OAR@UM Collection:

Medication adherence practices among patients attending the primary health care medical consultant clinics in Malta

2020-11-11T11:49:13Z

Title: Medication adherence practices among patients attending the primary health care medical consultant clinics in Malta Abstract: This study aimed to explore factors of adherence/non-adherence among patients attending the medical consultant follow-up clinic within five health centres in Malta These health centres were B'Kara, Gzira, Paola, Rabat and Mosta This was a quantitative cross-sectional study and regarded both current and past practices regarding treatment adherence to medication. The research objective aimed to assess: a) Prevalence of medication adherence within the said population b) Barriers to adherence practices c) If socio-demographic and socioeconomic factors within the chosen population affect medication adherence. d) If polypharmacy can affect medication adherence. e) If attendance to the medical clinics affects adherence to prescription medication. As the population chosen for the study is being followed-up at the medical consultant clinic [MCC], the research aimed to see if patients who attend for follow-up are more likely to adhere to their medications. For study eligibility patients had to be over 40 years of age, in possession of a Schedule V card as they had to be suffering from a chronic disease, and attending for MCC follow-up in one of the said clinics at the time the data collection took place. Structured interviews were carried out using the ©MMAS-8 questionnaire. A sample size of 480 patients was needed to achieve a 95% confidence level and a 5% confidence interval. A response rate of 85% was achieved after 401 questionnaires were collected by the researcher using face to face interviews with the patients involved in the study. Of the respondents 159 (39.65%) were male and 242 (60.53%) were female. Age distribution ranged from 40 to 80+years, the most prevalent age group in the cohort of patients was in the 60-69 age groups. Statistical analysis was carried out using STATA-software and Microsoft excel. Where population numbers were >5 the Pearson chi squared test was used. The Fishers' exact test was used to analyse the categorical variables in tables that had numbers <5. Spearman correlation coefficient, a measure of association between two variables was used to calculate if there is an association between number of tablets taken by respondents and adherence to medication. A p-value of less than 0.05 was considered as being statistically significant. Results of the study revealed an overall medium medication adherence level of 6.5. As predicted in the literature effects of non-adherence were gender, socioeconomic factors, smoking and polypharmacy especially in the older age group. A borderline p-value was achieved for age and patients who self-manage their medications. From the data collected educational level, marital status and living situation did not show any association to adherence levels. Future research would need to be more specific to involve other populations, as this study involved a specific population within a specified environment. Research should also include other disease and conditions to be able to assess if medication non-adherence exists within other areas and disease conditions. Description: M.SC. PUBLIC HEALTH

Beliefs and attitudes on antibiotic use in Malta : informing intervention strategies

2020-11-12T09:31:30Z

Title: Beliefs and attitudes on antibiotic use in Malta : informing intervention strategies Abstract: The use of antibiotics in the treatment and prophylaxis of bacterial diseases has contributed greatly to the reduction of the burden of infectious disease. However, trends show that with time, the emergence and spread of antibiotic resistance IS continuously threatening the effective treatment of some important infections. Amongst the determinants of inappropriate antibiotic use, literature has underlined patient education level, expectations of physicians and patients, cultural aspects, regulatory practice, and antibiotic price as the main contributing factors. The main aim of this research was to assess the knowledge, attitudes and perceptions of antibiotic users and to identify any changes in antibiotic consumption since the last survey done in 2009. The second part of the study was to determine the knowledge, attitudes and perceptions of prescribers. The combined aim was to get information to be able to inform strategies for effective interventions to promote appropriate antibiotic use. After a comprehensive literature review, it was established that the best way to achieve the aims was to carry out two retrospective cross-sectional surveys, one with the public and one with prescribers. Results from these studies showed that since 2009, when antibiotic consumption for Malta was last studied through a Eurobarometer study, there has been a 17% reduction in antibiotic consumption and a further improvement in non-prescribed use, with 96% of respondents having obtained their antibiotics with a prescription. The most commonly used antibiotics are the beta-lactams, particularly co-amoxiclav. The use of the narrow spectrum antibiotics is almost non-existent. Antibiotics were taken primarily for sore throat, followed by chest infection and flu and were almost all prescribed by private community general practitioners. Topical antibiotic use is high and used for minor skin conditions. What is concerning is the high level of non-prescribed use for totally inappropriate indications. The knowledge of the antibiotic users was not good, in particular in terms of the viral cause of cold and flu and the fact that antibiotics do not kill viruses. Their attitudes were also not conducive to proper antibiotic use - more than half stated that they expect a prescription for antibiotics for a cold and that they know they need an antibiotic for a sore throat before they go to the doctor. Knowledge and attitudes were better in females and the better educated. This must be taken into consideration in any intervention strategies to improve antibiotic use. Almost all the physicians had prescribed an antibiotic in the previous week, the majority prescribing more than three. Personal knowledge and previous experience were the factors that doctors considered that influenced them most in their prescribing decisions, possibly showing that most of them work in isolation. Physicians underestimated the level of resistance in the community and attributed it more to hospital rather than ambulatory care. However, general practitioners were more knowledgeable about resistance levels than the non general practitioner cohort. Whilst they identified the major causes for increasing resistance as overprescribing of antibiotics, especially broad spectrum antibiotics and inappropriate use for viral infections, their behaviour was not found to be in congruence, as they admitted that they prescribe mostly broad spectrum antibiotics, the main reason given being lack of laboratory support. Another finding which corroborates the attitudes reported by the public was that more than half said that patients specifically ask them for antibiotics. Prescribers identified the availability of national resistance data and guidelines and protocols as the preferred measures for improving prescribing. Due to the fact that knowledge, attitudes and perceptions in the public survey were only studied in antibiotic users, the results do not necessarily reflect those of the general population. Other limitations which effect validity of the study are response and selection bias. The representativeness of the results of the physician survey is also limited by the low response rate and by responder bias because of the methodology chosen. In conclusion, it is evident that there is no simple relationship between knowledge and attitudes and more prudent antibiotic use. Future national antibiotic campaigns should be targeted to defined audiences and aim to improve use of antibiotics by prescribers and the public. With these data, a number of recommendations were made for the design of strategies to optimise use of antibiotics. Description: M.SC. PUBLIC HEALTH

