A survey was conducted on three different groups of population viz. inpatients in the medical wards of General Hospital, Kuala Lumpur, the people of Kampong Pandan and two rubber estates as to their analgesic consuming habits. It is found that 0.5 to 2.0% of the people surveyed had consumed more than 2 kg of analgesics and 4.6 to 9.6% of the people surveyed had consumed more than 250g of analgesics. The commonest analgesic consumed is paracetamol followed by Chap Kaki Tiga and Chap Harimau. The commonest reason for consuming analgesic is headache. The implications of the above findings are discussed.
A survey on the use of antibiotics in surgical prophylaxis was carried out in seven Malaysian hospitals. Details of antibiotic prescriptions were obtained through questionnaires completed by the prescriber. A total of 430 such prescriptions was analysed. A large number of different antibiotic regimens were used for a variety of surgical procedures. The majority of prescriptions (70%) were issued for procedures where such prophylaxis was probably not necessary. Antibiotics were also often prescribed for durations that were longer than necessary. There is an urgent need to educate surgeons and standardize surgical prophylactic regimens in order to reduce cost and combat the emergence of antibiotic resistance.
The immunization status of children is improved by interventions that increase community demand for compulsory and non-compulsory vaccines, one of the most important interventions related to immunization providers. The aim of this study is to evaluate the activities of immunization providers in terms of activities time and cost, to calculate the immunization doses cost, and to determine the immunization dose errors cost. Time-motion and cost analysis study design was used. Five public health clinics in Mosul-Iraq participated in the study. Fifty (50) vaccine doses were required to estimate activities time and cost. Micro-costing method was used; time and cost data were collected for each immunization-related activity performed by the clinic staff. A stopwatch was used to measure the duration of activity interactions between the parents and clinic staff. The immunization service cost was calculated by multiplying the average salary/min by activity time per minute. 528 immunization cards of Iraqi children were scanned to determine the number and the cost of immunization doses errors (extraimmunization doses and invalid doses). The average time for child registration was 6.7 min per each immunization dose, and the physician spent more than 10 min per dose. Nurses needed more than 5 min to complete child vaccination. The total cost of immunization activities was 1.67 US$ per each immunization dose. Measles vaccine (fifth dose) has a lower price (0.42 US$) than all other immunization doses. The cost of a total of 288 invalid doses was 744.55 US$ and the cost of a total of 195 extra immunization doses was 503.85 US$. The time spent on physicians' activities was longer than that spent on registrars' and nurses' activities. Physician total cost was higher than registrar cost and nurse cost. The total immunization cost will increase by about 13.3% owing to dose errors.
Matched MeSH terms: Drug Utilization/economics*; Drug Utilization/statistics & numerical data*
Antibiotics are considered to be among the most commonly sold drug classes in Palestine. Resistance to antibiotics has increased for reasons relating to the use and misuse of antibiotics. The aim of this study was to evaluate the knowledge, and attitudes regarding antibiotic use and awareness about resistance among adults visiting the emergency departments at hospitals in North Palestine. A self-administered cross-sectional questionnaire survey involving participants aged 18 or over was conducted from June 2012 to February 2013. Adults who visited the emergency departments at hospitals in North Palestine were included. Demographic characteristics, knowledge and attitudes towards antibiotic use were included in the questionnaire. Poor and good knowledge were defined as a total knowledge score of 0-7 and 8-15 of 15 questions, respectively. Attitude scores of 0-3 and 4-7 of 7 questions were considered poor and good, respectively. A total of 375 questionnaires were included in the study. A response rate of 83.3% was attained. About 55.0% of the participants had a good knowledge and 56.5% had a good attitude towards rational antibiotic use. A significant positive correlation was shown between participants' knowledge scores and participants' attitude scores towards antibiotic use (R = 0.344, P = 0.001. Participants with a high family income were more likely to be aware of appropriate antibiotic use than participants with a low family income (P-value <0.001). Participants with a higher educational level (university) had a good attitude towards rational antibiotic use than those with a lower education level (P-value <0.001). This study has documented important knowledge and attitude gaps in antibiotic use. These findings will help health policymakers in Palestine to implement intervention programmes to rationalize antibiotic use. Continuing medical education, professional development and training workshops for healthcare professionals regarding rational use of antibiotics and health risks associated with the spread of antibiotic resistance are needed. In addition, minimizing non-prescription use of antibiotics and increasing the public awareness about the health and economic hazards of antibiotic resistance are also required.
