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Separation of prescribing and dispensing in Malaysia: a summary of arguments

Shafie AA, Hassali MA, Azhar S, See OG

Res Social Adm Pharm, 2012 May-Jun;8(3):258-62.
PMID: 21824823 DOI: 10.1016/j.sapharm.2011.06.002

The role of pharmacists has transformed significantly because of changes in pharmacists' training and population health demands. Within this context, community pharmacists are recognized as important health personnel for the provision of extended health services. Similarly, in Malaysia, the need to transform community pharmacy practice has been discussed by all interested parties; however, the transition has been slow due in part to the nonexistence of a dispensing separation policy between pharmacists and medical doctors in private community practices. For decades, medical doctors in private community practices have had the right to prescribe and dispense, thus diluting the role of community pharmacists because of overlapping roles. This article explores dispensing separation in Malaysia and, by taking into account the needs of health professionals and health care consumers, suggests a mechanism for how dispensing separation practice can be implemented.
Assessing quality of a worksite health promotion programme from participants' views: findings from a qualitative study in Malaysia

Liau SY, Hassali MA, Shafie AA, Ibrahim MI

Health Expect, 2014 Feb;17(1):116-28.
PMID: 22050457 DOI: 10.1111/j.1369-7625.2011.00742.x

An assessment of the process and outcomes of a health promotion programme is necessary for the continuous improvement of a programme.
Exploring community pharmacists' views on generic medicines: a nationwide study from Malaysia

Chong CP, Hassali MA, Bahari MB, Shafie AA

Int J Clin Pharm, 2011 Feb;33(1):124-31.
PMID: 21365404 DOI: 10.1007/s11096-010-9470-1

OBJECTIVE: To evaluate the Malaysian community pharmacists' views on generic medicines.
SETTING: A sample of 1419 Malaysian community pharmacies with resident pharmacists.
METHOD: A cross-sectional nationwide survey using a self-completed mailing questionnaire.
MAIN OUTCOME MEASURE: Pharmacists' views on generic medicines including issues surrounding efficacy, safety, quality and bioequivalence.
RESULTS: Responses were received from 219 pharmacies (response rate 15.4%). Only 50.2% of the surveyed pharmacists agreed that all products that are approved as generic equivalents can be considered therapeutically equivalent with the innovator medicines. Around 76% of respondents indicated that generic substitution of narrow therapeutic index medicines is inappropriate. The majority of the pharmacists understood that a generic medicine must contain the same amount of active ingredient (84.5%) and must be in the same dosage form as the innovator brand (71.7%). About 21% of respondents though that generic medicines are of inferior quality compared to innovator medicines. Most of the pharmacists (61.6%) disagreed that generic medicines produce more side-effects than innovator brand. Pharmacists graduated from Malaysian universities, twinning program and overseas universities were not differed significantly in their views on generic medicines. Additionally, the respondents appeared to have difficulty in ascertaining the bioequivalent status of the marketed generic products in Malaysia.
CONCLUSION: The Malaysian pharmacists' have lack of information and/or trust in the generic manufacturing and/or approval system in Malaysia. This issue should be addressed by pharmacy educators and relevant government agencies.
Dosing information in a standard drug reference: are pediatrics still therapeutically neglected?

Permala J, Hassali MA, Awaisu A, Shafie AA

Pediatr Int, 2010 Apr;52(2):290-5.
PMID: 19744224 DOI: 10.1111/j.1442-200X.2009.02958.x

BACKGROUND: In many countries, the most readily accessible drug information resources, such as the Monthly Index of Medical Specialties (MIMS), lack information concerning use in children. We reviewed the product information (PI) of medications in the most widely used drug information reference in Malaysia in an effort to determine the extent and the nature of available information related to pediatric dosing.
METHODS: The products listed in the 2007 Malaysian MIMS Annual were reviewed for PI on pediatric use as per inclusion and exclusion criteria. The dosing information for each PI was extracted according to age groups. Product information that claimed suitability for use in pediatrics was further evaluated for information on pediatric dosage formulations.
RESULTS: A total of 421 PI items from seven categories of therapeutic classes were reviewed. Of these, 69% gave inadequate pediatric dosing information. The proportions, for each age group of PI items that gave adequate pediatric dosing information were: neonates (13.1%), infants (23.3%), and children (32.2%). Therapeutic classes of drugs differed significantly in terms of dosing information adequacy for all pediatric age groups (P < 0.05). Most PI reviewed under all legal categories provided inadequate pediatric dosing information, but suitable pediatric formulations were commonly (70.1-85.5%) available where the dosing information existed. Overall, category B (prescription only) products did not differ significantly from category C (pharmacy only medicine) products in terms of pediatric dosing information adequacy, except for children.
CONCLUSION: This study has managed to contribute substantial additional information regarding the extent of pediatric dosing information and dosage formulations available in the MIMS Annual, stressing that the majority of PI for the products reviewed did not provide adequate dosing information for pediatric patients, subjecting this population to a therapeutically disadvantaged status.
Knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang: a cross-sectional survey

