Pharmaceutical care for patients with tuberculosis and diabetes mellitus in Malaysia: a complex intervention

The increasing comorbid burden of tuberculosis (TB) and diabetes mellitus (OM) worldwide requires the management of all stakeholders including pharmacists. This raises the question whether current single disease management system fulfils patients' health needs and whether pharmacists could effectively play a role in enhancing the joint management of these two commonly associated diseases. Pharmacists have begun to provide pharmaceutical care through pharmacist-led medication therapy adherence clinics and clinical pharmacy services for several diseases and conditions (e.g. OM, asthma) in some public hospitals in Malaysia but are yet to be involved in the management of TB. The management of TB has been largely delivered through directly observed treatment (OOT) as high level of adherence to treatment is vital. However, little is known on how TB patients with OM are being managed and how these patients cope with their medication. The aim of this study was to develop a pharmaceutical care service for patients with TB and OM. The first three phases (preclinical, phase 1 and phase 2) of the UK Medical Research Council framework for the development of complex interventions to improve health was applied to develop a pharmaceutical care service for patients with both TB and DM in a tertiary hospital in Malaysia. First, literature relating to TB and OM was reviewed (preclinical). Second, the pharmaceutical care needs of TB and DM patients were explored using semi-structured interviews with twenty patients, three physicians, three nurses, and a focus-group with four pharmacists (phase 1). Third, action research was conducted to assess the feasibility of providing a pharmaceutical care service for patients with TB and OM (phase 2). This study received ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia. Patients and health care professionals reported several medication-related issues in the phase 1 study. Patients were most inclined to discuss their concerns about their medication. Patients also tended to display different attitudes towards medication-taking, depending on their beliefs, the severity of illnesses, perceived efficacy of the treatment, and the severity of medication-related problems. The findings also revealed that many of these concerns had not been discussed with their physicians. This was also caused by the patients' and physicians' tendencies to prioritise the management of TB, and unintentionally neglecting other comorbidities especially when patients were primarily managed at the chest clinic. Other difficulties identified in comorbid management included delayed initiation of both TB and OM treatment, chest physicians' lack of confidence in managing 'difficult' OM in TB patients and the burden of attending multiple clinics for patients. Health care professionals believed that pharmacist-led medication therapy adherence clinics (MTACs) encouraged the provision of patient-centred care, enhanced pharmacist-patient communication, created opportunities for inter-professional interactions and could be used as a model to provide pharmaceutical care services. Health care professionals urged pharmacists to play a role in the management of TB and OM by providing patient education and counselling. The phase 2 study revealed that the prevalence of OM in TB patients was 15%. Action research allowed the researcher, together with a hospital pharmacist, to identify pharmaceutical care needs in TB and OM patients, and fulfilled some of them. Pharmaceutical care issues identified included lack of medication adherence, poor management of OM, the need to manage adverse drug reactions, and the lack of frequent monitoring of certain monitoring parameters for TB, OM and other comorbidities at the chest clinic. Many patients had uncontrolled OM, however, many were more likely to be adherent to TB medication than medication of OM and/or other conditions. As a follow-up action, pharmacists advised these patients to place equal importance to TB and non-TB related management. Additionally, pharmacists also made treatment recommendations and referred patients to their chest physicians for further management of medication-related problems. Nevertheless, there were barriers that impinged the provision of pharmaceutical care service. The barriers include the lack of space with privacy to provide education and counselling to patients; the unavailability of medication records and other clinical information for comorbidities at the chest clinic; and the lack of time to develop inter-professional relationship. Despite the need to address the barriers, the provision of pharmaceutical care service to TB and OM patients was feasible as pharmacists were able to integrate TB and OM management by identifying, communicating, and resolving some medication-related problems. In summary, this study provided the groundwork by conducting phase 1 and phase 2 study prior to developing a full-fledged pharmaceutical care service for TB and DM patients. Future work can be done to improve the service through critical analysis of the challenges faced in the developmental phase with the effectiveness of the service care plan assessed through a randomised controlled trial (RCT)

Pharmaceutical care for patients with tuberculosis and diabetes mellitus in Malaysia: a complex intervention

