Improving Syrian refugees' knowledge of medications and adherence following a randomized control trial assessing the effect of a medication management review service

Majdoleen Alalawneh, Alberto Berardi, Nabeel Nuaimi, Iman A Basheti, Majdoleen Alalawneh, Alberto Berardi, Nabeel Nuaimi, Iman A Basheti

Abstract

Background: Syrian refugees living in Jordan have many chronic conditions and use many medications. Pharmacists delivering the Medication Management Review (MMR) service can have a role in improving this growing global refugees' problem.

Objectives: To assess the effect of the MMR service on adherence to treatment therapy and knowledge of chronic medications for Syrian refugees residing in Jordan.

Methods: This randomized intervention control single-blinded study was conducted in Jordan. Syrian refugees were recruited and randomized into intervention and control groups. Two home visits were delivered to each participant, at baseline and three months later. All participants completed questionnaires regarding adherence and knowledge. As a part of the MMR service, treatment-related problems (TRPs) were recognized for all patients; recommendations to resolve these TRPs were only delivered to intervention group refugees' physicians; TRPs were corrected. At follow-up, TRPs assessment, adherence and medication knowledge were assessed for all refugee participants.

Results: Participants (n = 106; intervention n = 53, control n = 53) had a number of medications and diagnosed chronic diseases of 5.8 ± 2.1 and 2.97 ± 1.16 per participant respectively. A significant improvement in the adherence and knowledge scores were noted in the intervention (P < 0.001 for both) but not the control group (P = 0.229, P = 0.07 respectively).

Conclusion: The MMR service can significantly improve refugees' TRPs, adherence to therapy and knowledge of chronic medications. If this approach was extended to the large scale, many refugees in need would be able to access a quality essential health-care service; a step towards achieving universal health coverage.

Trial registration: Registry: ClinicalTrials.gov Identifier: NCT04554810.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Consort diagram showing patients’ recruitment…
Fig 1. Consort diagram showing patients’ recruitment and retention during the study period.
Fig 2. ‘Adherence to medication’ mean changes…
Fig 2. ‘Adherence to medication’ mean changes at baseline and follow-up.
Fig 3. The knowledge about drug therapy…
Fig 3. The knowledge about drug therapy mean changes at baseline and follow-up.

