Independent living: The perspectives of occupational therapists in Thailand

This research used focus groups to investigate the views of occupational therapists from contrasting geographic areas of Thailand on the concept and practicability of the independent living movement within a Thai context. In addition, convergent interviews were employed with individuals from a region where insufficient professionals for group formation agreed to participate. Emerging themes were around the issue of differences and similarities in the concept of independent living between Western and Eastern cultures. Rather than independent living promoting an individualistic culture in Thailand, interdependent living was seen to be likely to be more suitable for a collectivistic culture like Thailand. However, independent living, along with other constructs concerning activity and participation were deemed to have been integrated with values shared by the participants. According to their construction of responsibilities, the participants felt it was crucial to- provide support for clients for independent living. Moving from an agricultural to an industrial society has caused changes in family structure in Thailand that have resulted in disabled people being pushed to live more independently. There do appear to be mechanisms within Thailand allowing independent living for disabled people to be made possible but it requires a period of time to address the barriers existing in disabled people themselves, their families, people in the community, physical environment, the Thai government and therapy professionals as well as financial barriers. To support independent living in Thailand, strategies for practice are suggested. Some strategies require cooperation and collaboration from other stakeholders in society. The client-centred and occupation- based models are viewed as being appropriate to form a frame of occupational therapy practice for promoting independent living and need to be augmented by community service, counselling and social skill, and knowledge for occupational therapists to be enabled to support independent living

キノウ ブンポウ カラ ミタ ニホンゴ ノ モダリティ フクシ

学位記番号 : 甲第65号（旧）大阪外国語大学で授与された博士論文であ

Drug utilisation studies on the impact of the reduction of the prescription charge in Wales and the reclassification of medicines

Since 2000 there have been a number of policy changes in the UK to remove barriers that limit access to medicines. Perhaps the most significant of these have been the phased reduction and abolition of the prescription charge in Wales and the efforts of the UK Government to encourage the reclassification of medicines. This thesis explored aspects of both these changes. The percent change in the number of prescription items dispensed over the two year period before and after the first reduction of the prescription charge in October 2004 was determined. There was an increase in the percent change median interquartile range for non-sedating antihistamines 7.3 5.0 - 10.7 to 13.7 10.9 - 17.1, p=0.001 and laxatives 2.2 0.8 - 3.1 to 3.7 1.4 - 6.4, p=0.04, whilst no change was observed for loperamide -1.2 -3.3 - 3.2 to 2.6 -0.9 - 5.2, p 0.11 and fluconazole -7.4 -14.4 - 2.1 to -3.7 -10.9 - 1.4, p=0.52. Over the counter OTC sales of omeprazole and simvastatin were monitored following reclassification and accounted for less than 1 of the volume of their prescription counterpart. In contrast, sales of OTC hyoscine butylbromide and chloramphenicol eye drops were more than 20 of the number of items dispensed. Twelve months after reclassification there was an increase in the percent change in the number of prescription items dispensed for hyoscine butylbromide in Wales 5.8 0.2 - 12.6 to 20.7 4.4 - 25.6, p=0.007, whilst prescriptions for chloramphenicol eye drops decreased 10.0 6.0 - 13.6 to -8.9 -13.1 - -4.4, p=0.001. More OTC chloramphenicol was sold in less deprived areas r=-0.44, p=0.04. The changes in prescription volume and OTC medicine sales varied from medicine to medicine and require a qualitative evaluation to better understand the reasons behind the differences observed

How Area Health Management Leads to Improved Equity in Health: A Scoping Review

Background: The scoping review of published studies aims to explore what practices and processes can improve equity (horizontal and vertical) in countries that adopted Area Health Management (AHM) utilizing the “Six Building Blocks Plus” (SBBP) concept. Method: An electronic search was conducted from the inception to January 27, 2021, from 6 databases (Embase, Social Sciences, Web of Science, PubMed, CINAHL, and WHO) and the gray literature. The inclusion criteria were AH, SBBP, and equity. Data extraction was using a standardized data collection form. Results: This scoping review includes 63 full-text studies. SBBP are identical in the horizontal and vertical equity. However, the majority of SBBP were health service delivery, leadership & governance, and health workforce. The result showed the practice and process to improve health equity were related to a health service delivery (HSD). Conclusion: The included study showed horizontal and vertical equity. The equity measurement focused on utilization. AHM utilizing SBBP was mostly showed in HSD, HWF, leadership & governance. This review indicates that HSD could improve equity or cooperate with other SBBP by increasing healthcare accessibility and utilization. The demographic factor that affected equity is ethnicity. Therefore, HSD in area health was crucial in enhancing health promotion equity in different areas, specific diseases, and target patients

