Journal of Pharmacy (JOP)
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An overview of the hospitals’ antimicrobial stewardship programs implemented to improve antibiotics’ utilization, cost and resistance patterns
No full textIntroduction: The high reliance of the physicians and surgeons on the antibiotics since their discovery has led to an irrational antibiotic utilization which not only has raised the incidence of antimicrobial resistance (AMR) but also increased the cost of treatment with antibiotics as high use of antibiotics has been found related to the occurrence of certain nosocomial infections which need extra antibiotic courses to be cured. In order to overcome these antibiotic utilization related problems an antimicrobial stewardship (AMS) program being the set of various persuasive, restrictive and structural interventions is considered an effective tool to rationalize the in-patient antimicrobial utilization worldwide.
Method: The focus of this review is on the interventions that are being implemented during the in-patient AMS programs and have been described effective in controlling the antibiotic utilization, their cost of treatment and an overall infection control. The literature containing the information about various AMS interventions effecting the utilization and cost patterns along with the impact on AMR was searched in various databases such as PubMed, Google Scholar, Science Direct, Ovid (Medline) and Scopus. The categorical sorting of the published data is based on various AMS interventions such as the guideline development, formulary restriction (pre-authorization), educative interventions, clinical pathway development and prospective (post prescription) audit. Considering the objectives of the study such as the goal to curb overutilization of antibiotics, control of their cost of treatment for in-patients and infection control the sorted literature is presented in three different tables describing the AMS impact on the said outcomes.
Results: The post AMS changes in utilization patterns are described as fall of antibiotics defined daily doses (DDD) and days of therapy (DOT) which resulted in the reduction of the cost of treatment with antibiotics. The reduction of the cost of treatment with antibiotics also resulted due to the AMS impact on the control of various nosocomial and multi-drug resistant (MDR) infections.
Conclusion: It has been concluded that the AMS program if implemented under the supervision of an expert AMS team mainly comprising of an infectious disease (ID) physician, clinical pharmacists and microbiologists with considerable support by the hospital authorities could be a highly efficient tool of the pharmacovigilance for rationalizing the in-patient antimicrobial practice
The Mortality and its Related Factors among HIV Positive People Who Inject Drugs (PWID) in Malaysia.
No full textIntroduction: People who inject drugs (PWID) has long been associated with HIV transmission in the community. In Malaysia, the government has adopted Methadone Maintenance Therapy (MMT) Program since 2006 as one of the harm reduction approaches to reduce the HIV seroprevalence rates. In many countries, MMT has been regarded as a critical platform to ensure HIV positive PWIDs receive appropriate antiretroviral treatment. Abstinent patients, however, may also enrol to the Infectious Disease Clinic in the tertiary public hospital. Despite treatment, mortality was nevertheless quite extensively observed in the population, and the contributing factors are still scarcely investigated. This study aimed to investigate the factors affecting mortality among HIV positive PWID from Malaysia's two mainstream treatment settings.
Method: This was a retrospective cohort study where the data was collected from one HIV Clinic of a tertiary hospital and six (6) MMT programs of primary care clinics in the district of Kuantan, Pahang from 2006-2019. The patients were categorised into three different subgroups. The mortality was recorded throughout until the end of the study period. The survival rate was analysed using one-way ANOVA, and the associated factors were analysed using Cox proportional hazard regression analysis.
Results: In total, 141 records were found to have met the inclusion and exclusion criteria. There were 15 HIV-related mortalities recorded throughout the study period. Patients who were started on ART and received ART counselling were associated with protective factors for mortality of all PWID in the study. Among those who have initiated with ART, the time to treatment initiation was the crucial and significant factor for survival.
Conclusion: In conclusion, ART initiation has significantly contributed to HIV positive PWID survival, and the sooner it's started can significantly improve the mortality rate among them.
