Rony M. Zeenny

Background and Aims: While pharmacists undoubtedly exert considerable influence over medication adherence and the patient experience with healthcare, a complex interplay of factors should also be considered, encompassing the sociodemographic characteristics of patients, the pharmacist‐related factors, patient satisfaction, and the nature of the community pharmacy experience. This study aimed to assess the dynamics of these factors and examine their association with the adherence of patients to medications. Methods: An online cross‐sectional study was undertaken from April 11 to April 27, 2023, to assess the association between community pharmacy‐related experiences and patient medication adherence in a sample of 865 Lebanese adults using the Lebanese Medication Adherence Scale (LMAS‐14). Results: Of all participants, 38.5% were regular visitors to the community pharmacy, and 57.7% visited the community pharmacy to obtain nonprescription medications. Almost half of the participants stated that the counseling time by the pharmacist is between 5 and 10 min (47.6%). The majority of the participants perceive the pharmacist as a medication expert (94.2%), a health counselor (81.0%), a health promoter (66.2%), and a practitioner who is patient‐centered (73.3%). Older patient age (Beta = 0.08), always visiting the community pharmacy to obtain nonprescription medications (Beta = 3.63), having public health coverage (Beta = 2.37), and spending more than 10 min on counseling about a medication and/or medical condition (Beta = 3.10) were significantly associated with better medication adherence. Visiting a pharmacy to obtain chronic and nonprescription medications (Beta = −2.98) and having irregular health coverage (Beta = −2.60) were significantly associated with lower medication adherence. However, overall satisfaction with pharmacy experience was not associated with medication adherence ( p > 0.05). Conclusion: Pharmacists are seen as experts in medication and holistic healthcare providers. Sociodemographic attributes and specific community pharmacy experience items influence medication adherence. While recognizing that the effects of age and health coverage can guide interventions, emphasizing the role of pharmacists, including extended counseling, could enhance medication adherence and, thus, health outcomes.

Chronic diseases are a major cause of morbidity and mortality in Lebanon, straining the healthcare system. Patient empowerment is recognized as a strategy to enhance self-management and outcomes. This study aimed to develop and validate a Patient Empowerment Outcomes (PEO) scale adapted to Lebanon and to examine associated factors. A cross-sectional survey was conducted with 640 adults with chronic conditions using structured face-to-face interviews. The questionnaire included sociodemographic and behavioral items, along with four validated tools: the focused Patient Assessment of Chronic Illness Care (fPACIC), General Practice Interpersonal Care (GPIC), Health Empowerment and Self-Management (HESM), and the new PEO scale. Higher PEO scores were significantly associated with older age (B = 0.102, p = 0.002), proactive behaviors (B = 5.486, p = 0.001), and higher GPIC (B = 0.319, p < 0.0001), HESM (B = 0.681, p < 0.0001), and fPACIC (B = 0.104, p = 0.037) scores. Negative associations included greater medication burden (B = − 0.395, p = 0.029) and health fatalism (B = − 1.406, p = 0.008). The PEO scale is a valid, culturally adapted tool to assess empowerment in Lebanese patients with chronic diseases. Findings highlight the role of communication, self-management, and informed decision-making in guiding patient-centered interventions and policies.

In Lebanon, widespread antibiotic prescribing has led to antimicrobial resistance (AMR), a notable public health concern driven by inappropriate use. As future prescribers, medical students play a critical role in combating AMR. This study aimed to evaluate their AMR awareness and antibiotic prescribing practices, identify knowledge gaps, and suggest interventions to promote appropriate antibiotic use and limit local AMR emergence. A cross-sectional study was conducted among Lebanese medical students from July 1, 2021, to September 30, 2022. Data were collected via a structured online questionnaire using snowball sampling. The questionnaire was informed by published articles and the authors’ expertise. It included sociodemographic data and novel, context-specific scales assessing antibiotic prescribing attitudes, knowledge of AMR drivers, and prudent prescribing practices, addressing gaps in existing tools. The sample included 164 medical students, with a mean age of 22.78 ± 3.94 years. Furthermore, 89.6% were interns, 50.6% were females, and 68.3% studied at a public university. Antibiotic prescription attitudes among the surveyed participants were affected by a better awareness of some contextual factors related to the prescribed drug and the pharmaceutical companies. Decreased awareness was observed for pharmacist-related factors, patient characteristics, and marketing-related factors. Interns had higher awareness than residents about marketing and the contextual factors influencing antibiotic prescribing. Participants had average knowledge levels of AMR and relatively high knowledge levels of strategies to manage it. A significant interrelation was found between awareness of factors influencing physicians’ antibiotic-prescribing attitudes and AMR knowledge (p < 0.05). Lebanese medical students demonstrated adequate overall knowledge of antibiotic use and resistance, along with generally positive attitudes toward appropriate antibiotic prescribing. However, gaps were noted in their understanding of prudent antibiotic prescribing practices. Targeted interventions, including curriculum enhancement, AMR-focused workshops, stewardship training, and supportive national policies, are recommended to strengthen AMR awareness and promote responsible antibiotic use.

