A randomized control trial assessing the effect of a pharmaceutical care service on Syrian refugees’ quality of life and anxiety

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Refugees, Quality of Life, Anxiety, Counseling, Pharmacists, Randomized Controlled Trials as Topic, Syria, Jordan


Background: Syrian refugees residing in Jordan suffer from chronic illnesses, low quality of life (QoL) and anxiety. Pharmacists delivering the medication review service can have a role in improving this growing worldwide problem. 

Objectives: To assess the effect of the medication review service on QoL and anxiety scores for Syrian refugees living with chronic medical conditions.

Methods: This randomized single-blinded intervention control study was conducted in Jordan. Syrian refugees were recruited and randomized into intervention and control groups. Two home visits were organized with each participant, at baseline and three months later. The medication review service was delivered to the participants and questionnaires regarding QoL and anxiety were completed by all participants. As a part of the medication review service, drug-related problems (DRPs) were identified by a clinical pharmacist for all patients, but recommendations to resolve these DRPs were delivered to intervention group refugees’ physicians only (control group patients did not receive this part of the service till the end of the study); DRPs were corrected and pharmacist-delivered counseling and education were provided as well. At follow-up, DRPs assessment, QoL and anxiety scores were assessed for refugees in the intervention and control groups.

Results: Syrian refugees (n=106) were recruited and randomized into intervention (n=53) and control (n=53) groups with no significant difference between both groups at baseline. The number of medications and diagnosed chronic diseases per participant was 5.8 (SD 2.1) and 2.97 (SD 1.16), respectively. At follow-up, a significant decrease in the number of DRPs for refugees in the intervention group was found (from 600 to 182, p<0.001), but not for the control group (number stayed at 541 DRPs, p=0.116). Although no significant difference between the groups was found with regards to QoL at follow-up (p=0.266), a significant difference was found in the anxiety scores between the groups (p<0.001).

Conclusion: The medication review service delivered by clinical pharmacists can significantly improve refugees’ DRPs and anxiety scores. As for QoL, significant improvements can be seen for all refugee patients, regardless of whether the DRPs identified were resolved or not.

