A Proposed Model for Enhancing Chronic Disease Patients’ Health Through Dispensing Medication Safely in the Egyptian Pharmacies

1. Research Title
A proposed model for enhancing chronic
disease patients’ health through dispensing
medication safely in the Egyptian
pharmacies.
MBA
2021
Submitted to: Prof Mona Kadry
Group: General Dokki Branch (G4)
Course: Research & Business Reporting
Code: BIS960

2. MBA
2021
General G4
Group Members
Ahmed
Selim
IT Deputy Manger
19121194
Amira
Nabil
Travel Consultant
17124448
Khaled
Gamal
Human Capital Lead
19121193
Lubna Abd
El Nasser
Quality Assurance
19121195
Mahmoud
Abdel Baky
Consultant of Onco- Surgery
18221403
Nourhan
Swilam
Pharmacist
19121713
page 2

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General G4
Research Main points
page 3
• Preliminary data gathering
• Problem Identification
• Research Objectives
• Research Questions
• Model
• Proposition
• Research Design
• Findings
• Recommendation & Future Work
Main points

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Preliminary Data gathering
for problem Identification
page 4
Government expenditure on health care sector
∙ CAIRO – 21 April 2020: Minister of Finance Mohamed Ma’it
stated that allocations of spending on health sector in the
state’s draft budget for 2020/2021 amounted to LE 258
billion, marking an increase of 46 percent or LE82 billion
compared to 2019/2020 budget.
∙ According to the World Health Organization, Egypt spends
about 5.8% of its gross domestic product on health. This is
lower than the countries in the Organization for Economic
Cooperation and Development (OECD)—which Egypt
wants to join—which spend around 8% of their gross
domestic product on health
Government direction and vision 2030
Health pillar:
∙ All Egyptians enjoy a healthy, safe, and secure life
through an integrated, accessible, high quality, and
universal healthcare system capable of improving
health conditions through early intervention, and
preventive coverage.
∙ This will lead to prosperity, welfare, happiness, as
well as social and economic development, which will
qualify Egypt to become a leader in the field of
healthcare services and research in the Arab world
and Africa.

5. MBA
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General G4
Preliminary Data gathering
for problem Identification
page 5
∙ “The prevalence of potential DDIs among patients admitted to CCUs was 53.07%. [Research Study: Prevalence
and Pattern of Potential Drug-Drug Interactions in the Critical Care Units CCUs of a Tertiary Hospital in
Alexandria, Egypt ]
Two main independent significant factors
Therefore, our study was mainly based on elderly chronic disease patients as they
resemble both factors.
Age Number of
prescribed drugs

6. MBA
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Preliminary Data gathering
for problem Identification
page 6
Harmful effects of DDIs on chronic disease patients
∙ A drug-drug interaction (DDI) may be defined as the pharmacologic or clinical response to the administration of
a drug combination different from that anticipated from the known effects of the two agents when given alone.
∙ Drug interactions occur on pharmacodynamic levels Such as interactions are (additive interaction), (antagonistic
interaction). and pharmacokinetic levels such as interactions at the levels of absorption, elimination and
metabolism.
∙ Previous studies showed that DDIs significantly increased risk of hospitalization, significantly prolonged length
of hospital stay, cost of treatment and elevated the risk of death
Examples:
∙ Acid Reducers -H2 Receptor Antagonists (drug-drug interaction)
(drugs that prevent or relieve heartburn associated with acid indigestion and sour stomach)
Products containing ranitidine shouldn’t be taken with phenytoin (seizure drug).
∙ Bronchodilators (Contraindication)
drugs for the temporary relief of shortness of breath, tightness of chest and wheezing due to bronchial asthma)Ask
a doctor before use if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination
due to an enlarged prostate gland have ever been hospitalized for asthma or are taking a prescription drug for
asthma

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Preliminary Data gathering
for problem Identification
page 7
∙ In US The system was evaluated during a three-month period in 1985 to determine physicians' responses to
the patient management suggestions. A total of 927 patients had 1004 potentially interacting drug
combinations prescribed for them. Changes in drug dosage were made in 44% of these instances, and in
75%, patients were monitored for the development of adverse clinical effects.
∙ similarly, in Egypt if computerized drug-interaction monitoring system can help increase physicians'
awareness of possibly interacting drug combinations and provide them with useful information about the
clinical management of patients for whom such drug combinations have been prescribed.

