Beyond the Counter: Navigating the Landscape of Deanxit® Dispensing – Insights from Jordanian Community Pharmacies

doi:10.21203/rs.3.rs-3795744/v1

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Research Article

Beyond the Counter: Navigating the Landscape of Deanxit® Dispensing – Insights from Jordanian Community Pharmacies

https://doi.org/10.21203/rs.3.rs-3795744/v1

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published 29 Feb, 2024

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Background: This study investigates the dispensing patterns and knowledge of community pharmacists regarding Deanxit®, a combination of melitracen and flupentixol approved for depression and anxiety treatment in Jordan.

Methods: Employing a mixed-methods approach, 75 randomly selected pharmacies in two governances of Jordan (Amman and Irbid) underwent simulated patient scenarios and structured interviews using a validated questionnaire.

Results: revealed that 70.6% of pharmacists were willing to dispense Deanxit® based on simulated scenarios, indicating malpractice. The mean practice score was 0.5867 out of 18, underlining a substantial level of malpractice. Pharmacists exhibited poor knowledge, with a median score of 2.0 out of 15, reflecting a lack of awareness about Deanxit®'s labeled indications. Furthermore, 96% reported dispensing without prescriptions, and 62.1% acknowledged encountering cases of improper Deanxit® use.

Conclusion: The findings underscore significant gaps in pharmacists' knowledge and highlight the prevalence of improper Deanxit® use in Jordan, where easy access without prescriptions contributes to the problem. To address these issues, recommendations include implementing comprehensive education and training programs, establishing clear dispensing guidelines, strengthening regulatory measures, launching public awareness campaigns, and promoting collaboration between pharmacists and other healthcare professionals. Urgent interventions are imperative to enhance pharmacist knowledge, improve dispensing practices, and safeguard public health in the context of Deanxit® usage in Jordan.

Flupentixol

Melitracen

Deanxit

Substance use

Knowledge

Practice

Deanxit®, a combination of melitracen 10 mg and flupentixol 0.5 mg, which are tricyclic antidepressants and classical antipsychotics respectively, has been shown to have a rapid onset with both anxiolytic and antidepressant characteristics (Fu et al., 2008). As stated in the leaflet (Appendix 1), Deanxit® is only approved for treating depression and anxiety, with no off-label uses mentioned (Fu et al., 2008; Moffaert et al., 1983). Although it's only clinically approved uses are as an antidepressant and anxiolytic, Deanxit® is being used to treat gastric reflux disease, inflammatory bowel syndrome(IBS), depression, tinnitus, and somatic pain disorder, among other conditions, (Fu et al., 2008; Moffaert et al., 1983).

Drugs are classified into many classes based on their prescription behaviors. The diagnosis nature of diseases and the safety profile of treatments are important factors in drug classification. Prescription medications are frequently used to treat severe diseases, whilst non-prescription medications are used to treat minor disorders [1]. The United States Food and Drug Administration (USFDA) defines a prescription medication as a drug prescribed by a physician, purchased at a pharmacy, prescribed for and meant to be used by one person and regulated by FDA[2]. Whereas non-prescribed medication is a drug that is available without a prescription and can be bought from a pharmacy [2, 3].

Self-medication is defined as the self-administration of certain drugs by the patient to manage a recognized illness or symptom with no previous medical experience, according to the World Health Organization (WHO) [4, 5]. Self-medication behavior is rather common, involving, in addition to the use of Over The Counter (OTC) pharmaceuticals, the intake of previously prescribed drugs afterward used without medical guidance [6]. The use of self-medication has several personal and societal advantages. In nations with overloaded health systems, where scheduling an appointment with a doctor may be difficult, it promotes rapid access to medicine that provides rapid relief to the patient [7]. Self-medication, however, is also associated with a number of hazards for the patient who uses it and, in certain situations, for the community. We can list a number of risks associated with self-medication, including incorrect self-diagnosis, inappropriate therapy selection, serious adverse effects and contraindications, drug-drug interactions, inappropriate route of administration and drug improper use or dependence risk [8], which makes it in fact, a measure of low quality of care.

