ความต้องการและทัศนคติต่อการศึกษาต่อและฝึกอบรมเฉพาะทาง ของเภสัชกรโรงพยาบาลในประเทศไทย Needs and Attitudes of Thai Hospital Pharmacists on Continuing Specialty Education and Training

วัตถุประสงค์: เพื่อสำรวจความต้องการและทัศนคติในการศึกษาต่อและการอบรมเฉพาะทางของเภสัชกรโรงพยาบาลและปัจจัยที่เอื้อและถ่วงโอกาสในการศึกษาต่อ การศึกษา: การศึกษาเชิงพรรณนาแบบภาคตัดขวาง กลุ่มตัวอย่าง คือ เภสัชกรโรงพยาบาล สังกัดสำนักงานปลัดกระทรวงสาธารณสุขทุกระดับ โดยการสุ่มตัวอย่างแบบชั้นภูมิ การสำรวจใช้แบบสอบถามชนิดตอบด้วยตนเองโดยถามความต้องการและรูปแบบการศึกษาต่อ และทัศนคติเกี่ยวกับการศึกษาต่อ นำเสนอผลการศึกษาด้วยสถิติเชิงพรรณนาและการวิเคราะห์ความถดถอยโลจิสติก ผลการศึกษา: มีผู้ตอบแบบสอบถาม 451 คน โดยมีเพียง 17.7% ที่เคยเรียนหรือฝึกความเชี่ยวชาญเฉพาะทาง ส่วนมากต้องการศึกษาในหลักสูตรประกาศนียบัตรระยะสั้น (80.9%) ตามด้วยหลักสูตรเภสัชกรประจำบ้าน (10.9%) ส่วนมากต้องการระยะเวลาในการศึกษาเพียง 4 เดือน (66.5%) ตามด้วย 6 เดือน (18.8%) ส่วนมากคิดว่าผู้อำนวยการโรงพยาบาลและหัวกลุ่มงานเภสัชกรรมมีส่วนร่วมในการวิเคราะห์และวางแผนการส่งเภสัชกรไปศึกษาต่อ โรงพยาบาลส่วนใหญ่ไม่กำหนดให้จำนวนเภสัชกรที่ได้ศึกษาต่อเป็นตัวชี้วัดคุณภาพของโรงพยาบาล (88.5%) ปัจจัยที่สนับสนุนให้เภสัชกรตัดสินใจศึกษาต่อ ได้แก่ ต้องการเพิ่มพูนความรู้ ความเชี่ยวชาญ พัฒนาทักษะดูแลผู้ป่วย รายได้และตำแหน่งที่สูงขึ้น ส่วนปัจจัยถ่วง ได้แก่ จำนวนเภสัชกรไม่เพียงพอที่จะอนุญาตให้ไปเรียน และขาดแคลนเงินทุนสนับสนุน เภสัชกรมีทัศนคติเชิงบวกต่อการศึกษาต่อ ผลการทดสอบความถดถอยโลจิสติกพบว่าเภสัชกรที่มีอายุงานน้อยกว่า 10 ปี เคยเรียนเฉพาะทาง และมีทัศนคติทางบวกต่อการเรียนเฉพาะทางมีความต้องการการศึกษาต่อมากกว่าอย่างมีนัยสำคัญทางสถิติ (P-value < 0.05) สรุป: เภสัชกรโรงพยาบาลส่วนใหญ่เห็นด้วยว่าการศึกษาต่อและการอบรมเฉพาะทางมีประโยชน์ โดยมีปัจจัยเอื้อหลายอย่าง ส่วนปัจจัยถ่วงมักเป็นผลจากการจัดสรรทรัพยากรมนุษย์ ความต้องการการศึกษาต่อสัมพันธ์อายุงานน้อย การเคยเรียนเฉพาะทาง และทัศนคติทางบวกต่อการเรียนเฉพาะทาง คำสำคัญ: ความต้องการศึกษาต่อเฉพาะทาง, เภสัชกรเฉพาะทาง, เภสัชกรรมโรงพยาบาลObjective: To determine needs and attitudes of hospital pharmacists toward continuing specialty education and training and relevant factors including opportunities and obstacles to pursuing the education. Methods: In this cross-sectional descriptive study, participants were pharmacists from all-level hospitals under the Office of Permanent Secretary, Thailand Ministry of Public Health selected by a stratified sampling method. A self-administered questionnaire asked about needs and types of specialty education, and attitudes towards the education. Decriptive statistics and logistic regress were used for data analysis. Results: Of the 451 participants, only 17.7% had an experience with training program. Most reported the need for the short-term certification program (80.9%), followed by general residency program (12.0%). Most preferred 4 and 6 months of study (66.5% and 18.8%, respectively). Most participants thought that the hospital director and head of pharmacy department involved in the analysis and planning for pharmacist specialty education. Most also reported that hospitals did not use the number of pharmacists with specialty education as an indicator for hospital accreditation (88.5%). Factors supporting pursuing specialty education were the need for advanced knowledge, expertise, and skills for patient care, higher salary, and career advancement. Obstructive factors included a shortage of staff in the pharmacy department and a lack of financial support. Most participants had positive attitude toward the education. Logistic regression analysis revealed that those with less than 10 years of work experience, a history of specialty training, and positive attitude were significantly more likely to have a need for specialty education (P-value < 0.05). Conclusion: Most hospital pharmacists agreed that continuing specialty education and training was beneficial. Both supporting and obstructive factors were found. The need for continuing specialty education was associated with shorter work experience, a history of the training, and positive attitude toward the education. Keywords: needs for continuing in specialist education, specialist pharmacist, hospital pharmac