Wound contraction and epithelisation effects of Acrostichum aureum L. in rabbits
Get PDFIntroduction: Rhizomes paste from Acrostichum aureum Linné was used traditionally by Malays ethnic groups in Malaysia for wound healing treatment. To evaluate wound healing properties of aqueous and ethanolic extract of A. aureum on rabbits. Materials and methods: There were four treatments namely aqueous extracts of rhizomes, leaves and stems A. aureum with low and high dose (5 % and 10 %). There were four rabbits in three treatment groups with each individual were inflicted with excisional wounds on their back near the neck with 6 mm in diameter. Topical treatment was applied once daily until complete healing with Solcoseryl jelly served as positive control group and blank aqua cream served as negative control group. The percentage period of epithelisation and wound contraction were measured every 3 days interval. At day 15, all healed wound specimens were biopsied and stained with Masson’s trichrome staining for histopathological study. Results and discussion: From the results, all extracts from A. aureum possessed tannins and total tannin content showed that ethanolic extracts had higher total tannin content compared to aqueous extracts. Based on percentage wound contraction and epithelisation period, the treatment with 5 % aqueous extracts of leaves A. aureum was the most effective wound healing agent in enhancing higher percentage wound contraction, rapid epithelisation period, producing more collagens and fibroblasts proliferation. Conclusion: It was suggested that wound healing properties of rhizomes and leaves A. aureum was contributed by its high total tannin content. This finding would be able to justify its traditional claim as wound healing treatment by Malays communities in Malaysia
Validity of claims database compared with electronic medical record of private health clinics in Malaysia: A Pilot Study.
Get PDFIntroduction: The validity of health insurance claims data in private health sectors has been widely reported in many developed countries to monitor details of private healthcare utilisation. Little is known regarding the data validity of private health care services and insurance claims in Malaysia. This pilot study aimed to validate the claims data from a private health insurance database, using electronic medical records (EMR) at the private clinics as the gold standard.
Materials and methods: Patients’ data were retrieved from the PMCare health insurance database from 2016-2019 recorded for International Islamic University Malaysia employees. Patients were sampled from the PMCare database and manually compared with data from EMR of selected private panel clinics. Data were analysed for descriptive statistics using Microsoft Excel 2013.
Results: A total of four panel clinics consented to the study, and data were available for 2016, 2017 and 2019. The number of observations obtained from 118 patients (male = 63, female = 55) was 386, with the most common diagnosis reported in the PMCare database was acute upper respiratory tract infection (63.6%). Total accuracy between PMCare and EMR data was 91.5%, with an 8.5% difference or inaccuracy. Percentage accuracy was varied between different clinics (A= 92.6%, B=84.7%, C=98.6%, D=82.6%).
Conclusion: Data submitted to PMCare claims by private health clinics had high accuracy (>90%) and is acceptable for research and other applications. Future studies should investigate the differences in clinic-based practice for documenting the identified types of discrepancies to improve the accuracy of private health insurance databases
Prescribing Practices of Antibiotics for Acute Diarrhea in Children Aged Less than Five Years Old in Pakistan
Get PDFIntroduction: Childhood diarrhea accounts for 16% of child deaths in Pakistan. Irrational prescribing of antibiotics, prescribing of antibiotics for viral infections, self-medication using antibiotics, prescription sharing, and refilling are very common practices in Pakistan. The aim of this study was to evaluate the prescribing practices of antibiotics for acute diarrhea in children less than five years of age at a Secondary Healthcare Hospital of Pakistan and to assess the compliance of prescribers with authentic clinical guidelines of treatment for childhood acute diarrhea.
Method: A cross-sectional study was conducted for a period of one year, from August 2020 to August 2021, at a Secondary Care Hospital of Karachi, Pakistan. It was based on the collection of outpatient clinic prescriptions of children aged less than five years and suffering from acute diarrhea. The regimens or suggested therapies by prescribers for acute diarrhea were assessed as per The National Institute of Care and Health Excellence and World Health Organization guidelines. A brief questionnaire was also distributed among prescribers, pharmacists, and caretakers of children to extract their opinions regarding antibiotic prescribing in acute diarrhea.Results: Antibiotics were inappropriately prescribed for acute diarrhea among children in Pakistan because p-value was less than 0.05 (p<0.05) as calculated by descriptive statistical tools using Z-test. More than 90% prescriptions of acute diarrhea in children less than five years of age failed to comply with the authentic treatment guidelines.Discussion: Due to the limited knowledge of prescribers regarding treatment guidelines and compliance of parents with antibiotic prescribing for diseases in children, irrational prescribing of antibiotics for acute diarrhea in children less than five years of age is frequent in Pakistan. Healthcare professionals must be adequately trained to ensure the proper management of acute diarrhea by following authentic clinical guidelines.
Conclusion: Antibiotics are irrationally prescribed for acute diarrhea in children less than five years of age in Pakistan and prescriptions do not comply with authentic clinical guidelines
Knowledge, Attitude, and Practice Towards Antibiotic Use Among the Public in the City of Kuantan, Pahang State, Malaysia.
Get PDFBackground: Public knowledge and attitudes towards antibiotic use play a vital role in the success of controlling antibiotic resistance. This study aimed to assess the public’s knowledge, attitudes, and practice (KAP) towards antibiotic use in Kuantan, Malaysia.
