Mohd Baidi Bahari

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.

Generic medicine substitution practices among community pharmacists: a nationwide study from Malaysia

AimsThis study aims to assess generic medicine substitution practices among Malaysian community pharmacists.MethodA cross-sectional nationwide descriptive study using a specific mailing data collection form was conducted from May 2007 through December 2007. A sample of 1,419 community pharmacies was involved in this study. Data were collected across the brand name medicine requests encountered on 14 working days and for which an equivalent generic product was available. Pharmacists’ generic substitution rate, physicians’ and patients’ acceptance of substitution and cost saving achieved from substitution were assessed.ResultsResponses were received from 157 pharmacies (response rate 11.1%). The pharmacists recommended generic substitution for 84.7% (1,538/1,815) of the brand name medicine requests. While suggesting substitution, the pharmacists voluntarily consulted the physicians for 13.1% (91/695) of the recommendations which involved prescription orders. The majority of the physicians (87.9%) when consulted by the pharmacists accepted the recommendation for substitution. Meanwhile, 88.9% (1,368/1,538) of the pharmacists’ substitution suggestions were accepted by the patients. The overall patients’ expenditure on medicines was reduced by a total of 57.4% (Malaysian ringgit 27,266.30 or US

Factors contributing to customer satisfaction with community pharmacies in Malaysia

7,369.30; US

Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients

1.00 = Malaysian ringgit 3.70) through acceptance of substitution.ConclusionThe Malaysian community pharmacists actively recommended generic substitution for brand name medicine requests which they encountered. Both the physicians and patients highly accepted the substitution recommendation and this contributed to significant reduction in patients’ medicines expenditure.

Medical care costs of newly diagnosed children with structural-metabolic epilepsy: A one year prevalence-based approached

AimsTo determine the factors affecting customer satisfaction with community pharmacies.MethodA cross-sectional survey was carried out among randomly selected customers who visited 30 community pharmacies in Kuala Lumpur, Malaysia. Data were collected using structured questionnaires consisting of 7 questions related to customer demographics and 29 items related to customer satisfaction. Descriptive statistics, factor analysis, independent samples t-tests and one-way ANOVA were used for data analysis.ResultsA total of 393 out of 1,200 (32.75%) questionnaires distributed were completed and collected. The respondents comprised 46.6% Malay, 41.5% Chinese, 9.9% Indian and 2% other races. The four most influential variables affecting customer satisfaction are convenient hours, availability of OTC drugs and a variety of products, pricing and the attitude of the pharmacy/pharmacist. It was found that elderly and unemployed groups have a significant influence upon satisfaction (p < 0.01).ConclusionThe study concluded that there are four main factors affecting customer satisfaction towards community pharmacy services in Malaysia. In addition, the elderly and unemployed groups are more concerned about their health.

Development of a questionnaire on knowledge, attitude and practice about immunization among Iraqi parents

ObjectivesTo conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug.MethodsThe articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan.ResultsThere were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics.ConclusionsThere was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly imperative in certain clinical situations characterized by hypoalbuminemia (e.g., burn patients).

Cost-effectiveness analysis for the use of serum antiepileptic drug level monitoring in children diagnosed with structural-metabolic epilepsy

PURPOSE Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population. METHOD This was a prevalence-based retrospective chart review that included patients who attended a pediatric neurology clinic in a tertiary referral center in Malaysia. The total first-year medical care costs were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardized for the year 2010 (One Malaysian Ringgit MYR is equivalent to 0.26 Euro or 0.32 USD). RESULTS The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalization and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the first-year medical care costs. Similarly, child development, seizure type, therapy type (i.e., polytherapy versus monotherapy), and therapeutic drug monitoring utilization were also not associated with the cost of management. The first-year medical care costs positively correlated with seizure frequency (r(s)=0.294, p=0.001). However, the only variable that significantly predict the first-year medical care costs was the type of antiepileptic drugs (R(2)=0.292, F=7.772, p<0.001). CONCLUSION This investigation was the first cost analysis study of epilepsy in Malaysia. The total first-year medical care costs for 120 patients with structural-metabolic epilepsy were MYR 202,816 (i.e., MYR 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management.

Incorporating an Immunization Course in the Pharmacy Curriculum: Malaysian Experience

AimTo test the reliability and validity of the translated version of the knowledge, attitude and practice (KAP) questionnaire on immunization among Arabic parents.MethodA cross-sectional prospective survey was carried out among 53 parents to obtain demographic data of immunized children. Other data were collected using translated KAP immunization questionnaires consisting of ten questions related to knowledge and ten questions related to attitude and practice. Descriptive statistics were used, and reliability was tested for internal consistency using Cronbach’s alpha coefficient.ResultsEmploying the recommended scoring method, the mean ± standard deviation of the KAP scores was 13.226 ± 3.01. Good internal consistency was found (Cronbach’s alpha = 0.735); the test-retest reliability value was 0.812 (p < 0.001). For validity, known-groups validity was used, and three pharmacist specialists judged the face and content validity of the questionnaire. The level of immunization knowledge among parents was positively associated with the attitude and practices of immunization.ConclusionThe study concluded that the translated KAP immunization questionnaire appears to be reliable and valid for measuring the knowledge, attitude and practices among Arab parents and that it can be used in future research.

