Utilisation of non-steroidal anti-inflammatory drugs (NSAIDs) through community pharmacies in Malaysia

This study was conducted to evaluate the use of non-steroidal anti-inflammatory drugs (NSAIDs) by consumers who obtained these drugs from community pharmacies. Factors that influenced community pharmacists in their choice of NSAIDs were also determined. Personal interviews were conducted on consumers who visited the 25 participating community pharmacies throughout Malaysia. Of the 389 respondents, 49 requested for an NSAID by name, 42 asked the pharmacist to recommend a medication and 9 had a doctor's prescription. NSAIDs were mainly purchased for joint/shoulder pain and the most commonly dispensed was diclofenac. Elderly respondents were more likely to be dispensed a selective COX-2 inhibitor than those below 60. NSAIDs were recommended based mainly on the pharmacist's perception of their efficacy, cost and safety. Community pharmacists play an important role in assisting patients in choosing the most appropriate NSAID for their health problems

Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia

Nur Sufiza Ahmad,1 Azuana Ramli,1 Farida Islahudin,2 Thomas Paraidathathu21Pharmaceutical Services Division, Ministry of Health, Petaling Jaya, Malaysia; 2Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaPurpose: Diabetes mellitus is a growing global health problem that affects patients of all ages. Even though diabetes mellitus is recognized as a major chronic illness, adherence to antidiabetic medicines has often been found to be unsatisfactory. This study was conducted to assess adherence to medications and to identify factors that are associated with nonadherence in type 2 diabetes mellitus (T2DM) patients at Primary Health Clinics of the Ministry of Health in Malaysia.Materials and methods: The cross-sectional survey was carried out among T2DM patients to assess adherence to medication in primary health clinics. Adherence was measured by using the Medication Compliance Questionnaire that consists of a total of seven questions. Other data, such as patient demographics, treatment, outcome, and comorbidities were also collected from patient medical records.Results: A total of 557 patients were recruited in the study. Approximately 53% of patients in the study population were nonadherent. Logistic regression analysis was performed to predict the factors associated with nonadherence. Variables associated with nonadherence were age, odds ratio 0.967 (95% confidence interval [CI]: 0.948–0.986); medication knowledge, odds ratio 0.965 (95% CI: 0.946–0.984); and comorbidities, odds ratio 1.781 (95% CI: 1.064–2.981).Conclusion: Adherence to medication in T2DM patients in the primary health clinics was found to be poor. This is a cause of concern, because nonadherence could lead to a worsening of disease. Improving medication knowledge by paying particular attention to different age groups and patients with comorbidities could help improve adherence.Keywords: type 2 diabetes mellitus, adherence, glycemic control, primary car

Chronic care model in primary care: can it improve health-related quality of life?

Faridah Md Yusof Aryani,1 Shaun Wen Huey Lee,2 Siew Siang Chua,3 Li Ching Kok,4 Benny Efendie,2 Thomas Paraidathathu5 1Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, 2School of Pharmacy, Monash University Malaysia, Bandar Sunway, 3Department of Pharmacy, Faculty of Medicine, University of Malaya, 4Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, 5School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Purpose: Chronic diseases such as hypertension, diabetes mellitus, and hyperlipidemia are public health concerns. However, little is known about how these affect patient-level health measures. The aim of the study was to examine the impact of a chronic care model (CCM) on the participant’s health-related quality of life (QoL). Patients and methods: Participants received either usual care or CCM by a team of health care professionals including pharmacists, nurses, dietitians, and general practitioners. The participants in the intervention group received medication counseling, adherence, and dietary advice from the health care team. The QoL was measured using the EQ-5D (EuroQoL-five dimension, health-related quality of life questionnaire) and comparison was made between usual care and intervention groups at the beginning and end of the study at 6 months. Results: Mean (standard deviation) EQ-5D index scores improved significantly in the intervention group (0.92±0.10 vs 0.95±0.08; P≤0.01), but not in the usual care group (0.94±0.09 vs 0.95±0.09; P=0.084). Similarly, more participants in the intervention group reported improvements in their QoL compared with the usual care group, especially in the pain/discomfort and anxiety/depression dimensions. Conclusion: The implementation of the CCM resulted in significant improvement in QoL. An interdisciplinary team CCM approach should be encouraged, to ultimately result in behavior changes and improve the QoL of the patients. Keywords: diabetes mellitus, hypertension, hyperlipidemia, quality of life, EQ-5

Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings

BACKGROUND: The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. METHODS: This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. RESULTS: Of the 477 participants, 53.7 had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3), insufficient awareness and knowledge about disease condition and medication (20.4), adverse drug reactions (15.6), therapeutic failure (13.9), drug-choice problems (9.5) and dosing problems (3.4). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52) were classified as probably clinically insignificant, 38.9 with minimal clinical significance, 8.9 as definitely clinically significant and could cause patient harm while one issue (0.2) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3 were carried out as recommended. CONCLUSIONS: This study demonstrates the importance of pharmacists working in collaboration with other healthcare providers especially the medical doctors in identifying and resolving pharmaceutical care issues to provide optimal care for patients with chronic diseases