Pranaya Mishra

A non-clinical randomised controlled trial to assess the impact of pharmaceutical care intervention on satisfaction level of newly diagnosed diabetes mellitus patients in a tertiary care teaching hospital in Nepal

BackgroundPatient satisfaction is the ultimate goal of healthcare system which can be achieved from good patient-healthcare professional relationship and quality of healthcare services provided.Study was conducted to determine the baseline satisfaction level of newly diagnosed diabetics and to explore the impact of pharmaceutical care intervention on patients’ satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal.MethodsAn interventional, pre-post non-clinical randomised controlled study was designed among randomly distributed 162 [control group (nu2009=u200954), test 1 group (nu2009=u200954) and test 2 group (nu2009=u200954)] newly diagnosed diabetes mellitus patients by consecutive sampling method for 18 months. Diabetes Patient Satisfaction Questionnaire was used to evaluate patient’s satisfaction scores at baseline, three, six, nine and, twelve months’ follow-ups. Test groups patients were provided pharmaceutical care whereas control group patients only received their usual care from physician/nurses. The responses were entered in SPSS version 16. Data distribution was not normal on Kolmogorov-Smirnov test. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences among the groups before and after the intervention (p ≤0.05).ResultsThere were significant (pu2009<u20090.001) improvements in patients’ satisfaction scores in the test groups on Friedman test. Mann-Whitney U test identified the significant differences in satisfaction scores between test 1 and test 2 groups, control and test 1 groups and, control and test 2 groups at 3-months (pu2009=u20090.008), (pu2009<u20090.001) and (pu2009<u20090.001), 6-months (pu2009=u20090.010), (pu2009<u20090.001) and (pu2009<u20090.001), 9-months (pu2009<u20090.001), (pu2009<u20090.001) and (pu2009<u20090.001) and, 12-months (pu2009<u20090.001), (pu2009<u20090.001) and (pu2009<u20090.001) follow-ups respectively.ConclusionPharmaceutical care intervention significantly improved the satisfaction level of diabetics in the test groups compare to the control group. Diabetic kit demonstration strengthened the satisfaction level among the test 2 group patients. Therefore, pharmacist can act as a counsellor through pharmaceutical care program and assist the patients in managing their disease. This will not only modify the patients’ related outcomes and their level of satisfaction but also improve the healthcare system.

Socio-demographic factors of pig farmers associated in transmission of taeniosis/cysticercosis

Background: Pig farmers socio-economical and environmental conditions that comprise the risk factors for the contraction of cysticercosis in Nepal are as the socio-economic condition of pig farmers is very poor. They are ignorant about health and hygiene. In Terai districts, 80% farmers keep pigs in the open field. Most of the families of the pig rearing communities do not have latrines. They use open field for defaecating. Free range feeding of pig is quite common all over Nepal traditionally. The unhygienic disposal of the waste helps the problem to be graver. Method: This study was carried out in three VDCs i.e. Tindobate VDCs, Thumpokhara VDC, Jagatradevi VDC and Walling Municipality in Syangja district. Household keeping pigs farmers were randomly selected from villages in the district. About 437 households and pig farming area were surveyed. Results: This contamination of soil and water contributes greatly for the parasitic infestation of both pig and human. Most of the pigs are kept inside the house at night and are fed on kitchen wastes and excreta. This is the important factor that is co-related with the high prevalence of parasitic infestations like Taeniasis in pigs and humans. Conclusion: Pig husbandry system should be improved. Mass awareness education programmes for controlling parasitic diseases in general, and taeniasis and cysticercosis in particular should be launched in all pig pocket production areas of the country. Social upliftment programmes like adult education, toilet construction, safe drinking water supply, gender indiscrimination in the pig husbandry as a source of poverty elimination must be carried out. Journal of Institute of Medicine Vol.28(1) 2006

Does pharmacist-supervised intervention through pharmaceutical care program influence direct healthcare cost burden of newly diagnosed diabetics in a tertiary care teaching hospital in Nepal: a non-clinical randomised controlled trial approach

BackgroundCost is a vital component for people with chronic diseases as treatment is expected to be long or even lifelong in some diseases. Pharmacist contributions in decreasing the healthcare cost burden of chronic patients are not well described due to lack of sufficient evidences worldwide. In developing countries like Nepal, the estimation of direct healthcare cost burden among newly diagnosed diabetics is still a challenge for healthcare professionals, and pharmacist role in patient care is still theoretical and practically non-existent. This study reports the impact of pharmacist-supervised intervention through pharmaceutical care program on direct healthcare costs burden of newly diagnosed diabetics in Nepal through a non-clinical randomised controlled trial approach.MethodsAn interventional, pre-post non-clinical randomised controlled study was conducted among randomly distributed 162 [control (nu2009=u200954), test 1 (nu2009=u200954) and test 2 (nu2009=u200954) groups] newly diagnosed diabetics by a consecutive sampling method for 18xa0months. Direct healthcare costs (direct medical and non-medical costs) from patients perspective was estimated by ‘bottom up’ approach to identify their out-of-pocket expenses (1USDu2009=u2009NPR 73.38) before and after intervention at the baseline, 3, 6, 9 and 12 months follow-ups. Test groups’ patients were nourished with pharmaceutical care intervention while control group patients only received care from physician/nurses. Non-parametric tests i.e. Friedman test, Mann–Whitney U test and Wilcoxon signed rank test were used to find the differences in direct healthcare costs among the groups before and after the intervention (pu2009≤u20090.05).ResultsFriedman test identified significant differences in direct healthcare cost of test 1 (pu2009<u20090.001) and test 2 (pu2009<u20090.001) groups patients. However, Mann–Whitney U test justified significant differences in direct healthcare cost between control group and test 1 group, and test 2 group patients at 6-months (pu2009=u20090.009, pu2009=u20090.010 respectively), 9-months (pu2009=u20090.005, pu2009=u20090.001 respectively) and 12-months (pu2009<u20090.001, pu2009<u20090.001 respectively).ConclusionPharmacist supervised intervention through pharmaceutical care program significantly decreased direct healthcare costs of diabetics in test groups compared to control group and hence describes pharmacist’s contribution in minimizing direct healthcare cost burden of patients.

