ASSESSMENT OF SATISFACTION WITH MEDICINE INFORMATION AMONG PATIENTS WITH CHRONIC DISEASES AT A NIGERIAN TERTIARY HEALTHCARE FACILITY

292 Nigerian Journal of Pharmaceutical and Biomedical Research Vol. 8 Issue.3 December, 2024. p-ISSN: 2579-1419 e-ISSN: 2814-1423 ASSESSMENT OF SATISFACTION WITH MEDICINE INFORMATION AMONG PATIENTS WITH CHRONIC DISEASES AT A NIGERIAN TERTIARY HEALTHCARE FACILITY Paul Otor Onah Department of clinical pharmacy and pharmacy practice, Faculty of Pharmacy, University of Maiduguri, Borno State Correspondent Author Email: [email protected], Tel: +2348038258589 http://doi.org/10.55639/607.phar.10901.009 Abstract Background: Medicine information is a critical component of pharmaceutical care for patients on chronic medication therapy. This pharmacist led service is expected to provide basic information on the purpose, usage, storage and benefits of therapy as well as potential side effects of medicines. The information is expected to be patient specific and tailored to meet unique needs at various stages of medication therapy. Satisfaction with medicine information is known to improve clinical outcomes, reduce adverse drug events and help patients achieve better adherence with medications among other benefits. In recent times there are concerns about the quality of medicine information provided to patients and its effects on satisfaction with pharmaceutical care service experience in public health facilities in the country. This study therefore aim to explore patients satisfaction with information received alongside their dispensed medications. Methods: This was a cross sectional survey study carried out among patients with four common non-communicable diseases. A total of four hundred and twelve respondents selected using convenience sampling were self-administered with “satisfaction with information about medicine scale” (SIMS). The seventeen item four point Likert scale instrument (Too much, about okay, too little, non-received and non-needed) was scored as satisfied (about right and non-needed scored = 1) and other options were classified as unsatisfied (score = 0). Satisfaction was determined using summary score of > 12 and further analysis was done using Students t test, one way ANOVA and Chi square test. P values <0.05 was significant. Results: Satisfaction with medicine information ranged between 13.8 to 44.5% of patients with the highest being “how to get a further supply” (44.5%) and the least “what to do if you forget to take a dose” (13.8%). There are significant differences in satisfaction between different aspects of medicine information and demographic variables (p<0.001). Satisfaction is significantly associated with gender (p<0.001), marital status (p<0.001), educational level (p = 0.009) and duration of therapy (p = 0.003). Conclusion: Satisfaction with medicine information was generally low and an indication of ineffective information service delivery system. There is need to revise the current medicine information service delivery to not only improve satisfaction but also to promote proper use of medicines among patients on chronic disease medication therapy. Keywords: Medicine information, chronic diseases, satisfaction, pharmaceutical care Introduction Medication information is a central component of pharmaceutical care services that should be provided to all patients particularly to those on complex medication therapy for non-communicable diseases. The four commonly encountered non-communicable diseases include