Abdul Aziz AM, Manan MM, Bahri S, Md Yusof FA, Kamarruddin Z, Said S, et al.
ISBN: 978-967-5570-45-2
Citation: Abdul Aziz AM, et al. Drug Utilization in the Treatment of Diabetes Mellitus in the Ministry of Health Facilities. Petaling Jaya: Pharmaceutical Services Division, Ministry of Health, Malaysia; 2013
Diabetes Mellitus (DM) is a costly disease to manage because of its chronic nature and severity of complications. Treatment of DM incurred high healthcare cost in both developed and developing countries. In Malaysia, treatment of DM is provided by all Ministry of Health (MOH) healthcare facilities and treatment may vary according to types of facilities. These differences may be associated with the utilization pattern and patient’s adherence to therapy and it is important to link actual medication therapy and the direct medical cost in the management of Malaysian DM patients. Thus, this study is to describe the utilization of medications in the treatment of DM in the MOH healthcare facilities and DM patient’s adherence towards their medication. This is a cross-sectional study in 94 MOH health facilities from November 2010 to December 2011. The healthcare facilities were categorized as National Referral Hospital, State Hospitals, Hospitals with Specialist, Hospitals without Specialist and Health Clinics. Patients were selected by the method of systematic random sampling and screened based on the inclusion and exclusion criteria. Face-to-face interview and retrospective data retrieval of patients’ medical record were conducted. The questionnaire and Morisky’s four questions adherence scale were utilized during the interview. A total of 2,509 (88.2%) patients were included in the study. The findings showed that variables for age, gender, race, marital status, household income, and occupation were essential components in examining its impact towards DM care. Most of the patients were between 45 to 55 years old and were burdened with co-morbidities. The observed trend in disease status showed that DM is closely related to co-morbidities such as hypertension, cardiovascular diseases, and hyperlipidaemia; more commonly in patients with more than 5 disease years. A total of 14.6% of DM patients have yet to be initiated with insulin while 84% and 78.9% of patients had poor control of HbA1c and fasting blood glucose. In terms of drug utilization and medication cost, there was no significant difference in the pattern of medication used for the first-line treatment of DM among type of facilities. Biguanides, sulphonamides, urea derivatives, and insulin are the top three DM medications. Insulin usage ranges from 25.6% at Hospitals without Specialist to 57.8% at State Hospitals and this corresponds to 2.5 to 7.0 times increment from National Health and Morbidity Survey (NHMS) III. Use of non-antidiabetic agents (ADA) corresponds with the top 10 co-morbidities. These include platelet aggregating inhibitors, ACE-inhibitors and statins. The pattern of treatment for co-morbidities showed significant differences among facilities and may be due to the degree of severity of DM patients. Also, the policies of categorizing A*/A/KK has led to these medications being less commonly prescribed in Hospitals without Specialist and Health Clinics. Adherence is an issue that DM patients need to improve. This study found that race, household income, and age were significant indicators for poor adherence. The odds ratio (OR) for age showed it contributed to almost one time lower in adherence. The OR for inter-racial differences found that both Chinese and Indian patients were about 0.7 times more likely to be non-adherence than Malays. Household income of less than RM1,000 per month similarly showed a 0.8 times less adherence compared to households earning between RM1,000 to RM3,000 per month. Pharmacists had been giving counselling to patients and the personalized approach by pharmacist had shown positive impact on Diabetic Medication Therapy Adherence Clinic (DMTAC) patients. The study findings, however, showed no improvement in adherence between those who attended DMTAC and those who have not. These findings might not be generalizable since most facilities had a very small percentage of DM patients and they are usually the problematic or difficult patients; this could have led to the rather uneventful findings. Finally, this study showed that there is no significant difference in the utilization of medication among health facilities in the treatment of DM. Adherence is still an area of concern and collaboration between healthcare professionals is vital for better treatment outcome.