Pharmacists have noticed high malpractice in community pharmacies regarding Deanxit® dispensing and use. Few studies in literature have investigated the combination flupentixol/miletracin and its applications. At the time of this research project, this is the first study to document the suspected observed improper use among patients and dispensing patterns of Deanxit® in a community pharmacy setting. The study's main aim is to cover community pharmacists' knowledge and general practice and dispensing patterns regarding Deanxit® intake in Jordan. This study investigates the dispensing patterns and knowledge of community pharmacists regarding Deanxit® using a mixed- method approach.

Study design and settings

This study was conducted using a mixed-method approach, Fig. 1. It was an observational study design that used simulated patients (Mystery Shopper) and a structured face-to-face interview methodology. It was conducted at different community pharmacies in two main provinces in Jordan, Amman (the capital of Jordan) and Irbid (the second biggest province in terms of the population). The study was carried out from February 2023 to June 2023.

Ethical approval

Applied Science Private University (ASU) Institutional Review Board (IRB) authorized the study outline after being approved by the postgraduate committees in the Faculty of Pharmacy. Final approval was obtained from the deanship of research (REF: 2022-PHA-40) (Appendix 4). Pharmacists who agreed to participate in the interviews, gave a verbal consent and included in the study.

Phase 1: Simulated patient

This study applied a simulated patient method, a nontraditional observational design often known as "patient-actors," which are similar to real patients and are trained to act out specific scenarios during teaching or evaluation [9]. The mystery shopper technique is unique because it directly observes events and behaviors in an uncontrolled environment. In our study, we used this method to evaluate pharmacists' behavior and dispensing patterns of Deanxit®. For the scope of the study, researchers included 75 different pharmacies (41 in Amman, 34 in Irbid) in the study. The visits in each province were divided into two mystery shopper scenarios. A trained pharmacist played the role of simulated patient in both scenarios during the visits. Directly following each visit, the pharmacist filled a pre-designed assessment form (appendix 2) adapted from previously published studies [10].The form assembled information about pharmacy location, shift, pharmacist therapy approval based on provided scenarios, and any counseling points provided by the pharmacist during the pharmacy visit.

1.2 The used Scenarios in the first phase

Scenario A: 40 community pharmacies distributed almost evenly between Amman n=22 and Irbid n=18 were selected and visited by a mystery shopper with irritable bowel syndrome. After clarifying the symptoms, the simulated patient showed the pharmacist the medication sachet claiming it was for his mother and asked if it was fine to take it? The scenario conducted was "I have irritable bowel syndrome symptoms, including bloating, indigestion and abdominal pain, and my mother takes this medication for irritable bowel syndrome symptoms, is it okay if I take it too?"

Scenario B: another 35 community pharmacies distributed almost evenly between Amman n=19 and Irbid n=16 were selected and visited by the same simulated patient but with a mood disturbances scenario. After representing his symptoms, the simulated patient showed the pharmacist the medication sachet, claiming it was for his mother and asked if its fine to take it too. The scenario conducted was " I am in a bad mood due to a personal problem and I saw my mother take this medication whenever she is upset, is it okay if I take it too?"

1.3 Practice scoring

Grading was based on the pharmacists’ patient care process formulated by the joint commission of pharmacy practitioners [11]. Which is based on five primary disciplines, collect, assess, plan, implement and follow up, with subsections in each. Each participant received one point for each correct answer and zero points for each incorrect or did not know the answer, and a total practice score out of 18 was calculated for each participant.

Phase 2: Structured interview

This phase was conducted after assessing the results of Phase 1. This method has been used to evaluate the pharmacists' knowledge and perception about Deanxit® using structured interviews with a pre-designed questionnaire filled by the researcher (appendix 3). It comprises a series of standardized, typically closed-ended questions administered to a fixed data sample in a standardized interview sequence (Azarpazhooh, 2008).