ความเข้าใจด้านยาของผู้ป่วยศัลยกรรมทางเดินปัสสาวะ Medication Understanding among Urinary Tract Surgical Patients

วัตถุประสงค์: เพื่อศึกษาระดับของความเข้าใจด้านยาของผู้ป่วยศัลยกรรมทางเดินปัสสาวะ และความสัมพันธ์ระหว่างระดับความเข้าใจด้านยากับปัจจัยส่วนบุคคลและปัจจัยเสริม วิธีการศึกษา: การศึกษาภาคตัดขวางมีกลุ่มตัวอย่างคือ ผู้ป่วยนอกแผนกศัลยกรรมทางเดินปัสสาวะ โรงพยาบาลสมเด็จพระเจ้าตากสินมหาราช จังหวัดตาก ที่ได้รับการวินิจฉัยว่าเป็นโรคนิ่ว ต่อมลูกหมากโต ภาวะพร่องฮอร์โมนเพศชาย และกระเพาะปัสสาวะบีบตัวไวเกิน ได้รับยาชนิดรับประทานต่อเนื่องอย่างน้อย 1 เดือน เก็บข้อมูลโดยใช้แบบสัมภาษณ์กลุ่มตัวอย่างจำนวน 292 คน แบบประเมินความเข้าใจด้านยา (medication understanding) สำหรับยาแต่ละรายการนั้น ให้คนไข้ระบุ 1) ชื่อยา 2) ข้อบ่งใช้ 3) ขนาดยา และ 4) ความถี่ โดยให้ 1 คะแนนสำหรับแต่ละคำตอบที่ถูกต้อง คะแนนรวมสำหรับยาแต่ละรายการ คือ 4 คะแนน คำนวณคะแนนเฉลี่ยโดยหารคะแนนรวมด้วยจำนวนรายการยา ใช้สถิติเชิงพรรณนาเพื่ออธิบายข้อมูลทั่วไปและระดับความเข้าใจด้านยา ทดสอบความสัมพันธ์ระหว่างระดับความเข้าใจด้านยากับปัจจัยส่วนบุคคลและปัจจัยเสริมโดยใช้สถิติถดถอยพหุลอจิสติก ผลการศึกษา: ตัวอย่างส่วนใหญ่มีความเข้าใจด้านยาเฉลี่ยในระดับพอใช้ (คะแนนเฉลี่ย 2.69 คะแนน) โดยมีร้อยละ 63.0 ที่อยู่ระดับดี และร้อยละ 37.0 อยู่ระดับพอใช้ พบว่าส่วนมากระบุความถี่ ขนาดยา และข้อบ่งใช้ได้ถูกต้อง (ร้อยละ 97.60, 88.01 และ 80.48 ตามลำดับ) แต่มีเพียงร้อยละ 2.74 ที่ระบุชื่อยาได้ พบว่าการไม่มีผู้ดูแลเตรียมให้ยา กับการมีจำนวนชนิดยาน้อยสัมพันธ์กับระดับความเข้าใจด้านยาระดับดีอย่างมีนัยสำคัญทางสถิติ (P-value < 0.05) สรุป: ผู้ป่วยที่ใช้ยาระบบทางเดินปัสสาวะมีความเข้าใจด้านยาระดับพอใช้โดยเฉลี่ย โดยส่วนมากระบุความถี่ ขนาดยา และข้อบ่งใช้ของยาได้ แต่บอกชื่อยาไม่ได้ เภสัชกรและบุคลากรทางการแพทย์ที่เกี่ยวข้องควรหาแนวทางสื่อสารให้ผู้ป่วยเห็นความสำคัญและตระหนักถึงความจำเป็นที่ผู้ป่วยต้องทราบชื่อยาที่รับประทาน เพื่อป้องกันไม่ให้เกิดปัญหาการได้รับยาซ้ำซ้อน คำสำคัญ: ความเข้าใจด้านยา, โรคระบบศัลยกรรมทางเดินปัสสาวะ, ผู้ป่วยนอกObjectives: To determine levels of medication understanding among urinary tract surgical patients and relationships between medication understanding and demographic characteristics and reinforcing factors. Methods: In this cross-sectional study, patients receiving care at the Department of Urinary Tract Surgery, Somdejphrajaotaksin Maharaj Hospital, Tak province, Thailand were recruited. They were diagnosed with urinary tract stones, benign prostatic hyperplasia, androgen deficiency, or overactive bladder, and prescribed with medications for urological diseases for at least one month. 292 patients were tested for medication understanding with four questions for each urological medication: name, indication, dosage, and frequency. One point was given for each correct answer. With the total of 4 points for a given medication, an average score for each patient was the total sum score divided by the number of medications. Descriptive statistics were used to present demographic characteristics and levels of medication understanding. Associations between medication understanding and demographic characteristics and reinforcing factors were tested using multiple logistic regression. Results: Most participants had an average level of medication understanding (mean = 2.69 points) with 63.3% and 37.05%  with good and fair level, respectively. Most participants stated frequency, dosage and indication of the medication correctly (97.60%, 88.01% and 80.48%, respectively), while only 2.74% stated the name correctly. Having no caregivers to help administer medications and fewer medication items were significantly associated with good level of medication understanding (P-value < 0.05). Conclusion: Patients using medications for urological diseases had a fair level of medication understanding. They were able to state frequency, dosage and indication, but not the name of the medication correctly. Pharmacists and medical staff could find ways to communicate with patients to raise their awareness of knowing drug names to prevent drug duplication. Keywords: medication understanding, urinary tract surgery, outpatien

