5 research outputs found
āļāļĨāļāļāļāļāļēāļĢāļāļąāļāļāļēāļĢāļāļđāđāļāļĩāđāđāļāđāļĢāļąāļāļĒāļēāļ§āļēāļĢāđāļāļēāļĢāļīāļāđāļāļĒāđāļ āļŠāļąāļāļāļĢ āļ āđāļĢāļāļāļĒāļēāļāļēāļĨāļĄāđāļŦāļŠāļ āļŠāļēāļāļēāļĢāļāļĢāļąāļāļāļĢāļ°āļāļēāļāļīāļāđāļāļĒāļāļĢāļ°āļāļēāļāļāļĨāļēāļ§ Effects of Pharmacist-Managed Warfarin Therapy at Mahosot Hospital, Lao PDR
āļāļāļāļąāļāļĒāđāļ āļ§āļąāļāļāļļāļāļĢāļ°āļŠāļāļāđ: āđāļāļ·āđāļāđāļāļĢāļĩāļĒāļāđāļāļĩāļĒāļāļāļĨāļĨāļąāļāļāđāļāļāļāļāļēāļĢāļāļąāļāļāļēāļĢāļāļđāđāļāđāļ§āļĒāļāļĩāđāđāļāđāļĢāļąāļāļĒāļēāļ§āļēāļĢāđāļāļēāļĢāļīāļāđāļāļĒāđāļ āļŠāļąāļāļāļĢāļāļąāļāļāļēāļĢāļāļđāđāļĨāđāļāļāļāļāļāļīāļāļĩāđāđāļāļāļāļāļđāđāļāđāļ§āļĒāļāļāļ āđāļĢāļāļāļĒāļēāļāļēāļĨāļĄāđāļŦāļŠāļ āļŠāļēāļāļēāļĢāļāļĢāļąāļāļāļĢāļ°āļāļēāļāļīāļāđāļāļĒāļāļĢāļ°āļāļēāļāļāļĨāļēāļ§ āļ§āļīāļāļĩāļāļēāļĢāļĻāļķāļāļĐāļē: āđāļāđāļāļāļēāļĢāļāļāļĨāļāļāđāļāļāļŠāļļāđāļĄāđāļĨāļ°āļĄāļĩāļāļĨāļļāđāļĄāļāļ§āļāļāļļāļĄ āļ āđāļāļāļāļāļđāđāļāđāļ§āļĒāļāļāļ āļĻāļđāļāļĒāđāļŦāļąāļ§āđāļāļĨāļēāļ§-āļĨāļąāļāđāļāļĄāđāļāļīāļĢāđāļ āļāļĨāļļāđāļĄāļāļąāļ§āļāļĒāđāļēāļāļāļ·āļ āļāļđāđāļāđāļ§āļĒāđāļāđāļĢāļąāļāļĒāļēāļ§āļēāļĢāđāļāļēāļĢāļīāļ 1 āđāļāļ·āļāļāļāļķāđāļāđāļ āđāļĨāļ°āļĢāļąāļāļĒāļēāļāđāļāļāļĩāļāļāļĒāđāļēāļāļāđāļāļĒ 4 āđāļāļ·āļāļ āļĄāļĩāļāļĨāļāļĢāļ§āļāļāđāļē INR āļāļļāļāļāļĢāļąāđāļāļāļĩāđāļĄāļēāļāļīāļāļāļēāļĄāļāļēāļĢāļĢāļąāļāļĐāļē āļāļđāđāļāđāļ§āļĒāļāļ°āļāļđāļāļŠāļļāđāļĄāđāļāđāļēāļāļĨāļļāđāļĄāļāļāļĨāļāļ (āļĄāļĩāđāļ āļŠāļąāļāļāļĢāļāļąāļāļāļēāļĢāļāļēāļĢāđāļāđāļĢāļąāļāļĒāļēāļ§āļēāļĢāđāļāļēāļĢāļīāļ) āđāļĨāļ°āļāļĨāļļāđāļĄāļāļ§āļāļāļļāļĄ (āļĢāļąāļāļāļēāļĢāļāļđāđāļĨāđāļāļāļāļāļāļī) āļ§āļąāļāļāļĨāļĨāļąāļāļāđāļāļēāļāļāļĨāļīāļāļīāļāđāļāđāđāļāđ āļāļĨāļĨāļąāļāļāđāļāđāļēāļāļāļĢāļ°āļŠāļīāļāļāļīāļ āļēāļ āļāļĢāļ°āļāļāļāļāđāļ§āļĒ 1) āļāđāļ§āļāđāļ§āļĨāļēāļāļĩāđāļāđāļēāđāļāđāļāđāļāļāļēāļĢāđāļāļĒāļđāđāđāļāļāđāļ§āļāļĢāļąāļāļĐāļē (TTR) 2) āļāđāļē INR 3) āļāļ°āđāļāļāļāļ§āļēāļĄāļĢāļđāđ 4) āļāļąāļāļŦāļēāļāļēāļāļāļēāļĢāđāļāđāļĒāļē (āļāļāļēāļāļĒāļēāļāđāļģāļāļ§āđāļēāļāļāļēāļāļāļĩāđāļāļ§āļĢāđāļāđāļĢāļąāļ āļāļāļēāļāļĒāļēāļŠāļđāļāļāļ§āđāļēāļāļāļēāļāļāļĩāđāļāļ§āļĢāđāļāđāļĢāļąāļāđāļĨāļ°āļāļāļīāļāļīāļĢāļīāļĒāļēāļĢāļ°āļŦāļ§āđāļēāļāļĒāļēāļ§āļēāļĢāđāļāļēāļĢāļīāļ) 5) āļ āļēāļ§āļ°āļĨāļīāđāļĄāđāļĨāļ·āļāļāļāļļāļāļāļąāļ 6) āļāļ§āļēāļĄāļĢāđāļ§āļĄāļĄāļ·āļāđāļāļāļēāļĢāđāļāđāļĒāļēāļāļāļāļāļđāđāļāđāļ§āļĒ āļŠāđāļ§āļāļāļĨāļĨāļąāļāļāđāļāđāļēāļāļāļ§āļēāļĄāļāļĨāļāļāļ āļąāļĒ āļāļ·āļ āļāļēāļāļēāļĢāđāļĄāđāļāļķāļāļāļĢāļ°āļŠāļāļāđāļāļēāļāļāļēāļĢāđāļāđāļĒāļē (āļāļēāļāļēāļĢāđāļĨāļ·āļāļāļāļāļāļāļāļīāļāļĢāļļāļāđāļĢāļ āļŦāļĢāļ·āļāļāļēāļāļēāļĢāđāļĨāļ·āļāļāļāļāļāļāļāļīāļāđāļĄāđāļĢāļļāļāđāļĢāļ) āļ§āļīāđāļāļĢāļēāļ°āļŦāđāļāđāļāļĄāļđāļĨāđāļāļĒāđāļāđāļŠāļāļīāļāļī student t-test, Mann-Whitney U test repeated-measure ANOVA