2.2 Population and sampling (sample size calculation)

Amman was divided into Eastern and Western areas. The Eastern area is more traditional. The Western area is more liberal and serves as the city's economic center. Irbid's was distributed between urban districts and local trade mart areas. Based on Tabachnick and Fidell recommendation for sample size calculation in analysis, 5–20 subjects per predictor are suggested to be preferable [12]. Based on the number of independent variables levels used in this study (n = 11) and using the number of 20 subjects per predictor level, a minimum sample size of 220 or higher was considered suitable for the purpose of this study. The decision was made to increase the number to around 240 pharmacists to take into account missing responses and other unknown issues that might arise.

2.3 Validation and piloting of study tool

The study questionnaire was developed and validated after a comprehensive review of related literature [13]. Twenty pharmacists have assessed the content and face validity of the study questionnaire which was prepared in English. According to their feedback, minor adjustments were implemented to improve the questioner clarity. The responses of the pilot study were not included in the final data analysis. The study questionnaire consisted of three sections, the socio-demographic data, pharmacists' knowledge about Deanxit®, participants experience/practice with Deanxit® improper use. The time needed for the respondent to answer the questions ranged from 10 to 15 minutes.

2.4 Knowledge scoring

For the knowledge section, a series of questions regarding Deanxit® were asked. Each participant earned one point for each correct answer and zero point for each incorrect or do not know the answer. A total knowledge scores out of 18 was calculated for each participant. The median and IQR were calculated, and the cut-off point for good knowledge was 7.5 out of 15.

2.5 Statistical analysis

Data analyses were performed using Statistical Package for Social Sciences (SPSS) software version 22 (IBM Co. USA) to conduct statistical analyses. Data was presented as frequency (%), median ± interquartile range (IQR) and mean ± standard deviation (SD). Single linear regression was used to look for predictors that may affect knowledge scores. After performing univariate linear regression analysis, all variables having P-values <0.250 were put into multiple linear regression analysis. The multiple linear regression analysis identified variables that independently influenced participants' knowledge. Chi-square test was used to determine if there was any significant difference between the independent variables, were P-values less than 0.05 was considered statistically significant.

Phase 1: Simulated Patient Phase

Sociodemographic data

A total of 75 different community and chain pharmacies were visited by the simulated patient. Around half of the pharmacists were females (50.6%) and working in the mid-day shift B (53.4%). In parallel, more than two thirds of the visited pharmacies were individual pharmacies (76.0%). There were no significant differences between the two conducted scenarios in terms of the gender of the pharmacist included in the study, pharmacy location, pharmacy shift, or pharmacy status. Table 1 summarizes the characteristics and demographic data of the visited pharmacies.

Pharmacists Agreement with Deanxit® administration

As provided in Figure 2, the majority of the pharmacists agreed with the use of Deanxit® in the first and second scenarios, 48% and 97%, respectively. Some of the pharmacists who disagreed with Deanxit's suggestion in the first scenario (IBS scenario), suggested an alternative. While, no alternatives were provided for the second (mood disturbances) scenario, as provided in (Figure 1S), some of which are medications and others are herbal supplements. Poxidium® (Chlordiazepoxide and Clidinium bromide) was the most alternative prescribed (n=8, 36.3%).

Pharmacist's practice regarding Deanxit® dispensing.

According to pharmacists’ patient care process formulated by the joint commission of pharmacy practitioners, Table 2 shows that pharmacists’ mean practice score. As demonstrated, the pharmacy practice was poor, hence the score was 0.5867 out of 18 (SD = 0.68). Only 22 pharmacists out of 75 provided pharmaceutical education and instructions on how to use the drug (33.3%). While they provided a variable answers for Deanxit dosing Table 3.