Immunization Errors among Pediatrics Younger than 2 years

Treatment with antiepileptic drugs is commonly guided by serum level monitoring. Such monitoring requires expensive laboratory equipment and products. However, well-conducted studies on the cost-effectiveness of therapeutic drug monitoring for antiepileptic drugs are lacking particularly in patients with structural-metabolic epilepsy. The study aims to assess the cost-effectiveness of serum level monitoring services in the management of children with structural-metabolic epilepsy during the first year of diagnosis. A retrospective cost-effectiveness analysis was conducted from the provider perspective. It included patients attended a paediatric neurology clinic. The effectiveness measures used in this analysis were the number of patients that achieved ≥50% reduction in seizure frequency, and the number of patients with 3-month seizure free. Medical records of the patients were reviewed for the required information. Medical chart/billing data obtained from the hospital were collected to estimate the resources used (One Malaysian Ringgit MYR is equivalent to 0.31 USD). The recruited children were followed for one year following their first visit. The average cost effectiveness ratio for the monitored patients (MYR 2735 per patient that achieved a ≥50% reduction in seizure frequency) was lower than that for non-monitored patients (MYR 2921 per patients that achieved a ≥50% reduction in seizure frequency), with incremental cost-effectiveness ratio of MYR 2357 per one additional patient that achieved a ≥50% reduction in seizure frequency. The average cost effectiveness ratios for monitored and non-monitored group were MYR 8279 and MYR 6433 per patient with a 3-month seizure-free period, respectively, with incremental cost-effectiveness ratio of MYR 29,666 per one additional patient with a 3-month seizure-free period. In terms of the effectiveness measures used, serum level monitoring of antiepileptic drugs was found to be cost-effective. However, the incremental cost-effectiveness ratio was found to be sensitive to the cost of management.

Practices Associated with Serum Antiepileptic Drug Level Monitoring at a Pediatric Neurology Clinic A Malaysian Experience

To the Editor. The immunization system is a successful systematic program, especially during the last century. However, the immunization system is still imperfect because many countries still have unvaccinated children. The most common reasons for parents not having their child vaccinated are concern about immunization adverse effects, disbelief that the vaccine works, lack of awareness that the immunization is necessary, and lack of healthcare provider recommendation for the immunization.1 Health-care providers play an important role in child immunization because they have positive effects on parental decisions related to immunization.2 As a health care provider, pharmacists have played a role in promoting, maintaining, and improving immunization rates among children because the pharmacist is one of the most accessible healthcare professionals. A pharmacist can be trained to screen children for immunizations and counsel parents on immunization decisions, including providing information on immunizations risks and immunization benefits. In addition, pharmacists are highly regarded by the parents and by most immunization providers as drug information specialists, and often sought by people for medical advice.1,3 In the United States, 49 states have granted authority to pharmacists to immunize people, and pharmacists can play an important role in disease prevention by advocating and administering immunizations.4-6 While pharmacists in Malaysia are not authorized to immunize people, they can promote immunization through several types of activities: history and screening, patient counseling, documentation, administrative measures, and public education and reminders. In Malaysia, there are about 17 pharmacy colleges and schools (public and private) and 10 schools are fully accredited.7 Most of the schools or colleges do not have enough education courses regarding immunization. These deficiencies in immunization education and training in colleges and schools of pharmacy may contribute to low immunization rates in the Malaysia. An immunization course was introduced in Kulliyyah of Pharmacy- International Islamic University Malaysia during the current academic year (2012-2013). The course was offered as a part of the Pharmacotherapeutics I module during the first semester for fourth-year students enrolled in the bachelor of pharmacy degree program. The immunization course consists of 3 hours presented in 3 lectures. The first lecture consists of: immunization and vaccine types in children and adults; schedule and timing; adverse reactions; and contraindications. The topics for the second lecture hour consist of: epidemiology and disease prevention, pharmacist’s role, documentation, record keeping, planning, storage, parents’ education, and reminder. Immunization errors types, pharmacovigilance, and recommendations are presented in the last lecture. At the end of the immunization course, questionnaires will be administered to students to assess their perceptions of the course. As academic pharmacists, we believe that it is time for Malaysian pharmacy schools to help reach the national goals for immunization compliance through educating future generations of pharmacists. Schools of pharmacy have the responsibility to improve immunization education and to develop the practice skills of undergraduate pharmacy students. It can be done by introducing immunization into the undergraduate pharmacy curriculum. Although the initiation of the new course in pharmacy school requires additional resources and takes time to develop and update the curriculum, we strongly advise others Malaysian schools of pharmacy to mandate immunization education course and training as part of their core curriculum. The authors thank Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed (Academic Deputy Dean) and Assistant Professor Dr.Siti Hadijah Shamsudin (Head of Department of Pharmacy Practice) for their support in establishing and approving this immunization course in Kulliyyah of Pharmacy- International Islamic University Malaysia.