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Problem
Identification
page 8
In this research, we are seeking to
minimize the dangerous effects of drug-to-
drug interactions, inappropriate dosing
and contraindications on chronic patients’
health by implementing a software system
in the Egyptian pharmacies. This model
contains patient's profile for the purpose of
screening these potential medication
errors.
Problem Identification

9. MBA
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General G4
Research
Objectives page 9
∙ To reduce yearly government expenditure on
healthcare sector resulting from prognosis of chronic
diseases.
∙ To raise the awareness of Egyptian patients
regarding harmful effects of unsafe medication use.
∙ To reduce the impact of drug-to-drug interactions,
inappropriate dosing and contraindications for
chronic diseases patients.
∙ To implement a software model that contains chronic
disease patients’ medical profile history along with
drug-to-drug interactions checker.
∙ To automate communication between Pharmacies
and Patients
Research Objectives

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Research
Questions
page 10
1) How can we increase the patient’s
awareness?
2) What are the effects of drug-drug
interactions on patients?
3) What are the similar models implemented
worldwide?
4) Are the Egyptian pharmacies ready for such
an implementation?
5) What are the benefits from that software?
6) What are the limitations which might face
applying the model?
7) What are the possible resources to fund such
a model?
Research Questions

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Model
Unified Modeling Language
page 11
• Activity Diagram
(Swim-lanes)

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Model
Unified Modeling Language
page 12
• Use Case Diagram

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Model
Unified Modeling Language
page 13
• Use Case Diagram
(Subsystems)

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Proposition
page 14
[DV]
Patients
Health
[IV]
DDIs, Dosage &
contraindication
[IV]
Software Model
with patient medical
profile
Proposition
Conceptual Model
Proposition

15. MBA
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General G4
Research Design
Data Collection & Research Methodology
Data Collection Techniques
Primary Data
• (Questionnaire) Monkey survey
(population unknown =384, in our case 90)
• Interview with pharmacists
Secondary data
• Data collected from kasr el ainy hospital
• literature review about Tertiary Hospital in
Alexandria
Research Methodology
mixed approach
• Qualitative interview
• Quantitative (Survey)
page 15

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Research Design
Data Analysis /Interpretation Data collected from Al Kasr el Ainy Hospital
page 16
104
26
16
10 8 6 4 4 4 3 3 2 1 1 1
0
20
40
60
80
100
120
[Dosing Regimen] (4.1) Dose/ interval is not appropriate according to: Indication, Age, Weight, Renal & Liver
function, Patient's response to the drug (effect/ safety)
[Needs Drug] (1.4) Indication (medical condition) without medication
[Unnecessary Drug] (1.1) There is no valid indication.
[Drug Interactions] (3.0) A drug interaction that may affect effectiveness or safety
[Monitoring] (6.1) Initial or additional monitoring is needed
[Selection] (2.3) The Route of administration / Dosage form is inappropriate.
[Selection] (2.2) Contraindication (selected drug is contraindicated due to comorbidity)
[Selection] (2.4) The selected drug is not the most effective for this condition according to guidelines or patient's
response
[Needs Drug] (1.7) A medical condition requires additional drug therapy.
[Instructions for Prep./Adm.] (5.1) The Administration rate may affect effectiveness or safety
[Adherence] (7.5) The drug product is not available for the patient.
[Needs Drug] (1.6) Abrupt discontinuation of drug that should be gradually withdrawn
[Selection] (2.5) Alert/Warning due to risk factors.
[Needs Drug] (1.5) Preventive drug is required to reduce risk of developing a new condition.
[Dosing Regimen] (4.2) Duration of drug therapy is not appropriate (too short/ long).
104
10
4
0
20
40
60
80
100
120
[Dosing Regimen] (4.1)
Dose/ interval is not
appropriate according to:
Indication, Age, Weight,
Renal & Liver function,
Patient's response to the
drug (effect/ safety)
[Drug Interactions] (3.0) A
drug interaction that may
affect effectiveness or
safety
[Selection] (2.2)
Contraindication (selected
drug is contraindicated due
to comorbidity)
Row Labels Count
[Dosing Regimen] (4.1) Dose/ interval is not appropriate according to: Indication,
Age, Weight, Renal & Liver function, Patient's response to the drug (effect/
safety) 104
[Drug Interactions] (3.0) A drug interaction that may affect effectiveness or safety 10
[Selection] (2.2) Contraindication (selected drug is contraindicated due to
comorbidity) 4
Grand Total 118