Our study aims to describe the extent of caregiver burden and its associated factors among family caregivers of community-dwelling older adults in Lebanon in the context of multiple crises. During May–June 2024, a quantitative cross-sectional study was carried out in Lebanon involving 544 caregivers of older adults. Participants were recruited online via various social media platforms. Measures of the caregiving burden and related concepts were executed using validated scales and reports related to the care recipient’s situation. Bivariate and multivariable analyses were conducted to investigate factors associated with caregiver burden. The findings showed that most caregivers were females with lower education levels and facing financial difficulties. Among the participants, 28% reported a severe caregiving burden, 19% a moderate burden, and 24% a mild burden. The burden of caregiving was higher when the care recipient was financially dependent on the caregiver, had dementia or chronic musculoskeletal (reduced mobility) conditions, and was not able to socially integrate. The burden was also higher when the caregiver was older, lived in a remote region, was a part-time worker, had financial distress, provided care for a longer period, used maladaptive coping strategies, had no assistance, and received lower social support. This study showed that the financial difficulties of both the caregiver and the care recipient added to the usual burden of caregiving in the Lebanese context. These findings highlight the need for targeted interventions and support systems to alleviate the burden on family caregivers in Lebanon, especially given the country’s rapidly aging population, the difficult multifaceted crisis, and the limited availability of formal care services.

This study examines the impact of program accreditation on education quality and career outcomes among students and graduates of health-related disciplines in Lebanon. In the absence of a national accrediting body, many universities seek international accreditation. Additionally, the study validates four scales measuring factors influencing university choice and perceptions of accreditation. A cross-sectional study was conducted between September and December 2023, enrolling 642 participants, including students and graduates from Lebanese health-related programs. Four validated scales included: Reasons for Choosing University Program (RCUP, 14 items), Perception of University Program Accreditation (PUPA, 12 items), Perceived Impact on Education Quality (PI-AQE, 27 items), and Perceived Impact on Career Outcomes (PI-ACO, 9 items). Principal component analysis with Promax rotation assessed construct validity. Bivariate analyses (t-tests and ANOVA) examined relationships between scales and participant characteristics. Multivariate analysis of covariance (MANCOVA) adjusted for sociodemographic and university-related factors, while multiple regression explored predictors of time to employment for graduates. Students from three universities reported significantly lower RCUP scores, indicating weaker motivations for their program choice. Clear communication of accreditation status correlated positively with RCUP (β = 1.097, p = 0.004). Pharmacy students scored higher on RCUP (β = 2.412, p = 0.002). Higher income levels (β = 1.829, p = 0.020) and awareness of accreditation (β = 2.348, p = 0.004) were linked to more favorable PUPA scores. Females (β = 4.981, p = 0.002) and high-income individuals (β = 3.777, p = 0.040) anticipated a stronger impact on PI-AQE. Graduates, particularly those with a PhD (β = 4.755, p = 0.042) or a Bachelor’s degree (β = 2.557, p = 0.003), expressed more positive PI-ACO perceptions. Conversely, uncertainty about accreditation was associated with lower PI-ACO scores (β = -3.019, p = 0.004). Notably, university accreditation status (β = -0.355, p = 0.011) and longer professional experience (β = -0.274, p = 0.010) were significantly linked to a shorter time to employment. This study validates tools for assessing accreditation’s impact on Lebanese health education. Findings emphasize that accreditation status, program choice, and demographics significantly shape perceptions of education quality and career prospects. Effective communication about accreditation may enhance career readiness and suggest potential benefits for employment prospects. These findings emphasize the importance of accreditation as a strategic tool for advancing health education quality and optimizing career prospects in the healthcare sector.

