Subjects and methods: A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t-test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients' self-efficacy in decision making.
Results: A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p<0.001). Patients had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients' perceived level of involvement, and attitudes toward concordance are significant predictors of patients' self-efficacy in decision making (p<0.05).
Conclusion: Patients who felt involved in their consultations had more positive attitudes toward concordance and higher confidence in making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients' involvement in medication-related decision making.
DESIGN: This was a qualitative study comprising semi-structured face-to-face interviews guided by 10 open-ended questions. Interviews were conducted until data saturation was achieved and no new ideas were formed. The interviews were audio-recorded, transcribed verbatim and analysed for themes. To derive themes, we employed directed content analysis of transcript data. Coding was completed using a combination of open, axial and selective coding.
SETTING: Four nursing homes in Singapore.
PARTICIPANTS: The study involved 17 participants (comprising 4 doctors, 4 pharmacists and 9 nurses).
RESULTS: Two key themes were identified, enablers and challenges. These were enablers and challenges faced by doctors, pharmacists and nurses towards deprescribing. The identified subthemes for enablers of deprescribing were: (1) awareness of medications that are unnecessary or could be targeted for deprescribing; (2) improving quality of life for patients with limited life expectancy; (3) improving communication between doctors, pharmacists and nurses; (4) systematic deprescribing practice and educational tools and (5) acknowledgement of possible benefits of deprescribing. The identified subthemes for challenges of deprescribing were: (1) symptoms not acknowledged as possibly drug-related; (2) lack of knowledge in patient's and family members' preferences; (3) lack of coordination between health professionals in hospitals and nursing homes and (4) limited tools for deprescribing. The development of a local guideline, mentoring nurses, case discussions, better shared decision-making and improving multidisciplinary communication, may help to support the process of deprescribing.
CONCLUSION: In conclusion, this study highlighted that deprescribing in the nursing homes is perceived by health professionals to be challenging and future research could assess how routine case studies, mentoring and better multidisciplinary communication could improve deprescribing knowledge and process in the nursing homes.
METHODS: This is a nationwide retrospective audit on the documentation of Dabigatran Prescribing and Dispensing Checklist for a period of two years from January 2013 till December 2014. Data from these Dabigatran Checklists (indication, dose, duration, renal function and adverse drug reactions encountered) were extracted by the pharmacist at MOH healthcare facilities.
RESULTS: A total of 52 out of 56 (92.9%) of MOH facilities complied to usage of checklist at their centres involving a total of 582 patients of which 569 (97.7%) patients were initiated on dabigatran for the approved indications. The recommended dose of dabigatran was used correctly in 501 (99.6%) of patients. Reason for switching to DOACs use was only documented in 76.7% (131/171) of patients. The most common reason for switching from warfarin was poor INR control (n=39), history of bleeding/overwarfarinisation (n=22) and unable to attend regular INR clinic (n=21). There were 75 cases of adverse events reported. The most common adverse event reported were abdominal discomfort (n=10) followed by gum bleeding (n=9) and dizziness (n=5).
CONCLUSIONS: Compliance to the dabigatran check list was high with 70% of patients prescribed the appropriate dosing.
METHODS: A cross-sectional study, using the 'Hospital Survey on Patient Safety Culture (HSOPSC)' questionnaire was carried out in 2018 in SGH. Random sampling was used to select a wide range of staff in SGH. A self-administered questionnaire was distributed to 500 hospital staff consisting of doctors, nurses, pharmacist and other clinical and non-clinical staff, conducted from March to April 2018. A total of 407 respondents successfully completed the questionnaire. Therefore, the final response rate for the survey was 81.4%. This study used SPSS 22.0 for Windows and Hospital Data Entry and Analysis Tool that works with Microsoft Excel developed by United States Agency for Healthcare Research and Quality (AHRQ) to perform statistical analysis on the survey data.
RESULTS: Majority of the respondents graded the overall patient safety as acceptable (63.1%) while only 3.4% graded as excellent. The overall patient safety score was 50.1% and most of the scores related to dimensions were lower than the benchmark scores (64.8%). Generally, the mean positive response rate for all the dimensions were lower than composite data of AHRQ, except for "Organizational Learning - Continuous Improvement", which is also the highest positive response rate (80%), higher than AHRQ data (73%). The result showed that SGH has a good opportunity to improve over time as it gains experience and accumulates knowledge. On the other hand, the lowest percentage of positive responses was "Non-punitive response to error" (18%), meaning that most of the staff perceived that they will be punished for medical error.
CONCLUSIONS: The level of patient safety culture in SGH is acceptable and most of the scores related to dimensions were lower than benchmark score. SGH as a learning organisation should also address the issues of staffing, improving handoff and transition and develop a non-punitive culture in response to error.
METHOD: This study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response.
RESULTS: Response rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed.
