Pharmacy Practice https://www.pharmacypractice.org/journal/index.php/pp <p><strong>Pharmacy Practice</strong> is a free full-text peer-reviewed journal with a scope on pharmacy practice. <strong>Pharmacy Practice</strong> is published quarterly. <strong>Pharmacy Practice <span style="text-decoration: underline; color: #ff0000;">does not charge any publication fee to the author</span><span style="text-decoration: underline;"><span style="color: #ff0000; text-decoration: underline;">s</span></span></strong>.</p> Centro de Investigaciones y Publicaciones Farmaceuticas en-US Pharmacy Practice 1885-642X <p>The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to <strong>Pharmacy Practice</strong> with this document.</p> <p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="https://creativecommons.org/licenses/by-nc-nd/3.0/" target="_blank" rel="noopener">Creative Commons Attribution License</a> (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana https://www.pharmacypractice.org/journal/index.php/pp/article/view/1151 <p><strong>Objectives</strong>: This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen’s behavioural model.</p> <p><strong>Methods</strong>: A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher’s exact test and multinomial logistic regression models were used to establish association between variables.</p> <p><strong>Results</strong>: A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95%CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant’s source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants’ source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one’s source of medicine information.</p> <p><strong>Conclusions</strong>: Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants’ source of medicine and medicine information was influenced by both predisposing and enabling factors.</p> Mercy N. Opare-Addo Kwame O. Buabeng Afia F. Marfo Francis A. Osei Ellis Owusu-Dabo Daniel Ansong Berko P. Anto Joseph M. Boaheng Isaac Nyanor ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-08-21 2018-08-21 16 3 1151 1151 Knowledge of pharmacists and parents towards antibiotic use in pediatrics: a cross-sectional study in Lebanon https://www.pharmacypractice.org/journal/index.php/pp/article/view/1194 <p><strong>Objectives</strong>: to assess the knowledge of both parents and community pharmacists regarding antibiotics use and resistance in pediatrics in Lebanon.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted between June and August 2017 in community pharmacies. A pre-established questionnaire targeting knowledge of parents and pharmacists regarding antibiotics use/misuse was carried out. An index of knowledge was computed to assess factors associated with good knowledge on antibiotics use/misuse.</p> <p><strong>Results</strong>: The study showed that 28.7% of pharmacists did not know which factors may contribute to antimicrobial resistance. Concerning the misuse of antibiotics, pharmacists blamed at first parents (90.1%), at second level physicians (72.8%), and third themselves (59.4%). Furthermore, pharmacists believed that the socioeconomic problems of the country (86.1%), the level of resistance to the molecule of choice (80.8%), the lack of consultation time (71.2%) and the lack of national guidelines/recommendations (66.3%) might be additional factors contributing to antimicrobial resistance. In case of acute otitis media, the majority of pharmacists chose the correct treatment, dose and duration according to international guidelines; this was in contrast to the results obtained in case of pharyngitis. Female pharmacists had a significantly higher knowledge score compared to their male counterparts (ORa=2.51). Half of parents (42.6%) declared that antibiotics act against both viruses and bacteria, 55.9% still believe that the presence of fever requires the administration of antibiotics, 50% didn’t know the consequences of antibiotics misuse, 58.4% said that it is okay to give their child antibiotics without a physician's advice and/or based on a pharmacist’s recommendation, and 66.7% trusted the pharmacist in the antibiotic prescription. Parents with a university level of education or a master’s degree had significantly better knowledge compared to illiterate ones (ORa=9.04 and ORa=16.46, respectively).</p> <p><strong>Conclusions</strong>: Based on the results obtained, it would be necessary to implement educational campaigns in order to increase awareness on antibiotics misuse and resistance in pediatrics.</p> Lama Zahreddine Souheil Hallit Shadia Shakaroun Amal Al-Hajje Sanaa Awada Nathalie Lahoud ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-08-12 2018-08-12 16 3 1194 1194 Evaluation of a vancomycin dosing nomogram in obese patients weighing at least 100 kilograms https://www.pharmacypractice.org/journal/index.php/pp/article/view/1204 <p><strong>Background</strong>: There remains variability in both practice and evidence related to optimal initial empiric dosing strategies for vancomycin.