hypertension, diabetes, asthma and cancers 293 require lifelong medication therapy (Idris et al, 2020, Wang &Wang, 2020) and patients are expected to be active participants in long term medical care (Devi et al, 2020, Lorber et al, 2020). It is therefore of critical importance for patients to be provided with adequate medication information needed for effective participation in treatment planning, adherence and optimization of clinical outcomes (Geryk et al, 2016, Nafradi et al, 2016). Medicines play a central role in the treatment of non-communicable diseases as well as prevention of long term complications. Recent studies have exposed major gaps between information needs of patients and that provided by healthcare providers (Chan et al, 2020, Boons et al, 2018). Furthermore, there is increasing awareness that long term medication therapy is challenged by side effects, non-adherence, confusion from complex treatment regimens, multiple dosing schedules, proper storage of medicines, drug interactions with food, alcohol and other drugs (Sheik et al, 2017). These problems cannot be effectively prevented or ameliorated without active participation of patients through adequate counseling and medication information (Alshahrani, 2023). In typical hospital settings, verbal and written medicine information is usually provided during the dispensing process, however problems remain with patient misunderstanding of instructions, ability to read, recall of oral information, wrong application of instructions and mix up of important details required for proper use of medications etc. (Benson et al, 2021, Niriayo et al, 2018). In addition the need for medicine information frequently change over time due to changes in drug regimen, emergence of complications and adverse drug events all of which require regular revision of information that is needed by patients (Eibergen et al, 2018). This evolution of information needs and the inability of providers to keep up with the pace of changes is a significant source of dissatisfaction (Kusch et al, 2018). The provision of adequate medication information is important for the prevention of medication errors (Sheik et al, 2017, Donaldson et al, 2017), potentially harmful interactions and avoidable adverse events (Takaki et al, 2017, Rameshkumar et al, 2022). The benefits of adequate medicine information extends well beyond direct clinical outcomes (Walker et al, 2023, Aldarwesh et al, 2022, Undeberg et al, 2022) to include improved adherence (Unni et al, 2022, Makhinova et al, 2022), enhance knowledge of disease (Sze et al, 2020), reduction in side effects (Langst et al, 2015) and safer use of drugs (Jose, 2020). Satisfaction with medication information is however known to be influenced by presentation format (Wongtaweepkij et al, 2021, Johnson et al, 2003), cultural and language barriers (Nguyen et al, 2019), trust (Sulistyaningrum et al, 2023, Druica et al, 2021), disease type (Adeniyi et al, 2017) and level of health literacy (Aggarwal et al, 2024, Martin, 2019). While the role of medication information in patient participation in treatment decisions is not in dispute (Sertan et al, 2023), its quality have been of mix performance (Chan et al, 2020). The poor information delivery system in sub Saharan countries have frequently produced inconsistent findings, although most of them have reported poor satisfaction among patients (Lucca et al, 2022, Ade et al, 2020) while others reported moderate level of satisfaction (Hammar & Zetterholm, 2020, Ofili