Validation of the Thai version of the family reported outcome measure (FROM-16)© to assess the impact of disease on the partner or family members of patients with cancer

© The Author(s). 2019Background: Cancer not only impairs a patient's physical and psychosocial functional behaviour, but also contributes to negative impact on family members' health related quality of life. Currently, there is an absence of a relevant tool in Thai with which to measure such impact. The aim of this study was to translate and validate the Family Reported Outcome Measure (FROM-16) in Thai cancer patients' family members. Methods: Thai version of FROM-16 was generated by interactive forward-backward translation process following standard guidelines. This was tested for psychometric properties including reliability and validity, namely content validity, concurrent validity, known group validity, internal consistency, exploratory and confirmatory factor analysis. Construct validity was examined by comparing the Thai FROM-16 version with the WHOQOL-BREF-THAI. Results: The internal consistency reliability was strong (Cronbach's alpha = 0.86). A Negative moderate correlation between the Thai FROM-16 and WHOQOL-BREF-THAI was observed (r = - 0.4545, p < 0.00), and known group validity was proved by a statistically significant higher score in family members with high burden of care and insufficient income. The factor analysis supported both 3-factor and 2-factor loading model with slight difference when compared with the original version. Conclusions: The Thai FROM-16 showed good reliability and validity in Thai family members of patients with cancer. A slight difference in factor analysis results compared to the original version could be due to cross-culture application.Peer reviewedFinal Published versio

The association of functional status with mortality and dialysis modality change : results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

BACKGROUND: Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis. METHODS: A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 - 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient's ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score < 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix. RESULTS: Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to < 13, 14% had a FS score 8 to < 11, and 6% had a FS score < 8. Relative to the US, low FS scores (< 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 - 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 - 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score < 8 vs 13, was 4.01 (2.44 - 6.61) for mortality and 0.91 (0.58 - 1.43) for transfer to hemodialysis. CONCLUSION: Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis

Does the Spiritual Well-Being of Chronic Hemodialysis Patients Differ from that of Pre-dialysis Chronic Kidney Disease Patients?

