Infectious diseases pharmacy practice,education, and research in Saudi Arabia: A review and future perspectives by the Infectious Diseases Pharmacy Specialty Network at the Saudi Society of Clinical Pharmacy

BackgroundInfectious diseases (ID) pharmacy is one of the rapidly evolving clinical pharmacy specialties in the Kingdom of Saudi Arabia (KSA). There are gaps in the literature on ID pharmacy status in KSA. This review aimed to provide an update on the current status of several areas related to ID pharmacy in KSA, including practice, education, and research, and make pertinent recommendations for future development to achieve the KSA Vision, 2030, KSA Vision, 2030.MethodsThis review was developed by a group of ID pharmacists working in different sectors under the umbrella of the ID Pharmacy Specialty Network (PSN) of the Saudi Society of Clinical Pharmacy (SSCP). The authors evaluated domains related to ID pharmacy in KSA and searched the literature for relevant articles. Based on the experts' assessment of the current gaps and challenges, recommendations were made for future improvement.ResultsSeveral aspects of ID pharmacy in KSA were evaluated, including history and development, antimicrobial resistance (AMR), antimicrobial stewardship programs (ASP), roles of ID pharmacists, ID pharmacy education, and research. The biggest challenges include AMR, the varying levels of ASP implementation, and the low number of ID-trained pharmacists, especially in non-major cities. Several recommendations for improvement were discussed.ConclusionInfectious diseases pharmacy has sustained remarkable progress in KSA in several areas. However, more efforts are needed to increase ASP implementation, increase the number of ID-trained pharmacists, and encourage ID pharmacists in publishing and participating in practice guidelines, which will eventually help achieve the KSA Vision, 2030, KSA Vision, 2030.     

Emerging frontiers of pharmacy education in Saudi Arabia: The metamorphosis in the last fifty years

The trends in the quality of biomedical education in pharmacy schools have witnessed significant changes in the 21st century. With the advent of continuous revision and standardization processes of medical curricula throughout the world, the focus has been on imparting quality education. This pedagogic paradigm has shifted to pharmacy schools. In Saudi Arabia, the concept of “medical and pharmacy education” is relatively new as mainstream pharmacy curriculum and universities were established only half a century ago. This period has seen major changes in the dimension of “pharmacy education” to keep pace with the education systems in the United States and Europe. As our knowledge and perceptions about pharmaceuticals change with time, this motivates educators to search for better teaching alternatives to the ever increasing number of enthusiastic and budding pharmacists. Recently, the academic system in Saudi Arabian Pharmacy has adopted a more clinically-oriented Pharm. D. curriculum. This paper deals with the major changes from the inception of a small pharmacy faculty in 1959, the College of Pharmacy at the King Saud University, Riyadh, to the model of progress and a prototype of pharmacy colleges in Saudi Arabia. The fifty year chronological array can be regarded as an epitome of progress in pharmacy education in Saudi Arabia from its traditional curriculum to the modern day Pharm. D. curriculum with a high population growth and expanding health care sector, the demand for qualified pharmacists is growing and is projected to grow considerably in the future. The number of pharmacy graduates is increasing each year by many folds and to meet the needs the system lays stress upon a constant revising and updating of the current curriculum from a global perspective.     

Pharmacist,the pharmaceutical industry and pharmacy education in Saudi Arabia: A questionnaire-based study

