Knowledge, Perceptions and Practices on Modified Release Tablets among Prescribers: A Preliminary Study

Introduction: Modified release tablets (MRTs) are developed to achieve different therapeutic outcomes and are frequently prescribed. This study aims to evaluate the knowledge, perceptions and practices on using MRTs among a selected cohort of prescribers. Methods: A self administered online survey was conducted using a pre-validated questionnaire, prepared in-house to assess knowledge, perceptions and practices on using MRTs, among academics with an MBBS degree in medical faculties of State universities in Sri Lanka. Results: The response rate was 15.5% among 375 prescribers. Most were females (53.4%) and were 46-55 years (29.3%). Over 50% correctly expanded abbreviations related to MRTs. Most defined enteric coated (87.9%) and targeted release (77.6%) forms accurately. However, 87.0% mixed-up definitions of sustained release with controlled release. Most believed that inability to split tablets (70.7%) and high cost (70.7%), as disadvantages of MRTs. Nearly half did not identify the risk of dose dumping (53.5%) and inflexible dosing schedule (44.8%) as disadvantages. For frequency of administering MRTs, 86.2% referred the product information leaflet (PIL) while 29.0% depended on the frequency of the corresponding immediate release tablet. Most (79.3%) prescribed MRTs to increase patient compliance while 12.1% prescribed them to reduce cost. When problems regarding MRTs were encountered, most referred PILs (81.0%) and clarified with experts (75.9%). Conclusions: Although the response rate was low, a clear gap in knowledge, perceptions and practices on using MRTs were identified among prescribers who responded. Interventions are needed to improve the knowledge, perceptions, and practices on using MRTs among prescribers.Keywords: Modified release tablets, Prescribers, Knowledge, Perceptions, Practice

Doctors and nurses perceptions towards the introduction of clinical pharmacy service to the Sri Lankan healthcare system- Experience from a tertiary care hospital

Objectives: To evaluate the rate of acceptance of the clinical pharmacist’s (CP’s) recommendations regarding Drug Related Problems (DRPs) by healthcare team, to determine the quality and quantity of drug information queries directed to the CP and to assess the level of acceptance of clinical pharmacy service (CPS) by other members of the ward staff.Methods: This was a controlled trial conducted in a tertiary care hospital. The control group received standard care. The intervention group received a CPS in addition to the standard care. DRPs were classified according to the adapted PCNE classification system V5.01. The CP discussed the identified potential DRPs with healthcare team. All the drug related questions directed to the CP by healthcare staff were recorded. A staff survey was carried out before and after the study.Results: A total of 270 drug related recommendations were directed to the healthcare team. 83% (P < 0.001) of the recommendations were accepted by doctors and 74% (P < 0.001) were acted upon. 17 medication-related questions were directed to the CP from the team. The perceptions of doctors regarding ward-based CPS were satisfactory at baseline period. At end of study, the majority of doctors were happy to welcome a service from a competent CP. Nurses were resistant to this collaboration.Conclusions: There was high acceptance of CP’s recommendations regarding DRPs by the medical team. Doctors were satisfied with the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaisons between CP and nursing staff

Impact of a ward based clinical pharmacy service on drug-related hospital re-admissions - Evidence from a controlled clinical trial in a tertiary care hospital in Sri Lanka

Objective: To determine the impact of a ward-based clinical pharmacy service on drug related hospital re-admissions.Methods: This was a part of a controlled trial conducted in a tertiary care hospital in Sri Lanka to evaluate the clinical pharmacy service. The control group received the standard care whereas the intervention group received a ward-based pharmacist’s service in addition to the standard care. The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during their hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions.Results: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the control group, and 44 (involving 42/361 patients) were from the intervention group (P < 0.001). Non-compliance was the main reason for re-admissions in the control group and it was significantly higher in the control group (control vs. intervention: 53.8% vs. 34.1%; P = 0.013). Adverse drug reactions were the most common reason for re-admission in the intervention group (23/44; 52.3%). There was a significantly larger percentage of re-admissions in the control group due to unintentional omission of drugs on discharge prescription (control vs. intervention: 17.2% vs. 2.3%; P = 0.012).Conclusion: Ward based clinical pharmacy service was useful to reduce drug related hospital re-admissions in patients with chronic non-communicable diseases. Establishing a ward based clinical pharmacy service is recommended