The increasing comorbid burden of tuberculosis (TB) and diabetes mellitus (OM) worldwide requires the management of all stakeholders including pharmacists. This raises the question whether current single disease management system fulfils patients' health needs and whether pharmacists could effectively play a role in enhancing the joint management of these two commonly associated diseases. Pharmacists have begun to provide pharmaceutical care through pharmacist-led medication therapy adherence clinics and clinical pharmacy services for several diseases and conditions (e.g. OM, asthma) in some public hospitals in Malaysia but are yet to be involved in the management of TB. The management of TB has been largely delivered through directly observed treatment (OOT) as high level of adherence to treatment is vital. However, little is known on how TB patients with OM are being managed and how these patients cope with their medication. The aim of this study was to develop a pharmaceutical care service for patients with TB and OM. The first three phases (preclinical, phase 1 and phase 2) of the UK Medical Research Council framework for the development of complex interventions to improve health was applied to develop a pharmaceutical care service for patients with both TB and DM in a tertiary hospital in Malaysia. First, literature relating to TB and OM was reviewed (preclinical). Second, the pharmaceutical care needs of TB and DM patients were explored using semi-structured interviews with twenty patients, three physicians, three nurses, and a focus-group with four pharmacists (phase 1). Third, action research was conducted to assess the feasibility of providing a pharmaceutical care service for patients with TB and OM (phase 2). This study received ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia. Patients and health care professionals reported several medication-related issues in the phase 1 study. Patients were most inclined to discuss their concerns about their medication. Patients also tended to display different attitudes towards medication-taking, depending on their beliefs, the severity of illnesses, perceived efficacy of the treatment, and the severity of medication-related problems. The findings also revealed that many of these concerns had not been discussed with their physicians. This was also caused by the patients' and physicians' tendencies to prioritise the management of TB, and unintentionally neglecting other comorbidities especially when patients were primarily managed at the chest clinic. Other difficulties identified in comorbid management included delayed initiation of both TB and OM treatment, chest physicians' lack of confidence in managing 'difficult' OM in TB patients and the burden of attending multiple clinics for patients. Health care professionals believed that pharmacist-led medication therapy adherence clinics (MTACs) encouraged the provision of patient-centred care, enhanced pharmacist-patient communication, created opportunities for inter-professional interactions and could be used as a model to provide pharmaceutical care services. Health care professionals urged pharmacists to play a role in the management of TB and OM by providing patient education and counselling. The phase 2 study revealed that the prevalence of OM in TB patients was 15%. Action research allowed the researcher, together with a hospital pharmacist, to identify pharmaceutical care needs in TB and OM patients, and fulfilled some of them. Pharmaceutical care issues identified included lack of medication adherence, poor management of OM, the need to manage adverse drug reactions, and the lack of frequent monitoring of certain monitoring parameters for TB, OM and other comorbidities at the chest clinic. Many patients had uncontrolled OM, however, many were more likely to be adherent to TB medication than medication of OM and/or other conditions. As a follow-up action, pharmacists advised these patients to place equal importance to TB and non-TB related management. Additionally, pharmacists also made treatment recommendations and referred patients to their chest physicians for further management of medication-related problems. Nevertheless, there were barriers that impinged the provision of pharmaceutical care service. The barriers include the lack of space with privacy to provide education and counselling to patients; the unavailability of medication records and other clinical information for comorbidities at the chest clinic; and the lack of time to develop inter-professional relationship. Despite the need to address the barriers, the provision of pharmaceutical care service to TB and OM patients was feasible as pharmacists were able to integrate TB and OM management by identifying, communicating, and resolving some medication-related problems. In summary, this study provided the groundwork by conducting phase 1 and phase 2 study prior to developing a full-fledged pharmaceutical care service for TB and DM patients. Future work can be done to improve the service through critical analysis of the challenges faced in the developmental phase with the effectiveness of the service care plan assessed through a randomised controlled trial (RCT)

Self-medication with antibiotics in Sana’a City, Yemen

Purpose: To determine the prevalence of self-medication with antibiotics in Sana’a City, Yemen and its associated risk factors.Methods: In a descriptive cross-sectional study, a self-administered questionnaire was developed and distributed among consumers attending community pharmacies in Sana’a city, Yemen. Chi-square test was used to identify the risk factors associated with self-medication with antibiotics.Results: The prevalence of antibiotics use during self-medication was 87.1 % (58.2 % of males and 41.8 % of females). Among all respondents, only 49.5 % were aware of bacterial resistance due to antibiotic use. The majority of illness/symptoms treated with antibiotics during self-medication were common cold, cough, diarrhea and fever. The high cost of physician consultation was the main reason for self-medication with antibiotics. The most common source of information was community drug dispensers. Although different factors were assessed, no association could be found between factors like age, gender, material status, educational status, employment, monthly income or knowledge regarding bacterial resistance and self-medication with antibiotics.Conclusion: Self-medication with antibiotics is high among consumers in Sana’a City, Yemen.Keywords: Self-medication, Antibiotics, Community pharmacies, Sana’a City, Yeme

Pharmaceutical care for patients with tuberculosis and diabetes mellitus in Malaysia : a complex intervention