Background: In Saudi Arabia there is an estimated need of more than 100,000 pharmacy graduates to cover all present sectors. The shortage of pharmacists has affected many of these sectors especially the pharmaceutical industry. The contribution of Saudi pharmacists to local pharmaceuticals industry would be extremely beneficial and important for shaping the future of the drug industry within the Kingdom. It is not clear whether future Saudi pharmacists are willing to contribute to local pharmaco-industrial fields. Methods: A cross-sectional, questionnaire-based survey was conducted on all final-year pharmacy students in King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia (KSA). Results: Out of a total of 130 students registered in the final-year of the pharmacy program in KSU, 122 (93.8%) were able to complete the questionnaire. The results showed that the majority (83%) of Saudi pharmacy students indicated that they had not received practical training in the pharmaceutical companies, while only 17.2% of the students felt that they had the knowledge and the skills to work in the pharmaceutical industry after graduation. The majority of the students (66.7%) chose clinical pharmacy as their future career field while only 10.9% indicated willingness to work in a pharmaceutical industry career. Only 8.2% selected working in the pharmaceutical industry. The significant predictor of possibly choosing a career in the local drug industry is a student with a bachelor’s degree (compared to Pharm D degree) in pharmacy (OR = 2.7 [95% CI 1.1–6.3]). Conclusion: Pharmacy students who are enrolled in the capital city of Riyadh are not properly trained to play an influential role in local drug companies. As a result, their level of willingness to have a career in such important business is not promising (more among Pharm D program). Future research in other pharmacy colleges within Saudi Arabia is needed to confirm such results.     

Evaluation of knowledge of Alzheimer disease among health university students in Riyadh,Saudi Arabia

ObjectiveTo assess the knowledge of Alzheimer disease among healthcare students of King Saud University, Riyadh Saudi Arabia.MethodsThis cross-sectional survey was conducted via an online questionnaire using google form as the main platform to collect the data. We included Pharmacy, medical and dental students, who are studying at king Saud University, Riyadh Saudi Arabia during February to March 2019.ResultsA total of 671 healthcare students responded to the study, and a total of 529 participants completely filled the survey with a response rate 79%. Majority (70.1%) of the student studied about Alzheimer disease in their college life, only 16.6% were not and 13.2% of them not remember. Most of the respondents 373 (70%) answered correctly and said that Alzheimer disease is related to mental disorders, although majority of 73.5% knew that Alzheimer disease is a Neurodegenerative disease. There was significant difference in knowledge score of medical and dental students (p = 0.001), Pharmacy and dental students (p = 0.003) respectively.ConclusionSaudi healthcare students have variation in knowledge about Alzheimer disease. To increase levels of knowledge, it is necessary to provide adequate education Programme and training is needed in healthcare colleges. We suggest further studies with large sample sizes to identify the effectiveness of Alzheimer disease education programs healthcare schools are warranted.     

Adopting global tools for the advancement of pharmacy practice and workforce in Saudi Arabia

BackgroundThe continuing expansion of the pharmacist’s role necessitates continuous evaluation of current practice to identify strategies for improvements. The International Pharmaceutical Federation (FIP) has developed tools to support stakeholders in identifying development needs and planning advancement strategies. The aim of this research was to utilise the FIP Global Competency Framework, version 2 (GbCF v2), and FIP Development Goals (DGs) to evaluate competencies related to pharmacy practice in Saudi Arabia, and to understand the strategies needed to develop and improve the current practice.MethodsThe study involved four phases. Phase 1 involved translation of the FIP GbCF v2 into the Arabic language. Phase 2 was a consensus panel validation to establish the initial relevance of the competencies to current practice. Phase 3 included a national survey distributed to all registered pharmacists in Saudi Arabia. The final phase was conducted through mapping ‘not relevant’ competencies to FIP DGs to identify priorities.ResultsThe translation phase yielded a bilingual framework that could be utilized by pharmacists in Saudi Arabia. The initial validation phase identified 61 behavioral statements (from 124 in the GbCF v2) as ‘highly relevant’ or ‘relevant’ to pharmacy practice. Findings from the national survey identified a list of ‘not relevant’ competencies that could highlight gaps in current practice. The final mapping phase generated a list of three FIP DG priorities: DG5 (competency development), DG8 (working with others) and DG11 (impact and outcomes).ConclusionThe study indicated that competencies in the GbCF v2 were relevant to pharmacists practicing in the country. However, some competencies were perceived as ‘not relevant’ to current practice and these highlighted gaps in the current practice that need attention. Mapping ‘not relevant’ competencies to FIP DGs should be used as a starting point towards developing strategies, systems, and protocols to advance pharmacy practice in Saudi Arabia.     

