Assessment of pharmacist's knowledge on use of non-steroidal anti-inflammatory drugs in hypertensive patients with co-morbid arthritis and pharmaceutical services rendered in Ibadan, Nigeria.

Background: hypertension and arthritis are two co-morbid diseases that require pharmaceutical care (PC) services. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for treatment of arthritis.

Objectives: The study evaluated the knowledge of pharmacist on the use of NSAIDs in this set of patients and the PC services rendered to them.

Methods: structured tested questionnaires were distributed to pharmacists working in public hospitals and community pharmacies in Ibadan metropolis. The questionnaire elicited information on the demographics of respondents, identification of drug related problems and ways of resolving them, knowledge on pharmacotherapy of arthritis and hypertension. Data was analysed with descriptive analysis using statistical package for the social sciences (SPSS) version 16 for windows.

Results: a total of 165 questionnaires were distributed with 124 properly filled and returned giving a response rate of 75.2%. Majority (64.5%) were females, the mean year of graduation of the respondents was 9.12years and 50.8% practice as Community pharmacists. Common PC activities include; counseling (84.4%), monitoring of patients B.P (53.3%), blood glucose measurement (53.3%), monitoring patient's using available laboratory results (44.3%). Majority (85.5%) resolved side effects complaint from patients by reassuring the patients that side effect will subside as therapy continues while 77.4% took full medication history and 65.3% consulted physician for a change of medication. Majority (88.7%) agreed that they encountered prescriptions containing NSAIDs for arthritis in their practice. Good numbers of the respondents had no idea of what measure to take when a patient diagnosed of arthritis and hypertension was prescribed NSAIDs if the blood pressure was control or when it was uncontrolled. Few 16.9% and 8.9% indicated they monitored B.P of such patients with controlled or uncontrolled B.P, while more than half (55.6%) of the respondent indicated that COX2 inhibitor are safer in hypertension as compared to COX1 and that NSAIDs effects on hypertension is dose dependent. Most (77.4%) of them indicated that NASIDs can exacerbate hypertension while 55.6% indicated that NSAIDs can induce hypertension.

Conclusion: Respondents' knowledge of the pharmacotherapy with antihypertensives and NSAIDs use in patients with hypertension co-morbid arthritis need to be improved. Good and well established pharmacistphysician relationship, refresher courses and remuneration of pharmacist for the PC services will also improve services provided by the pharmacist.

研究背景：高血压与关节炎是两种需要药学服务（pharmaceutical care, PC）的共病。非甾体抗炎药（non-steroidal anti-inflammatory drugs, NSAIDs）是关节炎治疗的常用药物。

研究目的：本研究旨在评估药师针对此类共病患者使用非甾体抗炎药的相关知识，以及为其提供的药学服务情况。

研究方法：向伊巴丹都会区公立医院及社区药房工作的药师发放经过信效度检验的结构化问卷。问卷内容涵盖受访者人口学特征、药物相关问题的识别与解决途径，以及关节炎与高血压药物治疗相关知识。数据采用Windows版社会科学统计软件包（statistical package for the social sciences, SPSS）16.0进行描述性统计分析。

研究结果：本次研究共发放问卷165份，回收有效填写问卷124份，有效回收率为75.2%。受访者中多数（64.5%）为女性，平均毕业年限为9.12年，50.8%任职于社区药房。常见的药学服务内容包括：用药咨询（84.4%）、患者血压（BP）监测（53.3%）、血糖检测（53.3%）、结合现有实验室结果开展患者监测（44.3%）。多数（85.5%）药师通过告知患者不良反应会随治疗持续自行缓解，来处理患者的不良反应主诉；77.4%的药师会完整采集患者用药史，65.3%会咨询医师以调整用药方案。绝大多数（88.7%）的受访者表示，在执业过程中曾接触到针对关节炎患者开具非甾体抗炎药的处方。仍有相当比例的受访者不清楚，当合并有关节炎与高血压的患者被开具非甾体抗炎药时，无论其血压是否得到控制，应采取何种应对措施。仅16.9%与8.9%的受访者表示，会分别对血压控制良好与控制不佳的此类患者开展血压监测；超过半数（55.6%）的受访者认为，与COX1抑制剂相比，COX2抑制剂在高血压患者中使用更为安全，且非甾体抗炎药对血压的影响呈剂量依赖性。多数（77.4%）受访者表示非甾体抗炎药会加重高血压，而55.6%的受访者认为非甾体抗炎药可诱发高血压。

研究结论：受访者针对合并有关节炎与高血压的患者开展降压药物治疗与非甾体抗炎药使用的相关知识，仍有待提升。建立良好且成熟的药师-医师协作关系、开展继续教育课程，以及为药师提供的药学服务给予薪酬补偿，均有助于提升药师的服务质量。