OBJECTIVE:To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured.METHODS:An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data.RESULTS:The majority of products come from manufacturers headquartered in North America and Europe (63%-67%). The percentage of medicines procured from generic companies is 60%-87%; and 25%-50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased.CONCLUSIONS:The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.

ObjectivesTo determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic.DesignCross-sectional online survey.SettingHCWs from four major hospitals within the Regional Health Authorities of Trinidad and Tobago.Participants395 HCWs aged ≥18 years.Main outcome measuresDepression, anxiety and stress scores.ResultsAmong the 395 HCWs, 42.28%, 56.2% and 17.97% were found to have depression, anxiety and stress, respectively. In the final stepwise regression model, contact with patients with confirmed COVID-19, p<0.001 (95% CI 3.072 to 6.781) was reported as significant predictors of depression. Further, gender, p<0.001 (95% CI 2.152 to 5.427) and marital status, p<0.001 (95% CI 1.322 to 4.270) of the HCWs were considered to be correlated with anxiety. HCWs who had contact with patients with suspected COVID-19 had lower depression, p<0.001 (95% CI −5.233 to −1.692) and stress, p<0.001 (95% CI −5.364 to −1.591).ConclusionsThis study has depicted the prevalence and evidence of depression, anxiety and stress among HCWs during the COVID-19 pandemic. The findings of the study will serve as supportive evidence for the timely implementation of further planning of preventative mental health services by the Ministry of Health, for frontline workers within the public and private health sectors.

BACKGROUND:The Caribbean Regulatory System is a centralized medicine assessment procedure established to serve the needs of the Member States of the CARICOM region. In order to better understand the effectiveness and efficiency of the processes implemented by the Caribbean Regulatory System for the regulatory assessment of medicines for the region, the system has been participating in the Optimizing Efficiencies in Regulatory Agencies (OpERA) program, a multinational endeavor to characterize the assessment procedures and the corollary metrics associated with medicine review activities in regulatory agencies and regional regulatory initiatives.METHODS:The OpERA tool was used to collect process and specific milestone data for products approved by the Caribbean Regulatory System during 2017 (n = 10) and 2018 (n = 11).RESULTS:The median total approval time was 57.5 days (25th/75th percentiles: 54, 60) in 2017 and 148 days (120, 163) in 2018. The median time to conduct the scientific assessment of the dossier was 37 days (24, 42) in 2017 and 66 (40, 132) days in 2018, within the target of 90 days for this activity. The time increases observed in 2018 were due to staff manpower limitations that reduced the ability of the system to conduct the timely assessment of applications. Based on these observations, recommendations to optimize the effectiveness and efficiency of the Caribbean Regulatory System include a commitment from Member States and partner organizations to the use of the procedure to accelerate product availability, encouraging the use of the Caribbean Regulatory System for non-generic products approved by a reference agency, ensuring the establishment of policy and legal frameworks to facilitate the rapid uptake of Caribbean Regulatory System registrations as marketing authorizations in the Member States, and maintaining the sustainability of the process through a fee-based approach.CONCLUSIONS:The observations obtained using the OpERA methodology indicate the Caribbean Regulatory System is an effective and efficient mechanism to provide recommendations to Member States for important medicines.

INTRODUCTION:As the profession of pharmacy has evolved, pharmacy education has developed to include competencies and skills related to pharmacy administration services. Competencies taught in pharmacy administration courses are expected to provide graduates with skills to effectively undertake administrative functions. Our study aimed to assess perceptions about knowledge and skills gained by the pharmacists during the Pharmacy Administration course at the School of Pharmacy, the University of the West Indies (UWI), Trinidad and Tobago.METHODS:A cross-sectional survey was carried out among pharmacists working in hospitals and community pharmacies in Trinidad using non-probability convenience sampling. A structured questionnaire was distributed to 262 pharmacists who completed the Pharmacy Administration course. Two-hundred eighteen (83%) usable responses were included for analysis.RESULTS:Many (45.4%) respondents agreed that the course provided them with the knowledge of running a business, 78% said they were able to apply the skills in their practice, and 80% mentioned that the course should be mandatory. Pharmacists found that the course on business management enhanced their knowledge in the fields of managing human resources, conflict management, marketing, project management, corporate turnaround, inventory, and financial management.CONCLUSIONS:The Pharmacy Administration course in the bachelor of science degree in pharmacy programme at the School of Pharmacy, UWI remains relevant in the areas of marketing, human resource management, and inventory management. The programme can be extended to a full time masters course to interested pharmacy graduates.