et al, 2023). Medication information should be part of routine pharmaceutical care provided to patients, so assessment offers an 294 opportunity to view its quality from the perspective of patient’s service experience. This study therefore aim to evaluate satisfaction with the quality of medicine information among patients being managed with selected non-communicable diseases and its association with demographic factors. Methods Settings: The study was carried out among outpatients living with four chronic diseases (Diabetes mellitus (DM), hypertension (HTN), cardiovascular diseases (CVD) and asthma) in a tertiary care hospital. Study design: This was a cross sectional survey study carried out among patients being managed in the hospital. Sample size/sampling: The sample size was determined using Raosoft calculator at 95% confidence interval and 5% margin of error. The sample size was 377 and 10% attrition rate factored in bring the final sample size to 415. The respondents were selected using simple random sampling method. Eligibility criteria:  Patients being managed for DM2, HTN, asthma or CHF  Patients must have being on therapy for at least six months  Patients with coexisting noncommunicable disease were excluded Questionnaire: Satisfaction with information about medicine scale (Horne et al, 2001) consist of 17 items relating medicine knowledge and use. Each item was rated on a four point Likert scale (Too much, about okay, too little, non-received and non-needed) and patients were required to rate information they were provided about their current medications. While “about right” and “non-needed” were classified as satisfied (score = 1), other options were classified as unsatisfied (score = 0). Item scores ranged from 0 to 17 with scores (> 12) indicating satisfaction while scores of ≤ 12 is dissatisfaction. Data collection: The questionnaire was self-administered on patients who provided verbal consent and after receiving their medicines at the pharmacy department of the hospital. A total of 430 questionnaires were administered out of which 412 were used for final analysis giving a return rate of 93%. Data analysis: The data were entered into Microsoft excel, cleaned and loaded into SPSS version 21 for descriptive and inferential analysis. Student’s t test, one way ANOVA and Chi square were used to determine significant differences and /or association between demographic variables and satisfaction with medicine information. P values < 0.05 was statistically significant. Ethical issues: Approval for the study was obtained from the health research ethics committee of the Borno State specialist hospital Maiduguri (SSH/GEN/641/Vol.1). Result Demographic data showed that 54.2% of respondents were males compared to 45.8% females. Majority of respondents were married (85.5%) and major occupations were civil service (49.7%) and selfemployment (38.5%). About half of respondents had secondary level education (50%) and tertiary level education was reported by 26.8% of them. The most encountered diseases were CVDs (31%), HTN (25%), DM2 (25.2%) and least being asthma (18.8%). The mean duration of therapy was 4.4 ±1.4 years (Table 1). 