Clinical pharmacy definition,required education,training and practice in Saudi Arabia: A position statement by the Saudi society of clinical pharmacy

The Saudi Society of Clinical Pharmacy (SSCP) is a scientific and professional society in the field of clinical pharmacy that operates under the Saudi Commission for Health Specialties governance. The SSCP believes that there is a need to define and describe many aspects related to the clinical pharmacy profession in Saudi Arabia. Moreover, there is an increasing demand for promoting the concept of clinical pharmacy and developing a consensus regarding the scope of practice and clinical pharmacist's required postgraduate education and training in Saudi Arabia. This paper is intended to present several position statements by the SSCP that define the concept of clinical pharmacy, describe the required education and training, and highlight clinical pharmacists' scope of practice in Saudi Arabia. This paper calls for further investigations that examine the impact of clinical pharmacists on individual and population health levels.     

Pharmacy practice research in Saudi Arabia; A bibliometrics analysis from (2000 to 2021)

BackgroundPharmacy is a growing profession in the Kingdom of Saudi Arabia which has experienced tremendous changes in the past 20 years. Pharmacy practice or clinical pharmacy have an attention ever since the emerging of PharmD programs throughout the Saudi universities. As a result, the number of affiliated faculty in the pharmacy practice departments has increased dramatically in the past 20 years and thus significant changes in research output were observed.ObjectivesThe main objective is to conduct a bibliometric analysis and evaluate the research output of pharmacy practice faculty in Saudi Universities from 2000 to 2021MethodsA systematic search was conducted using Scopus database to explore the research output from pharmacy practice affiliated faculty from 2000 to 2021. The following search terms AFFILORG (“Pharmacy Practice Department” OR “Department of Pharmacy practice” OR “Clinical Pharmacy Department” OR “Department of Clinical Pharmacy” OR “Department of Pharmacy Services”) AND AFFILCOUNTRY (“Saudi Arabia” OR “KSA” OR “Kingdom of Saudi Arabia”) were used. Only original research papers were retrieved and analyzed using MS Excel (v16.0), MS Access (v16.0), Bibexcel (v2017), VOS viewer, and Biblioshiny.ResultsIn the past two decades, most publications with pharmacy practice departments affiliation were pharmacy practice research irrelevant (only 1075 out of 2809). King Saud University and King Abdulaziz University were the top performing institutes, and median of 5-year impact factor for journals was more than 3 for most of the top 10 institutes. 19% of the total retrieved articles were review publications were the rest majorly classified as cross-sectional studies.ConclusionThe research contribution of pharmacy practice departments in Saudi Arabia has been improving. Key recommendations are to promote more applied and interventional research, increase publications in top journals, and enhance national collaborations.     

Antimicrobial susceptibility and serogroups of Salmonella isolates from Riyadh, Saudi Arabia

The antimicrobial susceptibility and serogroups of 153 Salmonella strains isolated during a period of 22 months from both children and adults at a major teaching hospital in Riyadh, Saudi Arabia were studied. Antimicrobial susceptibility testing by comparative disc method and MIC determination by E-test method were performed on selected antimicrobial agents. For nalidixic acid and trimethoprim only the comparative disc method was used. Discrepancy between the two methods were noticed only in 1.3% of isolates. The majority of isolates from children (41%) were serogroup B, while those from adults (43%) were serogroup C1. The overall resistance was 16% to ampicillin and ampicillin/sulbactam, 13% to nalidixic acid, and 11% to chloramphenicol and trimethoprim/sulphamethoxazole. The resistance of Salmonella isolates to the so-called first line anti-Salmonella agents, i.e. ampicillin, chloramphenicol and trimethoprim/sulphamethoxazole, has increased compared to that reported 4 years ago from this Institution. Almost all isolates were susceptible to the second, and third generation cephalosporins, fluoroquinolones, aztreonam, mecillinam and gentamicin. Multiple drug resistance to two or more drugs was noticed in 16% of isolates, most of which were serogroup B. The majority of these multiple drug resistant isolates (96%) were ampicillin resistant and β-lactamase producers. Although these isolates showed reduced MICs to ampicillin/sulbactam, their MICs were still higher than the susceptibility breakpoint for this combination. The nalidixic acid-resistant isolates showed higher MICs to the fluoroquinolones compared to the nalidixic acid-sensitive isolates. Isolates from children showed higher resistance to some of the antimicrobial agents compared to those from adults.     

