Introduction: The increasing cost of health care in developed and developing economies has called for a change in the way health activities are implemented. Nigeria is faced with fundamental health care related challenges coupled with recent security issues. Uncertainty prevails as health system dynamics unfolds.Objectives: To explore the relationship between environmental uncertainty and health care delivery system in Nigeria. The study aims at reviewing the dynamics of health care delivery in some developed economies and Nigeria with regard to methods of adaptation of health care under uncertainty, and developing a framework for sustainable health care delivery. Methods:Databases were searched for relevant literatures using the following keywords: environmental and health uncertainty, Nigerian health care system, Nigerian primary health care, health care financing and sustainability. Other keywords used include: US, Europe and China health care dynamics, among others. Scientific databases obtained from the Internet were used including online journals, which were sourced mainly from the Google. Relationships if any were established and a framework for sustainability developed. Results:Environmental uncertainty has a multiplicity of interactions with different aspects of health care system, resulting in poor infrastructural development, inadequate government funding, absence of integrated system for disease prevention and surveillance, policy reversals, security challenges, and unimpressive health indicators in Nigeria. A framework for implementing sustainable health care delivery under uncertainty is proposed. Discussion and conclusion: Uncertainty abounds in the Nigerian health care delivery system; causing further distortion in development of the health sector. Effective mobilization of health care professionals, use of sustainable care plans by government, use of integrated medical intelligence and surveillance systems, accountability, commitment, and above all quality leadership -will minimize uncertainty factors and enhance health care performance and sustainability in Nigeria.

Background: The increasing need for adherence evaluation of CHF amongst senior physicians in our environment prompted this study.Objective: To determine physician-adherence to pharmacotherapy guidelines in CHF in an economically resource-poor tertiary health facility. Methods:Review of prescription pattern of anti-CHF drug-class of 100 confirmed systolic-CHF patients was carried out. Data for adherence-evaluation were obtained from follow-up information from out-patient clinic-notes, while data on acute care medications and precipitating factors were from in-patient hospitalization notes.Results: CHF patients aged 54.7 ± 14.5 years, had NYHA III/IV symptoms (47%) and hypertension (61%). Anti-CHF pharmacotherapy averaged three drug-types; and consisted of ACEI/ARB (83%), β blockers-BB (48%), aldosterone antagonists (41%), CG (82%), and diuretics (75%). Adherence was assessed as good or complete in 50%, partial/ incomplete in 33%; but non-adherent in 17% of the total. While overall physician-adherence was 59.6% on single drug-classes, survival-advantage combinations with ACEI/ARB+BB and ACEI/ARB+BB+AA were present in 40% and 16% respectively. Older patients (≥ 65 years) had significantly lower prescriptions of all three classes of survival advantage anti-HF drugs, as follows: ACEI/ARB (56% versus 95%); BB (37.5% versus 52%); and AA (31% versus 63%) [p < .05].Conclusion: BB and AA were under-prescribed. Physician-adherence to evidence-based anti-HF drug classes was variable and influenced by patient's age. It was also comparable with reports from other countries. Our physicians will benefit from a structured HF education and feed-back program.

Background/Objective: Types of conflicts in pharmacy organizations were discussed and conflict management styles by pharmacists in academia and hospital pharmacists in two affiliate tertiary institutions in Lagos, Nigeria were assessed. Methods:An adapted questionnaire of 20-item inventory for conflict management scale (CMS) for pharmacy was used to obtain responses from hospital pharmacists and pharmacists in academia in the practice areas. The multistage inventory item comprising questions that used four graded scales and appropriate alphabets A to D against each column was used in line with the described explanatory model. Scales of A, B, C, and D represent: imposing, settling, avoiding and thwarting respectively. Some items were rephrased and content-validated for clarity to respondents, while the last item (number 20) was introduced to reflect a pertinent issue in conflict management. The instrument was administered in voluntary situation over a period of two weeks; the results were collated and analyzed.Results: Thirty-one full-time pharmacist lecturers (14 males, 17 females) and 29 registered hospital pharmacists (6 males, 23 females) in the respective institutions completed the questionnaires. The summed scores of dominant and secondary conflict management styles for the two respective groups show that pharmacists in the two practice areas have different approaches to conflict management in workplace. A substantial number of respondents in both settings are either dominantly settling or avoiding in their style. Conclusion:Training in conflict management and reflective practice is highly recommended for pharmacists, to attain the skills that enhance their interpersonal environment, aimed at making pharmacy practice a very fulfilling and rewarding profession.

Introduction: Prescribing errors and uncertainty are of increasing concern to health professionals due to their prevalence and implications for patient safety and wellness. Objectives: To assess the coping strategies of doctors and pharmacists who experienced or observed prescribing errors and uncertainty in a tertiary university hospital, and the implications for therapeutic outcomes. Methods: A self-assessment questionnaire was used to elicit information from a convenience sample of 94 physicians and 35 pharmacists of at least 2 years working experience in a tertiary hospital in Lagos, Nigeria, from October to December 2014. Ethical approval was sought and obtained for the study. The research instrument was validated by experts in the field of medicine, hospital pharmacy, and strategic management, and pilot-tested. Concerns and attitudes to committing/observing prescription errors and at different uncertainty levels were assessed. Also the outcomes of their encounters, specific actions taken by the two professional groups when faced with prescribing errors, causes of, and non-detection of prescribing errors, methods used to deal with the errors, and the extent to which pharmacy intervention was successful, were evaluated. Results: Doctors and pharmacists (35.1% vs. 40%) admitted committing medication errors, while both professional groups (10.6% vs. 20%) admitted having avenues to discuss prescription errors. They also admitted prescribing or dispensing more, respectively when decision uncertainty was least. None of the doctors and few pharmacists admitted telling the patient about any prescription errors committed or observed respectively. There were varied responses on the causes of errors and non-detection of prescription errors. Coping strategies in terms of the use of technologies, medium and mode of communication, and use of continuing education to minimize errors, all fall below expectations for mitigating errors in prescribing and uncertainty. Discussion and Conclusions: A number of variables assessed on good prescribing decisions and uncertainty were at variance with the studies from other countries. An organizational culture and structure that promote collaboration in prescribing decisions, infrastructural facilities, effective communication, enabling decision support systems, and relevant continuing education are needed to foster a care-process that is less prone to prescribing errors and uncertainty.

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