295 Table 1: Demographic data Variable Number Percentage Gender Male 217 54.2 Female 183 45.8 Age (yrs.) ≤ 40 92 23 41 – 50 100 25 51 – 60 79 19.8 61 – 70 69 17.2 ≥ 71 60 15 Mean age (yrs.) = 49.7 ± 18.6 Marital status Single 13 3.3 Married 342 85.5 Widowed 45 11.2 Occupation Civil servant 199 49.7 Self employed 154 38.5 Unemployed 47 11.8 Farming Educational status Primary 93 23.2 Secondary 200 50 Tertiary 107 26.8 Morbidity DM2 101 25.2 HTN 100 31 Asthma 75 18.8 CVD 124 25 Duration of therapy (yrs.) <2 36 9 2 – 5 147 36.8 > 5 217 54.2 Mean duration (yrs.) = 4.4 ±1.4 Key: DM2 – diabetes mellitus type 2, HTN – hypertension, CVD – cardiovascular diseases Satisfaction with medicine information on items ranged from 13.8 to 44.5% with “how to get a further supply” (44.5%), “how to use your medicine” (43.5%) and “what is the name of your medicine called” (35.3%) being the highest levels. Satisfaction with “what to do if you forget to take a dose” (13.8%) was the least (Figure 1). 296 Figure 1: Satisfaction with medicine information The distribution of item response to items showed overall satisfaction with medicine information of 38.7% among respondents. The level of dissatisfaction was highest with “what to do if a dose is missed” (86.2%) and “what medicines do “(85.5%) as well as “how medicines work” (84.2%) (Table 2). 010 20 30 40 50 What name is your medicine called What your medicine is for What your medicine do How your medicine works How long it takes to act How can you tell if it is working How long will you need to be the medicine How to use your medicine How to get a further supply Whether the medicines have unwanted side effects What are the risks of side effects What to do when you experience side effects Whether you can take alcohol while on your medication Whether your medicine interfer with other medicines Whether the medicines will make you drowsy Whether your medicine will affect your sex life What to do if you forget to take a dose Percentage 297 Table 2: Distribution of response to items Item description Too much N (%) About right N (%) Too little N (%) Non received N (%) Non needed N (%) Q1 What is the name of your medicine called 231 (57.7) 141 (35.3) 28 (7.0) - - Q2 What is your medicine for 227 (56.7) 70 (17.5) 36 (9.0) 67 (16.8) - Q3 What your medicine do 172 (43) 30 (7.5) 142 (35.5) 28 (7.0) 28(7.0) Q4 How your medicine works 113 (28.2) 50 (12.5) 149 (37.3) 64 (16) 24 (6) Q5 How long it takes to act 115 (28.7) 59 (14.8) 180 (45) 16 (4) 30 (7.5) Q6 How can you tell if it is working 51 (12.8) 62 (15.5) 148 (37) 64 (16) 75(18.7) Q7 How long will you need to be on your medicine 141 (35.3) 70 (17.5) 85 (21.2) 80 (20) 24 (6) Q8 How to use your medicine 100 (25) 112 (28) 59 (14.7) 67 (16.8) 62 (15.5) Q9 How to get a further supply 103 (25.8) 129 (32.2) 110 (27.5) 28 (7) 30 (7.5) Q10 Whether the medicine has any unwanted side effects 56 (14) 99 (24.7) 105 (26.3) 108 (27) 32 (8) Q11 What are the risks of you getting side effects 84 (21) 81 (20.3) 142 (35.5) 61 (15.2) 32 (8) Q12 What to do if you experience unwanted side effects 79 (19.8) 64 (16) 139 (34.7) 81 (20.3) 37 (9.2) Q13 Whether you can drink alcohol while on this medicine 35 (8.7) 92 (23) 87 (21.8) 138 (34.5) 48 (12) Q14 Whether this medicine interfere with other medicines 12 (3) 55 (13.7) 141 (35.3) 140 (35) 52 (13) Q15 Whether this medicine will make you drowsy 77 (19.3) 70 (17.5) 128 (32) 99 (24.7) 26 (6.5) Q16 Whether this medicine will affect your sex life 51 (12.8) 82 (20.5) 118 (29.5) 95 (23.7) 54 (13.5) Q17 What you should do if you forget to take a dose 87 (21.7) 34 (8.5) 137 (34.3) 121 (30.2) 21 (5.3) Key: “About right” and “non-needed” were scored as satisfaction items 298 Satisfaction with information on “what name is your medicine” and “what your medicine do” were associated with age, morbidity, educational status