Spiritual well-being is viewed as an essential component of health-related quality of life (HRQOL) in the modernized biopsychosocial-spiritual model of health. Understanding spiritual well-being should lead to better treatment plans from the patients’ point of view, and improved patient adherence. There are numerous studies of traditional HRQOL, physical, mental, and social well-being; however, studies of spiritual well-being in chronic kidney disease (CKD) patients are limited. Thus, this study compared spiritual well-being of chronic hemodialysis patients and pre-dialysis CKD patients. A total of 31 chronic hemodialysis and 63 pre-dialysis CKD patients were asked for consent and then interviewed for spiritual well-being using the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp). Analysis of covariance was applied to compare FACIT-Sp scores between pre-dialysis CKD and chronic hemodialysis groups that were adjusted by patient characteristics. The FACIT-Sp scores of pre-dialysis CKD patients were non-significantly greater than those of chronic hemodialysis patients after adjustment for gender, age, and marital status. However, all FACIT-Sp scores of males were significantly lower than those of females [FACIT Meaning −1.59 (p = 0.024), FACIT Peace −2.37 (p = 0.004), FACIT Faith −2.87 (p = 0.001), FACIT Total Score −6.83 (p = 0.001)]. The spiritual well-being did not significantly differ by stages of chronic kidney disease; however, patient gender was associated with spiritual well-being instead. To improve spiritual well-being, researchers should consider patient gender as a significant factor

Glucose Tolerance Test and Pharmacokinetic Study of <i>Kaempferia parviflora</i> Extract in Healthy Subjects

Kaempferia parviflora Wall. ex Baker (KP), Krachaidam in Thai or Thai ginseng, is a herbal medicine that has many potential pharmacological effects. The effect of KP extract on blood glucose level in rodent was reported. This study focused on the oral glucose tolerance test and pharmacokinetic study in healthy volunteers administered with KP extract (90 and 180 mg/day, placebo). The oral glucose tolerance tests were performed at baselines and 28-days of administration. The pharmacokinetics were determined after a single dose administration of the tested products using 3,5,7,3&#8242;,4&#8242;-pentamethoxyflavone (PMF) and 5,7,4&#8242;-trimethoxylflavone (TMF) as markers. The results showed that glucose metabolism via oral glucose tolerance test was not affected by KP extract. Blood glucose levels of volunteers at 120 min after glucose loading were able to be returned to initial levels in placebo, KP 90 mg/day, and KP 180 mg/day groups both at baseline and 28-days of administration. The results of the pharmacokinetic study revealed that only TMF and PMF, but not 5,7-dimethoxyflavone (DMF) levels could be detected in human blood. The given doses of KP extract at 90 and 180 mg/day showed a linear dose-relationship of blood PMF concentration whereas blood TMF was detected only at high given dose (180 mg/day). The half-lives of PMF and TMF were 2&#8722;3 h. The maximum concentration (Cmax), area under the curve of blood concentration and time (AUC), and time to maximum concentration (Tmax) values of PMF and TMF estimated for the 180 mg/day dose were 71.2 &#177; 11.3, 63.0 &#177; 18.0 ng/mL; 291.9 &#177; 48.2, 412.2 &#177; 203.7 ng∙h/mL; and 4.02 &#177; 0.37, 6.03 &#177; 0.96 h, respectively. PMF was quickly eliminated with higher Ke and Cl than TMF at the dose of 180 mg/day of KP extract. In conclusion, the results demonstrated that KP extract had no effect on the glucose tolerance test. In addition, this is the first demonstration of the pharmacokinetic parameters of methoxyflavones of KP extract in healthy volunteers. The data suggest the safety of the KP extract and will be of benefit for further clinical trials using KP extract as food and sport supplements as well as a drug in health product development