Previous research studies have shown that poorly controlled type 2 diabetes patients do not receive insulin therapy because of the resistance of the patients to insulin therapy. This study aimed to assess the belief of Caribbean insulin-naïve type 2 diabetes patients on insulin therapy. Five hundred ten insulin-naïve type 2 diabetes patients who have had diabetes for at least 5 years were recruited for a questionnaire interview. The questionnaire was a modified version of a previously validated research questionnaire. Data collected was analysed with SPSS software using chi-square to test for significances. The majority of the patients have had diabetes for > 10 years and take > 2 different diabetes medications daily. About 67% and 81% of the patients do not believe that insulin therapy will cause them hypoglycemia and weight gain respectively. Similarly, a significant percentage does not believe that taking insulin will interfere with their normal lifestyle activities (72.2%, p = 0.048). Although a majority (64%) of the patients believe that taking insulin translates to personal failure in optimal blood glucose control, 90% do not believe that taking insulin will cause people to treat them differently. A majority of the patients do not believe that taking insulin will be helpful in preventing long-term diabetes complications (63.9%, p = 0.001), though 51% thought it would make them feel better. Contrary to several reports, this study shows that insulin-naïve Caribbean type 2 diabetes patients do not have a significant negative perception towards insulin therapy. This finding might be related to the socio-cultural background of the patients studied.

Background and Aim: Previous research studies have shown that poorly controlled type 2 diabetes patients do not receive insulin therapy because of the resistance of the patients to insulin prescription. This study aimed to assess the belief of Caribbean insulin-naive type 2 diabetes patients on insulin therapy. Methods: We recruited 510 insulin-naive type 2 diabetes patients who have had diabetes for at least five years for a questionnaire interview. The questionnaire was a modified version of a validated research questionnaire previously used by other researchers. Data collected was analysed with SPSS software using chi-square to test for significances. Results: The majority of the patients were females, of East Indian descent, have had diabetes for more than 10 years and take more than two different diabetes medications daily. About 67% and 81% of the patients do not believe that insulin therapy will cause them hypoglycaemia and weight gain respectively. Similarly, a significant percent do not believe that taking insulin will interfere with their normal lifestyle activities (72.2%, p=0.048). Although, a majority (64%) of the patients believe that taking insulin translates to personal failure in optimal blood glucose control, an overwhelming percent (90%) do not believe that taking insulin will cause people to treat them differently. Whereas a majority of the patients do not believe that taking insulin will be helpful in preventing long-term diabetes complications (63.9%, p=0.001), 51% thought that switching to insulin therapy would make them feel better within six months. Conclusion: Contrary to several reports, this study shows that insulin-naïve Caribbean type 2 diabetes patients do not have a significant negative perception towards insulin therapy. This finding might be related to the socio-cultural background of the patients studied. Disclosure C.E. Ezenwaka: None. P.C. Onuoha: None. R. Extavour: None. S.S. Yearwood: None. Funding University of the West Indies at St. Augustine

