. Jiří Vlček, CSc. Title of Doctoral Thesis Analysis of the Use of Antibiotics in the United Arab Emirates Introduction and Aims: The misuse of antibiotics for viral infections (for which they are of no value) and the immoderate use of broad spectrum antibiotics instead of narrower spectrum antibiotics have been well-documented and reported. Therefore the inappropriate use of antibiotics is getting a global problem, mainly in the developing countries. Emergence of antibiotics resistance is often a result of irrational prescribing patterns, misuse of the antibiotics as well as self-medication. Although the United Arab Emirates (UAE]) antimicrobial policy restricts dispensing of antibiotics without prescription , studies revealed the wide availability of these agents over the counter (OTC), their over prescribing pattern and the high prevalence of self-medication with antibiotics, unfortunately and regardless of this results, there is a lack and paucity in studies that tracking the prevalence of antibiotics resistance. The aim of our research was to evaluate the attitude of the community towards the use of antibiotics, estimate...

Class of 2014 Abstract / Specific Aims: The purpose of this quality improvement project was to compare the completeness of home medication lists generated upon hospital admission between pharmacy student interns and nurses. Methods: This project was a retrospective review of completed home medication lists obtained by pharmacy student interns or nurses in a Southern Arizona community hospital. During August and September 2013, medication lists from the previous day’s admissions were collected and de-identified. Medication lists were included in the evaluation if the patient was admitted directly to the hospital or through the emergency department, stayed for at least 24 hours and had at least one home medication upon admission. The primary outcome was the number of omissions left on home medication lists completed by pharmacy student interns or nurses. An omission was defined as any missing information in the medication list categories of drug name, dose, unit, route or frequency. Main Results: Fifty medication lists that included 519 medications were collected in the pharmacy student intern group and forty-four lists that included 376 medications were collected in the nurse group. Of the total medications, nurses left significantly more omissions in the categories of dose (19% vs. 1.9%), units (20.2% vs. 2.3%), and frequency (11% vs. 0.7%), where the P-value was < 0.05 for each. Lastly, the total number of omissions left by nurses compared to pharmacy student interns was significantly different (201 vs. 35 omissions, P < 0.05). Conclusion: Compared to nurses, these results suggest pharmacy student interns left fewer omissions and created a more complete home medication list for patients being admitted to the hospital.

Class of 2014 Abstract / Specific Aims: The primary aim of this project was to determine how receptive patients of Avella Specialty Pharmacy are towards using a mail-back medication disposal envelope by phone survey. This evaluated the hypothesis: participants in the Avella Pharmacy Medication Mail-Back Program will find the program helpful and easy to use. A secondary aim was to describe the participation in Avella’s pharmacy based medication mail-back program. This evaluated the hypothesis: Avella’s pharmacy based mail-back program will produce more participants versus non-participants. Methods: Patients of Avella Specialty Pharmacy with unused medications from discontinued prescriptions for any reason were offered a pre-paid Take Away™ envelope to dispose their medications. Each patient who accepted an envelope was called and asked about their experience using the envelope. Main Results: The majority of patients (58%) who were offered a medication disposal envelope agreed to receive one. All of the respondents surveyed indicated they would use their envelope to mail medications back. Patients of Avella Specialty Pharmacy think medication disposal envelopes are easy (100%) and helpful (97%) to use. Utilizing the trash or toilet to dispose of medications made up 41% of responses when asked about their usual method of medication disposal. A majority of respondents (74%) had not heard of a medication disposal program before Avella’s call regarding the envelope. Conclusion: Medication mail-back disposal envelopes are helpful and easy to use for disposing of unused medications among Avella Specialty Pharmacy patients. The majority of Avella Specialty Pharmacy patients are receptive towards receiving and using medication mail-back disposal envelopes.

Class of 2017 Abstract / Objectives: Medication adherence tools and technologies can have a significant impact on the level of drug therapy continuation as well as improved outcomes. The RxTimerCap© is a device that aims to act as a medication adherence cap with an embedded timer to indicate the time since the medication was last taken. Our aim was to assess if this cap technology would aid in increased drug adherence and duration of therapy with abiraterone (Zytiga®). Methods: The study was a prospective, single-center, interventional study that included males 18 or older being treated with Zytiga for castration-resistant metastatic prostate cancer. Medication possession ratio (MPR) and duration on therapy were the primary measures used to assess if there would be improved adherence. Paired t- tests were used to analyze the data and assess the significance of the outcomes. Results: There was no significant difference between patients in MPR (p = 0.50) or in the duration of treatment (p = 0.20). Conclusions: The difference in adherence rates for patients using the RxTimerCap© and those using the standard vial cap were non-significant. The limited size of our study population and short study duration may have led to these undifferentiated outcomes. Future studies should examine this type of adherence technology in a larger sample of patients with a prolonged window of observation to better assess the benefits of using the RxTimerCap©.