test, Chi-squared test, Fisherâs exact test āđāļĨāļ° Cochranâs test āļāļĨāļāļēāļĢāļĻāļķāļāļĐāļē: āļāļđāđāļāđāļ§āļĒāđāļāđāļēāļĢāđāļ§āļĄāļāļēāļĢāļĻāļķāļāļĐāļēāļāļąāđāļāļŦāļĄāļ 72 āļāļ (āļāļĨāļļāđāļĄāļĨāļ° 36 āļāļ) āļāđāļē TTR āļāļāļāļāļđāđāļāđāļ§āļĒāđāļāļāļĨāļļāđāļĄāļāļāļĨāļāļāđāļāđāļēāļāļąāļ 63.3 Âą 35.5% āļāļķāđāļāļŠāļđāļāļāļ§āđāļēāļāđāļē TTR āđāļāļāļĨāļļāđāļĄāļāļ§āļāļāļļāļĄ (45.3 Âą 39.9%) āļāļĒāđāļēāļāļĄāļĩāļāļąāļĒāļŠāļģāļāļąāļāļāļēāļāļŠāļāļīāļāļī (P-value = 0.046) āļāļ°āđāļāļāļāļ§āļēāļĄāļĢāļđāđāļĢāļ°āļŦāļ§āđāļēāļāļāļĨāļļāđāļĄāļāļāļĨāļāļāđāļĨāļ°āļāļĨāļļāđāļĄāļāļ§āļāļāļļāļĄāļāļĩāđāļāļēāļĢāļāļīāļāļāļēāļĄāļāļĢāļąāđāļāļāļĩāđ 3 āļāđāļēāļāļāļąāļāļāļĒāđāļēāļāļĄāļĩāļāļąāļĒāļŠāļģāļāļąāļāļāļēāļāļŠāļāļīāļāļī (13.2 āđāļĨāļ° 7.0 āļāļēāļĄāļĨāļģāļāļąāļ, P-value = 0.013) āļāļąāļāļŦāļēāļāļēāļāļāļēāļĢāđāļāđāļĒāļēāļāļĩāđāļāļāļĄāļēāļāļāļĩāđāļŠāļļāļ āļāļ·āļ āļāļāļēāļāļĒāļēāļāđāļģāļāļ§āđāļēāļāļāļēāļāļāļĩāđāļāļ§āļĢāđāļāđāļĢāļąāļ (30 āļāļĢāļąāđāļāđāļāļāļĨāļļāđāļĄāļāļāļĨāļāļ) āđāļĨāļ°āļāļāļāļąāļāļŦāļēāļāļēāļāļāļēāļĢāđāļāđāļĒāļē āļ āļāļēāļĢāļāļīāļāļāļēāļĄāļāļĢāļąāđāļāļāļĩāđ 4 āđāļāļāļĨāļļāđāļĄāļāļāļĨāļāļāļāļģāļāļ§āļ 6 āļāļĢāļąāđāļāđāļĄāļ·āđāļāđāļāļĢāļĩāļĒāļāđāļāļĩāļĒāļāļāļąāļāļāļĨāļļāđāļĄāļāļ§āļāļāļļāļĄāļāļāļāļģāļāļ§āļ 15 āļāļĢāļąāđāļ āļŠāļĢāļļāļāļāļĨāļāļēāļĢāļĻāļķāļāļĐāļē: āļāļđāđāļāđāļ§āļĒāđāļāļāļĨāļļāđāļĄāļāļāļĨāļāļāļĄāļĩāļāļĨāļĨāļąāļāļāđāļāļĩāđāļāļĩāļāļ§āđāļēāđāļĄāļ·āđāļāđāļāļĢāļĩāļĒāļāđāļāļĩāļĒāļāļāļąāļāļāļĨāļļāđāļĄāļāļ§āļāļāļļāļĄ āļāļēāļĢāļāļąāļāļāļēāļĢāļāļēāļĢāđāļāđāļĢāļąāļāļĒāļēāļ§āļēāļĢāđāļāļēāļĢāļīāļāđāļāļĒāđāļ āļŠāļąāļāļāļĢāļŠāļēāļĄāļēāļĢāļāļāđāļ§āļĒāđāļāļīāđāļĄāļāļĨāļĨāļąāļāļāđāļāļēāļāļŠāļļāļāļ āļēāļāļāļāļāļāļđāđāļāđāļ§āļĒ āļāļķāđāļāļāļĨāļĨāļąāļāļāđāđāļŦāļĨāđāļēāļāļĩāđāļāļ°āļāļģāđāļāļŠāļđāđāļāļēāļĢāļāļąāļāļāļąāđāļāļāļĨāļīāļāļīāļāļ§āļēāļĢāđāļāļēāļĢāļīāļāđāļāļĒāđāļ āļŠāļąāļāļāļĢāđāļāļĢāļ°āļĒāļ°āļĒāļēāļ§āļāđāļāđāļ āļ āđāļĢāļāļāļĒāļēāļāļēāļĨāļĄāđāļŦāļŠāļ āđāļĨāļ°āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļ·āđāļ āđ āļāļģāļŠāļģāļāļąāļ: āđāļ āļŠāļąāļāļāļĢ, āļĒāļēāļ§āļēāļĢāđāļāļēāļĢāļīāļ, āļāđāļ§āļāđāļ§āļĨāļēāļāļĩāđāļāđāļēāđāļāđāļāđāļāļāļēāļĢāđāļāļĒāļđāđāđāļāļāđāļ§āļāļĢāļąāļāļĐāļē, TTR, āļāļ§āļēāļĄāļĢāļđāđAbstract Objective: To determine the effects of warfarin clinic serviced in patients receiving pharmacist-managed warfarin therapy and those receiving usual care at out-patient department, Mahosot Hospital, Lao PDR. Methods: A randomized controlled trial was conducted at the out-patient department, Lao Luxembourg heart center. To be eligible, patients had to receive warfarin for at least 1 month, continue warfarin for a minimum of 4 months, and have the INT result for each visit. Patients were randomized