Chanuttha Ploylearmsang

Diabetes and Hypertension Screening by Pharmacy Students in Thai Communities

Objective. To integrate pharmacy education into a diabetes and hypertension screening program to improve pharmacy student disease knowledge and screening skills and provide a valuable service to the community. Methods. One hundred eighty third-year PharmD students were trained and subsequently screened people aged ≥35 years in 2 Thai communities. Those with high risk factors were encouraged to see a pharmacist or nurse for further evaluation and referral to a physician for diagnosis. Results. After training, the third-year students showed significantly higher knowledge scores on diabetes and hypertension than a control group of second-year students (p<0.05). More than 80% of the third-year students were rated by pharmacist observers as having good community screening skills. More than 95% of community participants were satisfied or very satisfied with the screening session. The active screening program improved the screening coverage in the targeted communities from 41 people/month under the passive screening program to 127 people/month and improved the coverage rate over a 6-month period from 24% to 73%. Conclusion. This active screening project by pharmacy students enhanced the health knowledge and awareness of members of the targeted communities and increased pharmacy students’ knowledge of and ability to screen for hypertension and diabetes.

Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use

Background: Potential inappropriate medication (PIM) prescribing is a medication that puts patients at risk rather than having benefits. PIM use has been associated with hospitalization, morbidity, and mortality resulting from ADRs in elderly patients. The Lists of Risk Drugs for Thai Elderly (LRDTE) was developed as the new screening tool to identify PIMs use. The prevalence of PIM use using the LRDTE has not been determined in Thailand. Purpose: The main purpose of this study was to examine the prevalence of PIM use based on the LRDTE. In addition, this aimed to address the PIM problem by identifying factors that influenced PIM use among elderly patients in Thailand. Methods: A retrospective cross‐sectional descriptive study was conducted using the computerized database at four community hospitals in Thailand during fiscal year 2014. The LRDTE criteria were used as a screening tool for identifying the medicine items of PIM use. Descriptive statistics and multivariate logistic regression were used to identify common and Thai region‐specific predictors of PIM use. Results: Of a total of 13274 elderly patients, 79% were prescribed at least one PIM, as indicated by the LRDTE criteria. Amlodipine (32%), omeprazole (30%), and tramadol (18%) were the most commonly prescribed PIMs in elderly patients aged 60 years and older. Hospital and physician characteristics were identified as independent predictors after adjustment for patient and utilization factors. Conclusion: PIM use in Thai elderly patients was highly prevalent in community hospitals because the LRDTE criteria reflected clinical practice in Thailand. Hospital and physician factors were identified as region‐specific factors that were highly associated with PIM use. Revision of hospital formularies and educational programs for physicians are needed to improve prescribing and avoid PIM use.

Unit cost of common illness management: a comparison between a primary care unit and a community pharmacy in Thailand

Aim This study was to perform unit cost analysis of managing common illnesses comparing between a primary care unit (PCU) and a community pharmacy. BACKGROUND PCU is a key point of access for primary care in Thailand. Although a community pharmacy is an ideal setting, it has not been successfully incorporated in Thailands health service. Common illnesses are encountered everyday by community pharmacists, an appropriate compensation for this service has not been established. METHODS A primary care service of one educational institution was a study site. Eight common illnesses were emphasised. Patient visits were observed, prospectively at community pharmacy and retrospectively at PCU, during August to October 2013. Labour and material costs related to management of common illnesses were recorded. Total cost divided by total patient visits determined the unit cost. For the community pharmacy, patients were followed up after 3-14 days of visit to evaluate the effectiveness. Sensitivity analysis was performed by varying direct medical cost at ±10-30%. Findings At the community pharmacy, community pharmacists performed multiple tasks including interviewing and assessing patients, choosing an appropriate treatment and dispensing. Of 9141 visits, 775 (8.5%) with common illnesses were included. Upper respiratory disorder was found the highest 41.9% (325/755). Unit cost of treatment ranged from 54.16 baht (£1.18) for pain to 82.71 baht (£1.80) for skin disorder. Two-thirds of pharmacy visits (77.9%, 539/692) reported complete recovery. Managing common illnesses at the PCU was performed by nurse assistants, nurses, doctors and pharmacists. Of 6701 patient visits to the PCU, 1545 (23.1%) visits were at least one of the eight illnesses. Upper respiratory disorder was the majority, 53.0% (771/1454). Unit cost of treatment ranged from 85.39 baht (£1.86) for eye/ear to 245.93 baht (£5.36) for sexual health. Managing common illness at a community pharmacy shows satisfactory effectiveness with lower unit cost.