Class of 2016 Abstract / Objectives: The specific aims of this study were: 1) describe the frequency of off-label medication use in pediatric discharge medication regimens, 2) compare the frequency of FDA-approved and off-label medication use in pediatric discharge medication regimens, and 3) identify potential patient-specific risk factors, including use off-label use of medications, associated with 90-day readmission. Methods: This was a retrospective chart review of pediatric patients admitted to a tertiary academic medical center during a 6-month period. Inclusion criteria included age less than 18 years of age and admission between January 1, 2014 and June 30, 2014. Exclusion criteria included admission for oncology chemotherapy, admitted < 24 hours, admission to NICU only and patient expiration prior to discharge. Data collection included patient demographics, types and number of medications, and FDA approved and off-label indication of medications. Data analyses were completed on STATA 11.0 (College Station, TX) including student t-test/Mann Whitney U and Chi square/Fisher Exact test with a priori of α= 0.05. Results: A total of 706 admissions were included in the study. There were no significant differences in demographic characteristics between groups (readmitted within 90 days of discharge vs. not readmitted within 90 days of discharge) except sex (males vs. females, 56.3% vs. 44.2%, p=0.034). Length of hospital stay was significantly higher in subjects readmitted within 90 days of discharge compared to those who were not (8.55 ± 12.5 vs. 3.79 ± 4.43 days, p<0.001). Number of medications at discharge (7.31 ± 5.92 vs. 2.91 ± 2.93, p<0.001) and total number of non-FDA approved medications (3.16 ± 3.81 vs. 1.12 ± 1.44, p<0.001) were all significantly higher in subjects readmitted within 90 days of discharge compared to those who were not. The percentages of patients taking medications related to cardiovascular (6.1% vs. 2.4%, p=0.002), electrolytes and nutrition (12.2% vs. 8.5%, p=0.007), and gastrointestinal (19.2% vs. 14.3%, p=0.004) disorders were significantly higher in the subjects readmitted within 90 days of discharge compared to those who were not. Additonally, subjects readmitted within 90 days of discharge (versus those not readmitted within 90 days) demonstrated less use of medications related to neurology (17.7% vs. 25.8%, p<0.001) and respiratory (16.4% vs. 21.4%, p=0.008) disorders. A significantly higher percentage of subjects whose third party payor was Medicaid, were readmitted within 90-days of discharge (69.7% vs. 58.3, p=0.045). Conclusions: In comparing several characteristics of pediatric patients readmitted to a tertiary medical center within 90 days of discharge versus those who were not, it was noted that several factors may be associated with readmission, including: sex, length of initial hospital stay, third-party payor, and the number of medications as well as the types of medication a patient takes. Future research may be warranted to further investigate these potential patient-specific factors in helping identify children at increased risk for readmission and develop more effective approaches to patient education, discharge planning, and continuity of care to reduce preventable readmission.

Class of 2016 Abstract / Objectives: To first educate undergraduates involved in social sororities about prescription stimulant medications and to evaluate the effectiveness of an educational intervention in influencing the attitudes and beliefs regarding prescription stimulant medication use of undergraduates involved in social sororities. Methods: The intervention, an educational session, was presented to undergraduates involved in social sororities. The questionnaire collected demographic data regarding gender, age, ethnicity, race, undergraduate year, grade point average, type of sorority member, history of an attention-deficit/hyperactivity disorder (ADHD) diagnosis, and previous or current non-medical use of prescription stimulants. The participants’ attitudes and beliefs on nine statements regarding prescription stimulants were queried pre- and post-intervention using a four-point Likert scale ranging from strongly disagree to strongly agree. To analyze changes in attitudes and beliefs, Mann-Whitney test was used. Results: One hundred sixty-three sorority members participated in the study. The average age of participants was 19 years with the majority of respondents identifying as an active sorority member (81%) and in their first year of undergraduate study (69%). There was a statistically significant change in beliefs regarding the safety (p < 0.01) and health risks (p = 0.02) associated with prescription stimulants. There was no significant difference in topics relating to addiction, legal issues of taking someone else’s prescription medications, emotional and academic outcomes from the use of prescription stimulants. Conclusions: The educational program presented by pharmacy students was effective in changing the beliefs and attitudes regarding safety and health risks of prescription stimulants among undergraduate students involved in social sororities.