Abdul Hadi M, Hassali MA, Shafie AA, Awaisu A

Med Princ Pract, 2010;19(1):61-7.
PMID: 19996622 DOI: 10.1159/000252837

The objective of this study was to assess and compare the knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang.
Fulltext Evaluation of breast cancer awareness among female university students in Malaysia

Hadi MA, Hassali MA, Shafie AA, Awaisu A

Pharm Pract (Granada), 2010 Jan;8(1):29-34.
PMID: 25152790

Breast cancer is the most common cancer and the leading cause of cancer death among women of all ethnic and age groups in Malaysia.

OBJECTIVE: The objectives of this study were to evaluate the knowledge of breast cancer risk factors, symptoms and methods of screening among female university students and their perception towards the disease treatment outcomes.

METHODS: A cross-sectional survey was conducted from February to March 2008 at Universiti Sains Malaysia. Two hundred participants from 10 randomly selected faculties were interviewed face to face by a trained pharmacist using a validated questionnaire. In addition to their demographic characteristics, participants were required to answer 22 questions concerning knowledge of breast cancer and five questions related to their perception of breast cancer management and treatment outcomes. Data were analyzed using SPSS version 15.

RESULTS: The mean age of the respondents was 26.7 (SD=1.9) years. The results showed that the vast majority of the female university students had inadequate knowledge of breast cancer. The mean total knowledge score of the students was 60.7%. Indian students had significantly less knowledge of breast cancer compared to their Chinese and Malay counterparts (p<0.05). However, more than two third of the students were aware of breast self examination (BSE) and clinical breast examination (CBE) recommendations. Furthermore, the students had positive perceptions towards the treatment outcomes of breast cancer.

CONCLUSION: This study has highlighted the need of a breast cancer awareness campaign, which should also stress the importance of early detection and reporting of breast cancer.
Fulltext Professional training and roles of community pharmacists in Malaysia: views from general medical practitioners

Ahmad Hassali MA, Awaisu A, Shafie AA, Saeed MS

Malays Fam Physician, 2009;4(2-3):71-6.
PMID: 25606167 MyJurnal

AIM: This pilot study aimed to explore the perceptions of general medical practitioners (GPs) towards the professional training and roles of community pharmacists.
METHODS: A self-administered questionnaire was distributed to all private clinics (n=160) run by GPs in a northern state of Malaysia. The instrument contained questions to evaluate the practitioners' level of agreement using a 5-point Likert-type scale.
RESULTS: Of 160 GPs, 80 returned the questionnaire (response rate 50%). The respondents agreed that: GPs should consider the community pharmacists' recommendations whenever there is/are any problem(s) with the prescriptions given by them (46.3%); community pharmacists are the best healthcare professionals to educate patients about safe and appropriate use of medications (52.5%); the pharmacy profession had undergone a major metamorphosis from a product-oriented profession to a more patient-centred and outcome-oriented one (61.3%); if dispensing separation is implemented, they will work closely with the community pharmacists in monitoring patients' pharmacotherapeutic outcomes (77.5%).
CONCLUSION: The current findings suggest that GPs would support an extension of the role of the community pharmacists in number of activities of patient care activities such as medication counselling. Thus, suggesting potential collaborative care between GPs and community pharmacists towards patient care and the needs to develop and incorporate topics on inter-professional relationship in the current medical and pharmaceutical education curriculums.
KEYWORDS: Community pharmacists; general practitioners; perceptions; roles; training
A pilot survey on perceptions and knowledge of generic medicines among consumers in Penang, Malaysia

