Generic Medicines: the big picture

Outline: * BACKGROUND & INTRODUCTION * HEALTHCARE EXPENDITURE * ROLE OF GENERIC- MEDICINES IN HEALTH - CARE SYSTEM * GLOBAL SCENARIO * MALAYSIAN SCENARI

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

Perceptions of thalassemia and its treatment among Malaysian thalassemia patients: A qualitative study

Background Thalassemia is a common public health problem in Malaysia and one of the most common chronic and genetic disorders. Aims The present qualitative study explores knowledge about thalassemia, perceptions about conventional therapies and the points that affect Malaysian patients with thalassemia in taking medications correctly. Methods This study used a qualitative method. Purposive and theoretical samplings were combined to explore the issues related to thalassaemia and its perceptions. Twenty-one patients with thalassemia were recruited from the Thalassemia Society, Kedah, Malaysia from July to October 2015. The semi-structured interviews were audio taped, transcribed verbatim and translated into English for thematic content analysis. Results Participants perceived thalassemia as an incurable disease which is due to genetic and blood related disorders. A positive perception was shown towards conventional therapies considering it as effective for their condition. High treatment cost was given as a reason why patients perceived conventional therapies as effective. Fear of side effects was the main reason the patients gave for their delay in looking for treatment. However, due to limited treatment options, patients were reported to show positive attitude towards the side effects due to thalassemia treatment. Conclusion This explanatory investigation suggests that thalassemia patients’ understanding about thalassemia is complex in nature. The findings may help healthcare providers remove myths about the fear of the treatment. It may also help in improving patient’s compliance towards the thalassemia therapies. Main focus for future research should be on those patients who declined the conventional therapies

A latent trait approach to measuring HIV/AIDS related stigma in healthcare professionals: application of mokken scaling technique

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Background The attitudes of healthcare professionals towards HIV positive patients and high risk groups are central to the quality of care and therefore to the management of HIV/AIDS related stigma in health settings. Extant HIV/AIDS stigma scales that measure stigmatising attitudes towards people living with HIV/AIDS have been developed using scaling techniques such as principal component analysis. This approach has resulted in instruments that are often long. Mokken scale analysis is a nonparametric hierarchical scaling technique that can be used to develop unidimensional cumulative scales. This technique is advantageous over the other approaches; as the scales are usually shorter, while retaining acceptable psychometric properties. Moreover, Mokken scales also make no distributional assumptions about the underlying data, other than that the data are capable of being ordered by item and by person. In this study we aimed at developing a precise and concise measure of HIV/AIDS related stigma among health care professionals, using Mokken scale analysis. Methods We carried out a cross sectional survey of healthcare students at the Monash University campuses in Malaysia and Australia. The survey consisted of demographic questions and an initial item pool of twenty five potential questions for inclusion in an HIV stigma scale. Results We analysed the data using the mokken package in the R statistical environment providing a 9-item scale with high reliability, validity and acceptable psychometric properties, measuring and ranking the HIV/AIDS related stigmatising attitudes. Conclusion Mokken scaling procedure not only produced a comprehensive hierarchical scale that could accurately order a person along HIV/AIDS stigmatising attitude, but also demonstrated a unidimensional and reliable measurement tool which could be used in future studies. The principal component analysis confirmed the accuracy of the Mokken scale analysis in correctly detecting the unidimensionality of this scale. We recommend future works to study the generalisability of this scale in a new population.https://doi.org/10.1186/s12909-016-0676-316pubpub

Development, translation, and validation of a bilingual questionnaire on unused medications in homes.