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1. Turrini G, Purgato M, Ballette F, Nosè M, Ostuzzi G, Barbui C. Common mental disorders in asylum seekers and refugees: umbrella review of prevalence and intervention studies. Int J Ment Health Syst. 2017;11:51. https://doi.org/10.1186/s13033-017-0156-0
2. Georgiadou E, Morawa E, Erim Y. High manifestations of mental distress in arabic asylum seekers accommodated in collective centers for refugees in Germany. Int J Environ Res Public Health. 2017;14(6);612. https://doi.org/10.3390/ijerph14060612
3. Al-Smadi AM, Tawalbeh LI, Gammoh OS, Ashour AF, Alshraifeen A, Gougazeh YM. Anxiety, stress, and quality of life among Iraqi refugees in Jordan: A cross sectional survey. Nurs Health Sci. 2017;19(1):100-104. https://doi.org/10.1111/nhs.12323
4. Lindencrona F, Ekblad S, Hauff E. Mental health of recently resettled refugees from the Middle East in Sweden: the impact of pre-resettlement trauma, resettlement stress and capacity to handle stress. Soc Psychiatry Psychiatr Epidemiol. 2008;43(2):121-131. https://doi.org/10.1007/s00127-007-0280-2
5. Global Trends forced displacement in 2017. Available at: https://www.unhcr.org/5b27be547.pdf (accesed Feb 3, 2019).
6. United Nations population Fund regional situation report for the Syrian crisis. Available at: https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Regional_Situation_Report_for_the_Syria_Crisis_-_Issue_72_-_August.pdf (accesed Sep 3, 2018).
7. World Vision Team. Syrian refugee crisis: Facts, FAQs, and how to help. Available at: https://www.worldvision.org/refugees-news-stories/syrian-refugee-crisis-facts (accesed Feb 4, 2020).
8. Ay M, Arcos González P, Castro Delgado R. The Perceived Barriers of Access to Health Care Among a Group of Non-camp Syrian Refugees in Jordan. Int J Health Serv. 2016;46(3):566-589. https://doi.org/10.1177/0020731416636831
9. El-Khatib Z, Scales D, Vearey J, Forsberg BC. Syrian refugees, between rocky crisis in Syria and hard inaccessibility to healthcare services in Lebanon and Jordan. Confl Health. 2013;7(1):18. https://doi.org/10.1186/1752-1505-7-18
10. Jokanovic N, Tan EC, Sudhakaran S, Kirkpatrick CM, Dooley MJ, Ryan-Atwood TE, Bell JS. Pharmacist-led medication review in community settings: An overview of systematic reviews. Res Social Adm Pharm. 2017;13(4):661-685. https://doi.org/10.1016/j.sapharm.2016.08.005
11. Basheti IA, Ayasrah SM, Basheti MM, Mahfuz J, Chaar B. The Syrian refugee crisis in Jordan: a cross sectional pharmacist-led study assessing post-traumatic stress disorder. Pharm Pract (Granada). 2019;17(3):1475. https://doi.org/10.18549/PharmPract.2019.3.1475
12. Mahdikhani S, Dabaghzadeh F. Benefits of Pharmacist’s Participation on Hospitalist Team. Acta Med Iran. 2016;54(2):140-145.
13. Basheti IA, Rizik M, Bulatova NR. Home medication management review in outpatients with alarming health issues in Jordan: a randomized control trial. J Pharm Health Serv Res. 2018;9(2):91-100.
14. Brandt M, Hallas J, Graabæk T, Pottegård A. Description of a practice model for pharmacist medication review in a general practice setting. Pharm Pract (Granada). 2014;12(3):420-443. https://doi.org/10.4321/s1886-36552014000300005
15. Basheti IA, Tadros OK, Alnajjar MS, Aburuz S. Assessing patient satisfaction with the medication management review service delivered in Jordan. J Pharm Health Serv Res. 2019;10(1):49-55. https://doi.org/10.1111/jphs.12233
16. Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services. Drugs. 2009;69(4):393-406. https://doi.org/10.2165/00003495-200969040-00001
17. Castelino RL, Bajorek BV, Chen TF. Are interventions recommended by pharmacists during Home Medicines Review evidence‐based? J Eval Clin Pract. 2011;17(1):104-110. https://doi.org/10.1111/j.1365-2753.2010.01375.x
18. Al-Qudah RA, Tuza O, Tawfiek H, Chaar B, Basheti IA. Community pharmacy ethical practice in Jordan: assessing attitude, needs and barriers. Pharm Pract (Granada). 2019;17(1):1386. https://doi.org/10.18549/PharmPract.2019.1.1386
19. Alkoudsi KT, Basheti IA. Prevalence of anxiety and depression among women with Polycystic Ovary Syndrome living in war versus non-war zone countries: A randomized controlled trial assessing a pharmacist intervention. Res Social Adm Pharm. 2019 [Ahead of print]. https://doi.org/10.1016/j.sapharm.2019.08.027
20. Basheti IA, Tadros OK, Aburuz S. Value of a community‐based medication management review service in Jordan: a prospective randomized controlled study. Pharmacotherapy. 2016;36(10):1075-1086. https://doi.org/10.1002/phar.1833
21. Basheti IA, Al-Qudah RA, Obeidat NM, Bulatova NR. Home medication management review in outpatients with chronic diseases in Jordan: a randomized control trial. Int J Clin Pharm. 2016;38(2):404-413. https://doi.org/10.1007/s11096-016-0266-9