Al-Gedadi NA, Hassali MA, Shafie AA

Pharm Pract (Granada), 2008 Apr;6(2):93-7.
PMID: 25157287

OBJECTIVE: To explore the consumers' perceptions and knowledge towards issues surrounding generic medicines utilization in Penang, Malaysia.
METHODS: A cross sectional survey was conducted with consumers who attended the annual University open day. Using convenience sampling, survey forms were distributed to the respective consumers via the help of a group of trained 1st year pharmacy students. For a period of 5 days, 400 respondents had participated in the survey. Analysis of the response from the collected forms yielded in 396 usable forms.
RESULTS: Only 28.3% (n=112) of the respondents were familiar with the term "generic medicines". More than 70% of the respondents do not know that generic medicines can be marketed under different names. About 34% (n=38) of consumers stated that they had been given information regarding generics by their pharmacists. In terms of side effects, about 32% (n=127) of the respondents felt that generic medicines may cause more side effects than branded medicines. Majority of the consumers surveyed (64%) understand that generic cost less compared to their branded counterparts.
CONCLUSION: This survey showed that there is a gap in consumers' knowledge and understanding about generic medicines. The findings also suggest that direct patient education by the healthcare providers on issues relating to safety and efficacy of generic medicines could further enhance their uptake.
The role of pharmaceutical marketing and other factors in prescribing decisions: the Yemeni experience

Al-Areefi MA, Hassali MA, Mohamed Ibrahim MI

Res Social Adm Pharm, 2013 Nov-Dec;9(6):981-8.
PMID: 23218551 DOI: 10.1016/j.sapharm.2012.10.006

Prescribing decisions are a complex phenomenon and influenced by many pharmacological and non-pharmacological factors. Little is known about the actual prescribing behaviors of physicians or the factors behind their prescribing decisions.
Prescribing patterns for upper respiratory tract infections: A prescription-review of primary care practice in Kota Setar district, Kedah, Malaysia. [Abstract]

Md Rezal RS, Hassali MA, Saleem F, Kumar R

Value Health, 2015 Nov;18(7):A848-9.
PMID: 26534536 DOI: 10.1016/j.jval.2015.09.420

Conference abstrract
Objectives: Antimicrobial resistance is associated with irrational use of antibiotics in general practice. We aimed to assess the frequency with which patients with Upper Respiratory Tract Infections were prescribed with antibiotics and the patterns of antibiotic prescription at primary healthcare centres in Malaysia.
Methods: The study targeted all primary public healthcare centres in the district of Kota Setar, Kedah, Malaysia. A retrospective prescription analysis was conducted whereby prescriptions from 1st January 2014 to 31st March 2014 were screened and retrieved for antibiotics prescribed for upper respiratory infections. The data was entered into Microsoft Excel spread sheet, and exported to Statistical Package for Social Sciences, version 20 for further analysis. Frequencies and percentages were used to summarize the data. The Jonckheere–Terpstra test was used to evaluate the trend of antibiotic prescription. Where significant associations were reported, effect size was calculated by using Kendall tau correlation coefficient. P value of <0.05 was considered to be of statistical significance.
Results: For the period of three months, 123,524 prescriptions were screened and analysed. 2270 (31.8%) prescriptions contained antibiotics prescribed for all URTIs visits. Among all antibiotics, macrolides were the most commonly prescribed antibiotic, constituting of 61% (n=1404) of total antibiotics prescribed for all cases. The Jonckheere–Terpstra test revealed a statistical relationship between prescribers and the diagnosis of the disease (p=0·001). Furthermore, a weak positive trend of association was reported with FMS being more accurate in diagnosis followed by MOs and AMOs (τ=0·122).
Conclusions: Practicing physicians should adhere to the standard treatment practices, as antibiotic use in viral aetiology is ineffective, and encourages the persistence development of resistance. A comprehensive development of national antibiotic stewardship program is recommended to ensure organised and regulated control of antibiotic use in Malaysia.
Association among calendar packaging and medication adherence: Findings from a focus group discussion among hypertensive patients in Penang, Malaysia. [Abstract]

Tan BY, Shafie AA, Hassali MA, Saleem F, Kumar R

Value Health, 2015 Nov;18(7):A831.
PMID: 26534439 DOI: 10.1016/j.jval.2015.09.317

Objectives: Medication adherence to treatment recommendations has major impact on health outcomes. Numerous interventions to improve medication adherence among the patients have been studied in clinical trials, including calendar packaging and patient reminder letters. Therefore, this study is aimed to explore hypertensive patient’s perceptions towards calendar packaging and its impact on medication adherence.
Methods: A qualitative method was adopted, whereby two focus group sessions were conducted among 16 conveniently sampled hypertensive patients from a community based non-governmental organisation in the state of Penang, Malaysia. A pre validated focus group guide was constructed and used for data collection. Collected data was transcribed verbatim and analysed by thematic content analysis to identify the emerging themes.
Results: Each focus group consisted of 8 hypertensive patients. Thematic content analysis resulted into 3 major themes (knowledge and familiarity with the medicines names and their packaging; perception about the packaging and labelling of medicines; knowledge and views of calendar packaging) and each theme was further divided into 2 sub themes. Majority of the hypertensive patients were not familiar with their medication names, however they were able to identify their medications based on the appearance and packaging. Participants agreed that calendar packaging is a great intervention to increase awareness among patients about regular medicine use and increase medication adherence.
Conclusions: The study concluded that hypertensive patients relied on the packaging and labelling on the medications to identify their medications. Thus, packaging and labelling of the medications play an important role in improving medication adherence and reduce medication errors. This finding can help to enhance the drug manufacturers to pay attention on the drug packaging in order to increase medication adherence among the patients.
Does Treatment Adherence Correlates With Health-Related Quality of Life: Findings From A Cross Sectional Analysis of Type 2 Diabetes Mellitus Patients In Pakistan