and duration of therapy (P<0.001). While “what is your medicine for” was associated with age (P<0.001), education (P<0.001), morbidity (P = 0.016) and duration of therapy (P = 0.020). “How your medicine work” is associated with all the demographic variables except age (P = 0.988) and gender (P = 0.460) (Table 3). Table 3: Satisfaction with knowledge of medicines Variable Q1. What is the name of your medicine Q2. What is your medicine for Q3. What your medicine do Q4. How your medicine work STF NSTF P value STF NSTF P value STF NSTF P value STF NSTF P value Gender Male 83 (38.2) 134 (61.8) 0.172 70 (32.2) 147 (67,8) 0.361 35 (16.1) 182 (83.9) 0.314 37 (17.1) 182 (82.9) 0.460 Female 58 (31.7) 125 (68.3) 67 (36.6) 116 (63.4) 23 (12.6) 160 (87.4) 26 (14.2) 157 (85.8) Age (yrs.) ≤ 40 12 (14.1) 80 (85.9) <0.001 13 (14.1) 79 (85.9) <0.001 8 (8.7) 84 (91.3) 0.262 15 (16.3) 77 (83.7) 0.988 41 – 50 39 (39) 61 (61) 40 (40) 60 (60) 18 (18) 82 (82) 14 (14) 86 (86) 51 – 60 48 (60.7) 31 (39.3) 43 (54.4) 36 (45.6) 15 (18.9) 64 (81.1) 13 (16.4) 66 (83.6) 61 – 70 22 (31.9) 47 (68.1) 24 (34.8) 45 (65.2) 8 (11.6) 61 (88.4) 11 (15.9) 58 (84.1) ≥71 20 (33.3) 40 (66.7) 17 (28.3) 43 (71.7) 9 (15) 51 (85) 10 (16.7) 50 (83.3) Education Primary 27 (29) 66 (71) <0.001 19 (20.4) 74 (79.6) <0.001 5 (5.4) 88 (94.6) <0.001 4 (4.3) 89 (95.7) <0.001 Secondary 54 (27) 146 (73) 60 (30) 140 (70) 16 (8) 184 (92) 18 (9) 182 (91) Tertiary 60 (56.1) 47 (43.9) 58 (54.2) 49 (45.8) 37 (34.6) 69 (65.4) 41 (38.3) 66 (62.7) Marital status 299 Single 4 (30.8) 9 (69.2) 0.136 7 (53.8) 6 (46.2) 0.317 3 (23.1) 9 (76.9) 0.559 6 (46.1) 7 (53.9) <0.001 Married 127 (37.1) 215 (62.9) 115 (33.6) 227 (66.4) 48 (14) 294 (86) 48 (14) 294 (86) Widowed 10 (22.2) 35 (77.8) 15 (33.3) 30 (66.7) 7 (15.5) 38 (84.5) 9 (20) 36 (64) Morbidity DM2 22 (21.8) 79 (78.2) <0.001 37 (36.6) 64 (63.4) 0.016 17 (16.8) 84 (83.2) <0.001 17 (16.8) 84 (83.2) 0.069 HTN 25 (25) 75 (75) 33 (33) 67 (67) 28 (28) 82 (72) 19 (19) 81 (81) Asthma 16 (21.3) 59 (78.7) 15 (20) 60 (80) 9 (12) 66 (88) 16 (21.3) 59 (78.7) CVD 78 (62.9) 46 (37.1) 52 (41.9) 72 (58.1) 4 (3.2) 120 (96.8) 11 (8.9) 113 (91.1 Duration (yrs.) < 2 12 (33.3) 24 (66.7) <0.001 16 (44.4) 20 (55.6) 0.020 7 (19.4) 29 (80.6) 0.660 9 (25) 27 (75) 0.054 2 - 5 31 (21.1) 116 (78.9) 38 (25.8) 109 (74.2) 20 (13.6) 127 (86.4) 28 (19) 119 (81) > 5 98 (45.2) 119 (54.8) 83 (38.2) 134 (61.8) 31 (14.3) 186 (85.7) 26 (11.9) 191 (88.1) Key: STF – satisfied, NSTF – not satisfied Patients educational status and morbidity had significant association with satisfaction (P<0.001) while other items had mixed results. For instance, age and duration of therapy were associated with “how long medicine take to work” (P<0.001) and “how to tell if your medicine is working” (P<0.001), gender was only associated with “how can you tell if your medicine is working” (P = 0.002). Marital status was significantly associated with “how long medicine take to work” (P = 0.001) and “how long you will be taking your medicine” (P<0.001) (Table 4). 