</p> <p><strong>Objective</strong>: Our primary objective was to describe the percentage of obese patients receiving vancomycin doses consistent with nomogram recommendations achieving targeted initial steady-state serum vancomycin concentrations. Secondary objectives were to describe the primary endpoint in subgroups based on patient weight and estimated creatinine clearance, to describe the rate of supratherapeutic vancomycin accumulation following an initial therapeutic trough concentration, and to describe the rate of vancomycin-related adverse events.</p> <p><strong>Methods</strong>: This single-center, IRB-approved, retrospective cohort included adult patients ≥ 100 kilograms total body weight with a body mass index (BMI) &gt;30 kilograms/m2 who received a stable nomogram-based vancomycin regimen and had at least one steady-state vancomycin trough concentration. Data collected included vancomycin regimens and concentrations, vancomycin indication, serum creatinine, and vancomycin-related adverse events. Patients were divided into two cohorts by goal trough concentration: 10-15 mcg/mL and 15-20 mcg/mL.</p> <p><strong>Results</strong>: Of 325 patients screened, 85 were included. Goal steady-state concentrations were reached in 42/85 (49.4%) of total patients.</p> <p><strong>Conclusions</strong>: Achievement of initial steady-state vancomycin serum concentrations in the present study (approximately 50%) was consistent with the use of published vancomycin dosing nomograms.</p> Riley D. Bowers April A. Cooper Catherine L. Wente Dustin T3 Wilson Steven W. Johnson Richard H. Drew ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-08-13 2018-08-13 16 3 1204 1204 Falls in the elderly: assessment of prevalence and risk factors https://www.pharmacypractice.org/journal/index.php/pp/article/view/1206 <p><strong>Background</strong>: Falls in elderly people can lead to serious health problems. There is limited knowledge about the prevalence of falls, risk factors and causes of falls in the United Arab Emirates.</p> <p><strong>Objective</strong>: To assess the prevalence of falls among older adults aged 60 years and above and to determine the risk factors associated with falls.</p> <p><strong>Methods</strong>: This cross-sectional study was conducted using an anonymous, 20-item questionnaire which was developed in English and Arabic to be delivered as a semi-structured interview. The pre-piloted questionnaire was distributed to 510 families with at least one elderly person. The study was conducted in Sharjah and Dubai, United Arab Emirates, from September to November 2017.</p> <p><strong>Results</strong>: Participants were Arabs (368; 99.5%), living with family (339; 91.6%), females (256; 69.2%), married (240; 64.9%), holders of a university Bachelor’s degree (110; 29.7%), and unemployed (154; 41.6%). Almost half of the participants (188; 50.8%) had a fall in the past two years, and three quarters (141; 75%) of those claimed that their illness was the reason for their fall. The results indicate that female and 70 years and above old participants are more likely to experience falls than males and younger counterparts respectively. A larger proportion of elderly participants not taking medications did not experience falls, while those on 1-4 medications fallers were less than non-fallers. However as the number of medications increased to 5-8 and more than 8 the number of those experiencing falls was significantly higher than non-fallers.</p> <p><strong>Conclusions</strong>: Falls are prevalent among the elderly population studied and efforts should be made to decrease the incidence of falls, identify those at risk and increase awareness about falls and their health consequences among the elderly and the general public.</p> Suleiman I. El-Sharif Alaa B. Al-Harbi Alaa M. Al-Shihabi Dana S. Al-Daour Rubian S. Sharif ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-08-13 2018-08-13 16 3 1206 1206 Measuring the health literacy level of Arabic speaking population in Saudi Arabia using translated health literacy instruments https://www.pharmacypractice.org/journal/index.php/pp/article/view/1223 <p><strong>Background</strong>: Health literacy is an essential predictor of health status, disease control and adherence to medications.</p> <p><strong>Objectives</strong>: The study goals were to assess the health literacy level of the general population in Saudi Arabia using translated Gulf Arabic version of the short-version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and Single Item Literacy Screener (SILS) tests and to measure the relationship between health literacy and education level.