ORCID Profile
0000-0002-6826-4817
Current Organisation
Deakin University
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Publisher: Elsevier BV
Date: 05-2017
Publisher: Informa UK Limited
Date: 03-2022
DOI: 10.1080/14740338.2022.2044786
Abstract: Hyper-polypharmacy and potentially inappropriate prescribing (PIP) are common among older inpatients. This study investigated associations between hyper-polypharmacy and PIP with clinical and functional outcomes in older adults at 3-months after hospital discharge. At discharge, prescribed medications were collected and PIPs, comprising potentially inappropriate medications (PIM) and potential prescribing omissions (PPO), were retrospectively identified using STOPP/START version 2. Outcomes were collected prospectively via telephone follow-up and audit. Data for 232 patients (mean age 80 years) were analyzed. PIP prevalence at discharge was 73.7% (PIMs 62.5%, PPOs 36.6%). Exposure to at least 1 PIM was associated with an increased occurrence of unplanned hospital readmission (adjusted odds ratio (AOR) 5.09 95% CI 2.38─10.85), emergency department presentation (AOR 4.69 95% CI 1.55─14.21) and the composite outcome (AOR 6.83 95% CI 3.20─14.57). The number rather than the presence of PIMs was significantly associated with increased dependency in at least 1 activity of daily living (ADL) (AOR 2.31 95% CI 1.08─4.20). Increased PIP use was associated with mortality (AOR 1.45 95% CI 1.05─1.99). PIPs overall, and PIMs specifically, were frequent in older adults at hospital discharge, and were associated with increased re-hospitalizations and dependence in ADLs at 3-months post-discharge.
Publisher: Hindawi Limited
Date: 23-02-2016
DOI: 10.1111/JCPT.12364
Abstract: Medication reconciliation is recognized as an important tool for the prevention of medication discrepancies and subsequent patient harm at care transitions. However, there is inconclusive evidence as to the impact of medication reconciliation at hospital transitions overall, as well as pharmacy-led medication reconciliation services. This review sought to evaluate the impact of pharmacy-led medication reconciliation interventions on medication discrepancies at hospital transitions and to categorize these interventions as single transition interventions or multiple transitions interventions. PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO databases, inclusive from inception to December 2014, were searched. Included studies were published studies in English that compared the effectiveness of pharmacy-led medication reconciliation interventions to usual care and that aimed to assess medication discrepancies at hospital transitions. 'Usual care' was defined as any care where targeted medication reconciliation was not undertaken as an intervention, or if an intervention was conducted, it was not provided by a pharmacist harmacy technician. Nineteen studies which involved a total of 15 525 adult patients were included. Eleven studies were randomized controlled trials. Overall, pharmacy-led medication reconciliation intervention usually revealed a trend towards reduction in medication discrepancies, compared with usual care. Seventeen studies involving 18 medication reconciliation interventions targeting the various transitions (admission, 9 discharge, 4 and multiple transitions, 5) were included in the meta-analysis. Compared with usual care, single medication reconciliation interventions at transitions in care (either admission or discharge) showed a significant reduction of 66% in patients with medication discrepancies (RR 0·34 95% CI: 0·23-0·50) in favour of the intervention. There was no difference between groups for interventions targeting multiple transitions (RR 0·88 95% CI: 0·77-1·02). Subgroup analyses confined to RCTs showed that there were no differences for target of transition (admission vs. discharge), type of intervention (multifaceted intervention vs. medication reconciliation) and setting (single centre vs. multicentre), nor pharmacists vs. pharmacy technicians (non-RCTs only). Importantly, medication discrepancies of higher clinical impact were more easily identified through pharmacy-led interventions than with usual care. Pharmacy-led medication reconciliation interventions were found to be an effective strategy to reduce medication discrepancies, and had a greater impact when conducted at either admission or discharge but were less effective during multiple transitions in care. Further studies that are designed to assess the impact of the involvement of pharmacy technicians in medication reconciliation are also needed.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 07-12-2016
Publisher: Springer Science and Business Media LLC
Date: 23-06-2014
Publisher: Wiley
Date: 18-05-2021
DOI: 10.1111/BCP.14870