Methods: This cross-sectional study was conducted among the general public above 18 years old. The data was collected in public places using a pre-validated questionnaire. Software Statistical Package for Social Sciences (SPSS) was used for statistical analyses.
Results: Out of 410 participants who answered the questionnaire, 229 (55.9%) of them were female and 288 (70.3%) had a college/university degree. It was found that 258 participants (62.9%) have good knowledge and 306 of them (74.6%) have positive attitude towards antibiotic use. However, 160 respondents (39%) believe that antibiotics can kill viruses and 183 respondents (44.6%) stated that they would ask the doctor to give them antibiotics in case they have common cold symptoms. Having a good knowledge was significantly related to the age (P=0.005), employment status (P<0.001), education level (P<0.001), and the field of work or study (P<0.001). Furthermore, 313 of the sample (76.3%) had an overall good practice. However, 162 participants (39.5%) do not complete their antibiotic course. Additionally, 57 participants (13.9%) share and 69 of them (16.8%) use the leftover antibiotics. Showing a good practice correlated to the field of work/study (P =0.04), level of knowledge (Spearman's rho = 0.373; P<0.001) and attitude (Spearman's rho = 0.55; P<0.001).
Conclusion: Although the majority of the public showed good KAP, there are still important gaps that need to be filled. Therefore, a public educational campaign is needed to improve the knowledge, attitude and practice towards antibiotic use
Perception towards Insulin Therapy and Factors Related to Insulin Refusal among Insulin Naive Type 2 Diabetes Mellitus Patients in Primary Care Clinics PKD Lipis
Get PDFIntroduction: Insulin is one of the suggested treatments to prevent and reduce long-term diabetes complications. However, due to many factors such as socio-demographic factors, many Type 2 diabetes mellitus patients refuse this treatment. This study aimed to determine perception towards insulin among naive Type 2 diabetes mellitus patients, to calculate the prevalence of rejecting insulin therapy, and to find out factors related to the refusal.
Materials and methods: This cross-sectional study involved 188 insulin naive Type 2 diabetes mellitus patients attending five primary health clinics in Lipis district, Pahang from October to November 2017. A five-point Likert Scale was used to determine perception towards insulin therapy and the Chi-square test was used to assess the proportion of acceptance of the therapy. Simple and multiple logistic regressions were utilised to study the associated factor(s).
Results: Mean score of 60.5 ± 8.2 pointed towards a negative appraisal of insulin therapy. Embarrassment to inject in public (69.1%) and concern of frequent hypoglycaemia (52.7%) were the most common perception. Nearly half of the respondents (46.3%) refused insulin therapy upon suggestion. After adjusting the variables using multiple logistic regressions, only gender (Adjusted OR=0.20, 95% CI=0.10-0.40, p<0.001), educational level (Adjusted OR=0.17, 95% CI=0.06-0.50, p=0.001), age (Adjusted OR=1.04, 95% CI=1.01-1.08, p=0.012) and glycated haemoglobin level (Adjusted OR=1.33, 95% CI=1.07-1.67, p=0.013) remained significant.
Conclusion: In conclusion, insulin refusal among insulin naive patients was common in Lipis with an overall negative perception towards therapy. By tailoring strategies according to the patient’s factors such as gender, educational level, age, and glycated haemoglobin level, the insulin refusal rate might decrease in the future
Assessment of medication adherence and quality of life among patients with type 2 diabetes mellitus in a tertiary hospital in Kelantan, Malaysia
Get PDFIntroduction: Previous studies have reported the relationship between medication adherence and quality of life are interrelated. However, many of the results were found to be conflicting. This study aimed to assess the level and association of medication adherence and quality of life among type 2 diabetes mellitus patients in Raja Perempuan Zainab II Hospital, Kelantan, Malaysia.
Materials and methods: A cross-sectional survey was conducted among adult type 2 diabetes mellitus patients on treatment for over 1 year using convenience sampling at outpatient. Medication Compliance Questionnaire (MCQ) and revised Diabetes Quality of Life Questionnaire (DQOL) instrument were self-administered to eligible subjects. Data were analysed using GNU PSPP version 0.8.5 and reported for descriptive statistics as well as correlation of both parameters.