300 Table 4: Satisfaction with medicine use information Variable Q5. How long medicine takes to work Q6. How can you tell if your medicine is working Q7. How long will you be taking your medicine Q8. How to use your medicine STF NSTF P value STF NSTF P value STF NSTF P value STF NSTF P value Gender Male 61 (28.1) 156 (71.9) 0.515 88 (40.5) 129 (59.5) 0.002 49 (22.6) 168 (72.4) 0.637 98 (45.2) 119 (54.8) 0.465 Female 29 (15.8) 154 (84.2) 49 (26.8) 139 (73.2) 45 (24.6) 138 (75.3) 76 (41.5) 107 (58.5) Age (yrs.) ≤ 40 12 (14.1) 80 (85.9) <0.001 14 (15.2) 78 (84.8) <0.001 17 (18.5) 75 (81.5) 0.315 37 (40.2) 55 (59.8) 0.281 41 – 50 21 ((21) 79 (79) 32 (32) 68 (68) 19 (19) 81 (81) 39 (49) 51 (51) 51 – 60 16 (20.2) 63 (79.8) 41 (51.9) 38 (48.1) 22 (27.8) 57 (72.2) 39 (49.3) 40 (50.7) 61 – 70 30 (43.5) 39 (56.5) 19 (27.5) 50 (72.5) 20 (28.9) 49 (71.1) 22 (31.9) 47 (68.1) ≥71 11 (18.3) 49 (81.7) 31 (51.7) 29 (48.3) 16 (26.7) 44 (73.3) 27 (45) 33 (55) Education Primary 10 (10.7) 80 (89.3) <0.001 17 (18.3) 76 (81.7) <0.001 14 (15.1) 79 (84.9) <0.001 23 (24.7) 70 (75.3) 0.001 Secondary 23 (11.5) 177 (88.5) 45 (22.5) 155 (77.5) 36 (18) 164 (82) 94 (47) 106 (53) Tertiary 57 (53.3) 50 (46.7) 75 (70.1) 32 (29.9) 44 (41.1) 63 (58.9) 57 (53.3) 50 (46.7) Marital status Single 5 (38.5) 8 (61.5) 0.001 4 (30.8) 9 (69.2) 0.174 3 (23.1) 10 (76.9) <0.001 5 (38.5) 8 (61.5) 0.913 Married 66 (19.3) 267 (80.7) 112 (32.7) 230 (67.3) 69 (20.2) 273 (79.8) 150 (43.8) 192 (56.2) Widowed 19 (42.2) 26 (57.8) 21 (46.7) 24 (53.3) 22 (47.9) 23 (52.1) 19 (42.2) 26 (57.8) Morbidity DM2 27 (26.7) 74 (73.3) 0.022 36 (35.6) 65 (64.4) <0.001 26 (25.7) 75 (74.3) 0.059 57 (56.4) 43 (43.6) <0.001 HTN 28 (28) 72 (72) 53 (53) 47 (47) 22 (22) 78 (78) 55 (55) 45 (45) Asthma 19 (25.3) 56 (74.7) 28 (37.3) 47 (62.7) 25 (33.3) 50 (66.7) 34 (45.3) 41 (54.7) CVD 16 (12.9) 108 (87.1) 20 (16.1) 104 (83.9) 21 (16.9) 103 (83.1) 28 (22.6) 96 (77.4) Duration (yrs.) < 2 11 (30.5) 8 (69.5) <0.001 18 (50) 18 (50) 0.059 9 (25) 27 (75) 0.507 19 (52.8) 17 (47.2) 0.336 2 - 5 49 (33.3) 98 (66.7) 43 (29.2) 104 (70.8) 38 (25.8) 109 (74.2) 59 (39.5) 89 (60.5) > 5 30 (13.8) 187 (86.2) 76 (35) 141 (65) 47 (21.6) 170 (78.4) 97 (44.7) 120 (55.3) Satisfaction side effect information is associated with morbidity (P<0.001), education ((P<0.001), marital status (P = 0.019), duration of therapy (P<0.001) and age (P = 0.014) (Table 5). 307 patients receive. Journal of Health Communication. 21(10): 1122–1130. Goldstone LW, DiPaula BA, Werremeyer A, Botts S, Hepburn B, Liu HY, Duckworth K, Young AS, Kelly DL (2021). The role of boardcertified psychiatric pharmacists in expanding access to care and improving patient outcomes. Psychiatry Services. 72(7):794–801. Hussain S, Hussain AAS, Hussain K, Asif MA, Khalil MM, Rahman DA, Charara R, Alsuwaidi S, AlKhani R (2013). Pharmacist–patient counselling in Dubai: assessment and reflection on patient satisfaction. European Journal of Hospital Pharmacy. 20: 241–247 Horne R, Hankins M, Jenkins R (2001). The satisfaction with information about medicines scale (SIMS): a new measurement tool for audit and research. Quality Health Care. 10: 135–140. Hammar T, Zetterholm M (2020). Patients views on information about medicationsa pharmacy-based survey focusing on their information sources and experiences of pharmacists using a clinical decision support system. Proceedings of the 18th International Symposium on Health Information management Research. https://doi.org/10.15626/ishimr.2020 .15 Healy M, Richard A, Kidia K (2022). How to reduce stigma and bias in clinical communication; a narrative review. Journal of General Internal Medicine. 37(10): 2533 – 2540. Idris IO, Oguntade AS, Mensah EA, Kitamura N (2020). Prevalence of non-communicable diseases and its risk factors among Ijegun-Isheri Osun residents in Lagos State, Nigeria: a community based cross sectional study. BMC Public Health. 20: 1258. Johnson A, Sandford J, Tyndall J (2003). Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Databased of Systematic Reviews. 