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An Assessment of Prescribing skills Among Dental Students in the Eastern Province, Saudi Arabia, University of Dammam

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An Assessment of Prescribing skills Among Dental Students in the Eastern Province Saudi Arabia

Prescription of medications is an important part of the treatment process in the medical and dental field. Medications are used to enhance the healing process after some surgical procedures in order to improve patients' life.
A lot of diseases can be controlled by medications and every physician and dentist should be accurate and know what the best choice for the particular situation. Almost all medications have an adverse effect and some of them can be lethal. Such a problem does exist among most of the undergraduates as documented internationally by many studies (2, 10, 11, 14). One of which has concluded that the common error students have made, was related to drug posology (74.2%). Followed by improperly filled prescriptions (10.7%) (2). Another study by the Centers for Disease Control and Prevention (CDC) concluded that many Americans were prescribed medications without the patients being aware of other evidence-based treatments that might work better for them (7).
Pre-graduate dental students in the University of Dammam take two pharmacology courses during their twelve-semesters program in the pre and clinical phases in which they are supposed to acquire the skills of accurately prescribing drugs. However, in the pre-clinical phase, particularly in the fifth level, the course aims to deliver the basics of pharmacology in the form of pharmacokinetics, pharmacodynamics, the main categories of drugs and their respective side effects which is more theoretical rather than the more needed practical part in the field of dental practice. Dental students would have to wait till the tenth level to have the second pharmacology course which is more practical in addition to studying the common drugs in dental practice. Since the clinical phase starts in the seventh semester, students wouldn’t be prepared to actively and effectively prescribe drugs to patients whenever it is needed. Instead, this is usually done by faculty members with the students trying to follow their lead and gain their experience. Some students might even seek help from their senior colleagues. Being students we noticed that we lack the experience in prescribing medications to patients, and this could have serious impact on our patients in many ways, starting from prolongation of treatment plan, increasing healthcare cost, or even the exacerbation of the present illness (9). Some students think that their prescribing skills will improve after graduation but some researches, according the World Health Organization, have indicated that even though the general experience might get improved, the prescribing skills did not improve significantly (12).
Introduction
Objectives
This is a cross-sectional pre-post study with a consecutive sample. Ethical approval was received prior to the study (EA 2014, 021) from the college Research Review Board. A total of 96 dental students from College of Dentistry, university of Dammam (COD-UOD) from 4th year to interns were included. This was carried out in the COD-UOD during the period of January 2015 to June 2015. A self-administered structured questionnaire was developed by the research team for the study purposes. Information of the questionnaire was collected through: Faculty members of King Fahad staff (through emails) about the most common prescribed drugs by them, Information from "Pharmacology and Therapeutics for Dentistry" a well-known dental medication dictionary by Yagiela (12).
All collected information was checked and evaluated by faculty member of the pharmacology division in the college. As a result, a questionnaire with 27 closed ended-questions prepared.
Dependent variable of the study was knowledge expressed as score per section (antibiotic, antifungal, etc...) and the overall score. Independent variables of the study were: level of the student and their source of information. Demographic factors such as age and gender were not included in the study; as only 14 were females and age was expressed as the student's study level.
Before the actual data collection a pilot test was carried (n=26) to check the reliability and validity of the questionnaire. Pilot data were entered into excel sheet by research team and sent to college statistician for analysis.
Phase I:
Distribution of the questionnaire by research team to college students in lecture rooms during working hours to ensure maximum response; permission was obtained from teaching staff to distribute the questionnaire immediately after they finish their lectures.
A user friendly application (13) designed by the research team and university IT department was launched to provide a trusted evidence based reference following the WHO’s guide to good prescribing (12).
The information provided in the application was checked and revised by the pharmacology staff members. The application covered the most commonly used drugs in dental field and provided all needed information for the user that would help him/her in writing prescriptions.
The application delivered to the contributors using the official University emails and aided by social media.
Phase II:
The same questionnaire was distributed after one month from launching the application to the same participants (only those who filled the previous one was permitted to participate) to test the efficacy of the application. Some questions from the pre-questionnaire were removed to avoid repetition. On the other hand some questions were added to evaluate the web-application; such as if the student found it helpful, easy to use. Again data were entered in excel sheet, SPSS used for data analysis and comparison made before and after the application. The assessments of students’ prescribing skills were measured in terms of overall scores (Max 27 scores). Answers were categorized into poor, moderate and good depending on the number of correct answers. The results of scores were presented into mean and standard deviation. Analysis of variance (ANOVA) was performed to compare the scores among four levels of the dentists. P-value <0.05 was considered statistically significant.