Abstract: To synthesise associations of potentially inappropriate prescribing (PIP) with health‐related and system‐related outcomes in inpatient hospital settings. Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA and Cochrane library. Studies published between 1 January 1991 and 31 January 2021 investigating associations between PIP and health‐related and system‐related outcomes of older adults in hospital settings, were included. A random effects model was employed using the generic inverse variance method to pool risk estimates. Overall, 63 studies were included . Pooled risk estimates did not show a significant association with all‐cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90–1.36 adjusted hazard ratio 1.02, 83% CI 0.90–1.16), and hospital readmission (AOR 1.11, 95% CI 0.76–1.63 adjusted hazard ratio 1.02, 95% CI 0.89–1.18). PIP was associated with 91%, 60% and 26% increased odds of adverse drug event‐related hospital admissions (AOR 1.91, 95% CI 1.21–3.01), functional decline (AOR 1.60, 95% CI 1.28–2.01), and adverse drug reactions and adverse drug events (AOR 1.26, 95% CI 1.11–1.43), respectively. PIP was associated with falls (2/2 studies). The impact of PIP on emergency department visits, length of stay, and health‐related quality of life was inconclusive. Economic cost of PIP reported in 3 studies, comprised various cost estimation methods. PIP was significantly associated with a range of health‐related and system‐related outcomes. It is important to optimise older adults' prescriptions to facilitate improved outcomes of care.
Publisher: Wiley
Date: 03-2016
DOI: 10.1002/JPPR.1155
Publisher: SciELO Espana/Repisalud
Date: 03-2013
Publisher: Elsevier BV
Date: 2017
Publisher: Elsevier BV
Date: 2017
Publisher: BMJ
Date: 11-2016
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.PEC.2014.12.012
Abstract: The objective of this study is to use the Transtheoretical behavioral model to assess male involvement in family planning. A cross-sectional study was conducted in Angolela-Tera District of Amhara Region from February 15 to March 14, 2008 on married men. Multi-stage s ling technique was employed to select the 770 study participants. The relationship of stage of change and decisional balance, self-efficacy and processes of change was assessed by ANOVA tests. 225(30.5%) of the men were in the Precontemplation stage, 235(31.8%) were in the contemplation stage, 81(11.0%) were in preparation, 76(10.3%) were in action stage, and, 121(16.4%), were in the maintenance stage. Confidence increased across the stages while experiential and behavioral processes increased in the early stages and then decreased at a transition from action to maintenance stage. The pros were increased across the stages, the cons decreased and a crossover occurred prior to contemplation stage. The findings suggest that counselors need to understand that behavior change is a process that occurs in a series of stages and therefore can facilitate behavioral changes with various strategies. Health educators need to develop educational components that match stages of change. Based on our results, programs aimed at promoting contraceptive prevalence for contraception should seek ways and means for increasing the pros and for increasing self-efficacy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 23-01-2018
Publisher: BMJ
Date: 02-2016
Publisher: Springer Science and Business Media LLC
Date: 29-10-2022
DOI: 10.1007/S40271-021-00553-9
Abstract: Understanding the preferred choice of healthcare service attributes for women is important, particularly in sub-Saharan Africa where resources are constrained and improving reproductive and maternal healthcare services is of high importance. The aim of this systematic review was to identify attributes of reproductive and maternal healthcare services in sub-Saharan Africa, and summarise the factors shaping women's preference to access these services. PubMed/MEDLINE, EMBASE, PsycINFO and CINAHL were searched from the inception of each database until March 2021 for published studies reporting stated preferences for maternal and reproductive healthcare services in sub-Saharan Africa. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using PREFS and ISPOR (International Society for Pharmacoeconomics and Outcomes Research) checklists. The Donabedian's model for quality of healthcare was used to categorise attributes into "structure", "process" and "outcome". A total of 13 studies (12 discrete choice experiments and one best-worst scaling study) were included. Attributes related to the structure of healthcare services (e.g. availability of technical equipment, medications or diagnostic facilities, having good system conditions) are often included within the studies, and are considered the most important by women. Of the three dimensions of quality of healthcare, the outcome dimension was the least frequently studied across studies. All except one study explored women's preferences and the participants were pregnant women, women aged 18-49 years who had recently given birth and women living with human immunodeficiency virus. The included studies came from five sub-Saharan Africa countries of which Ethiopia and South Africa each contributed three studies. All of the included studies reported on the purpose, findings and significance of the study. However, none of the studies reported on the differences between responders vs non-responders. Nine of the 13 studies employed the ISPOR checklist and reported each item including the research question and the methods for identifying and selecting attributes, and provided the findings in sufficient detail and clarity. Aligning maternal healthcare service provision with women's preferences may foster client-oriented services and thereby improve service uptake and better patient outcomes.