Burden of stroke in the Kingdom of Saudi Arabia: A soaring epidemic

Stroke is a key cerebrovascular disease that is related to high morbidity and mortality in the globe. The Kingdom of Saudi Arabia (KSA) is not an exception where stroke is fast developing into a serious challenge due to the high mortality rate. Additionally, stroke presents a tremendous economic burden and has a devastating effect on the quality of lives of individuals. The number of stroke cases are increasing yearly, thus posing a major challenge to the health care system. Therefore, it is crucial to implement primary and secondary prevention strategies in the KSA. Nevertheless, as compared with developed countries, information on the prevalence, socio-demographic properties and prevention of stroke remains scarce that could be attributed to the shortage of research conducted in this specified region. The review is written to address the various aspects of stroke in the KSA, based on current literatures search using PubMed, Scopus, Web of Science and Google Scholar databases, to identify studies published since inception to Dec 2020.     

Evaluation of Antimicrobial Stewardship Programs (ASPs) and their perceived level of success at Makkah region hospitals,Kingdom of Saudi Arabia

Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. The general administration of pharmaceutical care in the Saudi ministry of health (MOH) is putting outstanding efforts in implementing antimicrobial stewardship in Saudi health care settings. Several surveys have been conducted globally and reported many types of antimicrobial stewardship strategies in health institutions and their effectiveness. This study aims to identify ASPs in Makkah region hospitals and their perceived level of success. We administered a regional survey to explore current progress and issues related to the implementation of ASPs in Makkah region hospitals at the pharmacy level (n = 25). Among responding hospitals, 19 (76%) hospitals, the most commonly reported ASP were as following: formulary restrictions (90%) for broad-spectrum antimicrobials and use of prospective feedback on antimicrobial prescribing (68%), use of clinical guidelines and pathways (100%), and use of automatic stop orders (68%) to limit inappropriate antimicrobial therapy. The study outcomes will also be of pivotal importance to devise policies and strategies for antimicrobial stewardship implementation in other non-MOH settings in the Makkah region. Based on our results, all reported institutions have at least one antimicrobial stewardship program in a process with a high success rate. A multidisciplinary ASP approach, active involvement of drug & therapeutic committee, formulary restrictions, and availability of education & training of pharmacists and physicians on ASP are the primary elements for perceived successful antimicrobial stewardship programs in the Makkah region hospitals.     

A comprehensive review program to prepare pharmacy students for the Saudi Pharmacist Licensure Examination (SPLE)

PurposeThe Saudi Pharmacist Licensure Examination (SPLE) has been mandated by the Saudi Commission for Health Specialties (SCFHS) for three and a half years; however, colleges of pharmacy and/or pharmacy organizations in Saudi Arabia have yet to implement a comprehensive review program to help prospective graduates to succeed. The aim of this study was to assess the impact of an integrated program designed to enhance students’ performance on the SPLE.MethodsA cross-sectional study was conducted to determine the impact of integrating SPLE review activities (clinical review quizzes (CRQs), disease state presentations (DSPs), a Capstone OSCE, and a mock SPLE) on students’ SPLE results and perceptions of their SPLE preparation and performance. Student scores from the review activities were analyzed and an anonymous, voluntary survey was used to assess the impact of these activities on student readiness levels and performance on the SPLE.ResultsA total of 127 Doctor of Pharmacy (Pharm.D.) students were included in the study. The average scores for the mock SPLE, DSPs, and Capstone OSCE were (55.8% ± 8.55), (91.3% ± 7.17), and (95.2% ± 6.90), respectively. Approximately 50% of the students responded to the survey. Most students had taken and passed the SPLE on the first attempt (94.6%) with an average score of 635.7 ± 39.4 (～79%). Over 60% and 70% of students recommended the SPLE CRQs activity and the DSP activity, respectively. With respect to mock SPLE, 60.9% believed that it provided an idea of what to expect on the SPLE and 54.7% recommended to add the Capstone OSCE into the curriculum. Overall, the majority of students would recommend these activities be incorporated in the college of pharmacy curriculum in order to better prepare pharmacy graduates for the SPLE.ConclusionProspective graduates from Saudi universities may benefit from college of pharmacy-organized SPLE reviews. Based on this study’s findings, a comprehensive review course including a mock SPLE and disease state presentations is recommended. In addition, SPLE review lectures, CRQs, and a Capstone OSCE may provide additional benefit.     