</p> <p><strong>Methods</strong>: The study was a cross-sectional with a convenience sample of 123 participants from the general population in Riyadh. Data were collected using the modified (Gulf) Arabic versions of both S-TOFHLA and SILS. Fisher’s Exact test was used to measure the difference of the health literacy scores according to the education degrees and Cronbach’s alpha was used to measure the internal consistency of the S-TOFHLA items.</p> <p><strong>Results</strong>: More than half (55.4%) of the participants were male, 50.4% had a middle school or less education level, and we found that 84.4% had adequate health literacy as measured by the S-TOFHLA, compared to 49.6% as measured by SILS. The Fisher’s Exact test showed a significant difference (P&lt;.05) in the S-TOFHLA and SILS scores according to education categories.</p> <p><strong>Conclusions</strong>: The level of education has a significant positive association with S-TOFHLA and SILS results. The Gulf Arabic version of S-TOFHLA is a reliable test with a good internal consistency and a significant positive correlation between the two parts of S-TOFHLA. We recommend the use of S-TOFHLA or SILS at the first patient visit.</p> <p><strong>&nbsp;</strong></p> Talal M. Alkhaldi Ali A. Al Jumaili Khalid A. Alnemer Khalid Alharbi Elharith S. Alakeel Mohammed M. Alharbi Othman Alshabanah Abdullah B. Juwair Abdullah Khoja ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-07 2018-09-07 16 3 1223 1223 Assessing pet owner and veterinarian perceptions of need for veterinary compounding services in a community pharmacy setting https://www.pharmacypractice.org/journal/index.php/pp/article/view/1224 <p><strong>Background</strong>: Pets, pet owners (referred to as clients in veterinary medicine and throughout this article), veterinarians, and community pharmacies may all benefit from veterinary compounding services provided in community pharmacies, but the benefits of this service are not well-documented in the literature.</p> <p><strong>Objectives</strong>: This study identified perceived benefits and barriers and evaluated the need for veterinary compounding services in community pharmacies; it also evaluated current business practices related to veterinary compounding services.</p> <p><strong>Methods</strong>: A cross-sectional survey was administered to three groups: 1) clients who filled a pet prescription at a study pharmacy, 2) clients who had not filled pet prescriptions, and 3) local veterinarians. Eligible participants were 18 or older; clients must have owned a pet in the past five years. The surveys collected demographic information and assessed benefits, barriers, need, and business practices regarding veterinary compounding services. Demographics were evaluated through descriptive statistics. Responses to Likert-scale items were compared between groups using the Mann-Whitney U test. Qualitative responses were assessed for emerging themes.</p> <p><strong>Results</strong>: One hundred eighteen clients and 15 veterinarians participated in the study. Seventy-two of 116 clients (62%) and eight of 10 veterinarians (80%) agreed that clients would benefit from veterinary compounds provided in community pharmacies. Only 40% of veterinarians agreed that community pharmacists have the knowledge to compound pet medications, compared to 67% of clients (P=0.010). Similarly, 47% of veterinarians agreed that community pharmacists have the skills to compound pet medications, compared to 72% of clients (P=0.016). Forty-eight of 118 clients (41%) would travel 10 miles or more out of their way for veterinary compounding services at community pharmacies.</p> <p><strong>Conclusions</strong>: This study assessed client and veterinarian perceptions of veterinary compounding service benefits, barriers, and need in community pharmacies. Clients identified more opportunities for veterinary compounding services in community pharmacies when compared to veterinarians. Both groups identified a need for veterinary compounding services and agreed community pharmacies providing these services would benefit pets and clients.</p> Shelby A. Bennett Janelle F. Ruisinger Emily S. Prohaska Katelyn M. Steele Brittany L. Melton ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-08-18 2018-08-18 16 3 1224 1224 Potentially inappropriate medication use among older patients attending a geriatric centre in south-west Nigeria https://www.pharmacypractice.org/journal/index.php/pp/article/view/1235 <p><strong>Objectives</strong>: To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients.</p> <p><strong>Methods</strong>: Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer’s criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05.