Phase 2: Structured interviews phase

Sociodemographic characteristics of study participants

A total of 240 different community pharmacists were visited in this study. Eight pharmacists disagreed to take part in the study and five pharmacists did not recognize the medication (Deanxit®). Accordingly, 227 responses were included in the final analysis. Pharmacies were distributed in four different provinces, (n=55, 24.2%) pharmacies in Eastern Amman, (n=59, 26.0%) in Western Amman, (n-58, 25.6%) in urban districts in Irbid and (n=55, 24.2%) in trade mart areas in Irbid. Of the responders, (n=144, 63.4%) were females and most of the respondents had a bachelor's degree (n=193, 85.0%). The sociodemographic characteristics of the respondents are presented in Table 4.

Pharmacists’ experience with Deanxit®dispensing

The majority of interviewed pharmacists (n=217,96%) reported that Deanxit used to be dispensed without a prescription. While, more than half of the interview pharmacists (n=141,62.1%) reported the exposure to at least one case of improper use of Deanxit, Figure 3.

Among the pharmacists who had ever exposed to Deanxit® improper use (n=141), there were varied answers about these uses including: "Deanxit could be used for mood disorders and to calm down" (n=37, 26.2%), " Deanxit could be used for euphoria in an addictive way" (n=36, 25.5%) and " Deanxit could be used for sleep disorders and insomnia" (30, 21.2%). Other improper uses reported by interviewed pharmacists are listed in Table 1S. In addition, Figure 2S illustrates that the source of information mostly guides Deanxit® improper users to use it according to pharmacists' answers in the structured interviews are friends (n=127) and family (n=122). In addition, most of the pharmacists (n=114, 80.8%) reported that the improper Deanxit® users often ask directly for it. Further data regarding improper users reported by the pharmacists are presented in Table 2S.

Pharmacists practice toward patients who are suspected to use Deanxit® improperly

Eighty-four pharmacists (n=84, 59.5%) declared that they would still dispense Deanxit®, even, in case of improper use confirmation. While, 43% of them stated the refusal to dispense or claim that the product is not available, more details in Table 3S.

Pharmacists’ knowledge regarding Deanxit®

In general, pharmacists showed poor knowledge about Deanxit®. The overall median knowledge score was 2.0 out of 15 (IQR = 3.0). Aspects are all listed in Table 5. Upon asking if there are any unlabeled indications of Deanxit®, about three-quarters of pharmacists answered yes (n=167, 73.5%), Table 4S lists these unlabeled indications that are mentioned by pharmacists in the interviews. Out of the 167 pharmacists who stated the presence of Deanxit® unlabeled indications, the most frequently mentioned indication was irritable bowel syndrome (n=102, 61.0%), followed by sleep disorders (n=60, 35.9%). Table 6 shows factors associated with pharmacists' knowledge score about Deanxit®, age, marital status, years of experience and highest education level were significantly affecting the knowledge score (P-value <0.05) at single linear regression. However, only the highest education level significantly affected the pharmacist knowledge score when multiple linear regression was conducted, in which the higher the education levels the highest the knowledge score.

This paper addresses a critical gap in the literature by presenting the first study on Deanxit® dispensing patterns among community pharmacists in Jordan. Deanxit® is a combination of a tricyclic antidepressant (TCA) and an atypical antipsychotic used in the treatment of anxiety and depression [14]. Despite being banned in several countries [15, 16], it remains accessible in Jordan, raising concerns about its improper use. The study aims to evaluate pharmacists' knowledge and practices regarding Deanxit®, shedding light on the motivations behind its misuse and the current methods employed by pharmacists to manage such requests.

Deanxit®'s improper use is a serious health issue, a study about Deanxit® use disorder in Lebanon reported that 29.6% of the participant used Deanxit® for relaxing and getting high [17]. Our study showed that the practice score regarding Deanxit® dispensing was low, which indicates malpractice in pharmaceutical care delivery. Minimal number of pharmacists asked the patient about his medication history or previous use of the drug, which are standard procedures for patient data collection; this is consistent with a study conducted in Jordan studying the practice of pharmaceutical care in community pharmacies in Jordan where only 31.0 % adapted standard procedures for patient’s data collection [18]. The same study showed that 24.2 % of the pharmacists documented over-the-counter recommendations which is consistent with our study were most pharmacists who carried out patient care provided education and instructions on how to use the drug (n=25, 33.3%). According to Eman et al, this malpractice is hindered by barriers, mainly which are lack of supporting laws and poor therapeutic knowledge [18]. Another study showed that main barrier towards the provision of proper practice is the lack of training, which was noticed by about 80 % of the pharmacists in the study[19] .