Results: A total of 200 patients were recruited and they were mostly at the age of 40 to 60 years old. The mean (SD) score for MCQ was 26.0 (1.6) with the majority of them were non-adherent (55.0%, n=110). The mean (SD) score for overall revised DQOL instrument was 25.5 (8.9) while each domain of “satisfaction”, “impact” and “worry” had mean (SD) scores of 12.0 (5.0), 7.7 (3.4) and 5.9 (2.7), respectively. The scores obtained were only approximately half of the possible range of scores for QoL. There was no significant correlation between total score of medication adherence and quality of life when tested using Pearson’s correlation (r=-0.083, p=0.240). Independent t-test also demonstrated no significant relationship between medication adherence status and quality of life (p=0.883).
Conclusion: Type 2 diabetes mellitus patients in our setting had unsatisfactory adherence but exhibited acceptable quality of life. We observed that both variables were not associated with one another. Further research is warranted to identify potential factors affecting non-adherence to medication
Experiential education as a strategy to preserve Maqasid Al-Shariah by identifying and addressing stigmatic views held by pharmacy students of patients with substance use disorders.
Get PDFoai:ojs2.journals.iium.edu.my:article/9Introduction: Stigmatising people with a history of substance use disorders (PHSUDs) is discriminatory, causes harm by hindering access to health services and promotes relapse. It jeopardises the preservation of Maqasid Al-Shariah, particularly the protection of life and well-being. Experiential education (EE) is a potential strategy to overcome stigma through direct experience with PHSUDs. This study aimed to identify stigmatised views of PHSUD's held by pharmacy students and, in accord with Maqasid Al-Shariah, the effectiveness of EE in changing those views.
Materials and methods: Interviews were conducted with seven undergraduate pharmacy students who provided care to PHSUDs through an EE programme. A semi-structured interview guide was used to explore students' perceptions on stigma. Each interview was audio-taped, transcribed verbatim and translated into English. Data were manually sorted and coded using Microsoft Excel 2016 and subjected to thematic analysis.
Results: The following themes related to stigma were identified: 1) individuals are to blame 2) moral versus biological views of addiction 3) stereotypes of unpredictability and dangerousness 4) lack of didactic education/training for pharmacy students regarding PHSUDs and 5) lack of face-to-face experiential education with PHSUDs. Less stigma and greater empathy towards PHSUDs were reported post-intervention attributable to increased knowledge about substance abuse and face-to-face interactions with PHSUDs.
Conclusion: Pharmacy students have pre-conceived stigmatic views regarding PHSUDs modifiable through experiential education. Contact by pharmacy students with stigmatised patients promotes health care without discrimination as advocated in the teaching of Islam. Future interventions to reduce stigma are required to preserve Maqasid Al-Shariah
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS): knowledge, perception, and attitude among pharmacists in Kelantan, Malaysia.
Get PDFIntroduction: Although pharmacists’ role in the care of human immunodeficiency virus (HIV)-infected and acquired immunodeficiency syndrome (AIDS) patients is well established, studies had reported pharmacists’ negative attitudes towards people living with HIV/AIDS (PLWHA), with negative impact on HIV management. This study aimed to explore pharmacists’ knowledge of HIV/AIDS, perception towards the changing of treatment regimens of HIV/AIDS, attitudes towards PLWHA, and to identify factors affecting the pharmacists’ attitudes towards PLWHA in the state of Kelantan, which reportedly have the third highest number of HIV/AIDS patients in Malaysia.
Materials and method: A validated online 43-item questionnaire was distributed to 400 pharmacists in Kelantan. Multivariate logistic regression was performed to identify factors associated with pharmacists’ negative attitude towards PLWHA.
Results: A total of 170 respondents (response rate 42%) completed the questionnaire. Respondents had knowledge on the potential causes of HIV infection [median(IQR) score=13.00(1); maximum score=14.00], and preventive measures of HIV/AIDS transmission [median(IQR) score=12.00(1); maximum score=12.00]. On decision in changing regimens, the respondents agreed on the need to change treatment regimen for HIV/AIDS when required [median(IQR) score=7.00(2); maximum score=8.00]. Up to 40.6% of respondents thought that the treatment regimen should not be switched based on cost. Two-thirds of the respondents had negative attitudes towards PLWHA (67.1%). Respondents who worked in community pharmacy reported positive attitudes towards PLWHA (Adj OR=0.125; 95%CI=0.025-0.623; p=0.011).
Conclusion: Pharmacists in Kelantan had several misconceptions towards the causes of HIV/AIDS, preventive measures of HIV/AIDS transmission, and necessity in changing treatment regimen when required. Despite good disease related knowledge, most pharmacists had negative attitudes towards PLWHA, while pharmacists working in community settings presented more positive attitudes towards PLWHA