either to the pharmacist-managed warfarin therapy (control group) or the usual care (control group). Efficacy outcomes were 1) time in therapeutic range (TTR), 2) INR 3) knowledge scores 4) DRPs (sub-therapeutic dosage, over dosage, and drug interactions) 5) thromboembolism events 6) patient adherences. Safety outcomes were adverse drug reactions (major bleeding or minor bleeding). A student t-test, a Mann-Whitney U test, a repeated-measure ANOVA test, a Chi-squared test, a Fisherâs exact test and a Cochranâs test were used statistical analysis. Results: From a total of 72 patients (36 in each group),TTR was 63.3 Âą 35.5% in the test group and 45.3 Âą 39.9% in the control group with statistical significance (P-value = 0.046). Knowledge scores about warfarin therapy were significantly different between the test and control groups at 3rd visit (13.2 and 7.0 points, respectively, P-value = 0.013). The most common DRPs identified were sub-therapeutic dosage (30 cases in the test group). At 4th visit, 6 and 15 DRPs were found in the test and control groups, respectively. Conclusion: Patients receiving pharmacist-managed warfarin therapy had better outcomes than those receiving usual care. These results then lead to the long-run establishment of warfarin clinic led by pharmacist at Mahosot Hospital, and other hospitals. Keywords: pharmacists, warfarin, time in therapeutic range, TTR, knowledg
Prescribing Patterns and Drug Related Problems of Opioid Analgesics and Adjuvant Medications in Patients with End-stage Cancer Receiving Palliative Care Management at a Community Hospital
Objective: To determine prescribing pattern on opioids analgesics and adjuvant medications among patients with last-stage cancer receiving palliative care. Drug related problems (DRPs) and their causes, and factors potentially associated with the DRPs were also investigated. Methods: In this retrospective descriptive study, patients with end-stage cancer were selected. Data were collected from inpatient medical records, outpatient medical record and home visit record for 1 year. That were explored and evaluated drug related problem by The PCNE classifications v.7.0 then summarized and analyzed by descriptive statistics and Chi-square test at a significance level of P-value < 0.05. Results: There are 35 inpatients, the majority were male (21 cases or 60% of all patients) with an average age of 61.46 Âą 14.98 years. The most diagnosed disease was liver cancer. DRPs during in hospitalization were found with an average of 1.17 DRPs per patient. The most common DRP the effect of drug treatment not optimal (39.02% of all DRPs). The