Healthy athletes?

2020-11-10T13:58:11Z

Title: Healthy athletes? Abstract: Society perceives athletes to be the healthiest of all people. Literature shows that former athletes have been found to have a lower risk of morbidity and a longer life expectancy when compared to the general population. This study sets out to explore whether the self-reported general health and lifestyle of current Maltese elite athletes, is better than that of the general Maltese population. To this end, a comparative study using historical matched controls was carried out. A cross-sectional interview survey was held among a random sample of elite and high level Maltese athletes between May and July 2013. Collection of quantitative data used an adapted version of the European Health Interview Survey (EHIS) tool, which made comparing our results to those collected from the EHIS held in Malta in 2008 possible. The study included 3 controls for every athlete, matched for age, gender and education. There were 107 respondents from a sample of 180 high level athletes identified by sporting entities, yielding a response rate of 60.5%. Although results show that no significant difference between the perceived health of athletes and the general population, a number of significant differences emerged. Athletes maintain a healthier weight and appear to engage in healthier lifestyles, in that they undergo more physical activity, eat more fruit and vegetables, and smoke less than their counterparts. However they also consume more alcohol. The life of an athlete is not without its trials and tribulations. Participating at high competitive levels leaves both physical and psychological sequelae. In fact, a third of participants had sustained an injury over the previous year, contributing to the fact that athletes had experienced significantly more pain (p<0.000), and reported being more limited in daily activities. Athletes are more likely to suffer from asthma (p=0.017) and stomach ulcers (p=0.010) than their counterparts. Our study population also consumes significantly more medication, both prescribed and non-prescribed, notably medication for asthma, allergies, pain and stomach problems. Athletes have a lower vitality index score than the controls. With regards to health care use, although athletes tend to visit general practitioners less than the general population, consultations with medical and surgical specialists is higher. These differences did not reach statistical significance. However, athletes are more likely to visit physiotherapists, psychologists, nutritionists and chiropractors (p<0.000), and check their blood parameters more than their counterparts. These findings may reflect a tendency among athletes to maintain optimal health, but is this a genuine concern, or a means to an end, for success in sports? This study is riddled with contradictory evidence, as although athletes lead a healthier lifestyle, they seem to be jeopardizing their health by stressing their body both physically and mentally. Thus, the notion of athletes being healthier than the general population has been challenged in this study. The research also embarks on a number of recommendations for the provision of a comprehensive health service directed towards athletes, which could be the lynch pin required to minimise their vulnerabilities and foster mental and physical well-being would can translate into more competitive success. Description: M.SC. PUBLIC HEALTH

The quality of primary care in Malta: patients' experiences, views and actions

2020-11-08T06:11:23Z

Title: The quality of primary care in Malta: patients' experiences, views and actions Abstract: Extensive literature showed that strong primary care is conducive to reaching important health care system goals by improving population health, reducing socio-economic inequalities and avoiding unnecessary hospitalizations. Due to demographic changes, technological developments and rising expectations, analysis of patient-perceived quality of primary care in the public and private sectors is crucial. This study aims to identify the patients' experiences, views and actions in primary care. The dataset of the Maltese arm of the QUALICOPC Project was analysed for this purpose. A descriptive, cross-sectional, retrospective study was designed. 70 practicing GPs were selected randomly from the Malta Medical Council Family Medicine register after systematically removing the inactive doctors. 10 patients presenting in each primary care clinic completed a self-administered questionnaire. Trained fieldworkers provided assistance when necessary. Internal comparison subgroup analyses were performed using statistical tests such as chi-squared test. Direct logistic regression was used to estimate the influences on primary care quality in the private-public sectors and in the urban-rural areas. The mean age of participants was 48.2 years and the majority were females (62%). The youngest and the oldest age groups tended to visit the public GP service. Only a limited number of patients abstained from a visit to the GP because of financial reasons. The majority of patients were satisfied with their GP consultation. No statistically significant association was found between doctors' attitudes in the public sector and in the private sector. Factors found to be significantly associated with the private primary care sector included female patients, GP knowing the patients' living situation, patients visiting their own doctor and difficulty in accessing out-of-hours care. Such findings provide information for clinicians and policy makers to improve equity in health care and resource allocations. A number of recommendations are drawn up to serve as guidelines for GPs' clinical practice, policy makers, public health education and research. Description: M.SC. PUBLIC HEALTH