الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Food drug interaction (FDI) and drug nutrient interaction (DNI) is an adverse
incident that can affect patient’s health in all age groups. In line with the FDA food drug
interactions (FDIs) is “a condition where a food influences the activity of a drug; for
instance, the achieved outcome is increased or decreased, or a new outcome of that drug is
generated that would not be generated without the utilization of that food”. Adverse drug
reactions pertaining to nutritional diseases are ranking among the top five co-morbid
conditions of hospitalized patients.
Health care providers specially physicians and pharmacists participate in a vital role
in identifying serious FDIs, and accordingly should be vigilant about monitoring these
interactions. Owing to the scarcity of research regarding the responsibility of physicians
and pharmacists in identifying and counseling their patients on serious FDIs, this study
aimed to assess the nutritional knowledge, verifying the attitudes, and detecting the
practices of hospital physicians and pharmacists working in MOH hospitals towards FDIs
and DNIs in Alexandria.
In the present study, a total of 279 physicians and pharmacists (95 and 184,
respectively) gathered from five different governmental hospitals affiliated to Ministry of
Health in Alexandria, volunteered to answer a structural designed questionnaire. The
specialties included were internists, pediatricians, hospital pharmacists and clinical
pharmacists. This cross-sectional study was performed during May 2019 till August 2019. The questionnaire gathered socio-demographic data, such as personal data (age,
gender and specialty) and professional characteristics (years of experience and
qualifications). This was followed by 20 questions on different FDIs and DNIs nutritional
knowledge. Then proceeding were 8 statements on attitudes towards FDIs/DNIs and its
importance. Subsequently were 6 questions to identify practices as regards to applying
patient counseling regarding FDIs/DNIs and increasing the awareness towards this field.
The socio-demographic data collected in this study discovered that the mean age of
physicians and pharmacists was 33.8±8.6 years. Females were exceeding males by more
than two thirds. About two thirds (66%) of the studied sample were pharmacists. As for the
graduation year, 53% of the studied sample was graduated in 2010 or above. The mean
year of experience was 10.6±8.1years. The studied sample had different education degrees
including bachelor, master, diploma, fellowship and doctoral degrees. The nutritional
background was lacking among the studied sample as only 36.2% had undergraduate
nutrition course and only 26.5% attended a nutrition course post-graduation.
The current study demonstrated that only 10.4% of the studied sample had good level
of knowledge with a mean score of knowledge 56.5%. Regarding attitude and practice,
86.7% had positive attitude with a mean attitude score 78.7%, while only 17.9% had good
practice with a mean practice score 53.0%.
Knowledge was related to the graduation year and to having a nutrition course
whether during the studying pre-graduation years or post-graduation years. The graduation
year, the undergraduate nutrition course and the nutrition courses post-graduation were
found to be the chief factors affecting knowledge in this study (p=0.037, 0.048 and 0.024
Summary, Conclusion and Recommendations
95
respectively). The graduation year of the studied sample was not significantly related to
having under graduate or post-graduation nutrition course.
Concerning attitude, pharmacists were noticed to have higher positive attitudes than
physicians towards FDIs/DNIs regarding some of the proceeding questions: (some FDIs
can be fatal, FDIs/DNIs must be given more time and attention during undergraduate
studies, the necessity to report any FDIs/DNIs they encounter during their clinical practice
to the pharmacovigillance, and informing the patients about the possible FDIs/DNIs is their
responsibility). Attitude was also highly related to the specialty of the studied sample,
where clinical pharmacists were seen have positive attitude (95.6%) towards FDIs and
DNIs more than pediatricians, pharmacists and internists (94.1%, 85.3% and 68.2%
respectively) (p=0.000). Physicians and pharmacists in all age groups had high positive
attitude towards FDIs/DNIs. Females were slightly of higher positive attitude towards
FDIs/DNIs than males (88% and 78.9% respectively). Those graduated before the year
2000 were noticed to have higher positive attitude than those graduated after the year 2000.
All physicians and pharmacists with different number of experience years had highly
positive attitudes. Those with master’s degree had slightly higher positive attitude than the
other degrees.