CONCLUSION: Overall, the study findings witnessed the expert panel's support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysia.
OBJECTIVE: The aim of this study was to determine the positioning and roles of ICT in community pharmacies in the state of Selangor, Malaysia.
METHODS: A cross-sectional study was conducted from November 2018 to January 2019 across 9 different subdistricts in the state of Selangor, including Subang Jaya, Cheras, Puchong, Port Klang, Kota Kemuning, Selayang, Chow Kit, Ampang, and Seri Kembangan. A total of 90 community pharmacists were approached from the 9 subdistricts and invited to participate in the study.
RESULTS: Of the 90 community pharmacies approached, 60 agreed to participate in the study, representing a response rate of 67%. The majority (36/60, 60%) of the respondents were women, and more than half (32/60, 53%) of the community pharmacies were run by young adults (ie, 30 years old and younger). More than three-quarters of the community pharmacies (46/60, 77%) used electronic health records. Half of the community pharmacies used online social media platforms for advertising and promoting their pharmacies. The vast majority of the community pharmacies (55/60, 92%) were using modern electronic payment systems, and some were also using other new electronic payment methods. Moreover, most of the community pharmacies (41/60, 68%) were using software and programs for accounting and logistics purposes. In addition, 47/60 (78%) of the community pharmacies used a barcode reading system for medicines/health products, and 16/60 (27%) of the pharmacies had online stores, and consumers could buy medicines and health products from these pharmacies via their online portal. In addition, 20/60 (33%) of the community pharmacies used at least one of the common online business platforms available in Southeast Asia to sell products/medicines. The telephone was the most commonly used means of communication with patients, although some pharmacies also used email, WhatsApp, SMS text messaging, and other communication platforms.
CONCLUSIONS: This study showed that the majority of community pharmacies in Selangor, Malaysia are using ICT for different purposes. However, there is still limited use of mobile apps to provide health services. Overall, community pharmacies have been adopting ICT apps for pharmacy services but the rate of adoption is relatively slower than that in other sectors of Malaysia.
Methods: We conducted a three-day course in February 2011 in Riyadh, Saudi Arabia. It was developed to provide attendees with the essential knowledge and skills to become a medication safety officer. Teaching methodologies included didactic teaching, group discussions, case presentations, and an independent study of medication safety materials. The content of the course focused on the various roles of a medication safety officer, the importance of medication safety in a health care setting, the incidence of adverse drug events in a hospital setting, strategies to identify and prevent adverse events, the use of root cause analysis and failure mode and effect analysis, the role of an officer in hospital accreditation, and ways for promoting safety culture. Assessment of the course outcome was accomplished by comparing scores of knowledge level before and after the course. The knowledge level was assessed by a 20-item exam which was developed and validated by course instructors.
Results: Twenty-one participants attended the course and completed both the baseline and after-course assessment questionnaires. The majority was male (N = 14, % = 66.7) with a job experience of 1-5 five years (N = 10, % = 47.6). The knowledge score increased from 14.3 ± 1.90 (mean ± standard deviation) at baseline to 18.5 ± 1.43 after successfully completing the course (P
METHODS: A Delphi questionnaire consisted of 29 Part 1 and nine Part 2 indicators which were incorporated into a tool called Simpler™. The indicators were mainly sourced from American, Australian and Malaysian diabetes management guidelines. Diabetes experts were asked to rank indicators in the order of importance in Part 1. In Part 2, indicators had to be chosen for inclusion into Simpler™ using a fivepoint Likert scale. The consensus level was pre-set at 60%.
RESULTS: A three round Delphi process was used to validate all 38 indicators by 12 experts from Australia and Malaysia: five pharmacists, four doctors, two endocrinologists and a diabetes nurse. Consensus was reached for 93.1% (27/29) of the Part 1 indicators and all nine Part 2 indicators (100%). Five out of nine indicators in Part 2 questionnaire obtained consensus disagreement for inclusion into the Simpler ™ tool.
CONCLUSION: The Simpler™ tool is the first structured diabetes multifactorial tool to address all seven evidence-based factors. The tool was refined and validated by multi-disciplinary health professionals from Australia and Malaysia. Pharmacists can use the Simpler™ tool to facilitate evidence-based comprehensive individualised care among type 2 diabetes patients.