Pattern and determinants of poisoning in a teaching hospital in Riyadh,Saudi Arabia

Background

The Drug and Poison Information Center (DPIC) at King Khalid University Hospital, Riyadh, Saudi Arabia, was founded in 1983. Since then it has responded adequately to queries from medical and non-medical callers from all over the Kingdom. Queries ranged from simple material identification to poisoning cases.

Objectives

To assess the pattern and circumstances of poisoning in the Kingdom of Saudi Arabia through reviewing data from DPIC in King Khalid University hospitals.

Methods

This is a retrospective study of referred cases and calls received by DPIC. All records and documentation forms during the study period were investigated.

Results

This study included 1161 cases. There were 7.9% infants, 52.9% under 5 years old, 7.2% between 6–12 years old and 32.0% more than 12 years old. Number of males with toxic exposure was almost equal to that of females. More than 92% of cases were toxic exposure through oral route. Causes of poisoning include drugs among 76.7% of cases followed by household chemicals (6.8%). Suicidal intention was reported among 25.6% of cases. Using multivariate regression analysis, significant predictors of suicidal attempts are more than 12 years old, patients who were exposed to more than one toxin and patient who came to the hospital within 1–3 h since poisoning.

Recommendations

Establishing and operating DPIC centers throughout the kingdom, in addition to implementing of legislations to ban over the counter selling of medications and to sell potentially dangerous chemicals in childproof containers.     

The role of pharmacoeconomics in formulary decision making in different hospitals in Riyadh,Saudi Arabia

Objective

To assess the trend of using pharmacoeconomic information by Pharmacy and Therapeutics (P&T) committees when making formulary decisions.

Design

A cross-sectional study conducted in 2007, using structured survey questionnaires which were distributed to members of the P&T committees in 11 different hospitals in Riyadh, Saudi Arabia.

Results

A total of 100 survey questionnaires were sent to head of pharmacy departments of 11 different hospitals in Riyadh, Saudi Arabia. Out of these, 48 questionnaires were completed and returned. Of the total respondents participated in the study, 64.58% were medical doctors and 16.66% were pharmacists and 75% of the respondents said they have applied pharmacoeconomic evaluations in their decision making process. More than 80% of the respondents perceived that they had a fair knowledge of pharmacoeconomics. Approximately 80% of respondents expressed some degree of agreement that pharmacoeconomics should be applied as a decision making tool. The majority of decision-makers (95%) expressed the interest in attending workshops on pharmacoeconomics.

Conclusion

The study showed that pharmacoeconomics can play an important role in the P&T committee formulary decisions. However, more education to health care professionals and to hospital administrators should be conducted to facilitate the use of such a tool. Also, hospitals should recruit health care professionals with pharmacoeconomic expertise to manage limited health resources in the best way available.     

