Impact of pharmacist-to-prescriber educational intervention on statin therapy prescribing for type 2 diabetes mellitus patients in selected Malaysian primary care setting

Introduction: Previous research reported suboptimal prescribing of statin therapy for patients with type 2 diabetes mellitus (T2DM). There is a lack of data about the evaluation of impact of pharmacist-led interventions to improve statin therapy prescribing among T2DM population in Malaysia. Objectives: To evaluate the impact of pharmacist-to-prescriber educational intervention on enhancing the overall appropriate statin therapy prescribing among T2DM patients in selected Malaysian primary care settings. Materials and Methods: This was a quasi-experimental design involving a total of 816 medical records from four primary care clinics. The records were distributed as 412 from two sites subjected to study intervention and 404 from control study sites. The intervention was an academic detailing program offered to the general practitioners in two primary care clinics focusing on improving statin therapy prescribing. Post-intervention data collection was performed three months later. A comparison of the overall percentage of appropriate statin therapy prescribing before and after the intervention was performed in all study sites. Results: The assessment of the impact of pharmacist-to-prescriber educational intervention in the intervention study sites has revealed a statistically significant improvement in the appropriate statin prescribing from 63.2% (129/204) pre-intervention to 77.9% (162/208) post-intervention, p = 0.002. Moreover, the appropriate statin prescribing in control study sites was increased insignificantly from 71% (142/200) pre-intervention to 73.5% (150/204), p = 0.551. Conclusion: The pharmacist-to-prescriber educational intervention showed a positive impact on improving statin therapy prescribing among patients with T2DM in selected Malaysian primary care settings

Smoking cessation problem-based learning: Virtual experience

Background and Objectives: Problem-based learning (PBL) is a student-centered teaching and learning methodology where students collaboratively address specific issues. Tobacco use is a major health issue globally. Health professions and students need to have knowledge and skills to facilitate smoking cessation. The objective of this study is to assess feasibility of PBL during a virtual attachment involving institutions from Malaysia and the USA. Methods: A 4-week smoking cessation virtual attachment was conducted for three third-year University of Pittsburgh, USA pharmacy students. Malaysian smoking cessation experts designed and facilitated a PBL smoking cessation module. It was split into two 2-hour sessions with 3 triggers; Trigger 1: ‘Chief Presentation’, Trigger 2: ‘History & Motivational Interview’, and Trigger 3: ‘Brief 5A’s Intervention’. Students received Trigger 1 a day earlier and discussed amongst themselves. In session 1, Triggers 1-3 were given sequentially and discussed after completing all tasks from each trigger. In session 2 one-week later, facilitators gave formative assessment and students provided reflection regarding the PBL session. Upon completing the four-week virtual attachment, students provided feedback and facilitators graded the students. Result and Discussion: A comprehensive and interactive PBL session was successfully conducted virtually. Based on the clinical practice guidelines of both countries, there were differences in terms of availability and use of cessation medications, but the general principles of smoking cessation consultation and interventions were similar. Students were able to discuss the case openly, putting forth ideas and questions in both sessions. All students provided positive feedbacks regarding the PBL. Conclusions: With the extensive development of online platforms connecting the world over, student virtual attachment and mobility programmes can be easily conducted with minimal cost. A suitable module embedding PBL can be designed and conducted to best suit the online platform and the intended students

Tobacco control education in pharmacy : from theory to practice.

Tobacco smoking is recognized as a major cause of preventable diseases and premature deaths worldwide. It is estimated that more than five million smokers die annually due to smoking related diseases globally (WHO, 2008), The death toll is expected to escalate to more than eight million deaths annually by 2030 if the current smoking patterns continue (Peto et aI., 1994). Almost half of the long-term smokers die of a smoking-related disease (Doll et aI., 1994). In Malaysia, about 10,000 Malaysians die every year from smoking attributable diseases, mainly cardiovascular, cancer and stroke (Ministry ofHealth, 2003)