Class of 2013 Abstract / Specific Aims: The purpose of the study is to describe the reasons for medication disposals at Take-Back-Rx events and make inferences regarding medication adherence. Methods: Participants at Take-Back-Rx were invited to complete a survey that collected information on the participants current medical conditions, associated medications, unwanted medications, and demographic information. Main Results: The majority of participants were non-Hispanic White (89.2%) on Medicare (87.8%) with at least some college education (72.1%). The mean number of reasons listed for disposal was 2.25 and the majority of medications were expired (70%) or the dose/agent changed (47%). Conclusion: This study effectively described the reasons for medication disposals at Take-Back Rx events, but applicability to further patient populations may be limited due to shortcomings of the instrument.

Class of 2011 Abstract / OBJECTIVES: To determine whether perceptions of drug disposal among patients are driven by environmental concerns or medication diversion, to determine the preferred method of medication disposal, and to identify related demographic characteristics. METHODS: This was a descriptive cross sectional study. The primary dependent variable is patients' perception of medication disposal. The secondary dependent variables include the impact of income and the preferred method of disposal. Demographic variables include age, medication use, education level, gender, and average household income. RESULTS: The paper survey was completed by 86 patients. Overall, study participants were more concerned with environmental concerns (69.6%, p<0.001) rather than with medication diversion (11.4%) or convenience (19.0%). In the disposal of medications, study participants preferred dropping off medications at a pharmacy (43.8%, p<0.001) to disposing medications at a secure drop off point (17.2%) , crushing medications into coffee grounds (28.9%), or mailing medications to a secure federal collection site (10.2%). Income level of the participants had no impact on their perception of drug disposal or preferred method of medication disposal. CONCLUSION: Patients' perception of drug disposal is more related to environmental concerns than with medication diversion or convenience. Patients' preferred method of medication disposal was pharmacy drop-off as opposed to driving to a secure medication drop off point, crushing medications into coffee grounds, or mailing medications to a secure federal site.

Class of 2005 Abstract / Objective: To determine whether prescription medication vials are exposed to excessive temperatures during delivery by mail or truck by recording temperatures continuously throughout the delivery process. Methods: During one part of the study, temperatures were recorded, starting when the package, housing the prescription vial and digital thermometer, was placed in the mailbox in Phoenix and continued every 15 minutes until the package was retrieved from the researcher’s mailbox in Tucson. During the second component of the study, temperatures were recorded starting when the package was dropped off at the shipping facility and continued every 15 minutes throughout ground delivery by truck until the package was delivered to the researcher’s home. Ten trials were done for each arm of the study on five different days, with two packages for each arm being sent each time. Results: There were 1,300 temperature readings for the mail arm of the study. Five hundred twenty-two temperature readings were in excess of the desired range of 59-86ο F; for a percentage of 40.1%. For the truck arm of the study, there were 1,272 temperature readings. Three hundred sixty-nine temperature readings were in excess of the desired range; a percentage of 29.0%. Temperature readings ranged from 69.8-111.2ο F for the mailed packages and 70.7-120.5ο F for the packages sent by truck. Conclusions: Prescription medication vials are subjected to excessive temperatures during delivery by mail and truck.

Class of 2005 Abstract / Objectives: To determine compliance rate of patients enrolled in the AIDS Drug Assistance Program (ADAP) at El Rio Health Center. Methods: This study was a retrospective observational study design that utilized medication refill data obtained from computerized pharmacy records. Lists were created for each anti-retroviral drug that included the following data: medical record number, medication, quantity dispensed, days supply and refill date. Patient age, gender and ethnicity were also obtained. The data was compiled into a database using Microsoft Excel©. The medication possession ratio (MPR) was calculated for each drug as well as for each drug group. The subjects in this study were patients enrolled in the ADAP at El Rio Health Center who obtained prescription refills between December 1, 2003 and November 30, 2004. The mean age was 44.56 (range 25-78); 94.8% were male and 5.2% were female. Ethnic distribution included 52.6% Caucasian, 39.6% Hispanic, 3.2%African American, 1.3% Asian, and 3.2% other. Results: The MPR was calculated for each drug as well as for each drug group. MPRs for individual drugs ranged from 0.586-0.906; MPRs for drug groups ranged from 0.717-0.756. Implications: The results of the study indicated that ADAP patients did not have adequate (>95%) compliance rates. The implications of the results are that patients are not fully benefiting from their medication, while at the same time promoting the development of resistant strains of HIV.