Publisher: Springer Science and Business Media LLC
Date: 09-02-2021
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-044606
Abstract: COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km. This study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples’ Region. The risk of COVID-19-related death is high in the country’s border regions, where public health preparedness for responding to COVID-19 is limited. This study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2018
DOI: 10.1007/S11096-018-0722-9
Abstract: Background The role of pharmacists in medication reconciliation (MedRec) is highly acknowledged in many developed nations. However, the impact of this strategy has not been well researched in low-and-middle-income countries, including Ethiopia. Objective The aim of this study was to investigate the impact of pharmacist-led MedRec intervention on the incidence of unintentional medication discrepancies in Ethiopia. Setting Emergency department in a tertiary care teaching hospital in Ethiopia. Method A single centre, prospective, pre-post study was conducted on adults (aged 18 years or over) that had been hospitalized for at least 24 h and were taking at least 2 home medications on admission. The intervention involved assignment of a pharmacist to an emergency care team so as to take the best possible medication history and reconcile this list with the current medications in use. Main outcome measure Incidence and potential clinical severity of unintentional medication discrepancies. Results 123 patients were included (pre-intervention, 49 post-intervention, 74). The proportion of patients with at least one unintended discrepancy was reduced from 59 to 10.5% after the intervention (p < 0.001). Similarly, the percentage of patients with potentially severe clinical impact medication discrepancies reduced significantly after the intervention (p < 0.01). Most importantly, the likelihood of occurrence of unintentional medication discrepancies was approximately 17 times more often in the absence of pharmacist intervention (OR 16.45, 95% CI 5.22, 51.85). Conclusion This study has found that pharmacist-led MedRec intervention was impactful, and it was able to minimize the incidence of unintentional medication discrepancies significantly.
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Oxford University Press (OUP)
Date: 21-02-2022
Abstract: There has been an increased interest in health technology assessment and economic evaluations for health policy in Ethiopia over the last few years. In this systematic review, we examined the scope and quality of healthcare economic evaluation studies in Ethiopia. We searched seven electronic databases (PubMed/MEDLINE, EMBASE, PsycINFO, CINHAL, Econlit, York CRD databases and CEA Tufts) from inception to May 2021 to identify published full health economic evaluations of a health-related intervention or programme in Ethiopia. This was supplemented with forward and backward citation searches of included articles, manual search of key government websites, the Disease Control Priorities-Ethiopia project and WHO-CHOICE programme. The quality of reporting of economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The extracted data were grouped into subcategories based on the subject of the economic evaluation, organized into tables and reported narratively. This review identified 34 full economic evaluations conducted between 2009 and 2021. Around 14 (41%) of studies focussed on health service delivery, 8 (24%) on pharmaceuticals, vaccines and devices, and 4 (12%) on public-health programmes. The interventions were mostly preventive in nature and focussed on communicable diseases (n = 19 56%) and maternal and child health (n = 6 18%). Cost-effectiveness ratios varied widely from cost-saving to more than US $37 313 per life saved depending on the setting, perspectives, types of interventions and disease conditions. While the overall quality of included studies was judged as moderate (meeting 69% of CHEERS checklist), only four out of 27 cost-effectiveness studies characterized heterogeneity. There is a need for building local technical capacity to enhance the design, conduct and reporting of health economic evaluations in Ethiopia.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2017
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.SAPHARM.2019.04.009