Nazir SU, Hassali MA, Saleem F, Bashir S, Aljadhey H

Value Health, 2015 Nov;18(7):A613.
PMID: 26533443 DOI: 10.1016/j.jval.2015.09.2129
Association between knowledge and medication adherence in patients with type 2 diabetes mellitus in Pakistan. [Abstract]

Nazir SU, Hassali MA, Saleem F, Bashir S, Aljadhey H

Value Health, 2015 Nov;18(7):A613.
PMID: 26533439 DOI: 10.1016/j.jval.2015.09.2128

Objectives: Diabetes mellitus is a serious health problem. Medication adherence is a key determinant of therapeutic success in patients with diabetes mellitus. The purpose of this study was to assess medication adherence and its potential association with diabetes related knowledge in patients with type 2 diabetes mellitus.
Methods: This study was carried out at the outpatient clinics of a public sector teaching hospital in Sargodha, Pakistan. Besides demographic and disease-related questions, previously validated questionnaires, Morisky Medication Adherence Scale and Michigan diabetes knowledge test was used to assess the medication adherence and diabetes related knowledge, respectively. Descriptive statistics were used to determine the demographic and disease characteristics of the patients while Spearman rank correlation was employed to measure the association between medication adherence and knowledge.
Results: Three hundred and ninety two patients were interviewed. Out of 392 patients, 245 (62.5%) of the patients had average knowledge about diabetes while 282 (71.9 %) were categorized as poor adherent. Only 13 patients (3.3 %) were considered as good adherent in the study. The correlation coefficient between total scores of knowledge and total medication adherence score was 0.036 (p< 0.05), indicating a weak correlation between knowledge scores and adherence level.
Conclusions: Knowledge of diabetes mellitus among these patients was average; however, adherence to drug therapy was also poor. Patients’ knowledge about diabetes had positive association with medication adherence. Improving diabetes knowledge of people can result in better adherence, which may result in better control of diabetes.
Generic medicines in the Malaysian health care system: Opportunities and challenges

Wong ZY, Alrasheedy AA, Hassali MA, Saleem F

Res Social Adm Pharm, 2016 04 20;12(5):807-10.
PMID: 27157864 DOI: 10.1016/j.sapharm.2016.04.002
Fulltext Knowledge and perception about health risks of cigarette smoking among Iraqi smokers

Dawood OT, Rashan MA, Hassali MA, Saleem F

J Pharm Bioallied Sci, 2016 Apr-Jun;8(2):146-51.
PMID: 27134468 DOI: 10.4103/0975-7406.171738

BACKGROUND:
Smoking is a major public health problem, especially in Iraq. There is very little information had been documented regarding smoking risk factors and quit intention among Iraqi smokers.

OBJECTIVES:
The main objectives of this study are to determine smokers' knowledge and perception about smoking health risks; and to determine smoking behavior and quitting intentions among Iraqi smokers; as well as to predict the factors that may associate with quit intentions.

METHODS:
A cross-sectional study was conducted at the outpatient clinic in Tikrit Teaching Hospital, Tikrit City, Iraq. Adult smokers who are smoking cigarette everyday and able to communicate with the researcher were invited to participate in the study. A self-administered questionnaire was used to collect data from 386 participants.

RESULTS:
This study showed that smokers had low awareness about some risk effects of smoking such as lung cancer in nonsmokers (30.1%), impotence in male smokers (52.6%), premature ageing (64%), and stroke (66.3%). In addition, the high score of knowledge and perception was significantly associated with quitting intention.

CONCLUSION:
Smokers' knowledge and perception regarding smoking health effects were low, especially in terms of secondhand smokers. Many efforts needed from health policy-makers and health care professionals to disseminate information about the risks of smoking and health benefits of give up smoking.