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Research Design
Data Analysis /Interpretation Data collected from Al Kasr el Ainy Hospital
page 17
104
10
4
0
20
40
60
80
100
120
[Dosing Regimen] (4.1)
Dose/ interval is not
appropriate according to:
Indication, Age, Weight,
Renal & Liver function,
Patient's response to the
drug (effect/ safety)
[Drug Interactions] (3.0) A
drug interaction that may
affect effectiveness or
safety
[Selection] (2.2)
Contraindication (selected
drug is contraindicated due
to comorbidity)
Row Labels Count
[Dosing Regimen] (4.1) Dose/ interval is not appropriate according to: Indication,
Age, Weight, Renal & Liver function, Patient's response to the drug (effect/
safety) 104
[Drug Interactions] (3.0) A drug interaction that may affect effectiveness or safety 10
[Selection] (2.2) Contraindication (selected drug is contraindicated due to
comorbidity) 4
Grand Total 118
Problem Type
[Drug Interactions] (3.0) A drug
interaction that may affect
effectiveness or safety
Department (Ward) (All)
Row Labels
Count of Clinical Pharmacist
Recommendation/Intervention
Digoxin 2
amiodarone 1
Ivabradine 1
allopurinol 1
calcium carbonate 1
Potassium chloride 1
quetipen 1
morphine 1
quetipen 1
amiloride hydrochlorothiazide 1
potassium chloride 1
desmopresin 1
hydrocortison 1
mycophenolate 1
calcium carbonate 1
quetipen 2
amiodarone 1
Nalbuphine 1
Grand Total 10
(The Year 2018)

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Research Design
Data Analysis /Interpretation Data collected from Al Kasr el Ainy Hospital
page 18
(August 2020)
106
4 3
0
20
40
60
80
100
120
[Dosing Regimen] (4.1)
Dose/ interval is not
appropriate according to:
Indication, Age, Weight,
Renal & Liver function,
Patient's response to the
drug (effect/ safety)
[Drug Interactions] (3.0) A
drug interaction that may
affect effectiveness or
safety
[Unnecessary Drug] (1.2)
Therapeutic Duplication
(Multiple-drugs used for a
condition that requires
single-drug)
Row Labels Count
[Dosing Regimen] (4.1) Dose/ interval is not appropriate according to:
Indication, Age, Weight, Renal & Liver function, Patient's response to the drug
(effect/ safety) 106
[Drug Interactions] (3.0) A drug interaction that may affect effectiveness or
safety 4
[Unnecessary Drug] (1.2) Therapeutic Duplication (Multiple-drugs used for a
condition that requires single-drug) 3
Grand Total 113
(September 2020)
82
2
0
10
20
30
40
50
60
70
80
90
[Dosing Regimen] (4.1) Dose/ interval
is not appropriate according to:
Indication, Age, Weight, Renal &
Liver function, Patient's response to
the drug (effect/ safety)
[Drug Interactions] (3.0) A drug
interaction that may affect
effectiveness or safety
Row Labels Count
[Dosing Regimen] (4.1) Dose/ interval is not appropriate according to:
Indication, Age, Weight, Renal & Liver function, Patient's response to the
drug (effect/ safety) 82
[Drug Interactions] (3.0) A drug interaction that may affect effectiveness or
safety 2
Grand Total 84

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Research Design
Data Analysis /Interpretation
Survey
page 19
TAM

