OBJECTIVE: To investigate the impact of customized CMI (C-CMI) on health-related quality of life (HRQoL) among type 2 diabetes mellitus (T2DM) patients in Qatar.
METHODS: This was a randomized controlled intervention study, in which the intervention group patients received C-CMI and the control group patients received usual care. HRQoL was measured using the EQ-5D-5L questionnaire and EQ visual analog scale (EQ-VAS) at three intervals [i.e. baseline, after 3 months and 6 months].
RESULTS: The EQ-5D-5L index value for the intervention group exhibited sustained improvement from baseline to the third visit. There was a statistically significant difference between groups in the HRQoL utility value (represented as EQ index) at 6 months (0.939 vs. 0.796; p = 0.019). Similarly, the intervention group compared with the control group had significantly greater EQ-VAS at 6 months (90% vs. 80%; p = 0.003).
CONCLUSIONS: The impact of C-CMI on health outcomes of T2DM patients in Qatar reported improvement in HRQoL indicators among the intervention patients. The study built a platform for health policymakers and regulatory agencies to consider the provision of C-CMI in multiple languages.
OBJECTIVE: To investigate the evidence available: 1) on government initiatives to mandate transparency in drug pricing worldwide, 2) on the reported effects of drug pricing transparency initiatives on drug price, and 3) on the limitations and barriers of the implementation of drug pricing transparency.
METHODS: Databases such as Medline-Ovid, Cochrane Central Register, PubMed, and Science Direct were used to search for relevant literature from inception to February 2018. A manual search of grey literature such as policy papers, governmental publications, and websites was also performed to obtain the information that was not available in the articles. Using narrative synthesis, the results were critically assessed and summarized according to its context of drug pricing approaches.
RESULTS: Of the 4382 relevant articles located, 12 studies met the inclusion criteria for drug price transparency initiatives. Only 3 studies reported the outcomes on the regulation of drug prices. Two studies in South Africa showed that price transparency initiatives did not necessarily reduce drug prices. Another study in the Philippines indicated a reduction in medicines' price based on the effects of government-mediated access prices. The limitations and barriers in price transparency initiatives include fragmentation of the healthcare system and nondisclosure of discounts and rebates by pharmaceutical companies.
CONCLUSION: Drug pricing transparency initiatives have been implemented in many countries and commonly coexist with a country's pricing policies. Nevertheless, due to sparse evidence, the effect of drug price transparency initiatives on price control is still inconclusive.
OBJECTIVE: This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA.
METHODS: We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and mean difference (MD) for continuous data] with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence. The review protocol was published on PROSPERO (CRD42020167994).
RESULTS: Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 [95%, CI 1.80, 4.05]), VL suppression (OR: 4.13 [95% CI 2.27, 7.50]), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low.
CONCLUSION: The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.
OBJECTIVE: To develop an adherence prediction model for CKD patients.
METHODS: This multi-centre, cross-sectional study was conducted in 10 tertiary hospitals in Malaysia using simple random sampling of CKD patients with ≥1 medication (sample size = 1012). A questionnaire-based collection of patient characteristics, adherence (defined as ≥80% consumption of each medication for the past one month), and knowledge of each medication (dose, frequency, indication, and administration) was performed. Continuous data were converted to categorical data, based on the median values, and then stratified and analysed. An adherence prediction model was developed through multiple logistic regression in the development group (n = 677) and validated on the remaining one-third of the sample (n = 335). Beta-coefficient values were then used to determine adherence scores (ranging from 0 to 7) based on the predictors identified, with lower scores indicating poorer medication adherence.
RESULTS: Most of the 1012 patients had poor medication adherence (n = 715, 70.6%) and half had good medication knowledge (n = 506, 50%). Multiple logistic regression analysis determined 4 significant predictors of adherence: ≤7 medications (constructed score = 2, p
METHODS: A systematic literature search was performed in May-July 2021, in electronic databases, which included PubMed (MEDLINE), Embase, and Web of Science. Studies were included in this systematic review if they were original articles published in English language from 2010 to 2021 and evaluated the effect of any types of educational interventions intended to improve the ability of community pharmacists to provide smoking cessation services.