Objective: This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients’ subgroups. Methods: A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, lifestyles, comorbidities, and medication use. Logistic regression models were employed to analyze the data and determine associations between CVD and metabolic drugs. Stratification analyses were performed based on diabetes and dyslipidemia status. Results: The study found significant associations with CVD among the 2048 participants. Higher scores on the Lebanese Mediterranean Diet Score (LMDS; ORa = 1.06), hypertension (ORa = 1.71), diabetes (ORa = 1.75), dyslipidemia (ORa = 1.89), family history of CVD (ORa = 1.58), and smoking (previous: ORa = 1.63, current: ORa = 2.15) were linked to increased CVD odds. Higher income (intermediate: ORa = 0.64, high: ORa = 0.40) was inversely related to it. A subsequent model that included hypoglycemic and lipid-lowering medications yielded similar results. However, neither hypoglycemic nor lipid-lowering medications demonstrated a significant association with CVD risk. A third regression model was conducted by taking the classes of drugs as an independent variable. Also, the result revealed that all the classes of medication were not associated with the risk of CVD. Stratification by diabetes revealed LMDS and hypertension as risk factors in both groups. Among non-diabetic participants, dyslipidemia (ORa = 2.40), current smoking (ORa = 2.28), and higher income (intermediate: ORa = 0.57, high: ORa = 0.62) were linked to CVD. Among people with diabetes, a family history of CVD (ORa = 2.69) increased the CVD odds, while being an employer (ORa = 0.49) lowered it. Stratification by dyslipidemia showed consistent risk factors, and higher LMDS (ORa = 1.07), diabetes (ORa = 2.14), hypertension (ORa = 1.79), and previous smoking (ORa = 1.95) were linked to CVD without dyslipidemia. Being a female (ORa = 0.52) and having a lower income (ORa = 0.40) were associated with lower CVD odds in those with dyslipidemia. Subgroup analyses showed that medications were not significantly associated with CVD odds among patients with diabetes or hyperlipidemia. Conclusions: This study’s findings highlight the importance of addressing modifiable risk factors and socioeconomic factors to reduce the burden of CVD. Targeted interventions and longitudinal research are necessary to optimize preventive strategies and improve the management of CVD in individuals using hypoglycemic and hypolipemic agents in low- and medium-income countries.

Objective: This study aims to identify the association between adherence to healthy eating, using the Lebanese Mediterranean Diet Scale (LMDS), and cardiovascular risk factors in the Lebanese population. Materials and Methods: A cross-sectional study using a multistage cluster sample was conducted in Lebanon. Sociodemographic characteristics were collected through structured interviews and self-administered questionnaires. The LMDS assessed dietary habits. The associations between diabetes, dyslipidemia, and cardiovascular disease were investigated using stratification analysis. Results: The study included 2048 people (mean age: 41.54 ± 17.09 years). Higher adherence to the Mediterranean diet was associated with older age (Beta = 0.175, p < 0.001), being female (Beta = 0.085, p = 0.001), being married (Beta = 0.054, p = 0.047), participating in regular physical activity (Beta = 0.142, p < 0.001), and having cardiovascular disease (Beta = 0.115, p < 0.001) and diabetes (Beta = 0.055, p = 0.043). Adherence was, however, negatively associated with being a smoker (Beta = −0.083, p = 0.002), a previous smoker (Beta = −0.059, p = 0.026), and having higher distress levels (Beta = −0.079, p = 0.002). Stratification analysis by diabetes, dyslipidemia, and cardiovascular disease (CVD) consistently demonstrated these associations. Conclusions: These findings suggest that demographic and health factors influence the Lebanese population’s adherence to the Mediterranean diet. Older age, female gender, married status, physical activity, CVD, and diabetes were all found to be associated with adherence to the Mediterranean diet in the Lebanese population. In contrast, smoking and distress were inversely associated with it.

While previous research underscores the independent effect of the pharmacist-patient relationship on patient outcomes, it did not delve further into the patient-pharmacist relationship dynamics and their effects on reported outcomes. Therefore, this study aimed to assess whether patient-pharmacist relationship aspects mediate the association between patient personal and health characteristics, on the one hand, and adherence to medication and quality of life, on the other hand (QOL). An online cross-sectional study was conducted between April 11 and 27, 2023. It enrolled 865 adults from all Lebanese governorates and used validated scales to measure the various concepts. The mean age was 32.52 ± 14.56 years, and 68.8% were female. Also, 79.3% reported having no chronic disease, and 57.7% indicated that getting nonprescription medications was the main reason for visiting a community pharmacy. The average routine intake of medications per day was 0.87 ± 1.78. Our key findings reveal a compelling association between worse health status and both increased medication non-adherence and reduced QOL. Sociodemographic factors were found to be correlated with QOL. Despite the considerable impact of demographic factors on patient expectations, our study challenges the expected mediation role of the pharmacist-patient relationship and counseling time on medication adherence. Nevertheless, patient expectations partially mediated the relationship between sociodemographic characteristics and QOL. This study sheds light on the intricate dynamics between patient characteristics, health status, medication adherence, and QOL within the context of the patient-pharmacist relationships.