Ramadan Mohamed Mahmod Elkalmi

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.

Understanding of antibiotic use and resistance among final-year pharmacy and medical students: a pilot study.

INTRODUCTION This study is aimed to investigate the understanding of antibiotic use and antibiotic resistance and its correlate factors among final-year medical and pharmacy students at International Islamic University Malaysia (IIUM). METHODOLOGY This was a cross-sectional study. The study instrument was developed by extensive literature search and was subjected to face validity and content validity to medical and pharmacy academics. A pilot study was conducted to ascertain the reliability coefficient. Data was entered to SPSS version 17 and descriptive and inferential statistics were applied. RESULTS A total of 123 questionnaires were included in the study. Out of 123 respondents, 58.5% (n = 72) were final-year medical students, while 41.5% (n = 51) were final-year pharmacy students. The majority of the respondents showed adequate knowledge regarding the course contents related to antibiotics (n = 116; 94.3%). Almost all the respondents correctly reported the difference between bactericidal and bacteriostatic antibiotics. Only 15.4% (n = 19) and 27.6% (n = 34) of students were able to recognize Streptococcus pyogenes as non-pencillin resistant bacterium and Enterococcus as vancomycin-resistant bacterium, respectively. CONCLUSIONS The students showed good understanding regarding antibiotic resistance. In comparison to medical students, pharmacy students showed better understanding and more adequate knowledge, as the mean value for each domain was slightly higher for pharmacy students. Extensively improving the curriculum and educating healthcare professionals, especially physicians and pharmacists, right from the time of their educational training can inculcate a moral responsibility toward the judicious use of antibiotics, which can serve to eradicate antibiotic resistance.

Adverse drug reactions reporting : Knowledge and opinion of general public in Penang, Malaysia

Objective: The objective of this study was to explore the knowledge of the general population towards ADR and their reporting system. Methods: An anonymous, self-administered questionnaire (15 items) was designed. The questionnaire was subjected to face validity and content validity. The reliability coefficient was found to be 0.71. This study recruited proportionately large convenience sample of the general public in Penang. Interviews using a structured questionnaire were conducted over a week period in August 2009. The recommended sample size was calculated to be 368. Results: Three hundred thirty-four responses were received. Slightly more than half of the respondents were in the age group of 18-25 years (53.6%; n = 179). When asked about the sources of their medication majority of them reported medical doctor (85.6%), whereas small number (34.7%) reported community pharmacists as sources of medications. Three-quarter of the respondents (77.2%) get their information about the side-effects of drugs from physicians, followed by pharmacist (44.6%). More than half of the respondents (65.6%, n = 219) reported unawareness about the existence of ADR center set up by the Ministry of Health. Conclusion: Respondents reflected inadequate knowledge on ADR reporting. This needs to be corrected as the trend of future pharmacovigilance is toward the patient. Moreover, the new trend seems to be more appropriate as the patient is the group of the people who are directly affected from the ADR of a particular drug and not the health-care providers. Furthermore, the patient will be informed about the economic implications of not reporting ADR. It is recommended that government agencies, like MADRAC needs to find ways to increase patient- reported ADR cases.

Community pharmacists' attitudes, perceptions, and barriers toward adverse drug reaction reporting in Malaysia: a quantitative insight.

Objectives This study was designed to explore awareness and attitudes of community pharmacists toward the national ADR reporting system activities in the northern states of Malaysia. Methods A cross-sectional survey using a validated self-administered questionnaire was used in this study. The questionnaire was delivered to all community pharmacists (N = 470) practicing in the four northern states of Malaysia (Perlis, Kedah, Pulau Pinang and Perak) during the study period. Results A total of 470 survey forms were sent with one wave of reminders. Only 116 pharmacists responded to the survey (response rate of 25.2%). The total number of usable responses was 104 (24.7%). The survey findings revealed that nearly three-quarters of pharmacists (n = 75; 72.1%) were not aware of the pharmacovigilance activities run by the drug regulatory authority in Malaysia. Although more than half (n = 65, 61.5%) of the surveyed pharmacists emphasized the importance of ADR reporting, only 13 pharmacists (12.9%) claimed that they submitted ADR reports to the Malaysia Adverse Drug Reaction Advisory Committee (MADRAC) before this survey. Barriers which prevent community pharmacists from ADR reporting were identified. These included lack of knowledge on how to report (n = 36; 34.7%), the unavailability of reporting forms (n = 44; 42.6%), and ignorance of where the report should be sent to (n = 46; 44.6%). Conclusions Despite the unfamiliarity and the common misconceptions, the study results show that community pharmacists in the northern states of Malaysia have a very positive attitude toward the ADR reporting system in the country. However, the study findings highlight the urgent need for special education programs to establish continuous efforts to promote ADR reporting among community pharmacists. Further studies at the national level aimed at identifying and removing barriers that prevent community pharmacists from performing ADR reporting are required.

A qualitative study exploring barriers and facilitators for reporting of adverse drug reactions (ADRs) among community pharmacists in Malaysia

Objective  The objective of this study was to ascertain the perception of practising community pharmacists (CPs) towards adverse drug reactions (ADRs) reporting and to identify the problems with the current system in place for ADR reporting in Malaysia.

Perceptions and practices of community pharmacists towards antimicrobial stewardship in the state of Selangor, Malaysia

Background Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. Methods A cross-sectional study was conducted among community pharmacists between March–April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. Results A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). Conclusion The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these gaps and improve their perception and practices towards antimicrobial stewardship.