RESULTS: In total, 12 studies were included for this systematic review. The effectiveness of the educational interventions across the included studies was measured using a range of outcomes, which can be broadly categorized into 3 categories, namely changes in pharmacists' self-efficacy, knowledge, and attitude toward providing smoking cessation service, changes in pharmacists' smoking cessation practices, and changes in the effectiveness of community pharmacy based smoking cessation services. Included studies reported that educational interventions can improve pharmacists' self-efficacy, knowledge, and attitude toward smoking cessation, as well as pharmacists' smoking cessation practices. Though the evidence is limited, improvement in the effectiveness of community pharmacy based smoking cessation services has also been observed.
CONCLUSION: Any form educational interventions can positively impact improve community pharmacists' self-efficacy, knowledge, and attitude toward smoking cessation, as well as pharmacists' smoking cessation practices, but it is currently uncertain whether these outcomes are able to translate into higher effectiveness of the community pharmacy based smoking cessation services.
OBJECTIVE: To identify community pharmacists-led interventions in TB management with their corresponding impacts in TB case detection and treatment outcomes.
METHODS: A systematic search was performed in six electronic databases and health organization websites, from database inception to August 2, 2022. Studies which described TB screening, referral and/or treatment monitoring by community pharmacists with their corresponding outcomes were screened and reviewed independently by two reviewers. The studies were checked for the risk of bias using Cochrane risk of bias tools. All data of included studies were analysed qualitatively and presented narratively.
RESULTS: The search yielded 8,121 studies and five reports for initial screening. Sixteen studies and two case study reports were included in this review. Community pharmacists were involved throughout the TB care cascade, contributing their services in TB screening, referrals and in directly observed treatment-short course (DOTS) program. These interventions showed improvements in the effective control and prevention of further spread of TB, which improves individual, community and population level outcomes.
CONCLUSIONS: The inclusion of community pharmacists into TB program can improve the continuity of care, bridging the gaps in TB case detection and treatment monitoring. Adequate training and support are essential, to further empower the role of community pharmacists in TB control and prevention, in building a TB-free world.
AIMS: To explore early career pharmacists' understanding of resilience, their strategies to enhance and maintain resilience as healthcare professionals and to identify resilience-fostering programmes they perceive could be implemented to support them.
METHODS: Three focus groups and 12 semi-structured interviews with a total of 15 hospital pharmacists and 10 community pharmacists (both less than 3 years post-registration) were conducted. An inductive thematic analysis of transcripts was performed to identify main themes and subthemes.
RESULTS: Pharmacists understood resilience as the capability to adapt to and learn from challenges and setbacks, which they can build through experience and exposure. Resilience in the workplace was challenged by their working environment and workload, which could lead to ego depletion, the transition from intern to registered pharmacist and working during the COVID-19 pandemic, which both added pressure and uncertainty to their role. Professional resilience was supported on individual, social and organisational levels and through self-care strategies. Pharmacists perceived mentorship and sharing experiences, experiential placements and constructive but challenging role play as potentially beneficial in building resilience during undergraduate studies and internship.
DISCUSSION: Pharmacists defined resilience constructively and identified challenges testing but also strategies supporting their resilience in the workplace. Workplaces can support pharmacists by monitoring workload and workplace relationships, creating opportunities for peer and mentor support and by allowing pharmacists to implement their personal, individualised resilience maintaining strategies. Early career pharmacists' experiences and insights would be valuable when considering the design and implementation of resilience-fostering programmes.
AIM: To explore community pharmacists' perceptions of barriers, facilitators, and strategies for the implementation of a medication review service in Malaysia.
METHODS: A focus group discussion followed by semi-structured interviews were conducted among purposively sampled community pharmacists with an interest in medication review service. A framework analysis approach using the consolidated framework for implementation research (CFIR) was utilized to generate and analyze the data. After data mapping, the CFIR-ERIC (expert recommendations for implementing change) matching tool was used to generate the strategies according to the barriers identified.
RESULTS: Twenty community pharmacists participated in this study. Several barriers and facilitators to service implementation were identified based on the respondent's input. The CFIR-ERIC strategies matching tool analysis reported potential plans that can mitigate the barriers such as: identify and prepare champions, conduct local consensus discussions, conduct educational meetings, alter incentive/allowance structures, and develop a formal implementation blueprint.
CONCLUSION: Multifaceted strategies are required to ensure the successful implementation of medication review services in Malaysia. The findings of this study will assist in the development of a sustainable medication review service blueprint for the Malaysian community pharmacy setting.