Our study showed a wide variation in pharmacists' advice regarding counseling the simulated patient on how to take Deanxit®, which indicates the pharmacist's lack of knowledge of the medication dosing. Some pharmacists indicated that it should be taken as needed (PRN); however, we didn’t find any studies on Deanxit®'s effect in a period less than two weeks. Some pharmacists recommended the daily dose of the medication to be three tablets daily; however, the leaflet states that the maximum dose is four tablets a day with the maintenance dose being one tablet daily. A study about toxicological exposures supports this report on a telephonic consultation service at a tertiary care hospital in Lebanon. Deanxit® toxicity was reported in 2.7% of the cases, indicating the potential for severe toxicity in overdose. [20].

In the simulated patients' suggested scenarios, the majority of pharmacists agreed to use Deanxit® according to the given cases. This agreement of the pharmacists to the use of Deanxit® as an OTC medication indicates their malpractice regarding the medication and it indicates their approval of the self-medication that patients practice, this is similar to a study conducted in Jordan showed that self-medication was a shared practice among Jordanians with a percentage of (42.5%) [21].

Based on observations of wrong dispensing patterns noticed by pharmacists in simulated patient scenarios, structured interviews were conducted to measure pharmacists' knowledge to determine the reason for pharmacists' dispensing patterns. Suppose it is a lack of knowledge or just malpractice. Our study revealed an overall pharmacists' median knowledge score of 2.0 out of 15 (IQR = 3.0), our findings are reliable with prior studies indicating pharmacists' poor knowledge about psychotropic drugs. In one research done in 2023 to assess community pharmacists' knowledge of psychiatric drugs, only 20.0% of 676 pharmacists completed the survey, and passed the minimum score (75.0%) for the knowledge questions concerning psychological medication [22].

The overall knowledge level was significantly (P < 0.05) associated with higher academic education, community pharmacists who had higher education levels scored higher in the level of Deanxit® knowledge, indicating a need for additional education and training before and during practice. This lack of knowledge explains the malpractice observed in our study. The majority of the interviewed pharmacists said it is more common for the drug to be dispensed without a prescription, indicating the high prevalence of self-medication with Deanxit® among the population. Which is reliable with a study conducted in Jordan showed that self-medication was a shared practice among Jordanians with a percentage of (42.5%) [21].

The majority of interviewed pharmacists confirmed their exposure to at least one case of improper use of Deanxit®, where most of them reveled that most frequent improper uses noticed was mood disorders and to calm down. A study about Deanxit® use disorder reported that 29.6% of participants used Deanxit® to relax and get high [17].

The population use of Deanxit® for irritable bowel syndrome was also reported by pharmacists, few studies in the literature mentioned Deanxit® use for IBS, a study assessing flupentixol and melitracen effect combined with trimebutine in patients with IBS accompanied with anxiety and depression showed that The incidence of improvement of gastrointestinal symptoms in the combined therapy group was 87.5% four weeks after treatment, which was greater than the rate in the control group [23].

Finally, this study investigates community pharmacists' dispensing patterns and knowledge related to Deanxit®, a medication for depression and anxiety in Jordan. Results indicate that most pharmacists were willing to dispense Deanxit® without prescriptions, revealing malpractice. Pharmacists demonstrated poor knowledge highlighting significant gaps. The prevalence of improper Deanxit® use in Jordan, coupled with easy access without prescriptions, emphasizes the need for urgent interventions, including education programs, clear dispensing guidelines, regulatory measures, public awareness campaigns, and enhanced collaboration among healthcare professionals.