</p> <p><strong>Results</strong>: Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080–2.725)] and being physically active [OR =1.879 (1.026–3.436)] as the most significantly associated with PIMs use.</p> <p><strong>Conclusions</strong>: The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists’, working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons.</p> Wuraola Akande-Sholabi Lawrence A. Adebusoye Olufemi O. Olowookere ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-14 2018-09-14 16 3 1235 1235 Evaluation of a prompt card for community pharmacists performing consultations with patients on anticoagulation – lessons learned https://www.pharmacypractice.org/journal/index.php/pp/article/view/1244 <p><strong>Objectives</strong>: To evaluate a prompt card (i.e., a post-card sized tool that lists counselling prompt information) with 5 key elements and 3 open key questions to ask patients in community pharmacies.</p> <p><strong>Methods</strong>: Community pharmacists practicing in England and accredited to perform consultations used the prompt card during a formal consultation with emphasis on patients receiving oral anticoagulation. Main outcome measure was the number of performed consultations with pharmacists’ thoughts and feedbacks in writing.</p> <p><strong>Results</strong>: During 8 weeks, 19 pharmacists (mean age: 36.6 (SD=9) years; 7 women; accredited an average of 12.9 (SD=9.8) years) performed 1,034 consultations and used the prompt card 104 times during anticoagulation consultations. Overall the prompt card was judged practical and relevant by the 16 pharmacists who used it (100%), especially because it outlines what a good consultation should comprise. The key elements offered a logical framework to guide the overall approach when undertaking a consultation. The two questions, “Why do you want to use this medicine?” and “Why would you not want to use this medicine?” generated negative responses from the patient and pharmacists, respectively.</p> <p><strong>Conclusions</strong>: Our prompt card with key questions summarizing all the points that should be addressed in a consultation supported effective communication during patient-pharmacist interaction. Two questions need rephrasing and a further question is needed to determine how patients are using their medicines.</p> Isabelle Arnet Michael Holden Sotiris Antoniou ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-20 2018-09-20 16 3 1244 1244 Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community https://www.pharmacypractice.org/journal/index.php/pp/article/view/1256 <p><strong>Background</strong>: Benzodiazepine and z-hypnotic prescribing has slowly decreased over the past 20 years, however long-term chronic prescribing still occurs and is at odds with prescribing guidance.</p> <p><strong>Objectives</strong>: To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge.</p> <p><strong>Methods</strong>: Retrospective observational longitudinal cohort study of patients admitted to two adult psychiatric wards between June and November 2012 (inclusive) who were discharged with a prescription for a benzodiazepine or z-hypnotic drug. Routinely collected prescription data available from NHS Scotland Prescribing Information System was used to identify and follow community prescribing of benzodiazepine and z-hypnotics for a 12 month period post-discharge. Data were entered in Excel® and further analysed using SPSS 23. Ethical approval was not required for this service evaluation however Caldicott Guardian approval was sought and granted.</p> <p><strong>Results</strong>: Eighty patients were admitted during the study period however only those patients with a single admission were included for analysis (n=74). Thirty per cent (22/74) of patients were prescribed a benzodiazepine or z-hypnotics at discharge; 14 of whom received ‘long-term’ benzodiazepine and z-hypnotics i.e. continued use over the 12 month period. Seven patients received a combination of anxiolytics and hypnotics (e.g., diazepam plus temazepam or zopiclone). Long-term use was associated with a non-significant increase in median benzodiazepine or z-hypnotic dose, expressed as diazepam equivalents.</p> <p><strong>Conclusions</strong>: One in three patients were prescribed a benzodiazepine or z-hypnotics at discharge with 1 in 5 receiving continuous long-term treatment (prescriptions) for 12 months post-discharge. As chronic long-term B-Z prescribing and use still remains an issue, future strategies using routine patient-level prescribing data may support prescribers to review and minimise inappropriate long-term prescribing.