Mohd Makmor-Bakry

Medication-handling challenges among visually impaired population

Objective: Visually impaired individuals are particularly at higher risk for experiencing a medication error. The aim of this study is to identify the problems encountered by the visually impaired population when handling their medication. Methods: A cross-sectional survey was conducted using an interviewer-guided questionnaire with 100 visually impaired individuals. The questionnaire comprised a series of questions in medication management. Results: All of the respondents perceived that self-administration of medication was a challenging task. A total of 89% of respondents were unable to read the prescription labels, 75% of respondents did not know the expiry date of their own medication, and 58% of respondents did not know the name of the medication. With regard to storage of medication, 72% of respondents did not practice appropriate methods to store their medication, and 80% of respondents kept the unused medication. All of the respondents disposed leftover medication through household rubbish. A total of 64% of respondents never practice medication review. Most (96%) of them did not tell health-care providers when they faced difficulties in handling their medication. Conclusion: Most of the visually impaired individuals did not receive appropriate assistance regarding medicine use and having low awareness in medication management. This can lead to increased risk of medication errors or mismanagement among visually impaired population. Hence, effective strategies, especially in pharmaceutical care services, should be structured to assist this special population in medication handling.

Insignificant influence of test order on cognitive behavior in Wistar rats

Objectives: The aim was to evaluate the effects of test order in behavioral performance of Wistar rats in cognitive performance tasks. Materials and Methods: The rats were tested with both object recognition and object location tasks in different test orders with an inter-test interval of 1-day. Results: An open field box sized 60 × 60 × 40 cm was associated with better experimental outcome compared with box sized 100 × 100 × 50 cm. Test order has insignificant effects on the exploration activity of rats with the 1-day inter-test interval. Conclusion: Test order of the cognitive performance tasks with inter-test interval of 1-day did not influence the performance of Wistar rats.

Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review

Purpose To identify the use pattern of complementary and alternative medicine (CAM) and its impact on antiepileptic drug (AED) adherence among patients with epilepsy. Method Potential studies were identified through a systematic search of Scopus, Science Direct, Google Scholar, and PubMed. The keywords used to identify relevant articles were “adherence,” “AED,” “epilepsy,” “non-adherence,” and “complementary and alternative medicine.” An article was included in the review if the study met the following criteria: 1) conducted in epilepsy patients, 2) conducted in patients aged 18 years and above, 3) conducted in patients prescribed AEDs, and 4) patients’ adherence to AEDs. Results A total of 3,330 studies were identified and 30 were included in the final analysis. The review found that the AED non-adherence rate reported in the studies was between 25% and 66%. The percentage of CAM use was found to be between 7.5% and 73.3%. The most common reason for inadequate AED therapy and higher dependence on CAM was the patients’ belief that epilepsy had a spiritual or psychological cause, rather than primarily being a disease of the brain. Other factors for AED non-adherence were forgetfulness, specific beliefs about medications, depression, uncontrolled recent seizures, and frequent medication dosage. Conclusion The review found a high prevalence of CAM use and non-adherence to AEDs among epilepsy patients. However, a limited number of studies have investigated the association between CAM usage and AED adherence. Future studies may wish to explore the influence of CAM use on AED medication adherence.

Qualitative exploration of the modifiable factors for medication adherence among subsidised and self-paying patients in Malaysia

BackgroundNumerous studies have evaluated the related factors of medication adherence among patients with chronic disease. However, the factors influencing medication adherence and non-adherence among subsidised patients with chronic diseases—for whom medication costs may not be a constraint—remain unexplored. Thus, this study aims to identify and compare the potential factors that may influence subsidised and non-subsidised (i.e., self-paying) patients’ adherence to medication.MethodsSubsidised and self-paying patients were identified at public and private healthcare institutions in three states of Malaysia. Patients were then purposively selected for semi-structured, face-to-face interviews according to their medication adherence status (including adherent and non-adherent patients), which was measured using the Medication Event Monitoring System (MEMS). Adherence was defined as having 80% or more for the percentage of days in which the dose regimen was executed as prescribed. The interview was conducted from January to August 2016 and during the interviews, patients were asked to provide reasons for their medication adherence or non-adherence. The patient interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis with NVivo 11 software.ResultsThirteen subsidised and 12 self-paying patients were interviewed. The themes found among subsidised and self-paying patients were similar. The factors that influenced adherence to medication include the ‘perceived importance of quality of life’ and ‘perceived benefit or value of the medications’. A unique factor reported by patients in this study included ‘perceived value of the money spent on medications’; more specifically, patients adhered to their medications because they valued the money spent to buy/receive the medications.ConclusionMedication adherence among subsidised and self-paying patients was influenced by many factors, including a unique factor relating to their perceptions of the value of money spent on medications.

A qualitative study exploring issues related to medication management in residential aged care facilities

Background Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). Participants and methods A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Results and discussion Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. Conclusion There are important issues related to medication management in RACFs which require a need to establish policy and guidelines.

Cost-effectiveness of bisphosphonates for prevention of fracture related to glucocorticoid-induced osteoporosis in Malaysia

Glucocorticoid therapy is associated with an appreciable risk of bone loss leading to fractures that require expensive treatments. This study aimed to evaluate the cost‐effectiveness of bisphosphonates for prevention of hip fracture in glucocorticoid‐induced osteoporosis (GIOP) in Malaysia.

A clinical tool to predict Plasmodium vivax recurrence in Malaysia

BackgroundRecurrence rates of Plasmodium vivax infections differ across various geographic regions. Interestingly, South-East Asia and the Asia-Pacific region are documented to exhibit the most frequent recurrence incidences. Identifying patients at a higher risk for recurrences gives valuable information in strengthening the efforts to control P. vivax infections. The aim of the study was to develop a tool to identify P. vivax- infected patients that are at a higher risk of recurrence in Malaysia.MethodsPatient data was obtained retrospectively through the Ministry of Health, Malaysia, from 2011 to 2016. Patients with incomplete data were excluded. A total of 2044 clinical P. vivax malaria cases treated with primaquine were included. Data collected were patient, disease, and treatment characteristics. Two-thirds of the cases (n = 1362) were used to develop a clinical risk score, while the remaining third (n = 682) was used for validation.ResultsUsing multivariate analysis, age (p = 0.03), gametocyte sexual count (p = 0.04), indigenous transmission (p = 0.04), type of treatment (p = 0.12), and incomplete primaquine treatment (p = 0.14) were found to be predictors of recurrence after controlling for other confounding factors; these predictors were then used in developing the final model. The beta-coefficient values were used to develop a clinical scoring tool to predict possible recurrence. The total scores ranged between 0 and 8. A higher score indicated a higher risk for recurrence (odds ratio [OR]: 1.971; 95% confidence interval [CI]: 1.562–2.487; p ≤ 0.001). The area under the receiver operating characteristic (ROC) curve of the developed (n = 1362) and validated model (n = 682) was of good accuracy (ROC: 0.728, 95% CI: 0.670–0.785, p value < 0.001, and ROC: 0.766, 95% CI: 0.700–0.833, p-value < 0.001, respectively). In both the developed and validated models, area under the ROC curves showed no significant difference in predicting recurrence based on the constructed scoring mechanism (p = 0.399; Z-value: −0.8441; standard error: 0.045).ConclusionsThe developed model to predict recurrence was found to be of good accuracy and could be a useful tool in targeting patients at a higher risk for recurrence for closer monitoring during follow-up, after treatment with primaquine.