STARZ-DRP: A STRUCTURED FRAMEWORK FOR TEACHING COMMUNITY PHARMACISTS TO COUNSEL SELF-CARE CUSTOMERS

Objective: Aim of this study is to take a look at the community pharmacists' (CPs) self-rating confidence of advocating self-care customers using before and after attending a STARZ-DRP training workshop.Methods: CPs (n=231) in the state of Penang had been invited via e-mail to engage in a STARZ-DRP training workshop. CPs had been trained to assess individual features and analyse the facts and figures before formulating a triage action plan. A self-administered questionnaire to evaluate CPs' self-confidence to performing self-care counselling had been handed out before and after the workshop.Results: Twenty CPs (8.7%) had responded to the invitation via e-mail. It was noted that CPs' self-rating confidence to performing self-care counselling making use of STARZ-DRP as a framework were improved in all domains reflected in the questionnaire. Among significant improvements (p<0.05) noted were making triage decision, consistently assessing individual features, and identifying actual or potential origins of the medical problem.Conclusion: CPs' self-confidence to performing self-care counselling making use of STARZ-DRP as a framework to advocate self-care customers is enhanced after turning up at the training workshop. It reflects the future use of STARZ-DRP as a potential framework to help out CPs to formulate a triage action plan for self-care customers

ACTUAL OR POTENTIAL EXTENDED SERVICES PERFORMED BY MALAYSIAN COMMUNITY PHARMACISTS, PERCEPTIONS AND BARRIERS TOWARDS IT'S PERFORMANCE: A SYSTEMATIC REVIEW

Objective: Aims of this review were to identify actual or potential extended services performed in community pharmacy settings, perceptions among community pharmacists (CPs), general practitioners (GPs), consumers and policymakers of these extended services and barriers towards its performance.Methods: A literature review was conducted, using Google Scholar and PubMed as a searching engine.Results: Identifying eight quality full texts to review which fulfil the inclusion searching criteria, revealing a wide range of actual or potential extended services performed by CPs such as counselling on asthma, cardiovascular disease, breast cancer, diabetes, smoking cessation and self-medication. GPs' perceptions towards these extended services were varied, not or in favour of CPs to perform some actual or potential extended services. Customers were in favour of CPs to perform these actual or potential extended services whereas CPs indicated a few barriers towards the performance of these actual or potential extended services.Conclusion: As a conclusion, CPs in Malaysia were in the right position to perform the actual or potential extended services, collaborating with GPs to promote better medication use and enhance patients' quality of life. Some barriers towards these extended services must be intervened in order to enhance the quality of the services

STARZ-DRP AS A TRIAGING TOOL FOR COMMUNITY PHARMACISTS: PERSPECTIVES AND EXPECTATIONS OF STAKEHOLDERS

Objective:  To investigate perspectives and expectations of stakeholders of community pharmacists' (CPs) roles and the use of STARZ-DRP as a structured and systematic framework to help CPs to extend their role to make an accurate triage decision in community pharmacy settings.Methods: Individuals who were in high positions in the Ministry of Health (MOH), pharmacy, medical and consumer associations and individuals who were a private medical practitioner and retail pharmacist were invited via mail to participate in the face to face interview. The interviews were audio-taped and transcribed verbatim to identify themes as many as possible.Results: Eight stakeholders had responded to the invitation. Mean (± standard deviation) age (years) of stakeholders was 56.50 ± 11.82. Five themes were noted which were: (i) CPs are focusing more on business-oriented, (ii) CPs should perform patient-oriented services, (iii) responsibilities to triage customers, (iv) a systematic approach for triaging activities, (v) STARZ-DRP as a systematic approach to making triage decision.Conclusion: CPs are paying particular attention on business-oriented than patient-oriented services. All stakeholders point out that CPs should intensify their current practice and all of them have the same opinion that CPs should take the responsibilities to make an accurate triage decision for self-care customers. Almost all stakeholders agree that STARZ-DRP is an ideal framework to help CPs to make an accurate triage decision in community pharmacy settings.Â

Community Pharmacy Marketing in the New Era: A Global Picture of Extended Community Pharmacy Services