22. AbuNaba'a Y, Basheti IA. Assessing the impact of medication management review service for females diagnosed with depression and anxiety: A randomized control trial. J Eval Clin Pract. 2019 [Ahead of print]. https://doi.org/10.1111/jep.13314
23. Basheti IA, Qunaibi EA, Bulatova NR, Samara S, AbuRuz S. Treatment related problems for outpatients with chronic diseases in Jordan: the value of home medication reviews. Int J Clin Pharm. 2013;35(1):92-100. https://doi.org/10.1007/s11096-012-9713-4
24. Aburuz SM, Bulatova NR, Yousef AM, Al-Ghazawi MA, Alawwa IA, Al-Saleh A. Comprehensive assessment of treatment related problems in hospitalized medicine patients in Jordan. Int J Clin Pharm. 2011;33(3):501-511. https://doi.org/10.1007/s11096-011-9497-y
25. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192-199. https://doi.org/10.1016/s1086-5802(16)31229-3
26. Kothari D, Gupta S, Sharma C, Kothari S. Medication error in anaesthesia and critical care: A cause for concern. Indian J Anaesth. 2010;54(3):187-192. https://doi.org/10.4103/0019-5049.65351
27. Pinilla J, Murillo C, Carrasco G, Humet C. Case-control analysis of the financial cost of medication errors in hospitalized patients. Eur J Health Econ. 2006;7(1):66-71. https://doi.org/10.1007/s10198-005-0332-z
28. Al Alawneh M, Nuaimi N, Basheti IA. Pharmacists in humanitarian crisis settings: Assessing the impact of pharmacist-delivered home medication management review service to Syrian refugees in Jordan. Res Social Adm Pharm. 2019;15(2):164-172. https://doi.org/10.1016/j.sapharm.2018.04.008
29. Sluggett JK, Ilomäki J, Seaman KL, Corlis M, Bell JS. Medication management policy, practice and research in Australian residential aged care: current and future directions. Pharmacol Res. 2017;116:20-28. https://doi.org/10.1016/j.phrs.2016.12.011
30. Freeman CR, Cottrell WN, Kyle G, Williams ID, Nissen L. An evaluation of medication review reports across different settings. Int J Clin Pharm. 2013;35(1):5-13. https://doi.org/10.1007/s11096-012-9701-8
31. Gusi N, Olivares PR, Rajendram R. The EQ-5D health-related quality of life questionnaire. In: Preedy VR, Watson RR, eds. Handbook of disease burdens and quality of life measures. New York, NY:Springer;2010. ISBN: 978-0-387-78664-3
32. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
33. Johnston M, Pollard B, Hennessey P. Construct validation of the hospital anxiety and depression scale with clinical populations. J Psychosom Res. 2000;48(6):579-584. https://doi.org/10.1016/s0022-3999(00)00102-1
34. Molino Cde G, Carnevale RC, Rodrigues AT, Visacri MB, Moriel P, Mazzola PG. Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection. Ther Clin Risk Manag. 2014;10:631-639. https://doi.org/10.2147/TCRM.S61821
35. Coutts A, Fouad FM. Response to Syria's health crisis—poor and uncoordinated. Lancet. 2013;381(9885):2242-2243. https://doi.org/10.1016/s0140-6736(13)61421-x
36. Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, Essien EJ, Chung N, Fleming M. A pharmacist telephone intervention to identify adherence barriers and improve adherence among nonadherent patients with comorbid hypertension and diabetes in a Medicare Advantage Plan. J Manag Care Spec Pharm. 2016;22(1):63-73. https://doi.org/10.18553/jmcp.2016.22.1.63
37. Mossialos E, Courtin E, Naci H, Benrimoj SI, Bouvy ML, Farris KB, Noyce P, Sketris I. From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy. 2015;119(5):628-639. https://doi.org/10.1016/j.healthpol.2015.02.007
38. Bruhn H, Bond CM, Elliott AM, Hannaford PC, Lee AJ, McNamee P, Smith BH, Watson MC, Holland R, Wright D. Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open. 2013;3(4): e002361. https://doi.org/10.1136/bmjopen-2012-002361
39. Obradovic M, Lal A, Liedgens H. Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain. Health Qual Life Outcomes. 2013;11:110. https://doi.org/10.1186/1477-7525-11-110
40. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537-549. https://doi.org/10.1001/jama.2009.1132
41. World Health Organization. Global strategy on human resources for health: workforce 2030. Available at: https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_24-en.pdf (accessed Feb 4, 2020).
42. World Health Organization. High-Level Commission on Health Employment and Economic Growth, Working for health and growth: investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. Available at: http://apps.who.int/iris/bitstream/10665/250047/1/9789241511308-eng.pdf (accesssed Feb 4, 2018.
43. Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999;49(443):477-482.

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