Abstract: In common with many developed countries, Saudi Arabia is currently experiencing an increasing cardiovascular disease (CVD) burden. However, systematic screening programs for early identification and minimization of CVD risk within community or general clinical settings are limited. Globally, research suggests that pharmacists can play an effective role in identifying, assessing, managing and referring people at risk of CVD in the community as well as in the hospital setting. This role is not yet developed in Saudi Arabia. This study aimed to explore the perspectives of hospital and community pharmacists in Saudi Arabia about potential roles in CVD risk screening. The purpose of the study was to propose potential interventions to facilitate the development of pharmacist delivered models for CVD risk prevention and management services in Saudi Arabia. A qualitative study was conducted using semi-structured in-depth interviews and focus group discussions with a purposive convenience s le of hospital and community pharmacists in Saudi Arabia. Data collection continued until saturation was achieved. All interviews were audio recorded, transcribed verbatim and thematically analyzed. A total of 50 pharmacists (26 hospital and 24 community pharmacists) participated in this study. Twenty hospital and eight community pharmacists were interviewed in idually, while the remaining participants contributed to three focus groups discussions. Currently, it appears that CVD risk prevention services are rarely provided, and when offered involved provision of discrete elements only such as blood pressure measurement, rather than a consolidated evidence based approach to risk assessment. Participating pharmacists did not appear to have a clear understanding of how to assess CVD risk. Four key themes were identified: pharmacists' perception about their current roles in CVD, proposed future clinical and service roles, impeding factors and enabling factors. Subthemes were mainly related to determinants likely to influence future CVD services. These subthemes included public perception of pharmacists' roles, pharmacist-physician collaboration, legislative restrictions, systemic issues, sociocultural barriers, organizational pharmacy issues, lack of professional motivation, government and organizational support and professional pharmacy support frameworks. These influencing factors need to be addressed at micro, meso and macro systems level in order to facilitate development of new pharmacist delivered cognitive services in Saudi Arabia. Pharmacists in Saudi Arabia are willing to expand their role and offer pharmacy-based services, but influencing determinants have to be addressed at the in idual, professional and health system levels. Further work is needed to clarify and develop practical and appropriate protocols for pharmacist CVD prevention and management services within the Saudi public and health care system. Such work should be guided by implementation science frameworks rather than embarking on conventional research trial pipelines where public benefit of generated evidence is delayed or limited.
Publisher: Springer Science and Business Media LLC
Date: 12-01-2017
Publisher: Public Library of Science (PLoS)
Date: 04-01-2018
Publisher: Springer Science and Business Media LLC
Date: 22-08-2016
Publisher: Medknow
Date: 05-2014
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-044618
Abstract: The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa. A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa. Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv. Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020. We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form. Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and in iduals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths. Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategies.
Publisher: Springer Science and Business Media LLC
Date: 04-04-2014
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Wiley
Date: 17-07-2023
DOI: 10.1111/BCP.15838
Abstract: Older adults are vulnerable to medication‐related harm mainly due to high use of medications and inappropriate prescribing. This study aimed to investigate the associations between inappropriate prescribing and number of medications identified at discharge from geriatric rehabilitation with subsequent postdischarge health outcomes. RESORT (REStORing health of acutely unwell adulTs) is an observational, longitudinal cohort study of geriatric rehabilitation inpatients. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation, using Version 2 of the STOPP/START criteria. In total, 1890 (mean age 82.6 ± 8.1 years, 56.3% female) were included. The use of at least 1 PIM or PPO at geriatric rehabilitation discharge was not associated with 30‐day and 90‐day readmission and 3‐month and 12‐month mortality. Central nervous system sychotropics and fall risk PIMs were significantly associated with 30‐day hospital readmission (adjusted odds ratio [AOR] 1.53 95% confidence interval [CI] 1.09–2.15), and cardiovascular PPOs with 12‐month mortality (AOR 1.34 95% CI 1.00–1.78). Increased number of discharge medications was significantly associated with 30‐day (AOR 1.03 95% CI 1.00–1.07) and 90‐day (AOR 1.06 95% CI 1.03–1.09) hospital readmissions. The use and number of PPOs (including vaccine omissions) were associated with reduced independence in instrumental activities of daily living scores at 90‐days after geriatric rehabilitation discharge. The number of discharge medications, central nervous system sychotropics and fall risk PIMs were significantly associated with readmission, and cardiovascular PPOs with mortality. Interventions are needed to improve appropriate prescribing in geriatric rehabilitation patients to prevent hospital readmission and mortality.
No related grants have been discovered for Alemayehu Mekonnen.