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Abstract Food drug interaction (FDI) and drug nutrient interaction (DNI) is an adverse incident that can affect patient’s health in all age groups. In line with the FDA food drug interactions (FDIs) is “a condition where a food influences the activity of a drug; for instance, the achieved outcome is increased or decreased, or a new outcome of that drug is generated that would not be generated without the utilization of that food”. Adverse drug reactions pertaining to nutritional diseases are ranking among the top five co-morbid conditions of hospitalized patients. Health care providers specially physicians and pharmacists participate in a vital role in identifying serious FDIs, and accordingly should be vigilant about monitoring these interactions. Owing to the scarcity of research regarding the responsibility of physicians and pharmacists in identifying and counseling their patients on serious FDIs, this study aimed to assess the nutritional knowledge, verifying the attitudes, and detecting the practices of hospital physicians and pharmacists working in MOH hospitals towards FDIs and DNIs in Alexandria. In the present study, a total of 279 physicians and pharmacists (95 and 184, respectively) gathered from five different governmental hospitals affiliated to Ministry of Health in Alexandria, volunteered to answer a structural designed questionnaire. The specialties included were internists, pediatricians, hospital pharmacists and clinical pharmacists. This cross-sectional study was performed during May 2019 till August 2019. The questionnaire gathered socio-demographic data, such as personal data (age, gender and specialty) and professional characteristics (years of experience and qualifications). This was followed by 20 questions on different FDIs and DNIs nutritional knowledge. Then proceeding were 8 statements on attitudes towards FDIs/DNIs and its importance. Subsequently were 6 questions to identify practices as regards to applying patient counseling regarding FDIs/DNIs and increasing the awareness towards this field. The socio-demographic data collected in this study discovered that the mean age of physicians and pharmacists was 33.8±8.6 years. Females were exceeding males by more than two thirds. About two thirds (66%) of the studied sample were pharmacists. As for the graduation year, 53% of the studied sample was graduated in 2010 or above. The mean year of experience was 10.6±8.1years. The studied sample had different education degrees including bachelor, master, diploma, fellowship and doctoral degrees. The nutritional background was lacking among the studied sample as only 36.2% had undergraduate nutrition course and only 26.5% attended a nutrition course post-graduation. The current study demonstrated that only 10.4% of the studied sample had good level of knowledge with a mean score of knowledge 56.5%. Regarding attitude and practice, 86.7% had positive attitude with a mean attitude score 78.7%, while only 17.9% had good practice with a mean practice score 53.0%. Knowledge was related to the graduation year and to having a nutrition course whether during the studying pre-graduation years or post-graduation years. The graduation year, the undergraduate nutrition course and the nutrition courses post-graduation were found to be the chief factors affecting knowledge in this study (p=0.037, 0.048 and 0.024 Summary, Conclusion and Recommendations 95 respectively). The graduation year of the studied sample was not significantly related to having under graduate or post-graduation nutrition course. Concerning attitude, pharmacists were noticed to have higher positive attitudes than physicians towards FDIs/DNIs regarding some of the proceeding questions: (some FDIs can be fatal, FDIs/DNIs must be given more time and attention during undergraduate studies, the necessity to report any FDIs/DNIs they encounter during their clinical practice to the pharmacovigillance, and informing the patients about the possible FDIs/DNIs is their responsibility). Attitude was also highly related to the specialty of the studied sample, where clinical pharmacists were seen have positive attitude (95.6%) towards FDIs and DNIs more than pediatricians, pharmacists and internists (94.1%, 85.3% and 68.2% respectively) (p=0.000). Physicians and pharmacists in all age groups had high positive attitude towards FDIs/DNIs. Females were slightly of higher positive attitude towards FDIs/DNIs than males (88% and 78.9% respectively). Those graduated before the year 2000 were noticed to have higher positive attitude than those graduated after the year 2000. All physicians and pharmacists with different number of experience years had highly positive attitudes. Those with master’s degree had slightly higher positive attitude than the other degrees. As for practice, it was noticed that physicians ask their patients more than pharmacists about the medications (prescription/OTC) and food supplements or herbal remedies that they use or intend to use together (23.2% and 15.8% respectively), while pharmacists were of a significantly higher good practice than physicians regarding using a handbook/ software program to check for FDIs/DNIs (p=0.004) and more insignificant good practice towards referring