BACKGROUND AND PURPOSE:Blended learning (BL) integrates face-to-face and online instructional methods, with applications in pharmacy education. This study aimed to assess pharmacy students' perceptions of BL in a pharmacy seminar course at The University of the West Indies, St. Augustine campus, Trinidad and Tobago.EDUCATIONAL ACTIVITY AND SETTING:Topics based on the use of medicines and public health were presented by student groups during live seminars, supplemented with online activities. An online survey of students' perceptions was administered at the end of the course. The usefulness of learning resources and course activities were assessed using 5-point Likert-like scales (1 = not helpful to 5 = very helpful). The effectiveness of the instructor, blended delivery, time value, and development of critical-thinking were rated on a 5-point Likert scale for agreement (1 = strongly disagree to 5 = strongly agree). Topics that were most instructive and additional topics of interest were also identified.FINDINGS:Approximately 51% of students (37/72) completed the questionnaire; 73% were female and mean age was 24 years. The learning resources and most course activities were generally helpful (median = 4) in facilitating learning. There was strong agreement (median = 5) on the ease of navigating the online platform, and instructor encouraging interest in pharmacy issues. Students agreed (median = 4) that the course facilitated critical thinking, the BL approach was effective, and the time spent was worthwhile. The most instructive topics included medication errors, antibiotic resistance, and medicines in children and the elderly.SUMMARY:BL in pharmacy seminars is a valuable approach to engage students learning about pharmacy and public health.

OBJECTIVE:To identify determinants of potentially inappropriate (PI) antidepressant and anxiolytic/sedative prescribing for older, community-dwelling adults.DATA SOURCES/STUDY SETTING:Office visits from the 2010 National Ambulatory Medical Care Survey.STUDY DESIGN:A cross-sectional study measuring associations between various patient and physician factors and prescribing of PI antidepressants, and PI sedatives among elderly, using Beers 2012/2015 criteria, a clinical decision model, and multivariate logistic regressions.DATA COLLECTION:Visits by older adults (≥65 years) involving medications were extracted to identify visits with antidepressants and sedatives.PRINCIPAL FINDINGS:Black race, asthma, depression, osteoporosis, payment type, consultation time, and computer systems with prescribing support were associated with reduced odds of PI antidepressant prescribing among users. Income, chronic renal failure, diabetes, and obesity were associated with reduced odds of PI sedative prescribing. Female sex, white race, depression, increasing number of medications, and physician specialty were associated with increased odds of PI sedative prescribing.CONCLUSIONS:Various patient and health-system factors influence the quality of antidepressant and sedative prescribing for older community-dwelling adults. Longer consultations and the use of computer systems with prescribing support may minimize potentially inappropriate antidepressant prescribing. As medication numbers increase, exposure to PI sedatives is more likely, requiring medication review and monitoring.

Objectives. To explore stakeholders' views regarding the performance of pharmacy graduates upon entering the workforce and to identify curricular deficiencies and possible solutions.Methods. Practicing pharmacists, many of whom were members of government and pharmacy organizations, were asked to complete a 40-item questionnaire to determine their views regarding the educational outcomes of pharmacy graduates from a Caribbean pharmacy school. In addition, the stakeholders participated in focus group discussions to capture feedback not gathered on the questionnaire.Results. Ten stakeholders completed the questionnaire and 11 participated in the focus group discussions. Stakeholders rated graduates higher than average in 13 educational outcomes: application of knowledge and skills, patient care, communication skills, confidentiality, ethics, problem solving, and innovation. However, responses to open-ended questions and comments made during the focus group discussions identified deficiencies, which included a lack of clinical faculty members and qualified preceptors to teach pharmacy students, and the need to revise basic sciences courses.Conclusion. Feedback from key stakeholders suggests that the quality of pharmacy graduates is above average for the most part; however, additional work is needed to address the deficiencies identified.

Background: When pharmacists across The Republic of Trinidad and Tobago were asked whether they were interested in additional pharmacy education, a large proportion responded positively.Aims: To identify the perceptions of registered pharmacists regarding the potential benefits of pursuing additional pharmacy education and factors that may affect decisions to do so.Method: A cross- sectional survey using a paper questionnaire, along with an invitation letter and a pre- stamped return envelope, were mailed to all registered pharmacists in November 2010. This was followed two weeks later by a reminder letter.Results: Two-thirds of pharmacists who held BSc pharmacy degrees indicated interest in obtaining an additional degree. Perceived benefits of pursuing additional pharmacy education that were rated the highest were: (1) not wanting to remain with current knowledge, (2) improving clinical and research skills and (3) providing better patient care.Conclusions: A large proportion of registered pharmacists in the Republic of Trinidad and Tobago, particularly those with a BSc pharmacy degree were interested in additional university-level education.