METHODS AND ANALYSIS: This is a protocol for a cluster randomised controlled trial that aims to evaluate the impact of the PRIME programme on participants' clinical outcomes and explore participants' and pharmacists' views towards its implementation. This protocol describes the development of the PRIME programme and mobile app, its feasibility and implementation in community pharmacy settings. 16 pharmacies from two states in Malaysia will be randomised to the intervention arm or standard care. The study will include overweight or obese adults with pre-diabetes. During each follow-up visit at the pharmacy, intervention participants will receive in-depth counselling from pharmacists after reviewing their self-monitoring data recorded in the PRIME app. They will also receive pre-diabetes education through the app and join a peer support chatgroup. The primary clinical outcome includes changes in body weight at 6 months, while the secondary clinical outcomes include changes in blood glucose profile, lipid profile, blood pressure and adiposity measures. The sustainability of the PRIME programme will be accessed using a follow-up questionnaire, while participants' engagement with the intervention will be evaluated using attendance rate and the app data. Focus group discussions and one-to-one interviews will be conducted for process evaluation. This study will inform the impact of community pharmacists-led digital health intervention in pre-diabetes management.
ETHICS AND DISSEMINATION: This study has been registered with clinicaltrials.gov (NCT04832984) and approved by the Monash University Human Research Ethics Committee (Project ID: 27512).
TRIAL REGISTRATION NUMBER: clinicaltrials.gov (NCT04832984).
OBJECTIVES: This aims to explore the knowledge, attitude, and practice (KAP) towards disaster medicine preparedness and readiness among community pharmacists in the United Arab Emirates (UAE).
METHOD: A cross-sectional study was conducted over the ten months among licensed community pharmacists who had three months' professional experience or more. Face-to-face interviews were carried out and a structured questionnaire was used for data collection. Logistic regression models were used to determine the factors influencing aboucine preparedness and readiness. SPSS Version 24 was used to analyze the data collected.
RESULTS: A total of 500 community pharmacists participated in the study. The average knowledge score was 25.6% with a 95% confidence interval (CI) of [21.7%, 29.4%]. Better knowledge scores were observed in the male gender (OR 2.43; 95% CI 1.05-3.72), participants aged ≥ 31 years old (OR 2.97; 95% CI 1.16-7.6), postgraduates (OR 4.36; 95% CI 2.6-7.3), participants from independent Pharmacies (OR 6.5; 95% CI 4.04-10.4 3), chief pharmacists (OR 3.1; 95% CI 1.86-5.07), participants with 16 years and more experience years (OR 2.42; 95% CI 1.063-5.522) and participants who graduated from regional/international universities (OR 5.92; 95% CI 2.65-13.2). Better attitude and practice about disaster medicine preparedness were observed in postgraduates (OR 2.54; 95% CI 1.26-pharmacists from independent pharmacies (OR 1.35; 95% CI 2.43-2,.66), and chief pharmacists (OR 1.26; 95% CI 1.17-1.35).
CONCLUSIONS: It's essential to provide a continuing education program using different educational strategies urgently needed to improve community pharmacy competencies (e.g. knowledge attitudes, and perceptions) to improve the skills and practices regarding disaster medicine preparedness and readiness.
Methods: This survey research was conducted from August to December 2018 through a pre-tested, self-administration, and cross-sectional random convenient sampling at various districts in the Klang Valley. A total of 275 registered community pharmacists were involved in this study by completing a pilot-tested questionnaire. Descriptive analysis, Mann-Whitney U test, and Kruskal-Wallis H test were used to analyze the data.
Results: The knowledge toward Zika virus infection of respondents was classified into "poor" (5.1%), "basic" (70.9%), and "broad" (24.0%). Most of the participants (n = 195, 70.9%) presented with basic knowledge toward Zika virus infection. A total of 268 (97.5%) participants presented with high awareness toward Zika virus infection. The mean score of respondents' knowledge and awareness was 15.88 ± 3.61 (maximum score = 28) and 13.96 ± 1.60 (maximum score = 16), respectively. There was a statistically significant difference between the years of practice of community pharmacists and the level of knowledge toward Zika virus infection.
Conclusions: In conclusion, our respondents demonstrated a basic level of knowledge and high awareness toward Zika virus infection. Also, we highlighted some possible pitfalls in the knowledge of Zika virus infection, including the virus transmission, symptoms, diagnosis, treatment, prevention, and complications of the disease.
Methods: This cross-sectional study was conducted via retrospective review of outpatients' medical records. Details regarding ADRs were identified by a pharmacist and verified by a consultant respiratory physician.
Results: A total of 91 cases, out of 210 patients enrolled in this study, were detected with 75 patients (35.7%) experienced at least one ADR. The three most common ADRs detected were cutaneous adverse drug reactions (CADRs) (21.0%), drug-induced hepatitis (DIH) (7.1%) and gastrointestinal disturbance (4.8%). Pyrazinamide was the most common causative agent and 15.7% of all TB patients required treatment modification due to ADRs. Females were shown to have a higher tendency to develop ADRs than the males in this study (P = 0.009). The development of ADRs was shown not to affect the TB treatment outcomes (P = 0.955).
Conclusion: The incidence of ADRs in this study was high so it is important to identify the risk factors for ADRs and the individuals who have those risk factors when initiating anti-TB drugs. These individuals require special attention when anti-TB drugs are initiated.