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Research Design
Data Analysis /Interpretation
Interview Questionnaire
Interview Guide
1-Years of experience /Previous workplaces.
2-Do you receive any case have a doctor prescription with
a medication which might cause allergies? If yes:
⮚ What was the case?
⮚ How did you deal with it?
⮚ What is your recommendation to avoid such cases?
3-Do you think that your role is a modular between
doctors and patients and why?
4-Do you have the ability to do test for the patients who
might have allergy to some medicines?
5-What is your opinion if there is a system to collect all to
data of patients to avoid any drug-drug interaction,
inappropriate dosing, contraindications? And why?
Answer Grouping
1)from 4 years to 17 years of experience - practiced pharmacy in
private and chain pharmacies.
2)They claimed that an allergy test should be done at the hospital
before dispensing any medication susceptible to allergy as penicillin;
in order to avoid any cases of anaphylactic shock, shortness of breath
or even rashes.
3)Most of the pharmacists claimed that they act as a modular between
physician and patient in patient advice regarding the correct dosage,
the duration of therapy and informing them with any possible side
effects, contraindications, and DDIs.
4)Allergy tests must be done at the hospital before dispensing those
drugs. This is based on the Egyptian MOH regulations.
5)Regarding the software system, only 1 pharmacists said that it will
be more beneficial for physicians rather than pharmacists. But the rest
said that it would be very beneficial because it will reduce the human
error from both; the pharmacist or the patients’ sides. Also, because
chronic patients usually deal with one pharmacy near their home or
workplace, so it will be beneficial to have all their medical profile
history recorded in this pharmacy as there is no connection between
different physicians. Others claimed that it must be government
regulations becoming essential to collect data of patients first to stand
up by health system to raise the economic status of Egypt as well.
page 20

21. MBA
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Research Design
Data Analysis /Interpretation
Interview Questionnaire
Interview Guide
6- How much it will take from you to enter patient’s data?
7-In normal cases, how it takes to dispense chronic medications on
the system related to medical insurance companies?
8-Do you check the possibility of a drug-drug interaction before
filling a prescription for a patient? Yes/No
9-When developing such a software, is it preferred to have
medications with active ingredients names or Egyptian trade names?
Grouping of Answers
6)Not too much time, normally all insurance companies have
data entries for all their clients (2-3 min.). Others said, it
depends on the system and size of data required; may be from
5-7 min.
7)maximum 10 minutes.
8)Most of the pharmacists said that they already check for
drug-drug interactions before dispensing the drugs.
9)All pharmacists said that drugs should enter the software by
active ingredient rather than by trade name.
page 21
Therefore, this software will ease the job for pharmacists to directly link between the
patients’ information and potential drug-drug interactions in few minutes.

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•Governmental regulations should be
imposed on all pharmacies in Egypt to
implement the software enforced by
sanctions in case of not abiding by the
law where it is more concerned with the
health of the patient not the profit of
pharmacies
•Need coordination form different levels
of health care sector to provide the best
service.
•There is a lack of awareness among
Egyptian patients regarding the harmful
effects of DDIs and Contraindications or
even of their potential prevalence
Findings
page 22

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Recommendations and Future Work
page 23
∙ Launch awareness campaigns for patients and pharmacies regarding better medication
adherence and convenience through pharmacovigilance such as no Harme campaign
previously launched in Egypt
∙ One centralized database to hold the medical profile data, DDIs checker and associated with
call center to support the pharmacists and secured where they must use with their registered
phone number same as banks
∙ Implementation on phases with the same approach of the Comprehensive health insurance
applied by the government.
∙ Pharmacies will be 1st phase, applying it to one chain of pharmacies in one city. Then to the
whole health sector including physicians, hospitals, and medical insurance companies where
the patient will use one ID to access his medical profile history.
∙ Implement the online app of safe medication for ease use of patients and reduce the physical
queue in the pharmacies.

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Recommendations and future work
page 24
∙ To funded by the government and 100 million seha and WE
∙ In future need to add more features to the software where the Pharmacies will send a monthly
reminder for patients to order their chronic medications
∙ In future the prescription need to have a validity date (6 months -1 year) where the patient needs
to review with the physician his medical status

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Thank You
page 25