</p> Chris F. Johnson Ola Ali Nassr Catherine Harpur David Kenicer Alex Thom Gazala Akram ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-26 2018-09-26 16 3 1256 1256 Pain management in hospitals: patients’ satisfaction and related barriers https://www.pharmacypractice.org/journal/index.php/pp/article/view/1268 <p><strong>Background</strong>: Suboptimal pain control has been frequently reported in healthcare settings and documented to negatively impact patients’ health. Patients’ perception regarding pain management may influence their satisfaction regarding treatment.</p> <p><strong>Objectives</strong>: This study focuses on the assessment of patients’ satisfaction regarding pain therapy and defining patient-related barriers for its implication.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted in two tertiary care hospitals from April till July 2017. A face-to face interview questionnaire was filled regarding pain scores and patients’ attitudes regarding pain management. Both medical and post-surgical adult patients with all types of pain were eligible to participate. A descriptive analysis of patient satisfaction and perceptions regarding pain management was done.</p> <p><strong>Results</strong>: Results from 183 participants with a mean age of 49 (SD=17.33) revealed that pain was their main reason for hospitalization (71.6% of the cases). Numeric pain scores were recorded only in 14.2% of the patient medical files. Pain intensity documentation by healthcare professionals was found in 41.5% of the cases, and 7.7% of the patients had to wait for more than 30 minutes before getting the pain medication. Around 85% of the patients were satisfied with their pain management. Patients’ barriers to effective pain therapy were mainly fear of adverse effects, addiction, and additional costs (p&lt;0.05).</p> <p><strong>Conclusions</strong>: Pain remains a prevalent problem that requires more efforts for improvement. Our study can effectively serve as a start for larger studies where barriers to pain management can be assessed as an independent variable affecting pain management practice.</p> Samah Tawil Katia Iskandar Pascale Salameh ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-25 2018-09-25 16 3 1268 1268 Knowledge, practice and attitudes regarding antibiotics use among Lebanese dentists https://www.pharmacypractice.org/journal/index.php/pp/article/view/1272 <p><strong>Objectives</strong>: Explore antibiotic use, assess conformity with evidence-practice guidelines, and describe knowledge and attitudinal factors among Lebanese dentists.</p> <p><strong>Methods</strong>: National cross-sectional telephonic survey, using a standardized questionnaire addressing demographic, educational and professional data, usual antibiotics prophylactic and curative prescription pattern and influential factors, knowledge concerning antibiotics use in selected patient-populations, and attitude regarding antimicrobial resistance. Analyses used descriptive statistics, and bivariate analysis to observe predictors of higher knowledge.</p> <p><strong>Results</strong>: the overall response rate for the study was around 21%. 322 dentists participated. On average, 17.51% of consultations resulted in antibiotic use; previous antibiotic experience mostly influenced prescriptions (81.3%). Referral of pregnant and lactating women and cardiac patients, when antibiotics are needed, was high (26.9%, 28.5% and 79.4%, respectively). Macrolides were the dominant first-line antibiotics in penicillin allergy (47.4%). Penicillins were most common for pregnant and lactating women. Penicillins (95.0%), 2g (63.9%), and 1 hour pre-procedure (34%) were the main components of prophylaxis for cardiac patients. Prophylactic and curative use varied widely; few dentists exhibited guideline-conform prescriptions. Mean knowledge scores of prophylaxis for cardiac and non-cardiac patients, and antibiotics’ side effects were predominantly poor (46.75±14.82, 39.21±33.09 and 20.27±18.77, respectively over 100). Practicing outside Beirut, undergraduate qualification in Lebanon, and post-graduate qualification predicted higher knowledge. 75.9% acknowledged the contribution of dentistry-based prescribing to antibiotic resistance and 94.7% knew at least one cause of resistance.</p> <p><strong>Conclusions</strong>: Dentists show positive attitude towards antimicrobial resistance. Yet, they lack uniformity in antibiotic stewardship. Poor knowledge and guideline-incongruent prophylactic and therapeutic prescribing are observed. Development of targeted interventions is needed to promote judicious antibiotic use within Lebanese dentistry.