BACKGROUND: Unused medications in homes pose significant health, economic, and environmental risks. Patients are the medications end users and their knowledge, attitude, and practices (KAP) play an important role towards medication use, unuse and wastage. Thus, a valid instrument to reliably measure patients' KAP towards unused medications in homes may help manage the associated risks. OBJECTIVE: To develop, translate, and validate a questionnaire for the assessment patients' KAP towards unused medications in Qatar homes (i.e., QUM-Qatar). SETTING: This cross-sectional validation study was conducted among randomly selected outpatients visiting various public and private pharmacies in Qatar between September 2019 and February 2020. METHOD: Nine experts in the field of pharmacy practice with Qatar contextual background established the content validity of the instrument. The validity was quantified using content validity index (CVI). Furthermore, construct validity was performed using principal component analysis (PCA), whereas internal consistency reliability of items was determined using Cronbach's alpha. Statistical analyses were performed using STATA 15 statistical software. MAIN OUTCOME MEASURE: The psychometric properties of the QUM-Qatar assessment instrument. RESULTS: An English/Arabic questionnaire was developed and validated. Content validity in the form of scale-level-CVI (S-CVI)/Average and S-CVI/UA was 0.88 and 0.84, respectively, suggesting adequate relevant content of the questionnaire. Variation explained by the multivariate model was 85.0% for knowledge, 94.8% for attitude, and 89.8% for practice. Cronbach's alpha coefficients were 0.68, 0.82, and 0.84, for knowledge, attitude, and practice domains, respectively. From the psychometric results obtained, the questionnaire's validity and reliability were attained. CONCLUSION: The QUM-Qatar instrument has acceptable psychometric properties and has the potential for future use in research and practice to assess KAP towards unused medications in Qatar and elsewhere. It may consequently help in improving medication use and mitigating the negative health, economic, and environmental impacts of unused medications.Impacts on practice.•There is now a valid and reliable English/Arabic language questionnaire to assess patients' KAP towards unused medications.•Policymakers can utilize this questionnaire to develop evidence-based policies and strategies for managing unused medications and their disposal.•To improve medication use review, rational use of medicines, and adherence, it is necessary to consider patient-reported outcomes that may eventually reflect on saving health, economic resources, and environment

Professionalisation and social attitude: a protocol for measuring HIV/AIDS-related stigma among health care students.

Introduction HIV/AIDS-related stigma affects the access and utilisation of health services. Although HIV/AIDS-related stigma in the health services has been studied, little work has attended to the relationship between professional development and stigmatising attitudes. Hence, in this study, we will extend earlier research by examining the relationship between the stage of professional development and the kinds of stigmatising attitudes held about people living with HIV/AIDS. Methods and analysis A serial cross-sectional design will be combined with a two-point in time longitudinal design to measure the levels of stigma among healthcare students from each year of undergraduate and graduate courses in Malaysia and Australia. In the absence of suitable measures, we will carry out a sequential mixed methods design to develop such a tool. The questionnaire data will be analysed using mixed effects linear models to manage the repeated measures. Ethics and dissemination We have received ethical approval from the Monash MBBS executive committee as well as the Monash University Human Research Ethics Committee. We will keep the data in a locked filing cabinet in the Monash University (Sunway campus) premises for 5 years, after which the information will be shredded and disposed of in secure bins, and digital recordings will be erased in accordance with Monash University's regulations. Only the principal investigator and the researcher will have access to the filing cabinet. We aim to present and publish the results of this study in national and international conferences and peer-reviewed journals, respectively

Attitudes and beliefs of patients with chronic depression toward antidepressants and depression

BACKGROUND: 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. OBJECTIVES: The primary aim of this study was to determine the attitudes and beliefs of patients with depression toward depression and antidepressants. A secondary aim was to assess the influence of ethnicity on patients' attitudes and beliefs. PATIENTS AND METHODS: The study involved patients with chronic depression being followed up at an outpatient clinic at a government-run hospital in Malaysia. Patients' attitudes and beliefs were assessed using the Antidepressant Compliance Questionnaire. RESULTS: A total of 104 patients of Malay, Chinese, and Indian ethnic groups met the selection criteria. Chinese patients had significantly negative attitudes and beliefs toward depression and antidepressants compared to Malays and Indians (b=-8.96, t 103=-3.22; P<0.05). Component analysis revealed that 59% of patients believed that antidepressants can cause a person to have less control over their thoughts and feelings, while 67% believed that antidepressants could alter one's personality; 60% believed it was okay to take fewer tablets on days when they felt better, while 66% believed that antidepressants helped solve their emotional problems and helped them worry less. CONCLUSION: Patients had an overall positive view as to the benefits of antidepressants, but the majority had incorrect views as to the acceptable dosing of antidepressants and had concerns about the safety of the medication. Assessing patients' attitudes and beliefs, as well as the impact of their respective cultures, can be used in tailoring psychoeducation sessions accordingly

Complementary and Alternative Medicine versus Conventional Medicine Use in Thalassemia Patients

Background: This study explores thalassemia patients' perceptions concerning the effectiveness of conventional therapies for Thalassemia healthcare. Method: The semi-structured interviews were audiotaped, transcribed verbatim, and translated into English. Results: Nearly all thalassemia patients reported to have relied on conventional treatment methods to treat and reduce the severity of their disease. Few patients reported not to comply with their treatment procedures due to fear of infection through blood transfusion, surgery and organ failure. Conclusions: In conclusion, patients showed positive views about the conventional therapies carried out for Thalassemia. Keywords:: Thalassemia; qualitative; conventional; complementary and alternative medicine eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &amp; Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i16.266