A.A. Shafie

Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something?

BACKGROUND Despite evidence of an association between tuberculosis (TB) treatment outcomes and the performance of national tuberculosis programmes (NTP), no study to date has rigorously documented the duration of treatment among TB patients. As such, this study was conducted to report the durations of the intensive and continuation phases of TB treatment and their predictors among new smear-positive pulmonary tuberculosis (PTB) patients in Malaysia. STUDY DESIGN Descriptive, non-experimental, follow-up cohort study. METHODS This study was conducted at the Chest Clinic of Penang General Hospital between March 2010 and February 2011. The medical records and TB notification forms of all new smear-positive PTB patients, diagnosed during the study period, were reviewed to obtain sociodemographic and clinical data. Based on standard guidelines, the normal benchmarks for the durations of the intensive and continuation phases of PTB treatment were taken as two and four months, respectively. A patient in whom the clinicians decided to extend the intensive phase of treatment by ≥2 weeks was categorized as a case with a prolonged intensive phase. The same criterion applied for the continuation phase. Multiple logistic regression analysis was performed to find independent factors associated with the duration of TB treatment. Data were analyzed using Predictive Analysis Software Version 19.0. RESULTS Of the 336 patients included in this study, 261 completed the intensive phase of treatment, and 226 completed the continuation phase of treatment. The mean duration of TB treatment (n = 226) was 8.19 (standard deviation 1.65) months. Half (49.4%, 129/261) of the patients completed the intensive phase of treatment in two months, whereas only 37.6% (85/226) of the patients completed the continuation phase of treatment in four months. On multiple logistic regression analysis, being a smoker, being underweight and having a history of cough for ≥4 weeks at TB diagnosis were found to be predictive of a prolonged intensive phase of treatment. Diabetes mellitus and the presence of lung cavities at the start of treatment were the only predictors found for a prolonged continuation phase of treatment. CONCLUSIONS The average durations of the intensive and continuation phases of treatment among PTB patients were longer than the targets recommended by the World Health Organization. As there are no internationally agreed criteria, it was not possible to judge how well the Malaysian NTP performed in terms of managing treatment duration among PTB patients.

Cost-Effectiveness of Clinical Pharmacy Education on Infection Management among Patients with Chronic Kidney Disease in an Indonesian Hospital

OBJECTIVES This study evaluated the clinical and economic impacts of clinical pharmacy education (CPE) on infection management among patients with chronic kidney disease (CKD) stages 4 and 5 in Haji Adam Malik Hospital, Indonesia. METHODS A quasi-experimental economic evaluation comparing CPE impact on 6-month CKD mortality was conducted on the basis of payer perspective. The experimental group (n = 63) received care by health care providers who were given CPE on drug-related problems and dose adjustment. The control group (n = 80) was based on the historical cohort of patients who received care before the CPE. Measure of clinical outcome applied in this study was number of lives saved/100 patients treated. Cost-effectiveness ratios for CKD stages 4 and 5 patients without CPE and with CPE and incremental cost-effectiveness ratios (ICERs) for CKD stages 4 and 5 patients were analyzed. RESULTS Lives saved (%) in the treatment of CKD without CPE: CKD stage 4, 78.57; CKD stage 5, 57.58. Lives saved (%) in the treatment of CKD with CPE: CKD stage 4, 88.89; CKD stage 5, 65.45. Cost-effectiveness ratios for stage 4 with and without CPEs were Rp3,348,733.27 and Rp3,519,931.009, respectively. Cost-effectiveness ratios for stage 5 with and without CPEs were Rp7,137,874.93 and Rp7,871,822.27, respectively. ICERs were Rp2,045,341.22 for CKD stage 4 and Rp1,767,585.60 for CKD stage 5. CONCLUSIONS Treatment of CKD stages 4 and 5 with CPE was more effective and cost-effective compared with treatment of CKD stages 4 and 5 without CPE. The ICERs indicated that extra costs were required to increase life saved in both stages.

Steps in Conducting an Economic Evaluation

Abstract This chapter outlines economic evaluation tools and steps in conducting an economic evaluation. This also narrate relevant case studies in hospital and community pharmacy settings. The three most common economic evaluation tools are cost-effectiveness analysis, cost–utility analysis, and cost–benefit analysis. Each of these differ by the nature of the measured consequences. There are generally four sequential steps to conduct an economic evaluation. First, researchers need to establish the research question. The alternatives to be compared to the existing treatment, and the perspective from which the comparison is to be made, have to be identified first. Second, the study design has to be determined. Economic evaluation can be designed either alongside a trial or through simulation model. Third, researchers have to identify, measure, and value the costs and consequences that are related to the alternatives in comparison. Following that is to analyze the data obtained in the third step, in order to know the efficiency of the alternative(s) compared to the existing treatment. If the incremental analysis of both cost and consequences shows that an alternative is cheaper and more effective than the comparator or if an alternative is more expensive and less effective than the comparator, or even if an alternative is cheaper and less effective than the comparator, then there would be no question of the alternative’s efficiency. Only when an alternative is more expensive yet more effective than the comparator it is important to explore the additional cost to gain an extra unit of outcome. This is achieved by calculating the ICER, and the efficiency can then be concluded by comparing the ratio against the external criteria such as threshold.

