Mohamed Azmi Hassali

The role of pharmacists in developing countries: the current scenario in Pakistan.

During the past few years, the pharmacy profession has expanded significantly in terms of professional services delivery and now has been recognized as an important profession in the multidisciplinary provision of health care. In contrast to the situation in developed countries, pharmacists in developing countries are still underutilized and their role as health care professionals is not deemed important by either the community or other health care providers. The aim of this paper is to highlight the role of pharmacists in developing countries, particularly in Pakistan. The paper draws on the literature related to the socioeconomic and health status of Pakistans population, along with background on the pharmacy profession in the country in the context of the current directions of health care.The paper highlights the current scenario and portrays the pharmacy profession in Pakistan. It concludes that although the pharmacy profession in Pakistan is continuously evolving, the health care system of Pakistan has yet to recognize the pharmacists role. This lack of recognition is due to the limited interaction of pharmacists with the public. Pharmacists in Pakistan are concerned about their present professional role in the health care system. The main problem they are facing is the shortage of pharmacists in pharmacies. Moreover, their services are focused towards management more than towards customers. For these reasons, the pharmacists role as a health care professional is not familiar to the public.

The experiences of implementing generic medicine policy in eight countries: A review and recommendations for a successful promotion of generic medicine use

Generic medicines are clinically interchangeable with original brand medicines and have the same quality, efficacy and safety profiles. They are, nevertheless, much cheaper in price. Thus, while providing the same therapeutic outcomes, generic medicines lead to substantial savings for healthcare systems. Therefore, the quality use of generic medicines is promoted in many countries. In this paper, we reviewed the role of generic medicines in healthcare systems and the experiences of promoting the use of generic medicines in eight selected countries, namely the United States (US), the United Kingdom (UK), Sweden, Finland, Australia, Japan, Malaysia and Thailand. The review showed that there are different main policies adopted to promote generic medicines such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland. To effectively and successfully implement the main policy, different complementary policies and initiatives were necessarily introduced. Barriers to generic medicine use varied between countries from negative perceptions about generic medicines to lack of a coherent generic medicine policy, while facilitators included availability of information about generic medicines to both healthcare professionals and patients, brand interchangeability guidelines, regulations that support generic substitution by pharmacists, and incentives to both healthcare professionals and patients.

Physicians' knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature.

Background: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this. Method: An extensive literature search from 1990 to 2014. Results: Nineteen articles were included; eight in ambulatory care, seven in hospital settings and four in both, across all countries. Physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. Moreover, some physicians, although aware that antibiotics are of limited benefit in some conditions, still prescribed them. Several factors influenced prescribing, including patients’ expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients and influence of pharmaceutical companies. Pocket-sized guidelines seen as an important source of information for physicians. Conclusion: Inadequate knowledge of prescribing is prevalent among physicians. However, many physicians were interested in improving their antibiotic prescribing. Multifaceted interventions targeting all key stakeholders, including patients, are needed to improve future antibiotic prescribing.

Pharmacy Students’ Knowledge and Perceptions About Pharmacovigilance in Malaysian Public Universities

Objective. To assess senior pharmacy students’ knowledge of and perceptions about pharmacovigilance and reporting of adverse drug reactions (ADRs) at 5 public universities in Malaysia Methods. A cross-sectional study was conducted between December 1, 2010, and January 31, 2010, using a validated self-administered questionnaire delivered to a sample of 510 final-year (fourth-year) pharmacy students at 5 Malaysian public universities. Results. Four hundred twenty-one (84%) students responded to the survey. About 60% (n = 240) indicated that they had taken courses on the concept of pharmacovigilance during their current pharmacy curriculum. The mean score for knowledge about pharmacovigilance and ADR reporting was 6.9 ± 1.4. There was a significant difference in the mean scores for knowledge about pharmacovigilance across the 5 universities. The majority (82.3%) of respondents felt it was necessary to confirm the causal relationship between the drug and the ADR. About 57.8% (n = 241) of the respondents believed that pharmacy students are competent and capable of reporting ADRs during their clerkships. The majority (87.0%) of respondents perceived that pharmacy students should be taught how to report ADRs. Conclusion. The results of this study demonstrate that the majority of final-year pharmacy students in Malaysian public universities have insufficient knowledge about pharmacovigilance and ADR reporting.