4: CD003716. Jose J (2020). Communication on drug safety-related matters to patients: is it even more significant in this digital era? Therapeutic Advances in Drug Safety. 11: 1–4. Kayyali R, Gomes AM, Mason T, Naik M (2016). Patient’s perceptions of medication counselling from community pharmacies. Pharmacy and Pharmacology International Journal. 4(2): 334 - 337 Klewitz F, Nöhre M, Bauer-Hohmann M, Tegtbur U, Schiffer L, Pape L, Schiffer M, de Zwaan M (2019). Information needs of patients about immunosuppressive medication in a German kidney transplant sample: prevalence and correlates. Frontiers in Psychiatry. 10: 444. Kusch MK, Haefeli WE, Seidling HM (2018). How to meet patients’ individual needs for drug information - a scoping review. Patient Prefer Adherence. 12:2339–2555. Langst G, Seidling HM, Stützle M, Ose D, Baudendistel I, Szecsenyi J, Wensing M, Mahler C (2015). Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals. Patient Prefer Adherence. 9: 1431– 1441. Lorber M, Reljic NM, Kegl B, Fekonja Z, Stiglic G, Davey A, Kmetec S (2024). Person-centred care; Support strategy for managing non communicable diseases. Healthcare. 12(5): 526. Lucca JM, Kurdi S, Albaqshi B, Joseph R (2022). Patient satisfaction with pharmaceutical care services for chronic diseases and their medication adherence during COVID-19 in 308 Saudi Arabia. International Journal of Pharmacy Practice. 30(2): 136 – 142. Makhinova T, Barner JC, Brown CM, Richards KM, Rascati KL, Nag A (2022). Improving asthma management: patient–pharmacist partnership program in enhancing therapy adherence. Pharmacy. 10: 34. Martin RW (2019). The impact of health literacy on rating of healthcare experience. MUSC Theses and Dessertations. 221. http://medicamusc.researchcommons.org/theses/2 21 Nyblade L, Stockton MA, Wouters E, Giger K, Bond V, Ekstrand ML, McLean R, Mitchell EMH, Nelson LRE, Sapag JC, Siraprapasiri T, Turan J, Wouters E (2019). Stigma in health facilities: Why it matters and how we can change it. BMC Medicine. 17: 25. Nafradi L, Galimberti E, Nakamoto K, Schulz PJ (2016). Intentional and unintentional medication nonadherence in hypertension: the role of health literacy, empowerment and medication beliefs. Journal of Public Health Research. 5(3): 762. Nguyen TM, La Caze A, Cottrell N. (2019). What are validated self-report adherence scales really measuring? A systematic review. British Journal of Clinical Pharmacology. 85(10): 2066-2077. Niriayo YL, Kumela K, Kassa TD, Angamo MT (2018). Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University specialized hospital, Southwest Ethiopia. Plos One. 13(10): e0206120. Newman TV, San-Juan-Rodriguez A, Parekh N, Swart ECS, KleinFedyshin M, Shrank WH, Hernandez I (2020). Impact of community pharmacist-led interventions in chronic disease management on clinical, utilization, and economic outcomes: an umbrella review. Research in Social Administrative Pharmacy. 16(9):1155–1165 Ofili SC, Okenwa SC, Iyi CL, Ekweo-zor CA, Uwaezuoke C, Onuzulike IJ, Somtochukwu MR, Igbokwe J, Odo CL (2023). Assessment of patients’ satisfaction with pharmaceutical care services in a Nigerian teaching hospital: A cross sectional study. Journal of Advances in Medical and Pharmaceutical Sciences. 25 100340): 1-10. Priebe S, Conneely M McCabe R, Bird V (2019). What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of nonspecific components. Epidemiology in Psychiatric Science. 