Motivations and Obstacles for Adverse Drug Reactions Reporting amongHealthcare Professionals from the Perspective of LewinâÂÂs Force Field AnalysisTheory: Analytic Approach

Spontaneous Adverse Drug Reactions (ADRs) reporting system is considered the back-bone for any pharmacovigilance system. Within this context, active Involvement of healthcare professionals is very crucial to improve the rate and quality of ADRs reporting. Despite the various techniques that have been adopted in order to improve the rate and quality of ADR reporting, there is a decline in the rate of ADRs notification. Under-reporting of ADRs is well-recognized phenomena associated with the almost all of pharmacovigilance systems around the world. Many logistic and personal barriers to ADRs reporting among healthcare professionals including resistance to change have been reported. This commentary focuses on the problem of resistance to change towards ADR reporting and the possibility of applying theory of Force Field Analysis (FFA) to overcome the problem of underreporting among these professionals.

Immunization knowledge and practice among Malaysian parents: a questionnaire development and pilot-testing

BackgroundParents are the main decision makers for their children vaccinations. This fact makes parents’ immunization knowledge and practices as predictor factors for immunization uptake and timeliness. The aim of this pilot study was to develop a reliable and valid instrument in Malaysian language to measure immunization knowledge and practice (KP) of Malaysian parents.MethodsA cross-sectional prospective pilot survey was conducted among 88 Malaysian parents who attended public health facilities that provide vaccinations. Translated immunization KP questionnaires (Bahasa Melayu version) were used. Descriptive statistics were applied, face and content validity were assessed, and internal consistency, test-retest reliability, and construct validity were determined.ResultsThe mean ± standard deviation (SD) of the knowledge scores was 7.36 ± 2.29 and for practice scores was 7.13 ± 2.20. Good internal consistency was found for knowledge and practice items (Cronbach’s alpha = 0.757 and 0.743 respectively); the test-retest reliability value was 0.740 (p = 0.014). A panel of three specialist pharmacists who are experts in this field judged the face and content validity of the final questionnaire. Parents with up-to-date immunized children had significantly better knowledge and practice scores than parents who did not (p < 0.001 and p = 0.001 respectively), suggesting a good construct validity. A significant difference was found in knowledge and practice scores among parents’ age (p = 0.006 and p = 0.029 respectively) and place of living (p = 0.037 and p = 0.043). The parents’ knowledge level was positively associated with their practice toward immunization (Spearman’s rank correlation coefficient 0.310, p = 0.003).ConclusionsThe pilot study concluded that the Bahasa Melayu version of the immunization KP questionnaire has good reliability and validity for measuring the knowledge and practices of Malaysian parents and therefore this version can be used in future research.

The Teaching of Subjects Related to Pharmacovigilance in MalaysianPharmacy Undergraduate Programs

Objectives: To evaluate the extent to which subjects related to pharmacovigilance are taught in the pharmacy programs within Malaysian universities. Methods: Self-completed questionnaires were sent (via surface mail) to all heads of schools and faculties of pharmacy and medicine that offer pharmacy programs in Malaysia. The questionnaires were intended for department heads or the person responsible for the teaching of the subject in the respective institutions. Results: Thirteen out of fourteen (n=13, 92.8%) medical and pharmacy schools responded to the survey. The vast majority (n=11, N=13, 84.6%) of the pharmacy programs within the studied Malaysian universities feature pharmacovigilance-related topics in their undergraduate syllabi. About two-thirds (n=8, 72.7%) of the pharmacy programs taught issues related to pharmacovigilance within epidemiology and/or pharmacoepidemiology courses. Pharmacovigilance-related topics are core/required in almost all (n=9, 81.8%) of the pharmacy programs. None of the pharmacy programs had a specific stand-alone course on pharmacovigilance. Conclusion: Subjects related to pharmacovigilance were widely taught in the majority of the universities surveyed. As the field of pharmacovigilance is very important for future pharmacy practitioners, this course should be made a core course within the local pharmacy curriculum in order to enhance medication safety for the population. To ensure effective practice in the area of drug safety, there is an urgent and necessary need for Malaysian pharmacy students to be adequately educated and exposed to the contemporary issues and challenges of pharmacovigilance implementation.

Does an educational intervention improve parents’ knowledge about immunization? Experience from Malaysia

BackgroundParents’ knowledge about immunization is an important predictor factor for their children’s immunization status. The aims of this study were to assess parents’ knowledge and to evaluate the effect of a short educational intervention on improving parents’ knowledge of childhood immunization.MethodsA cross-sectional study using a pre- and post-test intervention survey of a single group was conducted among Malaysian parents. Changes in total knowledge score before and after the intervention were measured using a validated questionnaire. The intervention consisted of an animated movie and lecture using simple understandable language. Wilcoxon signed ranks test and the McNemar x2 test were applied to compare the differences in knowledge before and after the intervention.ResultsSeventy-three parents were enrolled in this study; the majority were mothers (n = 64, 87.7%). Parents’ knowledge about childhood immunization increased significantly after the intervention compared to the baseline results (p < 0.001). There were significant differences between parents’ knowledge and their educational level and monthly income (p < 0.001 and p = 0.005), respectively.ConclusionsA short educational intervention designed for parents had a positive effect on their knowledge about immunization. Educational interventions targeting parents with low levels of education and income are needed. Further studies investigating the actual effectiveness of such interventions on immunization rates and statuses are required.