The Prevalence of Tobacco Smoking in Patients With Diabetes in Hospital Pulau Pinang, Malaysia.

RESULTS The majority of the study population was male (95.2%), with Malay and Chinese patients in almost equal proportions. Most of these patients had started smoking before they were diagnosed with diabetes. Among the 1,118 diabetic patients, only 108 patients smoked; therefore, the prevalence of tobacco smoking in our patients with diabetes was 9.66%. CONCLUSIONS The prevalence of tobacco smoking among diabetes patients in Malaysia was low. Tobacco smoking status should be evaluated as a routine care and advice should be given to those who are smokers, and they might be referred to smoking cessation program which is already available in the hospital studied if they want to quit.

PCV102 ASSOCIATION BETWEEN KNOWLEDGE AND DRUG ADHERENCE IN PATIENTS WITH HYPERTENSION IN QUETTA, PAKISTAN

Purpose: To evaluate the association between patient’s knowledge of hypertension management and medication adherence. Methods : A cross-sectional study was undertaken with 385 hypertensive patients who visited outpatient departments in two public hospitals in Quetta City, Pakistan. Besides demographic and disease-related questions, two validated questionnaires (Hypertension Fact Questionnaire and Drug Attitude Inventory) were used for data collection. Descriptive statistics were to determine the demographic and disease characteristics of the patients while Spearman rank correlation was employed to measure the association between knowledge and drug adherence. Results : Out of 385 patients, 236 (61.3 %) of the patients had average knowledge about hypertension while 249 (64.7 %) were categorized as poor adherent. No patient was considered as good adherent in the study. Correlation coefficient between total score of knowledge and total adherence was – 0.170 (p < 0.001), indicating an inverse association between knowledge scores and adherence level. Conclusion : Although the level of knowledge was average, patients were unsure of the benefits of continuous medication use which resulted in non-adherence to regimens. Educating patients about the benefits of medications and clarifying doubts regarding medication use should result in better control of hypertension

PMH16 PHARMACIST-RUN METHADONE CLINIC IN A MALAYSIAN PUBLIC HEALTH CENTER: EVALUATING PATIENT SATISFACTION AND QUALITY OF LIFE OUTCOMES

PMH16 PHARMACIST-RUN METHADONE CLINIC IN A MALAYSIAN PUBLIC HEALTH CENTER: EVALUATING PATIENT SATISFACTION AND QUALITY OF LIFE OUTCOMES Chiew GP, Shafi e AA, Hassali MA, Awaisu A, Cheah WK Larut Matang & Selama Health Offi ce, Taiping, Perak, Malaysia; Universiti Sains Malaysia, Minden, Penang, Malaysia; Hospital Taiping, Taiping, Malaysia OBJECTIVES: To assess the satisfaction and health-related quality of life (HRQoL) improvement of patients enrolled in a pharmacist-run Methadone Maintenance Therapy (MMT) program. METHODS: A cohort study design was used to measure satisfaction and to evaluate changes in HRQoL of patients after one month of receiving methadone treatment at Taiping Health Clinic. Respondent’s satisfaction was measured by using an eight-item pre-validated questionnaire. A post-survey reliability analysis of the questionnaire showed a high internal consistency of the items (Cronbach’s α = 0.785). Meanwhile, the HRQoL was measured using a validated EQ-5D and EQ-VAS questionnaire that are administered by face-to-face interview in two phases, after 1 month interval. The data were analyzed by using both descriptive statistics (frequencies and percentages) and inferential statistics (χ test, paired t-test and the McNemar χ test). RESULTS: All 54 patients in MMT clinic participated, but only 40 (74.1%) completed this study. Average methadone dose in both phases were low (Phase One = 37.4 mg [SD = 22.2], Phase Two = 44.4 mg [SD = 21.3]) that caused majority of respondents wishing to increase their current dose. Respondents were not satisfi ed with needs to come clinic daily (n = 18, 33.4%) and did not believe that MMT clinic can help in cessation of drug abuse (n = 9, 16.7%). These two items were signifi cantly associated with travelling distance of respondents to clinic (P = 0.001 and P = 0.039, respectively). Only pain/discomfort domain of the EQ-5D showed a signifi cant improvement from the baseline (P = 0.035). EQ-VAS score signifi cantly improved from 64.69 (SD = 16.7) at baseline to 71.43 (SD = 14.9) during the 1-month follow-up (P = 0.008). CONCLUSIONS: MMT program was able to improve patients’ QoL even in short duration of time. Improvement on dissatisfactions toward travelling distance, needs to travel daily to clinic and inadequate dose will help to increase treatment success.