Knowledge,attitudes and practices of the general public toward sun exposure and protection: A national survey in Saudi Arabia

Background: Many international studies have been conducted to assess the knowledge, attitudes and practices (KAP) of the public toward sun exposure and sun-protection measures. However, there are scarce data on these factors from the Middle East. Objectives: This study aimed to explore the KAP of the public toward sun exposure and sun-protection measures among Saudis. Methods: A cross-sectional survey using a specially designed questionnaire was conducted on a stratified random sample of the general population in the five geographical regions of Saudi Arabia (central, eastern, northern, southern, and western). Data were collected between October 2010 and March 2011. Multiple logistic regressions were applied to relate the use of sunscreen and skin cancer awareness with various socio-demographic variables. Results: The questionnaire was distributed to 2900 Saudis. A total of 2622 questionnaires were completed, returned, and included in the data analysis, corresponding to a response rate of 90.4%. The mean (SD) age of respondents was 27.8 ± 9.7 years. Fifty percent (1301/1601) of the respondents were males. Fifty-five percent (1406/2544) were aware of the association between sun exposure and skin cancer. Female, young and student respondents were more likely to be aware of the connection between sun exposure and skin cancer (p < 0.001). Likewise, respondents from the middle social class and those with higher education levels were more likely to be informed (p < 0.02). The prevalence of regular sunscreen use among study participants was only 23.7%, and female and employed respondents were more likely to use sunscreen (p < 0.001). Protective clothes were the most commonly used sun protection measure as reported by more than 90% of our participants. Conclusion: This study has shown that sun awareness and protection are generally inadequate in the Saudi population and suggests the need for health education programs.     

Pharmacy education in Saudi Arabia: Achievements and challenges during the last two decades with a focus on Taif University as a case study

Basic expectation from graduates of any pharmacy program is to be able to provide pharmaceutical care at both patients and community levels, be able to solve problems arising during practice, be able to improve quality and outcomes of the services provided continuously and be able to respond effectively to patients and community changing needs. Pharmacy education in Saudi Arabia established in 1959 by founding the first college in Riyadh (King Saud University) followed by establishing two pharmacy colleges in Jeddah (King Abdulaziz University, 2001) and Abha (King Khalid University, 2001), then a college in Al Ahsa (King Faisal University, 2002), followed by four colleges three-years later in each of Buraydah (Qassim University, 2005), Madinah (Taibah University, 2005), Taif (Taif University, 2005) and Makkah (Umm Al-Qura University, 2005). Up to date the number of pharmacy colleges offering basic degrees in pharmacy are 21 governmental and eight privates. This review describes pharmacy education in Saudi Arabia, the historical perspective, current situation, and the important features. The report focuses on the changes during the last two decades covering three main aspects (1) Clinical education and training, (2) Research output, and (3) Quality and accreditation.     

Challenges to and the future of medication safety in Saudi Arabia: A qualitative study

Background

Medication safety is a global concern among healthcare providers. However, the challenges to and the future of medication safety in Saudi Arabia have not been explored.

Objectives

We explored the perspectives of healthcare practitioners on current issues about medication safety in hospitals and community settings in Saudi Arabia in order to identify challenges to improving it and explore the future of medication safety practice.

Methods

A total of 65 physicians, pharmacists, academics and nurses attended a one-day meeting in March 2010, designed especially for the purpose of this study. The participants were divided into nine round-table discussion sessions. Three major themes were explored in these sessions, including: major factors contributing to medication safety problems, challenges to improving medication safety practice, and participants’ suggestions for improving medication safety. The round-table discussion sessions were videotaped and transcribed verbatim and analyzed by two independent researchers.

Results

The round-table discussions revealed that major factors contributing to medication safety problems included unrestricted public access to medications from various hospitals and community pharmacies, communication gaps between healthcare institutions, limited use of important technologies such as computerized provider order entry, and the lack of medication safety programs in hospitals. Challenges to current medication safety practice identified by participants included underreporting of medication errors and adverse drug reactions, multilingualism and differing backgrounds of healthcare professionals, lack of communication between healthcare providers and patients, and high workloads. Suggestions for improving medication safety practices in Saudi Arabia included continuous education for healthcare professionals and competency assessment focusing on medication safety, development of a culture that encourages medication error and adverse drug reactions reporting, use of technology proven to decrease medication errors, and promotion and implementation of national patient safety initiatives.

Conclusions

Healthcare professionals have identified major challenges and opportunities for medication safety in Saudi Arabia. Policy makers and practitioners should consider these factors when designing future programs aimed at improving the safe use of medications.