Assessment of the availability and rationality of unregistered fixed dose drug combinations in Nepal: a multicenter cross-sectional study

BackgroundThe medications that are registered and available in a country are meant for the prevention and treatment of ailments and diseases. However, a lack of effective regulatory bodies and operative control mechanisms, especially in developing countries, promotes irrational and inappropriate use of medicines. This study aims to evaluate the availability and rationality of unregistered fixed-dose drug combinations (FDCs) in Nepal.MethodsA snowball sampling method with visits to 20 retail pharmacies in each of five major cities in Nepal was used to assess the availability of unregistered FDCs. To justify the rationality of the FDCs obtained from these five cities, the toolkit developed by Health Action International Asia-Pacific (HAI-AP) was used.ResultsAltogether, 41 unregistered FDCs were obtained from the five cities. Among the total 41 FDCs, a majority were anti-inflammatory/analgesic/antipyretics. A maximum of eight drugs and a minimum of two drugs per combination were present among the total 41 FDCs, with a majority in the form of tablets followed by suspensions. The cost ranges from a minimum of 3.7 Nepalese Rupees (NRs) (= USD 0.05) to a maximum of 240 NRs (= USD 3.15). None of the FDCs fulfilled all the fundamental requirements as stated in the toolkit; thus, they were categorized as ‘irrational’.ConclusionsUnregistered FDCs are available in the Nepalese pharmaceutical market. All the unregistered FDCs found in our study were ‘irrational’ as per the HAI-AP toolkit. Regulatory authorities should initiate strict monitoring and appropriate regulatory mechanisms to prohibit the use of unregistered and irrational FDCs.

Evaluation of the registration status of fixed-dose drug combinations in Nepal

Analysing the registration status and the presence of fixed‐dose drug combinations (FDCs) in different drug lists and formularies, encourages the use of rational FDCs and helps to remove the irrational combinations booming in the pharmaceutical market. This study aimed to evaluate the registration status of FDCs in different formularies and drug lists of Nepal.

Assessment of utilization pattern of fixed dose drug combinations in primary, secondary and tertiary healthcare centers in Nepal: a cross-sectional study

BackgroundPrescription practices, especially in South Asian countries, have come under investigation for quality. Although there have been no studies in Nepal that have analyzed the prescription pattern of FDCs for different levels of health care centers, several studies from Nepal and other countries in the region have revealed poor medicine use practices, including irrational use of fixed-dose drug combinations (FDCs). This research aimed at assessing the utilization pattern of FDCs among primary (PHC), secondary (SHC) and tertiary health care (THC) centers in Western region of Nepal.MethodsA cross-sectional descriptive study was conducted at primary, secondary and tertiary health care centers in Western Nepal. One hundred prescriptions from each health care center were chosen through systematic random sampling. The International Network for Rational Use of Drug (INRUD) indicators were used to assess the rationality of prescribing. Both descriptive and inferential statistics were applied. The alpha level used was 0.05.ResultsAt the PHC center, 206 medicines were prescribed, of which 20.0% were FDCs. Antimicrobials were the most prescribed FDCs (57.1%). The unit prices of all FDCs were below 100 Nepalese Price Rupees (NPRs). At the SHC center, 309 medicines were prescribed, and 30% were FDCs. Vitamins, minerals and dietary supplements were the most prescribed FDCs (25.8%). The costs of 63.5% of FDCs were below 100 NPRs. At the THC center, 33.5% of 270 medicines were FDCs. As at the SHC center, vitamins, minerals and dietary supplements were the most prescribed FDCs (40.6%). The costs of 50.5% of FDCs were below 100 NPRs.ConclusionsFDCs were used extensively at different health care centers. The number of prescription in private centers, following established guidelines and the essential drug list (EDL), was much lower. The cost associated with the utilization of FDCs was higher in private sectors compared to public health care centers. In certain cases, the use of FDCs was questionable, and this study found a low use of essential medicines. Education to improve prescription practices at different healthcare levels is recommended.

Development of pharmacovigilance training module for community pharmacists in Nepal: A focus group study

Objective: We assessed the feedback from community pharmacists on training sessions on adverse drug reaction (ADR) reporting provided by the regional pharmacovigilance center. In addition, we examined the relationship between feedback scores and demographic characteristics of the community pharmacists. Methods: The training on ADR reporting was divided into three sessions. Each session lasted for 1-2 h duration, spanning over 6 months. A questionnaire was provided to obtain feedback on the training sessions. The questionnaire had a total of twenty questions on a 5-point Likert scale (maximum possible total score could be 100). The feedback scores obtained were compared with a demographic profile. Mann-Whitney U-test was used for comparing the scores of the subgroups with two groups and Kruskal-Wallis test for the subgroups with more than two groups. P < 0.05 was considered statistically significant. Results: Most of the pharmacists participated were male (n = 18), aged between 31 and 40 years (n = 14), with educational qualifications of community medical assistant (n = 12) and length of experience in community pharmacy between 1 and 5 years (n = 14). The overall median (interquartile range) of the responses was 79 (73.5-81.0); the maximum possible score was 100. There was no association between the total scores and gender, age, educational qualifications, and length of experience in the community pharmacy. Conclusions: The feedback revealed that participants find the training sessions were useful and they were interested in future sessions. Educational interventions can play an important role in improving ADR reporting.