29: e48. Rutter J, Rutter P (2019). Impact of pharmacy medicine information service advice on clinician and patient outcomes: an overview. Health Information & Libraries Journal. 36: 299–317. Rameshkumar T, Haputhanthrige IU1, Misbahunnisa MY, Galappatthy P (2022). Patients’ knowledge about medicines improves when provided with written compared to verbal information in their native language. Plos One. 17(10): e0274901. Sheikh A, Dhingra-Kumar N, Kelley E, Kieny MP, Donaldson LJ (2017). The third global patient safety challenge: tackling medication-related harm. Bulletin of World Health Organization. 95(8): 546–546A Sze WT, Pudney R, Wei L (2020). Inpatients’ satisfaction towards information received about medicines. European Journal Hospital Pharmacy. 27: 280–285. Showande SJ, Laniyan MW (2022). Patient medication counselling in community pharmacy: evaluation of the quality and content. Journal of Pharmaceutical Policy and Practice. 15: 103. Sertan A, Cek K, Oniz A, Ozgoren M (2023). The influence of medicine approaches on patient trust, 309 satisfaction, and loyalty. Healthcare (Basel). 11(9): 1254. Silkane V, Davidsone A, Veliverronena (2018). The role of health literacy in predicting patient satisfaction with healthcare. Society Integration education. Proceedings of the international Scientific Conference, Volume VII, May 25th – 26th, 2018, 240 – 250. https://doi.org/10.17770/sie2018vol1 .3223 Sulistyaningrum IH, Pribadi P, Santoso A, Arfianto E, Pangestuti RCA, Umma N, Ningrum MP (2023). The complex mechanism of developing trust in pharmacy. Pharmacia. 70(3): 765 – 770. Tan, YXF, Liim STL, Lim JL, Ng TTM, Chng HT (2023). Drug informationseeking behaviours of physicians, nurses and pharmacists: A systematic literature review. Health information and Library Journal. 40(2): 125–168. Takaki H, Abe T, Hagihara A (2017). Physicians’ and pharmacists’ information provision and patients’ psychological distress. Journal of Interprofessional Care. 31(5): 575– 582. Undeberg MR, McKeirnan KC, Easley D (2022). Respecting the patient’s Choice: A case of possible druginduced Parkinsonism. Pharmacy. 10: 10. Unni E, Bae S (2022). Exploring a new theoretical model to explain the behavior of medication adherence. Pharmacy. 10: 43. van Geffen EC, Philbert D, van Boheemen C, van Dijk L, Bos MB, Bouvy ML (2011). Patients’ satisfaction with information and experiences with counseling on cardiovascular medication received at the pharmacy. Patient Education and Counselling. 83(3): 303–309. Walker RE, Nelson LA, Kriz C, Iuppa CA, Liu Y, Diefenderfer LA, Elliott ESR, Sommi RW (2023). Enhancing outcomes: acceptability of medication formulations for the treatment of acute agitation in a psychiatric population. Pharmacy. 11: 4. Watkins A, McKee J, Hughes C, Pfeiffenberger T (2017). Community pharmacists’ attitudes toward providing care and services to patients with severe and persistent mental illness. Journal of American Pharmaceutical Association. 57(3s): S217–S224. Wang Y, Wang J (2020). Modelling and prediction of global non communicable diseases. BMC Public Health. 20: 822. Wongtaweepkij Km Corlett S, Krska J, Pongwecharak J, Jarensirijpornkul N (2021). Patient’s experiences and perspectives of receiving written medicine information about medicines: A qualitative study. Patient Preferences and Adherence. 15: 569 – 580. Xu RH, Zhou LM, Wong ELY, Wang D (2021). The association between patient’s eHealth literacy and satisfaction with shared decision making and wellbeing: Multi-centre cross sectional study. Journal of Medical Internet Research. 23(9): e26721