</p> Hicham Mansour Mireille Feghali Nadine Saleh Mona Zeitouny ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-29 2018-09-29 16 3 1272 1272 Management of allergic rhinitis in the community pharmacy: identifying the reasons behind medication self-selection https://www.pharmacypractice.org/journal/index.php/pp/article/view/1332 <p><strong>Background</strong>: Community pharmacists have a key role to play in the management of allergic rhinitis (AR). Their role is especially important because the majority of medications used to treat AR are available for purchase over-the-counter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients’ self-selection often results in suboptimal treatment selection, undertreated AR and poor clinical outcomes. In order for pharmacists to optimise the care for AR patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement.</p> <p><strong>Objectives</strong>: This study aimed to compare the demographics, clinical characteristics and medication selected, between pharmacy customers who choose to self-select and those who speak with a pharmacist when purchasing medication for their AR in a community pharmacy and identify factors associated with AR patients’ medication(s) self-selection behaviour.</p> <p><strong>Methods</strong>: A cross-sectional observational study was conducted in a convenience sample of community pharmacies from the Sydney metropolitan area. Demographics, pattern of AR symptoms, their impact on quality of life (QOL) and medication(s) selected, were collected. Logistic regressions were used to identify factors associated with participants’ medication self-selection behaviour.</p> <p><strong>Results</strong>: Of the 296 recruited participants, 202 were identified with AR; 67.8% were female, 54.5% were &gt;40 years of age, 64.9% had a doctor’s diagnosis of AR, and 69.3% self-selected medication(s). Participants with AR who self-select were 4 times more likely to experience moderate-severe wheeze (OR 4.047, 95% CI 1.155-14.188) and almost 0.4 times less likely to experience an impact of AR symptoms on their QOL (OR 0.369, 95% CI 0.188-0.727).</p> <p><strong>Conclusions</strong>: The factors associated with AR patients’ self-selecting medication(s) are the presence of wheeze and the absence of impact on their QOL due to AR symptoms. By identifying this cohort of patients, our study highlights an opportunity for pharmacists to engage these patients and encourage discussion about their AR and asthma management.</p> Rachel Tan Biljana Cvetkovski Vicky Kritikos Kwok Yan David Price Peter Smith Sinthia Bosnic-Anticevich ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-26 2018-09-26 16 3 1332 1332 Resource-based theory of competitive advantage – a framework for pharmacy practice innovation research https://www.pharmacypractice.org/journal/index.php/pp/article/view/1351 <p>A growing body of research demonstrates the effectiveness of evidence-based pharmacy practice, but too many practice innovations fail to survive past the initial implementation and study phase. This paper presents the resource-based theory of competitive advantage as a framework for describing, understanding, and predicting the adoption and dissemination pharmacy service innovations into routine practice. The theory argues that the sustainability of any business innovation (e.g., pharmacy service) is based upon (1) the internal resources of the firm offering it, (2) the firm’s capabilities in using those resources, (3) the competitive advantage to the firm of its resources and capabilities, (4) the attractiveness of the market in which it competes, and (5) the innovation’s contribution to financial performance of the firm. This paper argues that the resource-based theory of competitive advantage provides a foundation for comparing findings from different research frameworks and studies relating to innovations in services, service processes, and service business models. The paper also poses a number of research questions related to the theory that can be used to further the literature about pharmacy practice innovations. Finally, it makes a case that competition is a fundamental aspect of pharmacy practice and the resource-based theory of competitive advantage can serve as a general theory for studying innovations in pharmacy practice and in the social and administrative sciences.</p> David A. Holdford ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-14 2018-09-14 16 3 1351 1351 Erratum to: What drives using antibiotic without prescriptions? A qualitative interview study of university students in United Arab Emirates https://www.pharmacypractice.org/journal/index.php/pp/article/view/1326 Khalid A. Al-Kubaisi Mark De Ste Croix Don Vinson Suleiman I. Sharif Abduelmula R Abduelkarem ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/2.0/ 2018-07-26 2018-07-26 16 3 1326 1326 The Pharmacist Guide to Implementing Pharmaceutical Care https://www.pharmacypractice.org/journal/index.php/pp/article/view/1364 Fernando Fernandez-Llimos ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/3.0/ 2018-09-23 2018-09-23 16 3 1364 1364