majority cause of DRPs was Inappropriate drug according to guidelines/formulary. At out-patient visits, DRPs were found with an average of 1.30 DRPs per patient.In home visits, an average of 1.16 DRPs per patient was found with most common cause of the effect of drug treatment not optimal. Pain level was significantly associated with having DRP during hospitalization (P-value = 0.046). Conclusion: DRPs were found among patients with terminal cancer receiving palliative care. The findings emphasized optimal medication management with pharmacist involvement. To relieve DRPs, guidelines for opioid analgesics and adjuvant medications management should developed. Such improvement could lead to a rational drug use. Keywords: drug related problem, palliative care, end-stage cancer, analgesics, prescribing patter
Improving the management of chronic pain using mixed methods and an analytical framework to make recommendations for improving services
Methods: Three research methodologies were used including a comprehensive literature review, a descriptive study and a qualitative study. A revised root cause analysis framework (consisting of four major steps) adapted and created by the researcher was also applied as an analytical framework to the whole research programme to facilitate the achievement of the aim and objectives. Results: Antidepressants were the most commonly prescribed drugs followed by a combination of paracetamol and weak opioids. Drug-drug interactions between antidepressants and opioids were the most common potential MRPs. Analgesic prescribing was independently associated with cause of pain and health-related quality of life. Pain level, cause of pain and health-related quality of life were independent significant factors for adjuvant prescribing. The poorer the health-related quality of life was, the greater the number of analgesics and adjuvant drugs that were prescribed. A model of pain medication taking behaviours was developed, and relationships between MRPs, pain medication taking behaviours and considerations of patientsâ perspectives on pain and pain medication taking were identified. Patient factors were the main root causes of complex MRPs.  A set of recommendations (for both GPs and pharmacists) and evidence-derived questions for primary care pharmacists were proposed to help reduce and prevent MRPs. Conclusion: An intervention based on the findings of this study, and related to the pharmacistâs roles and responsibility could ultimately help to improve pharmaceutical care services for people with chronic pain in primary care.EThOS - Electronic Theses Online ServiceGBUnited Kingdo