Our study had some limitations; the study was conducted only in Amman and Irbid, not the entire country due to transportation issues, however, these are the two main provenience in Jordan with the highest population and registered pharmacies, samples also were taken during shift A (8:00am -4:00pm) and shift B (4:00pm-12:00am), however shift C (12:00 am-8:00am) was not included, because of the cultural limitations since a female researcher took the samples, simulated patient interviews were not recorded since an approval for recording was not obtained, self-reporting could be inaccurate since pharmacists may be hesitate to reveal behavior that could be perceived as wrong by others and a follow up in the practice scoring could not be applicable since the researcher will not revisit the pharmacy and thus progress toward goals of therapy and a clinical end point may not be established.

In conclusion, pharmacists presented a lack of proper education and knowledge regarding medication. Also, malpractice regarding Deanxit® dispensing was reported among pharmacists, although a number of participating pharmacists revealed the unwillingness to despise Deanxit® in case of improper use, their actual practice was found to be the opposite. Also, Deanxit® improper use was identified among the Jordanian population who have easy access to Deanxit® through community pharmacies without a prescription.

Future studies should focus on gathering statistical data on Deanxit® improper use in order to better identify the magnitude of the problem. A scoring tool of knowledge validated for the middle east countries should be formulated, also comprehensive education on Deanxit® is required for pharmacists and the population to reduce use and adverse effects. To reduce Deanxit® improper use, it is recommended that the Ministry of Health and the JFDA monitor Deanxit® use and administration in the Jordanian community and study adding it to the list of controlled drugs (if needed).

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Consent to Participate

All participants have provided a written informed consent electronically.

Availability of Data

The dataset generated and analyzed in this study is available from the corresponding author on a reasonable request.

Funding

This research project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author Contributions

Conceptualization: MB, RA; Methodology: MB, RA; Formal analysis: MB, RA; Writing—original draft preparation: MB, RA; Writing—review and editing: MB, RA. All authors have read and agreed on the submitted version of the manuscript.

Acknowledgment

The authors would like to thank the pharmacists who participated in this study.

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Table 1

Sociodemographic Characteristics of the recruited pharmacies in both scenarios (n = 75).
Variable	First scenario: Irritable bowel syndrome scenario (n = 40)	Second Scenario: Mood disturbances scenario (n = 35)	P-value#
Gender of the pharmacist
Female	17(42.5)	21(60.0)	0.134
Male	23(57.5)	14(40.0)
Pharmacy location
Amman	22(55.0)	19(54.2)	0.951
Irbid	18(45.0)	16(45.7)
Pharmacy shift
A	17(42.5)	18(51.4)	0.446
B	23(57.5)	17(48.5)
Pharmacy status
Chain	29(72.5)	28(80.0)	0.455
Individual	11(27.5)	7(20.0)
#Chi-square test

Table 2

Pharmacists' practice and patient care process regarding Deanxit® in simulated patient scenarios (n = 75).
Pharmacist practice	n(%)
Collect
Medication history	9(12)
Medical history	0(0)
Lifestyle habits	0(0)
Previous use of the drug	6(8)
Assess
Medication appropriateness	0(0)
Health and functional status	0(0)
Immunization status	0(0)
Plan
Addresses medication related problems	4(5.3)
Sets goals of therapy	0(0)
Engages the patient through education	0(0)
Support care continuity	0(0)
Implement
Initiates, modifies, discontinues, or administers medication therapy as authorize	0(0)
Provides education and instructions on how to use the drug	25(33.3)
Referral or transition of the patient to another health care professional	0(0)
Schedules follow-up care	0(0)
Follow-up
Medication appropriateness, effectiveness, and safety and patient adherence	0(0)
Clinical endpoints that contribute to the patient’s overall health	0(0)
Outcomes of care including progress toward goals of therapy	0(0)