to the drug information center (DIC) for checking any FDIs/DNIs (p=0.127). Pharmacists were also found to have insignificant good practice Summary, Conclusion and Recommendations 96 more than physicians regarding how they act when facing a case of FDI/DNI (20.1% vs. 16.8%, p=0.510), but significant good practice towards increasing the awareness of FDI/DNI (22.8% vs. 10.5%, p=0.012). Both physicians and pharmacists (21.1% each) had good practice towards counseling the patients on the possible FDIs/DNIs they may encounter. The studied sample in the age group ≥40 years were of higher level of good practice towards FDIs/DNIs compared to the other age groups. Females were of higher level of good practice than males (19.9% and 5.3%, respectively). Practice among different specialties was found to be higher in clinical pharmacists followed by pediatricians then pharmacists and least in internists. Practice was significantly related to having a nutrition course during both the pre and post-graduation years, but from the main predictors of practice was the under graduate nutrition course only (p=0.037). Also, good knowledge about FDIs/DNIs was found to be the key predictor for having good practice (p=0.000). from data of the present study, the following conclusions have been reached: • Most of the studied physicians and pharmacists had positive attitude and a moderate practice regarding food drug interaction during their daily practice. However, they generally lacked the sufficient knowledge about this topic. • This study has provided empirical support for the importance of nutrition and food drug interactions to the physicians and pharmacists in order to provide the most favorable therapy outcomes via patient education and counseling. Summary, Conclusion and Recommendations 97 • Physicians and pharmacists mainly gain their knowledge in this field through college tuition and post-graduation nutrition courses. • Even with positive or neutral attitudes, physicians and pharmacists lack the adequate nutritional knowledge and subsequently their patients might endure adverse drug reactions. • The main factors affecting knowledge are the graduation year, having an undergraduate nutrition course and attendance of nutrition courses post-graduation. The main factors affecting practice are knowledge and having an undergraduate nutrition course. In light of the findings of the present study, the following recommendations are suggested: 1. To policy makers (Ministry of Health, The Egyptian Medical Syndicate and Syndicate of Pharmacy): • Continuous educational programs and training campaigns addressing hospital physicians and pharmacists to enlighten them of their crucial role in food drug interactions, as the majority provides limited services to their patients in this field. • The incorporation of a nutrition module that includes food drug interactions in the curriculum of faculties of Medicine and Pharmacy. • Hospitals should have access to evidence-based references on most common food drug interactions. Computer-assisted educational software should be available to assist practitioners in discovering potential food drug and drug nutrient interactionsfor patients to prevent adverse events or problems. Also, the available reporting systems should be easy to use and non-tedious. • Counseling and standard operating procedures upon discharging patients from hospitals, they should be given information, orally as well as written, of potential food drug interactions they might encounter during their treatment period. • There should be a degree specific inpatient education concerning nutrition and drug interactions. 2. To physicians and pharmacists: • Physicians, pharmacists and clinical pharmacists should collaborate with nutritionists, dietitians and nurses for the aim of minimizing FDIs/DNIs and their adverse outcomes. • They should plan a strategy, or a treatment protocol based on their knowledge, experience, and skills in order to minimize any ADRs resulting from FDIs or DNIs. • Frequently check the recent updates, protocols and software interaction information programs to allow for the safe treatment choices. • Follow-up, document, communicate and report any prescription or order form given to the patient and having potentials for FDIs before the hospital discharge. • Computerize the interactions in drug interaction screening programs, warning software and patient counseling brochures, as an approach to spread the awareness of food drug interactions between the health care personnel and the patients.. To researchers: • Further research on other food drug interactions especially those related to herbal medicines and dietary supplements should be done. • Assessment of hospital physicians’ and pharmacists’ practice regarding patient counseling should be taken into consideration, as they are in contact with several chronic patients. • Include other medical specialties and the family doctors whom will have a great role in the medical insurance system regarding this topic. Hopefully the results in this study would draw the attention of the decision makers in the health sector to the vitality of providing physicians and pharmacists with the training needed to qualify them to give appropriate counseling and medical advice to their patients. |