Smoking cessation problem-based learning: Virtual experience

Background and Objectives: Problem-based learning (PBL) is a student-centered teaching and learning methodology where students collaboratively address specific issues. Tobacco use is a major health issue globally. Health professions and students need to have knowledge and skills to facilitate smoking cessation. The objective of this study is to assess feasibility of PBL during a virtual attachment involving institutions from Malaysia and the USA. Methods: A 4-week smoking cessation virtual attachment was conducted for three third-year University of Pittsburgh, USA pharmacy students. Malaysian smoking cessation experts designed and facilitated a PBL smoking cessation module. It was split into two 2-hour sessions with 3 triggers; Trigger 1: ‘Chief Presentation’, Trigger 2: ‘History & Motivational Interview’, and Trigger 3: ‘Brief 5A’s Intervention’. Students received Trigger 1 a day earlier and discussed amongst themselves. In session 1, Triggers 1-3 were given sequentially and discussed after completing all tasks from each trigger. In session 2 one-week later, facilitators gave formative assessment and students provided reflection regarding the PBL session. Upon completing the four-week virtual attachment, students provided feedback and facilitators graded the students. Result and Discussion: A comprehensive and interactive PBL session was successfully conducted virtually. Based on the clinical practice guidelines of both countries, there were differences in terms of availability and use of cessation medications, but the general principles of smoking cessation consultation and interventions were similar. Students were able to discuss the case openly, putting forth ideas and questions in both sessions. All students provided positive feedbacks regarding the PBL. Conclusions: With the extensive development of online platforms connecting the world over, student virtual attachment and mobility programmes can be easily conducted with minimal cost. A suitable module embedding PBL can be designed and conducted to best suit the online platform and the intended students

Evaluating effectiveness and safety toward electronic cigarette among Malaysian vapers: One-month observational study

Objective: Electronic cigarette (e‑cig) is recently growing substitute for smoking. The attention and practice of e‑cig among consumers is expanded globally, and Malaysia is not an exception to this, but the paucity of local data motivates us to do the current research. Methods: A total of 220 e‑cig vapers recruited for the study and divided into two categories based on smoking status as a single user and dual user. Both users observed for 1 month period to assess smoking cessation rate, adverse effects, withdrawal symptoms, and smoking‑related diseases. Results: A month follow‑up showed still 28.44% (P ≤ 0.001) of the entire study population (62 of 218, intention to treat analysis) were abstained from tobacco smoking. However, a high number of single user shown more quit rate as compared to of dual users (72.9% [51] vs. 7.4% [11]: Odds ratio 33.43; 95% confidence interval: 0.102–3.410) and merely two persons (<1%) started e‑cig by ever smokers. The key adverse effects and withdrawal symptoms that observed in dual users were coughing, breathing problems, and craving, whereas in single users high appetite cases documented; however, no cases of any diseases reported among both users during the whole study period. Conclusion: A month follow‑up showed a good smoking cessation rate among Malaysian vapers mainly in single users, whereas less number of quitters but the high reduction in tobacco cigarette consumption observed in dual users without any harmful effects. Furthermore, extended period studies are warranted to confirm its long‑term safety and effectiveness among different Malaysian population

Influence of hospitalization on potentially inappropriate prescribing among elderly patients in a Malaysian community

Purpose: To compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) on admission and discharge of patients, and to determine the associated predictors. Methods: This was a prospective observational study conducted in the multidisciplinary medical and surgical units of Hospital Tengku Ampuan Afzan (HTAA), Malaysia. The medications of patients who had been admitted to the hospital from community-dwelling settings were reviewed to identify PIMs/PPOs using version 2 of STOPP/START criteria. A logistic regression model was applied to detect the risk factors associated with PIM or PPO at discharge. Results: Among the 300 patients involved in the study, the prevalence of PIMs was 27 % upon admission, which decreased to 22.3 % at discharge (p = 0.014) with PIMs pertaining to increasing the risk of physical falls in elderly people being the most common for pre- and post-hospitalization. The prevalence of PPOs was 47.6 % upon admission, which increased to 48 % at discharge (p = 0.99), with the omission of musculoskeletal medications being the most common PPOs at admission and discharge. Having a PIM at discharge was associated with the number of discharge medications and the history of falls, whereas having a high comorbidity index score or history of falls was associated with having a PPO at discharge. Conclusion: Hospitalization significantly reduces the prevalence of PIMs, but not PPOs or polypharmacy, among elderly patients. The number of discharge medications and the history of falls are predictors of discharge PIM, whilst high comorbidities and the history of falls were the predictors of discharge PPO. Improving the knowledge of hospital practitioners regarding geriatric pharmacotherapy is required to optimize prescribing in elderly patients during hospitalization

Vape and the society: should it be encouraged, discouraged, or prohibited?

Vape, also known as electronic cigarettes, have become very popular globally especially among young people. In some countries vaping has been encouraged even by the health authorities and regarded as less harmful than conventional cigarettes; hence recommended to cigarette smokers for quitting. However, such view is not universally accepted. Emerging studies demonstrated negative consequences of vaping. In Malaysia there is lacuna in law regarding sale and purchase of vape. Subsequently, no protection is afforded to people against the negative impact of vaping. To determine whether there should be regulations on vape we need to examine the positive and negative aspects of vaping based on medical and scientific studies. This paper will provide evidence, views and arguments from those who promote, and support vape versus those who are against, followed by legal study on sale of vape in Malaysia focusing on consumer protection. Policy, law and experience of selected countries on vape issues are also included as it will give inputs for the authority of this country to formulate its own stand on this matter