Table 3

Pharmacists’ responses regarding Deanxit® use (n = 25).
variable	n(%)
• One tablet at bedtime	5(20%)
• One tablet twice a day	2(8%)
• One tablet three times a day	4(16%)
• One tablet three times a day for three days, then one tablet a day	1(4%)
• One tablet PRN	6(24%)
• Two tablets at bed time	3(12%)
• Two tablets PRN	4(16%)

Table 4

Sociodemographic characteristics of the participant pharmacists (n = 227).
variable	n(%)
Gender
• Female	144(63.4)
• Male	83(36.6)
Education level
• Diploma	22(9.7)
• Bachelor's degree	193(85.0)
• Postgraduates degree	12(5.3)
• Pharmacy student + trainee	0(0.0)
Marital status
• Single	125(56.8)
• Married	96(45.8)
• Divorced/Widowed	6(3.0)
Years of experience
• < 2	60(26.5)
• 2–5	80(35.2)
• > 5	87(38.3)
Province of work
• Amman (Eastern)	55(24.2)
• Amman (western)	59(26.0)
• Irbid (urban districts)	58(25.6)
• Irbid (trade mart areas)	55(24.2)
Pharmacy customers class distribution
• Low income	27(11.9)
• Middle income	129(56.8)
• Low-middle income	32(14.0)
• High income	39(17.3)

Table 5

Pharmacists' knowledge regarding Deanxit® according to their answers in structured interviews (n = 227). More than one answer was allowed.
Variable	Answers n(%)
What are the labelled indications of Deanxit®
• Anxiety (correct)	104(45.8)
• Depression (correct)	87(38.2)
• IBS (incorrect)	102(44.9)
Deanxit® has unlabelled indications
• Yes (incorrect)	167(73.5)
• No (correct)	60(26.4)
Deanxit® side effects
• Insomnia, agitation (correct)	40(17.6)
• Dizziness (correct)	157(69.1)
• Ocular side effects (correct)	0(0.0)
• Cardiac side effects (correct)	12(5.2)
• Gastric side effects (correct)	14(6.1)
Deanxit® drug-drug interactions
• Monoamine oxidase inhibitors (correct)	11(4.8)
• Adrenergic neuron blockers (correct)	4(1.7)
• Anticholinergic agents (correct)	2(0.8)
• Drugs that increase QT interval (correct)	14(6.1)
• CNS depressants (correct)	136(59.9)
Each correct answer was given 1-point, incorrect answer = zero point.

Table 6

Assessment of factors associated with pharmacists’ knowledge about Deanxit®.
Parameter		Knowledge score
	Beta	P Value#	Beta	P Value$
Age (years)	Reference 0.045	0.005^	0.062	0.45
Gender	Reference	0.501	…..	…..
• Female	0.185
• Male
The highest education level	Reference	0.001^	0.22	0.001*
• Diploma	0.216
• Bachelor's degree
• Postgraduates degree
• Pharmacy student or trainer
Marital status	Reference	0.003^	0.095	0.187
• Single	0.197
• Married
• Divorced/Widowed
Years of experience	Reference	0.001^	0.131	0.112
• < 2 years	0.217
• 2–5 years
• > 5 years
Province where you work	Reference	0.119	0.114	0.076
• Amman (Eastern)	0.101
• Amman ( western)
• Irbid (urban districts)
• Irbid (trade mart areas)
# using simple linear regression, $ using multiple linear regression, ^ eligible for entry in multiple linear regression, * significant at 0.05 significance level.

The authors declare no competing interests.

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published 29 Feb, 2024

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Beyond the Counter: Navigating the Landscape of Deanxit® Dispensing – Insights from Jordanian Community Pharmacies

Status:

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Abstract

Figures

1. Introduction

2. Methods

Study design and settings

Ethical approval

Phase 1: Simulated patient

1.2 The used Scenarios in the first phase

1.3 Practice scoring

Phase 2: Structured interview

2.2 Population and sampling (sample size calculation)

2.3 Validation and piloting of study tool

2.4 Knowledge scoring

2.5 Statistical analysis

3. Results

4. Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Journal Publication

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