BACKGROUND The debate over the overall benefits of self-monitoring of blood glucose in type 2 diabetes patients is still continuing. We aimed to assess the difference in glycaemic control and coronary heart disease (CHD) risk levels of experimental type 2 diabetes patients provided with facilities for self-monitoring blood glucose and their counterparts without such facilities. METHODS Sixty-one patients who had no prior experience in using glucometers were studied as intervention (n = 30) and control (n = 31) groups. The intervention group was trained in self-monitoring of blood glucose and documentation. Baseline blood glucose and fasting blood glucose were measured and the intervention patients were provided with glucometers and advised to self-monitor their fasting and postprandial blood glucose over six months. The 10-year CHD risk levels were determined with the United Kingdom Prospective Diabetes Study-derived risk engine calculator. RESULTS The age and diabetes duration were similar in the two groups (P > 0.05). The majority of the patients were unemployed or retired females with only a primary level education. After 3 months, the haemogolbin A 1C (HbA 1c) levels of the control patients remained unchanged ((7.8 ± 0.3)% vs. (7.9 ± 0.4)%, P > 0.05) whereas the HbA 1c levels of the intervention patients were significantly reduced from the baseline at three ((9.6 ± 0.3)% vs. (7.8 ± 0.3)%, P < 0.001) and six ((9.2 ± 0.4)% vs. (7.5 ± 0.3)%, P < 0.001) months. Interestingly, while the 10-year CHD risk level of the control group remained unchanged after three months, that of the intervention group was remarkably reduced at three and six months from the baseline level ((7.4 ± 1.3)% vs. (4.5 ± 0.9)%, P = 0.056). CONCLUSION Self-monitoring of blood glucose in type 2 diabetes patients significantly improved glycaemic control and the CHD risk profile, suggesting that type 2 diabetes patients will potentially benefit from inclusion of glucose meters and testing strips in their health-care package.

AbstractObjectiveTo describe the reported use of non-prescription medicines (NPMs) and the reported frequency of use by outpatients living with hypertension; to identify potential drug-drug and drug-disease interactions between reported NPMs and either antihypertensives prescribed or hypertension.SettingAdult outpatient clinics of the Eric Williams Medical Sciences Complex Adult Hospital in Trinidad.MethodOutpatients were interviewed about their use of NPMs using a structured instrument. Chi-squared test or Fisher's exact test was used to test for associations between NPM use and selected variables: age group, gender, education level, number of prescribed medicines, use of prescribed medicines and the presence of comorbidities. Combinations of NPMs and antihypertensive drugs or hypertension itself that may lead to undesirable interactions were identified.Key findingsOne hundred and fifty-five clients were interviewed (mean age 61 years; 46% men; 56% of East Indian descent). Of these, 82% were living with a cardiac condition and 60% with diabetes mellitus. In addition, 92% reported using NPMs to treat minor illnesses. Analgesic use was reported by 81%. Some 66% reported using paracetamol, 54% reported antitussives, 48% antacids, 47% antihistamines and 39% said they used sympathomimetic drugs. The majority (98%) of NPMs were used only when needed. Sixty per cent had at least one combination a with risk of interaction with NPMs and hypertension or antihypertensive medicines: 16% had risk of interactions between enalapril (or captopril) and antacids, 13% between angiotensin-converting enzyme (ACE) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs), 12% between beta-blockers and NSAIDs and 12% between thiazide diuretics and NSAIDs. Thirty-nine per cent had a drug-disease interaction risk due to sympathomimetic drugs and 26% had one due to NSAID use.ConclusionBased on self-reports, outpatients living with hypertension in north-central Trinidad use NPMs when needed to treat minor illnesses, mainly paracetamol for pain. Non-prescription-antihypertensive interactions may arise due to ACE inhibitor/antacid combinations and NPM-hypertension interactions may result from use of sympathomimetics. Interactions may also arise as a result of the use of NPMs containing NSAIDs and sodium.