Abstract
Aim: To explore medicine quality and perception among the stakeholders in the Ministry of Interior Medical Services (MOI-MSD) clinical settings in Saudi Arabia using glibenclamide as an indicator. Method: A mixed method approach was used in two phases. Phase one involved chemical analysis for identity and quantity of the active pharmaceutical ingredient (API), visual analysis and authentication of source of a popular diabetes medicine (glibenclamide) collected from MOI-MSD general warehouse in Riyadh, Saudi Arabia. Phase two contained a focus group discussion, self-completed survey questionnaires and semi-structured interviews to explore the perceptions of various stakeholders including commissioners, physicians, pharmacists and patients in the MOI-MSD settings in Saudi Arabia about medicine quality and related problems. Data analysis: Phase one collected quantitative data of API quantity from the chemical analysis of glibenclamide samples using a high performance liquid chromatography apparatus (HPLC) based on United States Pharmacopoeia (USP 36) method. The visual inspection of glibenclamide samples was performed using tool kit developed by The World Health Professions Alliance (WHPA) and The International Pharmaceutical Federation (FIP). The authentication of glibenclamide source was performed by on-site comparison of available samples in the general MOI-MSD warehouse with the available official reception documents. Phase two collected quantitative and qualitative data regarding perceptions about medicine quality and related problems and subsequently analysed them using SPSS for descriptive statistics and NVivo version 10 for thematic analysis following data coding and the development of themes and sub-themes. Subsequently, stakeholders’ data were triangulated to establish common and specific themes and sub-themes among MOI-MSD stakeholders. Findings: Phase one of the study found that all glibenclamide samples were within acceptable USP limits in terms of identity and quantity between 90-110%. It was also found that all available glibenclamide batch numbers were present in the official reception documents and the visual analysis of samples revealed no visible errors on the medicine samples or its packaging. Phase two of the study found that most stakeholders, particularly commissioners and physicians, believed that medicine quality was good or excellent in Saudi Arabia. However, the commissioners, physicians and pharmacists believed that the quality of medicines in the MOI-MSD was less than what is available in Saudi Arabia but patients mostly disagreed with these views. Most patients believed that the quality of medicines was high in both the Saudi Arabian market and in the MOI-MSD settings. Limited knowledge about good quality medicines and counterfeit medicines was found among most stakeholders where the quality of medicines was commonly associated with the effect rather than technical attributes of medicines including content, appearance and source. The stakeholders in this study reported a wide…
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