Generic medicines: Perceptions of general practitioners in Melbourne, Australia

The aims of this study were to investigate factors affecting generic medicine prescribing among general practitioners (GPs) in Melbourne, Australia. A qualitative approach was used. A convenience sample of GPs practising in Melbourne was interviewed using a semi-structured interview guide. Thematic content analysis of the interviews identified seven major themes: medicine prescribing patterns, knowledge and confidence with generic medicines, patient acceptance of generic medicines, issues related to ‘pseudo-generics’ and medicine labelling, drug advertising and marketing, brand substitution by community pharmacists and, finally, strategies to increase generics prescribing. Informants suggested some methods that could be used to increase the current rate of generics prescribing, including financial reward for GPs, patient education on generic medicines, convincing GPs of the safety and efficacy of generic medicines and educating senior medical students on issues involving generic medicines and generics prescribing. This study suggested that GPs in Melbourne have mixed attitudes to generics prescribing. The findings also show that misconceptions about safety and efficacy of generic medicines still persist among some GPs. Unless they are sufficiently educated by interested parties, such as the government and the generic medicines industry, this will have a negative impact on utilisation of generic medicines in future.

Pharmacy Practice in Malaysia

The pharmacists’ roles have been expanding around the globe in the recent years. In Malaysia, healthcare system is a two‐tier system consisting of the public and private sectors. Pharmacy service in Malaysia came into existence in 1951 with the enactment of three main legislations governing its profession, namely, the Registration of Pharmacist Act 1951, Poison Act 1952 and Dangerous Drug Act 1952. However, the absence of dispensing right has limited the community pharmacists’ professional roles to deliver pharmaceutical care, optimise their clinical knowledge and utilise their skill.

Osteoporosis and type 2 diabetes mellitus: what do we know, and what we can do?

Diabetes mellitus (DM) is a pandemic and chronic metabolic disorder with substantial morbidity and mortality. In addition, osteoporosis (OP) is a silent disease with a harmful impact on morbidity and mortality. Therefore, this systematic review focuses on the relationship between OP and type 2 diabetes mellitus (T2DM). Systematic reviews of full-length articles published in English from January 1950 to October 2010 were identified in PubMed and other available electronic databases on the Universiti Sains Malaysia Library Database. The following keywords were used for the search: T2DM, OP, bone mass, skeletal. Studies of more than 50 patients with T2DM were included. Forty-seven studies were identified. The majority of articles (26) showed increased bone mineral density (BMD), while 13 articles revealed decreased BMD; moreover, eight articles revealed normal or no difference in bone mass. There were conflicting results concerning the influence of T2DM on BMD in association with gender, glycemic control, and body mass index. However, patients with T2DM display an increased fracture risk despite a higher BMD, which is mainly attributable to the increased risk of falling. As a conclusion, screening, identification, and prevention of potential risk factors for OP in T2DM patients are crucial and important in terms of preserving a good quality of life in diabetic patients and decreasing the risk of fracture. Patients with T2DM may additionally benefit from early visual assessment, regular exercise to improve muscle strength and balance, and specific measures for preventing falls. Patient education about an adequate calcium and vitamin D intake and regular exercise is important for improving muscle strength and balance. Furthermore, adequate glycemic control and the prevention of diabetic complications are the starting point of therapy in diabetic patients.