The increasing comorbid burden of tuberculosis (TB) and diabetes mellitus (DM) worldwide requires the management of all stakeholders including pharmacists. This raises the question whether current single disease management system fulfils patients' health needs and whether pharmacists could effectively play a role in enhancing the joint management of these two commonly associated diseases. Pharmacists have begun to provide pharmaceutical care through pharmacist-led medication therapy adherence clinics and clinical pharmacy services for several diseases and conditions (e.g. DM, asthma) in some public hospitals in Malaysia but are yet to be involved in the management of TB. The management of TB has been largely delivered through directly observed treatment (DOT) as high level of adherence to treatment is vital. However, little is known on how TB patients with DM are being managed and how these patients cope with their medication. The aim of this study was to develop a pharmaceutical care service for patients with TB and OM. The first three phases (preclinical, phase 1 and phase 2) of the UK Medical Research Council framework for the development of complex interventions to improve health was applied to develop a pharmaceutical care service for patients with both TB and DM in a tertiary hospital in Malaysia. First, literature relating to TB and OM was reviewed (preclinical). Second, the pharmaceutical care needs of TB and OM patients were explored using semi-structured interviews with twenty patients, three physicians, three nurses, and a focus-group with four pharmacists (phase 1). Third, action research was conducted to assess the feasibility of providing a pharmaceutical care service for patients with TB and OM (phase 2). This study received ethical approval from the Medical Research and Ethics Committee (MRECl, Ministry of Health, Malaysia. Patients and health care professionals reported several medication-related issues in the phase 1 study. Patients were most inclined to discuss their concerns about their medication. Patients also tended to display different attitudes towards medication-taking, depending on their beliefs, the severity of illnesses, perceived efficacy of the treatment, and the severity of medication-related problems. The findings also revealed that many of these concerns had not been discussed with their physicians. This was also caused by the patients' and physicians' tendencies to prioritise the management of TB, and unintentionally neglecting other comorbidities especially when patients were primarily managed at the chest clinic. Other difficulties identified in comorbid management included delayed initiation of both TB and DM treatment, chest physicians' lack of confidence in managing 'difficult' DM in TB patients and the burden of attending multiple clinics for patients. Health care professionals believed that pharmacist- led medication therapy adherence clinics (MTACs) encouraged the provision of patient-centred care, enhanced pharmacist-patient communication, created opportunities for inter-professional interactions and could be used as a model to provide pharmaceutical care services. Health care professionals urged pharmacists to play a role in the management of TB and DM by providing patient education and counselling. The phase 2 study revealed that the prevalence of DM in TB patients was 15%. Action research allowed the researcher, together with a hospital pharmacist, to identify pharmaceutical care needs in TB and DM patients, and fulfilled some of them. Pharmaceutical care issues identified included lack of medication adherence, poor management of DM, the need to manage adverse drug reactions, and the lack of frequent monitoring of certain monitoring parameters for TB, DM and other comorbidities at the chest clinic. Many patients had uncontrolled DM, however, many were more likely to be adherent to TB medication than medication of DM and/or other conditions. As a follow-up action, pharmacists advised these patients to place equal importance to TB and non-TB related management. Additionally, pharmacists also made treatment recommendations and referred patients to their chest physicians for further management of medication-related problems. Nevertheless, there were barriers that impinged the provision of pharmaceutical care service. The barriers include the lack of space with privacy to provide education and counselling to patients; the unavailability of medication records and other clinical information for comorbidities at the chest clinic; and the lack of time to develop inter-professional relationship. Despite the need to address the barriers, the provision of pharmaceutical care service to TB and DM patients was feasible as pharmacists were able to integrate TB and DM management by identifying, communicating, and resolving some medication-related problems. In summary, this study provided the groundwork by conducting phase 1 and phase 2 study prior to developing a full-fledged pharmaceutical care service for TB and DM patients. Future work can be done to improve the service through critical analysis of the challenges faced in the developmental phase with the effectiveness of the service care plan assessed through a randomised controlled trial (RCT).EThOS - Electronic Theses Online ServiceGBUnited Kingdo

SELF-MEDICATION PRACTICE AMONG CONSUMERS IN SANA'A CITY

Objective: To determine the prevalence of self-medication practice and its associated risk factors in Sana'a City.Methods: A cross-sectional descriptive study was carried out on consumers attending community pharmacies in Sana'a City. A self-administered questionnaire containing open-ended and closed-ended questions was developed and used for this study. Chi-square test and multiple logistic regressions were used in this study.Results: A total of 400 consumers were involved in this study. The prevalence of self-medication in the past six months was found to be 90.7 % (94.1% of females and 88.3% of males). In Multivariate analysis, chewing khat, smoking, availability of medical services near the residence and the perception about death due to self-medication were significant predictors of self-medication practice. Those who chewed khat were less likely to use self-medication compared to those who did not chew khat (OR= 0.296, CI 95% 0.100-0.882, p= 0.029). Similar results showed that smokers were less likely to use self-medication compared to non-smokers (OR= 0.429, CI 95% 0.206-0.895, p= 0.024). It was also found that those who have medical services near their residence were more likely to use self-medication compared to those who do not have medical services near their residence (OR= 3.022, CI 95% 1.384-6.596, p= 0.006). Moreover, those who did not believe that self-medication leads to death were more likely to use self-medication compared to those who believed that self-medication may leads to death (OR=2.645, CI 95% 1.232-5.681, p= 0.013).Conclusion: Self-medication practice was high among consumers in Sana'a City. Chewing khat, smoking, availability of medical services near the residence and the respondent perception about the possibility of death due to self-medication was significantly associated with self-medication

Pattern of complementary and alternative medicine (CAM) use among patients with chronic kidney disease

[No abstract available

Public Awareness and Practices Towards Self-Medication with Antibiotics Among Malaysian Population: Questionnaire Development and Pilot Testing

Not Availabl