As for practice, it was noticed that physicians ask their patients more than
pharmacists about the medications (prescription/OTC) and food supplements or herbal
remedies that they use or intend to use together (23.2% and 15.8% respectively), while
pharmacists were of a significantly higher good practice than physicians regarding using a
handbook/ software program to check for FDIs/DNIs (p=0.004) and more insignificant
good practice towards referring to the drug information center (DIC) for checking any
FDIs/DNIs (p=0.127). Pharmacists were also found to have insignificant good practice
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more than physicians regarding how they act when facing a case of FDI/DNI (20.1% vs.
16.8%, p=0.510), but significant good practice towards increasing the awareness of
FDI/DNI (22.8% vs. 10.5%, p=0.012). Both physicians and pharmacists (21.1% each) had
good practice towards counseling the patients on the possible FDIs/DNIs they may
encounter.
The studied sample in the age group ≥40 years were of higher level of good practice
towards FDIs/DNIs compared to the other age groups. Females were of higher level of
good practice than males (19.9% and 5.3%, respectively). Practice among different
specialties was found to be higher in clinical pharmacists followed by pediatricians then
pharmacists and least in internists.
Practice was significantly related to having a nutrition course during both the pre and
post-graduation years, but from the main predictors of practice was the under graduate
nutrition course only (p=0.037). Also, good knowledge about FDIs/DNIs was found to be
the key predictor for having good practice (p=0.000).
from data of the present study, the following conclusions have been
reached:
• Most of the studied physicians and pharmacists had positive attitude and a moderate
practice regarding food drug interaction during their daily practice. However, they
generally lacked the sufficient knowledge about this topic.
• This study has provided empirical support for the importance of nutrition and food
drug interactions to the physicians and pharmacists in order to provide the most
favorable therapy outcomes via patient education and counseling.
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• Physicians and pharmacists mainly gain their knowledge in this field through college
tuition and post-graduation nutrition courses.
• Even with positive or neutral attitudes, physicians and pharmacists lack the adequate
nutritional knowledge and subsequently their patients might endure adverse drug
reactions.
• The main factors affecting knowledge are the graduation year, having an
undergraduate nutrition course and attendance of nutrition courses post-graduation.
The main factors affecting practice are knowledge and having an undergraduate
nutrition course.
In light of the findings of the present study, the following recommendations are suggested:
1. To policy makers (Ministry of Health, The Egyptian Medical Syndicate and
Syndicate of Pharmacy):
• Continuous educational programs and training campaigns addressing hospital
physicians and pharmacists to enlighten them of their crucial role in food drug
interactions, as the majority provides limited services to their patients in this field.
• The incorporation of a nutrition module that includes food drug interactions in the
curriculum of faculties of Medicine and Pharmacy.
• Hospitals should have access to evidence-based references on most common food
drug interactions. Computer-assisted educational software should be available to
assist practitioners in discovering potential food drug and drug nutrient interactionsfor patients to prevent adverse events or problems. Also, the available reporting
systems should be easy to use and non-tedious.
• Counseling and standard operating procedures upon discharging patients from
hospitals, they should be given information, orally as well as written, of potential
food drug interactions they might encounter during their treatment period.
• There should be a degree specific inpatient education concerning nutrition and drug
interactions.
2. To physicians and pharmacists:
• Physicians, pharmacists and clinical pharmacists should collaborate with
nutritionists, dietitians and nurses for the aim of minimizing FDIs/DNIs and their
adverse outcomes.
• They should plan a strategy, or a treatment protocol based on their knowledge,
experience, and skills in order to minimize any ADRs resulting from FDIs or DNIs.
• Frequently check the recent updates, protocols and software interaction information
programs to allow for the safe treatment choices.
• Follow-up, document, communicate and report any prescription or order form
given to the patient and having potentials for FDIs before the hospital discharge.
• Computerize the interactions in drug interaction screening programs, warning
software and patient counseling brochures, as an approach to spread the awareness
of food drug interactions between the health care personnel and the patients.. To researchers:
• Further research on other food drug interactions especially those related to herbal
medicines and dietary supplements should be done.
• Assessment of hospital physicians’ and pharmacists’ practice regarding patient
counseling should be taken into consideration, as they are in contact with several
chronic patients.
• Include other medical specialties and the family doctors whom will have a great
role in the medical insurance system regarding this topic.
Hopefully the results in this study would draw the attention of the decision makers in
the health sector to the vitality of providing physicians and pharmacists with the training
needed to qualify them to give appropriate counseling and medical advice to their patients.