References

    1. Doganay M, Demiraslan H. Refugees of the Syrian civil war: impact on reemerging infections, health services, and biosecurity in Turkey. Health security. 2016;14(4):220–5. doi: 10.1089/hs.2016.0054
    1. Guendelman S, Schauffler HH, Pearl M. Unfriendly shores: how immigrant children fare in the US health system. Health Affairs. 2001;20(1):257–66.
    1. Crockett M. New faces from faraway places: Immigrant child health in Canada. Paediatrics & child health. 2005;10(5):277–81.
    1. Sanmartin C, Ross N. Experiencing difficulties accessing first-contact health services in Canada: Canadians without regular doctors and recent immigrants have difficulties accessing first-contact healthcare services. Reports of difficulties in accessing care vary by age, sex and region. Healthcare Policy. 2006;1(2):103.
    1. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al.. Evidence-based clinical guidelines for immigrants and refugees. Cmaj. 2011;183(12):E824–E925. doi: 10.1503/cmaj.090313
    1. Doocy S, Lyles E, Roberton T, Akhu-Zaheya L, Oweis A, Burnham G. Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan. BMC Public Health. 2015;15(1):1097–2106. doi: 10.1186/s12889-015-2429-3
    1. Bailey C, Kodack M. Patient adherence to medication requirements for therapy of type 2 diabetes. International journal of clinical practice. 2011;65(3):314–22. doi: 10.1111/j.1742-1241.2010.02544.x
    1. Basheti IA, El Hait SS, Qunaibi EA, Aburuz S, Bulatova N. Associations between patient factors and medication adherence: A Jordanian experience. Pharmacy Practice (Granada). 2016;14(1):1–7. doi: 10.18549/PharmPract.2016.01.639
    1. Ascione FJ, Kirscht JP, Shimp LA. An assessment of different components of patient medication knowledge. Medical care. 1986:1018–28. doi: 10.1097/00005650-198611000-00006
    1. Williford SL, Johnson DF. Impact of pharmacist counseling on medication knowledge and compliance. Military medicine. 1995;160(11):561–4.
    1. Basheti IA, Ayasrah SM, Ahmad M. Identifying treatment related problems and associated factors among hospitalized post-stroke patients through medication management review: A multi-center study. Saudi Pharmaceutical Journal. 2019;27(2):208–19. doi: 10.1016/j.jsps.2018.10.005
    1. Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of hospitalization resulting from medicine‐related problems in adult patients. British journal of clinical pharmacology. 2014;78(2):202–17. doi: 10.1111/bcp.12293
    1. Stausberg J, Hasford J. Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data. BMC health services research. 2011;11(1):134. doi: 10.1186/1472-6963-11-134
    1. Basheti IA, Qunaibi EA, Bulatova NR, Samara S, AbuRuz S. Treatment related problems for outpatients with chronic diseases in Jordan: the value of home medication reviews. International journal of clinical pharmacy. 2013;35(1):92–100. doi: 10.1007/s11096-012-9713-4
    1. Mahdikhani S, Dabaghzadeh F. Benefits of Pharmacist’s Participation on Hospitalist Team. Acta Medica Iranica. 2016;54(2):140–5.
    1. Ramalho de Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. Journal of Managed Care Pharmacy. 2010;16(3):185–95. doi: 10.18553/jmcp.2010.16.3.185
    1. Castelino RL, Bajorek BV, Chen TF. Are interventions recommended by pharmacists during Home Medicines Review evidence‐based? Journal of evaluation in clinical practice. 2011;17(1):104–10. doi: 10.1111/j.1365-2753.2010.01375.x
    1. Bluml BM. Definition of medication therapy management: development of professionwide consensus. Journal of the American Pharmacists Association. 2005;45(5):566–72. doi: 10.1331/1544345055001274
    1. Basheti IA, Al-Qudah RA, Obeidat NM, Bulatova NR. Home medication management review in outpatients with chronic diseases in Jordan: a randomized control trial. International journal of clinical pharmacy. 2016;38(2):404–13. doi: 10.1007/s11096-016-0266-9
    1. Saleem F, Hassali MA, Shafie AA, Ul Haq N, Farooqui M, Aljadhay H, et al.. Pharmacist intervention in improving hypertension‐related knowledge, treatment medication adherence and health‐related quality of life: a non‐clinical randomized controlled trial. Health Expectations. 2015;18(5):1270–81. doi: 10.1111/hex.12101
    1. Sirin SR, Rogers-Sirin L. The educational and mental health needs of Syrian refugee children: Migration Policy Institute; Washington, DC; 2015.
    1. UNHCR. WHO and UNHCR join forces to improve health services for refugees, displaced and stateless peaple. Available [Accessed May 2020]. 2020.
    1. Voon F. Living in the shadows: Jordan home visits report 2014. United Nations High Commissioner for Refugees, Geneva . 2014.
    1. Stave SE, Hillesund S. Impact of Syrian refugees on the Jordanian labour market: ILO; Geneva; 2015.