The community pharmacists (CPs) are legally responsible to hand out a wide range of ready-made prescription medications to patients. Additionally, CPs are also involving in advocating customers who determine to self-medicate. Interestingly, it is also noted that CPs in developed countries like the United Kingdom, Germany, and Canada have performed more than these services. What are the extended community pharmacy services available? What are the barriers and perceptions of these extended services? It is rationale to explore such issues globally since it might have potential to give some possible course of action to CPs to incorporate more values to the contemporary services

Acyclovir Induced Acute Kidney Injury In Acute Meningitis Patient: A Case Report Highlights the Concurrence Of AKI Risk Factors And The Neutropenic Effect Of Ticlopidine

Nephrotoxicity is one of the challenging side effects of acyclovir use in clinical practice. The Concomitant use of other nephrotoxic antibiotics, in addition to patient's risk factors, can trigger acyclovir induced acute kidney injury (AKI). We described a case of acute meningitis in 68 year old female patient with underlying history of ischemic heart disease managed by ticlopidine. The gram stain, culture and PCR of the CSF did not show any positive growth of bacterial infection or HSV. However, the negative CSF gram stain and culture caused a confusion of the diagnosis of bacterial meningitis with viral meningitis. The patient had AKI induced by the treatment with acyclovir for 16 consecutive days and possibly triggered by other AKI risk factors. Hemodialysis and hydration did not reverse the kidney function to normal. However, it was reversed to its normal status only after the discontinuation of acyclovir. The neutropenic effect of ticlopidine can be a risk to the patient that could lead to fatal infection. In this case report we reviewed the literature on the nephrotoxicity of acyclovir, the neutropenia of ticlopidine and a proposed role of granulocyte colony stimulating factor (G-CSF)

Pilot testing of a pharmacist led care program for asthma patients in Saudi Arabia

AbstractThis study aimed at evaluating the usefulness of a structured patient counseling program on clinical outcomes of asthma patients in Saudi Arabia. This cross sectional study enrolled 10 asthma patients and all were evaluated for their baseline knowledge on asthma, quality of life, compliance, patient satisfaction and drug related problems among randomly selected 5 (of the total 10) patients. The median (IQR) age of the patients was 46 (33.5–56.2)years. The baseline knowledge scores was 9 (8–11), the maximum possible scores to be 21. Cronbach alpha of the KQ was 0.65. The overall total median (IQR) compliance (Morisky) score was 4 (3–5), the maximum possible score was 5. The patient satisfaction median (IQR) score was 35.5 (32–46.25), the maximum possible score was 70. Of the total patients 3 (30%) had a history of allergy. There were total 18 allergens observed in these patients. There has been no drug–drug or drug–food interactions observed between among the prescribed drugs of the patients. Altogether 2 patients reported a total of 2 ADRs. The knowledge of the asthma patients was found to be poor. Missing the dose was the most commonly encountered drug taking behavior. The compliance was found to be good and the patient satisfaction was average

Factors Associated With the General Public Knowledge and Awareness of Cardiovascular Diseases and its Risk Factors in Penang – Malaysia

Cardiovascular diseases(CVDs) are the top of the ten causes of hospital deaths in Malaysia. Increasing knowledge and awareness on CVDs and its risk factors is crucial for the prevention of CVDs. Identification of factors which are associated with the knowledge and awareness is important for the proper design of future awareness programs.This study was carried out to find out factors which are associated with the current knowledge and awareness of cardiovascular diseases (CVDs) and its risk factors among the general public in Penang-Malaysia