Drug utilisation studies on the impact of the reduction of the prescription charge in Wales and the reclassification of medicines

Since 2000 there have been a number of policy changes in the UK to remove barriers that limit access to medicines. Perhaps the most significant of these have been the phased reduction and abolition of the prescription charge in Wales and the efforts of the UK Government to encourage the reclassification of medicines. This thesis explored aspects of both these changes. The percent change in the number of prescription items dispensed over the two year period before and after the first reduction of the prescription charge in October 2004 was determined. There was an increase in the percent change median interquartile range for non-sedating antihistamines 7.3 5.0 - 10.7 to 13.7 10.9 - 17.1, p=0.001 and laxatives 2.2 0.8 - 3.1 to 3.7 1.4 - 6.4, p=0.04, whilst no change was observed for loperamide -1.2 -3.3 - 3.2 to 2.6 -0.9 - 5.2, p 0.11 and fluconazole -7.4 -14.4 - 2.1 to -3.7 -10.9 - 1.4, p=0.52. Over the counter OTC sales of omeprazole and simvastatin were monitored following reclassification and accounted for less than 1 of the volume of their prescription counterpart. In contrast, sales of OTC hyoscine butylbromide and chloramphenicol eye drops were more than 20 of the number of items dispensed. Twelve months after reclassification there was an increase in the percent change in the number of prescription items dispensed for hyoscine butylbromide in Wales 5.8 0.2 - 12.6 to 20.7 4.4 - 25.6, p=0.007, whilst prescriptions for chloramphenicol eye drops decreased 10.0 6.0 - 13.6 to -8.9 -13.1 - -4.4, p=0.001. More OTC chloramphenicol was sold in less deprived areas r=-0.44, p=0.04. The changes in prescription volume and OTC medicine sales varied from medicine to medicine and require a qualitative evaluation to better understand the reasons behind the differences observed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Supporting self management of type 2 diabetes: is there a role for the community pharmacist?

Teerapon Dhippayom,1 Ines Krass21Pharmaceutical Care Research Unit, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 2Faculty of Pharmacy, The University of Sydney, Camperdown, NSW, AustraliaBackground: Evidence supports the efficacy of pharmacy services in type 2 diabetes (T2D). However, little is known about consumer perspectives on the role of community pharmacists in diabetes care. The objectives of this study were to identify potential unmet needs and explore preferences for pharmacist-delivered support for T2D.Methods: A qualitative study using focus groups was conducted in Sydney, Australia. Patients with T2D who were members of the Australian Diabetes Council in Sydney, Australia, were recruited through a survey on medication use in T2D. Five focus groups with a total of 32 consumers with T2D were recorded, transcribed, and thematically analyzed.Results: The key themes were 1) the experiences of diabetes services received, 2) the potential to deliver self-management services, and 3) the suggested role of pharmacist in supporting diabetes management. Gaps in understanding and some degree of nonadherence to self-management signaled a potential for self-management support delivered by pharmacists. However, consumers still perceive that the main role of pharmacists in diabetes care centers on drug management services, with some enhancements to support adherence and continuity of supply. Barriers to diabetes care services included time constraints and a perceived lack of interest by pharmacists.Conclusion: Given the unmet needs in diabetes self-management, opportunities exist for pharmacists to be involved in diabetes care. The challenge is for pharmacists to upgrade their diabetes knowledge and skills, organize their workflow, and become proactive in delivering diabetes care support.Keywords: diabetes care, community pharmacy, community pharmacist, self-management, preferenc