A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan

BackgroundHepatitis B (HB) is a serious global public health problem. This study aims to evaluate Knowledge, Attitude and Practice (KAP) towards Hepatitis B (HB) among healthy population of Quetta city, Pakistan.MethodsA cross sectional, descriptive study was undertaken. One thousand healthy individuals (aged 18 years and above) were approached for the study. KAP towards HB was assessed by using a pre validated questionnaire. Descriptive statistics were used for elaborating patients’ demographic characteristics. Inferential statistics (Mann–Whitney U test and Kruskal Wallis test) were used for comparison while Spearman’s rho correlation was used to identify association between the study variables. All analyses were performed using SPSS 16.0.ResultsOut of 1000 distributed questionnaires, 780 were returned with a response rate of 78.0%. Four hundred and twenty (53.8%) respondents were male with mean age of 32.76 ± 9.40 year. Two hundred and eight (26.7%) had intermediate level of education and 354 (45.4%) were unemployed. Mean scores for knowledge, attitude and practice were 8.74 ± 2.7, 3.72 ± 1.2 and 2.76 ± 1.1 respectively. Significant and positive linear correlations between knowledge-attitude (r = 0.296, p < 0.01) knowledge-practice (r = 0.324, p < 0.01) and attitude-practice (r = 0.331, p < 0.01) were observed. Area of residence (locality) was the only variables significantly associated with mean KAP of the study respondents.ConclusionResults from the current study heighted poor KAP of healthy population towards HB. The positive linear correlations reaffirms that better knowledge can lead to positive attitude and subsequently in good practices. This will further help in prevention and management of HB. Therefore, extensive health educational campaign should be provided to general population and especially to the residents of rural areas.

Price Comparison between Innovator and Generic Medicines Sold by Community Pharmacies in the State of Penang, Malaysia

Generic medicines play a key role in the affordability of pharmaceuticals. This study aims to compare price and to document the actual savings that can be achieved if generics are used by consumers in the state of Penang, Malaysia. This is a cross-sectional pilot study on the price of innovator and generic medicines for the 20 most-used medications in Malaysia. Upon consent, 20 retail pharmacies were conveniently selected. A pre-validated data collection form was used to collect their selling price from the community pharmacist. The analysis was limited to medicines in the same dosage form and dose. Those still under patent protection or combined with other active ingredients were excluded from the study. This study found that most innovator drugs are 27–90 per cent more expensive than generics. Some generic drugs are, however, more expensive than their innovator counterparts (40 per cent higher). Some locally produced generics are also more expensive than foreign products. The current findings suggest that consumers can save up to 90 per cent of the cost of their medication by using generic products. Further investigation is needed to explore the causality of the observed differences in price of products in order to increase their accessibility to the general population.

Exploring community pharmacists’ views on generic medicines: a nationwide study from Malaysia

Objective To evaluate the Malaysian community pharmacists’ views on generic medicines. Setting A sample of 1419 Malaysian community pharmacies with resident pharmacists. Method A cross-sectional nationwide survey using a self-completed mailing questionnaire. Main outcome measure Pharmacists’ views on generic medicines including issues surrounding efficacy, safety, quality and bioequivalence. Results Responses were received from 219 pharmacies (response rate 15.4%). Only 50.2% of the surveyed pharmacists agreed that all products that are approved as generic equivalents can be considered therapeutically equivalent with the innovator medicines. Around 76% of respondents indicated that generic substitution of narrow therapeutic index medicines is inappropriate. The majority of the pharmacists understood that a generic medicine must contain the same amount of active ingredient (84.5%) and must be in the same dosage form as the innovator brand (71.7%). About 21% of respondents though that generic medicines are of inferior quality compared to innovator medicines. Most of the pharmacists (61.6%) disagreed that generic medicines produce more side-effects than innovator brand. Pharmacists graduated from Malaysian universities, twinning program and overseas universities were not differed significantly in their views on generic medicines. Additionally, the respondents appeared to have difficulty in ascertaining the bioequivalent status of the marketed generic products in Malaysia. Conclusion The Malaysian pharmacists’ have lack of information and/or trust in the generic manufacturing and/or approval system in Malaysia. This issue should be addressed by pharmacy educators and relevant government agencies.