ANALISA COST OF ILLNESS AKIBAT PENGGUNAAN NSAIDS DI SEBUAH APOTEK DI KOTA MEDAN, INDONESIA

Background: A drug therapy problem is any undesirable event experienced by a patient which involves, or is suspected to involve drug therapy and that interferes with achieving the desired goals of therapy. Drug Therapy Problems (DTPs) can lead to ineffective pharmacotherapy and may cause drug-related morbidity and mortality.Objective: The study aimed to estimates the direct medical cost of illness caused by the drug morbidity or mortality related to NSAID utilization in a community pharmacy setting at Medan, Indonesia.Method: Thisstudy used 7 (seven) categories probabilities and costs associated with the therapeutic outcomes to estimate the direct medical cost of illness resulting from morbidity related NSAIDs utilization. Direct non medical costs, indirect costs, and intangible costs related to drug-related-morbidity and mortality were not valued in this cost-of-illness analysis.The duration of the study was from July 2009 to October 2010.Result: The patient that experienced NSAIDs-related morbidity estimated to spend Rp.467.848,- each and Rp.11.696.200,- in total to managing the morbidity. Every Rp.1,- spent on NSAIDs therapy, an additional Rp.1,45,- was estimated to spent in managing morbidity related NSAIDs utilization.Conclusion: This result showed the cost of illnessrelated morbidity of NSAIDs utilization exceeds the cost of the medications themselve

Effect of Fruit/Vegetable-Drug Interactions on CYP450, OATP and p-Glycoprotein: A Systematic Review

Purpose: To review the concomitant use of certain drugs with fruit/vegetable juices that may lead to drug-juice interactions resulting in medication-related problems.Method: In this systematic review, online databases (PubMed, Google Scholar and Science Direct) were searched for information on juices derived from fruits and vegetables that are reported to have inhibitory effects on cytochrome P450, p-glycoprotein and organic anion transporting polypeptides (OATPs).Results: Fruits can inhibit CYP1A1, CYP1A2, CYP1A4, CYP3A1, CYP3A4, CYP2C6, CYP2C9,CYP2E1 and drug transporters (P-glycoprotein, OATP). On the other hand CYP1A1, CYP1A2, CYP2A2, CYP3A1, CYP1B1, CYP2B1, CYP2B2, CYP2C1, CYP2C6, CYP2E1 can be inhibited by some vegetables. Antihypertensives, antidiabetics, statins, analgesics and antipsychotics were the most common drugs interacting with fruits and vegetables. The inhibition of their metabolism by fruits and vegetables can cause serious toxic effects, e.g., hypertension, poor glycemic control, rhabdomyolosis and drug overdose-related toxic effects. Overall, active components of fruits and vegetables can interact with many drugs leading to adverse effects.Conclusion: Screening of fruits/vegetables for possible risk of interaction, and patient counseling are some effective strategies for preventing such interactions for optimal patient care.Keywords: Fruits and vegetables, Cytochrome P450, Drug interactions, p-Glycoprotein, Organic anion transporting polypeptide

Bleeding risk factors with enoxaparin for patients with NSTEMI/UA in HUKM

Low-molecular-weight heparins (LMWHs) are antithrombotic agents utilised in the treatment of acute coronary syndromes. They have been shown to be more effective than unfractionated heparins (UFHs) in reducing ischeamic e v e n t s , w h i c h i n c l u d e d e a t h , my o c a r d i a l i n f a r c t i o n (MI) a n d u r g e n t revascularisation. Enoxaparin is one of the products of LMWHs. Its safety and efficacy has been proven in the ESSENCE and TIMI IIB studies. This study was carried out to identify risk factors that may affect bleeding complications associated with the use of enoxaparin for non-ST-elevation MI (NSTEMI) or unstable angina (UA) in Universiti Kebangsaan Malaysia Hospital (HUKM). This observational, longitudinal study was conducted on patients who were admitted to the Coronary Care Unit (CCU), Coronary Rehabilitation Ward (CRW), Medical 1 and Medical 2 wards at HUKM and initiated on enoxaparin for NSTEMI/UA from 22 nd of March until 22 nd of April 2004. A total of 40 patients were included in the study with median age of 65 years, male to female ratio of 3:1, diagnosed with NSTEMI (55%) and UA (45%). 45% of patients developed an episode of bleeding and among them 83.3% (15 patients) characterised by haematuria. Higher percentages of women (80%) and those with creatinine clearance of < 30ml/min (100%) had incidence of bleeding as compared to men (50%) and those with creatinine clearance ≥ 30 ml/min, respectively (p < 0.05 for both parameters). Age, enoxaparin dose and duration of therapy, smoking and concomitant aspirin/ticlopidine therapy did not significantly affect the incidence of bleeding. In conclusion, renal impairment and gender were associated with bleeding in relation with the use of enoxaparin that may require dose adjustments