Methedology
A pilot study was carried to assess the validity and reliability of the questionnaire; 26 questionnaires were distributed among students from all grades that were later included in the study (4th to 6th grades and interns). From all the 26 distributed questionnaires 6 responded from 4th year, 15 from 5th year, 3 from 6th year and 2 were interns.
Data were entered into excel sheet and sent to biostatistician for analysis. The reliability of the questionnaire was 0.5. In order to improve the validity some questions were modified and others were deleted; as such the reliability was improved to 0.7
Out of 120 questionnaires distributed only 96 students filled the questionnaire (response rate was 80%). Out of those 49(50%) students were from 4th year, 27(28%) students were from 5thyear, 14 (15%) students were from 6th year and 6(7%) were interns.
Age of the participants was in the range of 21 – 25 years; the majority were males (n=82) 85.4 % and only (n= 14) 14.6 % were females.
All pharmacology courses to all years were taught by pharmacists.
Overall knowledge was poor through all levels (fig1).
The study showed that there was a significant difference in knowledge about part one (antibiotics) between 5th year students in relation to students in the other levels; while there was no significant difference between 4th, 6th year students and interns. For part two (antifungals), there was a significant difference in knowledge between the 4th, 5th year students and intern ( p =0.001). But no significant difference between 6th years compared with 4th and 5th year students.While for the antivirals, analgesics and sedatives there was no significant difference in score between all levels (table-1).
When comparing the overall score of the students from the different levels, the study showed a significant difference in knowledge p = 0.0001.
Overall, prescription skills among the 5th year students and intern were good compared to their counterpart in the 4th and 6th years (fig-1).
Results after launching the web-application showed that there was an improvement in knowledge as per question, part and the overall score.
We asked the students some questions about the application to assess their satisfaction and opinions.Of all participants 62.2% found it very helpful, 47.8% found it easy and user friendly and 55.1% said that they would definitely use it as a study guide.
Results
Conclusion
Prescribing medications skills are really important in our practice as we know, that is due to their serious impact on the quality and success of the treatment. The teaching strategies that are currently widely used to deliver this science are proven to be not effective as shown by previous researches. With that in mind, new methods should be implemented to improve students’ knowledge and skills.
References
1.Akram, A., ZamZam, R., Mohamad, N. B., Abdullah, D., & Meerah, S. M. (2012). An assessment of the prescribing skills of undergraduate dental students in malaysia. Journal of dental education, 76(11), 1527-1531. 2.Guzmán-Álvarez, R., Medeiros, M., Lagunes, L. R., & Campos-Sepúlveda, A. E. (2012). Knowledge of drug prescription in dentistry students. Drug, healthcare and patient safety, 4, 55. 3.Moura, C. S. D., Naves, J. O. S., Coelho, E. B., & Lia, E. N. (2014). Assessment of quality of prescription by dental students. Journal of Applied Oral Science, 22(3), 204-208. 4.Richir, M. C., Tichelaar, J., Geijteman, E. C., & de Vries, T. P. (2008). Teaching clinical pharmacology and therapeutics with an emphasis on the therapeutic reasoning of undergraduate medical students. European journal of clinical pharmacology, 64(2), 217-224. 5.Kohn LT, Corrigan JM, Donaldson MS, eds. To err is hu- man: building a safer health system. The Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: National Academy Press, 2000. 6.Brekke, M., Rognstad, S., Straand, J., Furu, K., Gjelstad, S., Bjørner, T., & Dalen, I. (2008). Pharmacologically inappropriate prescriptions for elderly patients in general practice: How common? Baseline data from The Prescription Peer Academic Detailing (Rx-PAD) study. Scandinavian journal of primary health care, 26(2), 80-85.
7.Smith, B. (2012). Inappropriate prescribing. Monitor on Psychology, 43(6), 36. 8.Franklin BD, Vincent C, Schachter M, Barber N. The incidence of prescribing errors in hospital inpatients: an overview of the research methods. Drug Saf 2005;28:891– 900. 9= Aronson JK. A prescription for better prescribing. Br J Clin Pharmacol. 2006;61(5):487-91. 10=Mendonca JM, Lyra DP Jr, Rabelo JS, et al. Analysis and detection of dental prescribing errors at primary health care units in Brazil. Pharm World Sci. 2010;32:30–35. 11=Espinosa-Melendez MT. An evaluation of the pharmacological knowledge of undergraduate and graduate students at UNAM’s School of Dentistry. Proc West Pharmacol Soc. 2006;49:173–176. 12= “UpToDate.com”, “MedScape.com”, “WHO guide to good prescribing”, “Pharmacology and Therapeutics for Dentistry sixth edition by Yagiela”. 13.dentdrug,https://play.google.com/store/apps/details?id=sa.edu.ud.dentdrug, https://itunes.apple.com/us/app/dentdrug/id994411755?mt=8 14.Rauniar, G. P., Roy, R. K., Das, B. P., Bhandari, G., & Bhattacharya, S. K. (2008). Prescription writing skills of pre-clinical medical and dental undergraduate students. 15. Wali, A., Ali, A., Siddiqui, T. M., & Jafri, H. (2012). Assessing Prescription Writing Skills of House Officers in Dental Teaching Hospitals of Karachi, Pakistan. World, 3(4), 294-296. 16. Hew, K. F., & Cheung, W. S. (2013). Use of Web 2.0 technologies in K-12 and higher education: The search for evidence-based practice. Educational Research Review , 9 , 47-64. 17. Kamarudin, G., Penm, J., Chaar, B., & Moles, R. (2013). Educational interventions to improve prescribing competency: a systematic review. BMJ open, 3(8), e003291.
Acknowledgment
Special thanks to Dr.Hatem M Abuohashish, Lecturer of Pharmacology-Department of Biomedical Dental Sciences(CoD-UoD) and to the IT Department in the University.
To assess knowledge and prescription skills of medications among dental student in Dammam University and evaluate the efficiency of an online application in improving their knowledge.

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