Associations among Spirituality, Health-Related Quality of Life, and Depression in Pre-Dialysis Chronic Kidney Disease Patients: An Exploratory Analysis in Thai Buddhist Patients

There are numerous studies of quality of life (QOL) in chronic kidney disease (CKD) patients; however, there are a few studies of spirituality and its association with QOL. Previous studies were done focusing on Western cultures; thus, the study of CKD patients in Eastern cultures would reveal interesting insights. This study was conducted to explore the spirituality, QOL, and depression of Thai CKD patients, and the associations between spirituality, QOL, and depression. This cross-sectional descriptive study using structured questionnaires was approved by the Khon Kaen University Ethics Committee in Human Research, Thailand. A total of 63 pre-dialysis CKD stage V patients who visited the kidney diseases clinic as appointed at the outpatient department in a community hospital in northeastern Thailand were recruited. The patients were asked for consent and then interviewed. Spirituality was assessed by using the WHOQOL Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The 9-item Thai Health Status Assessment Instrument (9-THAI) was used to assess QOL. The Beck Depression Inventory-II (BDI-II) was used to evaluate the depression. The study patients had high WHOQOL-SRPB and FACIT-Sp spirituality scores (median = 18.0, and 44.0, respectively). The 9-THAI QOL scores were within the normal range of the Thai general, healthy population (physical health score [PHS]; median = 48.0, mental health score [MHS]; median = 32.0). Based on BDI-II scores, most patients were in the minimal depression group (63.5%). The Spearman rho correlation coefficients (rs) of PHS and WHOQOL-SRPB and FACIT-Sp were moderate with 0.34 for both spirituality measures. Similarly, also the mental health scores (MHS) correlated moderately with WHOQOL-SRPB (rs = 0.46) and FACIT-Sp (rs = 0.37). Depressive symptoms (BDI-II) strongly negatively correlated with WHOQOL-SRPB (rs = −0.58) and FACIT-Sp (rs = −0.55). Overall results were consistent with previous studies in Western contexts. Understanding spirituality would lead to the better management of depression and improving patient survival. These significant associations suggest that further research is needed on how provider knowledge of patient spirituality could affect the outcomes for patients both in terms of depression and patient survival

The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

BACKGROUND: Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis. METHODS: A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 - 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient\u27s ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score \u3c 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix. RESULTS: Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to \u3c 13, 14% had a FS score 8 to \u3c 11, and 6% had a FS score \u3c 8. Relative to the US, low FS scores (\u3c 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 - 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 - 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score \u3c 8 vs 13, was 4.01 (2.44 - 6.61) for mortality and 0.91 (0.58 - 1.43) for transfer to hemodialysis. CONCLUSION: Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis

Spiritual well-being and its relationship with patient characteristics and other patient-reported outcomes in peritoneal dialysis patients: Findings from the PDOPPS

BackgroundSpiritual well-being (SWB), an individual's understanding of the meaning and purpose of life, may help patients with chronic or terminal illnesses cope with their diseases. This study aimed to assess SWB in patients on peritoneal dialysis (PD), as well as its relationship with patient characteristics and patient-reported outcomes (PRO).MethodsThe data were obtained from questionnaires that formed part of the PD Outcomes and Practice Patterns Study (PDOPPS). Measures used in this study were SWB scores derived from the WHO quality of life, spirituality, religiousness and personal beliefs (WHOQOL-SRPB) tool including 32 items from eight facets; physical (PCS) and mental component summary (MCS) scores of the 12-Item Short-Form Health Survey (SF-12), Center of Epidemiologic Studies Depression Scale-10 (CES-D-10) scores, burden of kidney disease scores and functional status scores.ResultsOverall, 529 out of 848 participants (62%) completely responded to the questionnaires and were included in the analysis. Over two-thirds of PD patients (70%) had moderate or higher SWB scores. The SWB scores were significantly lower in patients with age >65 years and unemployed status. SWB scores positively correlated with higher PCS, MCS, burden of kidney disease scores and functional status scores, while negatively correlated with depression scores by CES-D-10 scale. Patients who reported significant depressive symptoms (CES-D-10 score ≥ 10) had significantly lower SWB scores.ConclusionBetter SWB was significantly associated with better health-related QOL (HRQOL) and the absence of depressive symptoms. SWB may be an essential consideration in the delivery of high-quality PD