KEYWORDS:
Health risks; knowledge; perception; quit intentions; smoking
The need to incorporate generic medicines topic in the curriculum of Yemeni pharmacy colleges

Al-Tamimi SK, Hassali MA, Shafie AA, ALrasheedy AA

Int J Pharm Pract, 2016 Feb;24(1):72-3.
PMID: 26764227 DOI: 10.1111/ijpp.12204
Fulltext Attitudes and beliefs of patients with chronic depression toward antidepressants and depression

Jacob SA, Ab Rahman AF, Hassali MA

Neuropsychiatr Dis Treat, 2015;11:1339-47.
PMID: 26064052 DOI: 10.2147/NDT.S82563

Many patients have erroneous views with regard to depression and its management, and it was noted that these attitudes and beliefs significantly affected their adherence rates.
Using pictograms to assist caregivers in liquid medication administration: a systematic review

Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL

J Clin Pharm Ther, 2015 Jun;40(3):266-72.
PMID: 25865563 DOI: 10.1111/jcpt.12272

WHAT IS KNOWN AND OBJECTIVE: It has been reported that more than 80% of out-of-hospital medication errors among the young children involve liquid formulations. The usefulness of pictorial aids to improve communication of medication instructions has not been extensively investigated for child health. The objective of this study was to determine the effectiveness of pictorial aids used to assist caregivers in the administration of liquid medications.
METHODS: MEDLINE, CINAHL, PsycINFO, ScienceDirect, Scopus and the Cochrane Library were searched for articles published up to February 2015. Studies that used pictorial aids with liquid medications and measured at least one of the following outcomes were included: dosing accuracy, comprehension of medication instructions, recall of information and adherence of caregivers. Two authors independently selected studies, extracted data and assessed methodological quality of studies using the Cochrane Collaboration's tool.
RESULTS AND DISCUSSION: Five experimental studies (four hospital based and one community based) with a total of 962 participants were included. A wide range of liquid formulations were studied, including both prescription and over-the-counter medications. The existing findings suggest that pictographic interventions reduced dosing errors, enhanced comprehension and recall of medication instructions and improved adherence of caregivers. Incorporating pictorial aids into verbal medication counselling or text-based instructions was more beneficial than using the single approach alone. Mixed results were identified for the relationship between health literacy of caregivers and effectiveness of pictorial aids.
WHAT IS NEW AND CONCLUSION: The evidence remains limited due to the small number of studies found and variations in methodological quality. This review suggests that pictorial aids might be potential interventions, but more high-quality studies are needed to support the routine use of any pictogram-based materials with liquid medications in the clinical settings.
KEYWORDS: caregivers; graphics; health literacy; medication adherence; medication errors; paediatrics
A survey exploring knowledge and perceptions of general practitioners towards the use of generic medicines in the northern state of Malaysia

Chua GN, Hassali MA, Shafie AA, Awaisu A

Health Policy, 2010 May;95(2-3):229-35.
PMID: 20044165 DOI: 10.1016/j.healthpol.2009.11.019

OBJECTIVES: The objective of this study was to evaluate the general practitioners' (GPs') knowledge and perceptions towards generic medicines in a northern state of Malaysia.
METHOD: A postal cross-sectional survey involving registered GPs in Penang, Malaysia was undertaken. A 23-item questionnaire was developed, validated and administered on the GPs. Eighty-seven GPs responded to the survey (response rate 26.8%).
RESULTS: The majority of the respondents (85.1%) claimed that they actively prescribed generic medicines in their practice. On the other hand, only 4.6% of the respondents correctly identified the Malaysia's National Pharmaceutical Control Bureau's bioequivalence standard for generic products. There were misconceptions among the respondents about the concepts of "bioequivalence", "efficacy", "safety", and "manufacturing standards" of generic medicines. GPs in this survey believed that a standard guideline on brand substitution process, collaboration with pharmacists, patient education and information on safety and efficacy of generic medicines were necessary to ensure quality use of generics. Furthermore, advertisements and product bonuses offered by pharmaceutical companies, patient's socio-economic factors as well as credibility of manufacturers were factors reported to influence their choice of medicine.
CONCLUSION: Although it appeared that GPs have largely accepted the use of generic medicines, they still have concerns regarding the reliability and quality of such products. GPs need to be educated and reassured about generic products approval system in Malaysia concerning bioequivalence, quality, and safety. The current findings have important implications in establishing generic medicines policy in Malaysia.
Evaluating community pharmacists' perceptions of future generic substitution policy implementation: a national survey from Malaysia

Chong CP, Hassali MA, Bahari MB, Shafie AA

Health Policy, 2010 Jan;94(1):68-75.
PMID: 19762106 DOI: 10.1016/j.healthpol.2009.08.011

This study aims to provide baseline data to support the implementation of generic substitution policy in Malaysia by evaluating the community pharmacists' perceptions and opinions on generic substitution and current substitution practices.

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