    1. Council APA. Guidelines for medication management in residential aged care facilities. Accessed by: . 2007:1–98.
    1. Al-Qudah RA, Bulatova NR, Obeidatc NM, Basheti IA. Impact of home medication management review on medication adherence among Jordanian patients. Journal of Pharmaceutical Health Services Research. 2018;[Accepted].
    1. Freeman CR, Cottrell WN, Kyle G, Williams ID, Nissen L. An evaluation of medication review reports across different settings. International journal of clinical pharmacy. 2013;35(1):5–13. doi: 10.1007/s11096-012-9701-8
    1. Al Alawneh M, Nuaimi N, Basheti IA. Pharmacists in humanitarian crisis settings: Assessing the impact of pharmacist-delivered home medication management review service to Syrian refugees in Jordan. Res Social Adm Pharm. 2019;15(2):164–72. doi: 10.1016/j.sapharm.2018.04.008 Epub Apr 10.
    1. AbuRuz SM, Bulatova NR, Yousef AM. Validation of a comprehensive classification tool for treatment-related problems. Pharmacy World and Science. 2006;28(4):222–32. doi: 10.1007/s11096-006-9048-0
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Medical care. 1986:67–74. doi: 10.1097/00005650-198601000-00007
    1. AbuRuz SM, Bulatova NR, Yousef A-MM, Al-Ghazawi MA, Alawwa IA, Al-Saleh A. Comprehensive assessment of treatment related problems in hospitalized medicine patients in Jordan. International journal of clinical pharmacy. 2011;33(3):501–11. doi: 10.1007/s11096-011-9497-y
    1. Coutts A, Fouad FM. Response to Syria’s health crisis—poor and uncoordinated. The Lancet. 2013;381(9885):2242–3.
    1. El-Khatib Z, Scales D, Vearey J, Forsberg BC. Syrian refugees, between rocky crisis in Syria and hard inaccessibility to healthcare services in Lebanon and Jordan. Conflict and health. 2013;7(1):18. doi: 10.1186/1752-1505-7-18
    1. Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, James Essien E, et al.. A pharmacist telephone intervention to identify adherence barriers and improve adherence among nonadherent patients with comorbid hypertension and diabetes in a Medicare Advantage Plan. Journal of managed care & specialty pharmacy. 2016;22(1):63–73.
    1. Mossialos E, Courtin E, Naci H, Benrimoj S, Bouvy M, Farris K, et al.. From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy. 2015;119(5):628–39. doi: 10.1016/j.healthpol.2015.02.007
    1. Lam WY, Fresco P. Medication adherence measures: an overview. BioMed research international. 2015:1–12. doi: 10.1155/2015/217047
    1. Krousel-Wood M, Elizabeth H, Joyce C, Rachael R, Dornelles A, Webber LS, et al.. Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO). Journal of hypertension. 2015;33(2):412. doi: 10.1097/HJH.0000000000000382
    1. Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services. Drugs. 2009;69(4):393–406.
    1. Brummel A, Carlson AM. Comprehensive medication management and medication adherence for chronic conditions. Journal of managed care & specialty pharmacy. 2016;22(1):56–62. doi: 10.18553/jmcp.2016.22.1.56
    1. Al‐Eidan F, McElnay J, Scott M, McConnell J. Management of Helicobacter pylori eradication–the influence of structured counselling and follow‐up. British journal of clinical pharmacology. 2002;53(2):163–71. doi: 10.1046/j.0306-5251.2001.01531.x
    1. Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. Journal of Managed Care Pharmacy. 2012;18(7):516–26. doi: 10.18553/jmcp.2012.18.7.516
    1. Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication‐taking ability and adherence in older adults prescribed multiple medications. Cochrane Database of Systematic Reviews. 2020;(5). doi: 10.1002/14651858.CD012419.pub2
    1. Chow EP, Hassali MA, Saleem F, Aljadhey H. Effects of pharmacist-led patient education on diabetes-related knowledge and medication adherence: a home-based study. Health Education Journal. 2016;75(4):421–33.
    1. Chisholm-Burns MA, Lee JK, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, et al.. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Medical care. 2010:923–33. doi: 10.1097/MLR.0b013e3181e57962
    1. World Health Organization. Seventieth World Health Assembly. Provisional agenda item 13.1. Human resources for health and implementation of the outcomes of the United Nations’ High Level Commission on Health Employment and Economic Growth. World Health Assembly Journal Available at 18 Accessed 4 February 2018. 2017.
    1. World Health Organization. High-Level Commission on Health Employment and Economic Growth. Working for health and growth: investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. Found at . Accesssed on 4 February 2018. 2016.

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