Although therapeutic drug monitoring (TDM) has been used in practice, conflicting data on its usefulness in the management of epilepsy have been reported. These results range from identifying no significant differences in patients’ clinical outcomes to determining TDM to be a cost-effective service. Thus, this study was conducted to evaluate the effectiveness of our pharmacist-managed TDM service in helping patients with epilepsy (PWE) to achieve seizure control. This was a retrospective observational study conducted in the TDM Unit of Hospital Keningau, Sabah. Pharmacist-prepared reports issued for 30 subjects with uncontrolled seizures in 2014 were analysed to determine the effectiveness of their recommendations. Effectiveness was measured based on the number of patients who achieved ≥ 50% reduction in seizure frequency and the number of patients with a threemonth seizure-free period. Overall, 80% of the pharmacists’ TDM recommendations were accepted by prescribers. Based on the data collected, 17 (56.67%) subjects had their seizure frequency decreased at least by half, while 11 (36.67%) subjects achieved total remission. However, there was no significant association between acceptance of recommendations and seizure control; although acceptance of pharmacist recommendations was associated with 1.4 times greater odds of achieving seizure control among PWE, this difference was not statistically significant. In conclusion, a pharmacist-managed TDM service was associated with an improvement in seizure control of more than 50% among PWE with unsatisfactory seizure control.
Pharmacists play an important role in healthcare delivery. Over the years, their role has shifted from product-oriented to patient-oriented. This study aimed to assess the perceptions of the public towards the role of pharmacists and the willingness of the public to pay for pharmacist-provided dispensing services in Sabah. This was a questionnairebased, cross-sectional study conducted from September 2014 to June 2015 in three major cities in Sabah, namely, Kota Kinabalu, Sandakan and Tawau. The respondents were conveniently selected and interviewed based on a questionnaire to assess their perceptions of the role of pharmacists. A contingent valuation interview was then conducted to assess the respondents’ willingness to pay. A total of 647 respondents were interviewed. Of the respondents, 61.4% agreed that pharmacists knew more about their medications and side effects and how to use the medications than their doctors. However, more than half of the respondents (54.4%) perceived that the pharmacists’ role was only to supply medications and 66.6% of the respondents perceived that the pharmacist’s role was to follow doctors’ directions. Of the respondents, 89.0% appreciated and adhered to the counselling points provided by their pharmacists; 85.0% of the respondents hoped that pharmacists could play a greater role in healthcare in the future. Forty percent of the respondents agreed that community pharmacists were simply business people who sold products in their pharmacies. Finally, 55.3% of the respondents were willing to pay for pharmacist-provided dispensing services. The median (interquartile ranges [IQR]) amount that they were willing to pay was RM5.00 (IQR RM5.00). Respondents in this study showed variations in their views of the pharmacy profession. Nevertheless, more than half of the respondents valued pharmacist-provided dispensing services and were willing to pay RM5.00 for the services. To improve pharmacy practice, efforts should be undertaken to address the respondents’ misunderstandings about the pharmacy profession and to promote the roles of pharmacists to the general public.
Shared-decision making (SDM), occasionally called “participatory governance” is the approach in healthcare to ensure that patients have the right to participate effectively in the decision-making (DM) process. The aim of this research was to discuss the external aspect of SDM and put forward applicable solutions to ensure SDM at both patient and physician levels. A standardised validated nine-item SDM questionnaire (patient version SDM-Q-9) was employed. SPSS version 25 was used to perform data analysis. Multiple tests such as Mann-Whitney U and Jonckheere-Terpstra were used. Kendall’s Tau coefficient was used for interpretation of the significant relationship among all items of SDM-Q-9 and education. A total of 465 chronically ill patients took part, where majority (63.4%) of patients was above the age of 47. The cohort was dominated by females (67.5%) with 92% of the sample was married. Majority (86.9%) of the patient reported not involved in any decision. During analysis, considerable association was reported between gender and all items of SDM-Q-9, where more men were involved in SDM when compared with women. Our findings did produce significant association between education and SDM-Q-9, which reveals that increase in education can improve the SDM. SDM should not be limited to chronic or emergency in practice. Specific and tailored shared medical DM programmes must be developed for low literacy population implementation. SDM is to be supported at policy and operation levels.
Phenytoin follows Michaelis-Menten, a non-linear pharmacokinetics that occurs when drug molecules saturates the enzymes ability to metabolise the drug. When this occurs, steady state phenytoin serum concentration increases in a disproportionate manner after a dosage increase. General population data are usually used for the phenytoin dose calculation. However, many studies show that population pharmacokinetic parameters of phenytoin have high variations. Thus, use of specific local pharmacokinetic parameters for each population group in estimating individualised phenytoin dose can reduce phenytoin toxicity cases. This prospective, observational study was conducted to estimate a local Vmax and Km of phenytoin for adult epileptic patients in neurological ward and clinic at Hospital Pulau Pinang, Malaysia. All therapeutic drug monitoring of oral capsule phenytoin were studied in a three-month data collection period. Out of the 17 subjects in our study, there are 13 male subjects (76.47%) and 4 female subjects (23.53%). A total 11 Malay subjects (64.71%), 4 Chinese subjects (23.53%) and 2 Indian subjects (11.76%) were included. Median Vmax and Km were found to be 8.25 mg/kg/day and 3.80 mg/l. Male subjects have a higher Vmax (8.30 mg/kg/day) but a lower Km (3.3 mg/l). Chinese population has the highest Vmax (8.80 mg/kg/day). For Km, Indian population is the highest, with a value of 5.5 mg/l. From our study, gender does not correlate with Vmax and Km of phenytoin (p-value > 0.05). Ethnicity was also found to have no association with Vmax and Km (p-value > 0.05). Local Vmax (8.25 mg/kg/day) is higher and Km (3.8 mg/l) is lower when compared with standard Vmax (7 mg/kg/day) and Km (4 mg/l) obtained from Caucasian population.
Comfort and acceptance by healthcare professionals are crucial for effective operation of clinical pharmacy services. To date, there is no published report on the perceptions towards clinical pharmacy services from Tawau, Sabah or anywhere else in Malaysia. The objective of this study is to evaluate the comfort, perceptions and expectations of healthcare professionals towards the clinical pharmacy services in Tawau Hospital. This crosssectional, questionnaire-based study was carried out in 10 wards of Tawau Hospital with clinical pharmacy services, from June to July 2014. Validated questionnaires with consent were anonymously distributed to doctors and nurses. The self-administered questionnaires consisted of four sections: demographic, comfort level, expectations, and experiences dealing with clinical pharmacists. A 4-point Likert scale, where 1 = strongly disagree, while 4 = strongly agree, was used to indicate the level of agreement. Of 292 questionnaires administered, 269 were completed, giving a response rate of 92.1%. Compared to nurses, higher percentage of doctors were less comfortable with clinical pharmacists providing drugrelated education, suggesting the use of drugs to prescribers, designing pharmacotherapy regimes, and monitoring safety and outcomes of the designed regimens. The participants have great expectations, perceptions and experiences with clinical pharmacists of Tawau Hospital. Majority of the healthcare professionals who have direct contact with clinical pharmacists in their work were generally receptive and have high expectations towards patient-oriented clinical pharmacy services.