Teerapon Dhippayom

Adherence to diabetes medication: a systematic review

To investigate the extent of and factors associated with adherence to Type 2 diabetes medication.

Meta‐analysis of the effectiveness of smoking cessation interventions in community pharmacy

With the emerging and promising role of healthcare professionals in implementing smoking cessation services, community pharmacists, in particular, can play a pivotal role. The aim of this meta‐analysis is to evaluate the effectiveness of smoking cessation interventions delivered by community pharmacists in assisting smokers to quit.

How diabetes risk assessment tools are implemented in practice: A systematic review

This review aimed to explore the extent of the use of diabetes risk assessment tools and to determine influential variables associated with the implementation of these tools. CINAHL, Google Scholar, ISI Citation Indexes, PubMed, and Scopus were searched from inception to January 2013. Studies that reported the use of diabetes risk assessment tools to identify individuals at risk of diabetes were included. Of the 1719 articles identified, 24 were included. Follow-up of high risk individuals for diagnosis of diabetes was conducted in 5 studies. Barriers to the uptake of diabetes risk assessment tools by healthcare practitioners included (1) attitudes toward the tools; (2) impracticality of using the tools and (3) lack of reimbursement and regulatory support. Individuals were reluctant to undertake self-assessment of diabetes risk due to (1) lack of perceived severity of type 2 diabetes; (2) impracticality of the tools; and (3) concerns related to finding out the results. The current use of non-invasive diabetes risk assessment scores as screening tools appears to be limited. Practical follow up systems as well as strategies to address other barriers to the implementation of diabetes risk assessment tools are essential and need to be developed.

A National Survey of Training and Smoking Cessation Services Provided in Community Pharmacies in Thailand

Over the past few years, several training programs have been run in support of smoking cessation services within community pharmacy circles in Thailand. These have included a comprehensive training program offered by the Thai Pharmacy Network for Tobacco Control (TPNTC) and brief training programs run by other agencies. This study provides an estimate of the scale of smoking cessation activities among Thai pharmacies, and examines the impact of both the brief and comprehensive training programs on the provision of smoking cessation services. A self-administered questionnaire was mailed to 3,600 Thai community pharmacists. A total of 1,001 questionnaires were returned (response rate: 27.8%). Smoking cessation services were provided by 71.1% of the respondents, and 47.4% of such services gave only brief advice. Comprehensive services (defined by the 5A’s: ask, advise, assess, assist, and arrange follow-up) accounted for 15.3% of the respondents. Only 293 pharmacists (29.6%) said they had received cessation training; 62.5% of whom had received such training from TPNTC. The receipt of brief and comprehensive training was associated with a higher rate of the provision of brief advice, when compared with no training, showing adjusted odds ratios (ORs) of 2.93 (95% CI, 1.66–5.18) and 5.93 (95% CI, 3.18–10.17) respectively, while evidence of differences between these training programs was not observed, having an adjusted OR of 1.94 (95% CI, .89–4.21). TPNTC trained pharmacists were 4.98 times (95% CI, 2.24–11.05) more likely than those who received other brief training to provided the 5A’s cessation services. All types of training program help to promote the provision of brief counseling by pharmacists. Comprehensive training is associated with the increased provision of both 4A’s and 5A’s cessation services.

Intervention to Promote Patients' Adherence to Antimalarial Medication: A Systematic Review

Non-adherence as a major contributor to poor treatment outcomes. This study aimed to explore the effectiveness of existing interventions promoting adherence to antimalarial drugs by systematic review. The following databases were used to identify potential articles: MEDLINE, EMBASE, the Cochrane CENTRAL, and CINAHL (through March 2013). From 1,813 potential papers identified, 16 studies met the selection criteria comprising 9,247 patients. Interventions were classified as packaging aids, visual media, combined visual media and verbal information, community education, medication supervision, and convenient regimen. These interventions were shown to increase adherence to antimalarial drugs (median relative risk = 1.4, interquartile range 1.2-2.0). Although a most effective intervention did not emerge, community education and visual media/verbal information combinations may well have most potential to improve adherence to antimalarial medication. These interventions should be implemented in combination to optimize their beneficial effects. The current understanding on improved adherence would facilitate to contain outbreaks of malaria cost effectively.

Compliance of drugstores with a national smoke-free law: a pilot survey.

OBJECTIVES To examine the outcome of the recent implementation of a smoke-free policy in drugstores in Thailand, comparing participants and non-participants of the 100% smoke-free drugstore campaign promoted by the Thai Pharmacy Network for Tobacco Control (TPNTC). STUDY DESIGN A cross-sectional survey of 3600 drugstores in Thailand. METHOD Smoking prevalence on the premises, the number of stores displaying no-smoking signs, and the number of stores selling cigarettes were examined. RESULTS In total, 1001 questionnaires were returned (27.8% response rate). Smoking prevalences inside and outside drugstores in the past month were 26.4% and 84.7%, respectively. Seven percent of drugstores had at least one staff member who smoked tobacco. Overall, 63.3% of drugstores displayed no-smoking signs, as required by law. Compared with non-participating drugstores, those which participated in the TPNTC smoke-free campaign more frequently reported that they had asked smokers to stop smoking/leave the premises, in addition to possessing and displaying no-smoking signs. CONCLUSION Approximately one-third of drugstores in this survey did not meet the terms of the recent smoke-free regulation. The TPNTC campaign improved the compliance of drugstores with the law in various aspects. This study was considered a pilot study, and despite the low response rate, the findings suggest a need for further action to ensure that all drugstores comply with the law and are 100% smoke-free.

Statins utilisation pattern: a retrospective evaluation in a tertiary care hospital in Thailand

Objectives  To determine statin usage pattern and evaluate whether new generation statins are actually needed by the patients receiving them.

Clinical Effects of Krachaidum (Kaempferia parviflora): A Systematic Review

Kaempferia parviflora (Krachaidum) is a medicinal plant in the family Zingiberaceae. Its rhizome has been used as folk medicine for many centuries. A number of pharmacological studies of Krachaidum had claimed benefits for various ailments. Therefore, this study aimed to systematically search and summarize the clinical evidences of Krachaidum in all identified indications. Of 683 records identified, 7 studies were included. From current clinical trials, Krachaidum showed positive benefits but remained inconclusive since small studies were included. Even though results found that Krachaidum significantly increased hand grip strength and enhanced sexual erotic stimuli, these were based on only 2 studies and 1 study, respectively. With regard to harmful effects, we found no adverse events reported even when Krachaidum 1.35 g/day was used. Therefore, future studies of Krachaidum are needed with regards to both safety and efficacy outcomes.

Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis

Objective In 2008, the Thai government introduced the ‘high-cost medicines E2 access program’ as a part of the National List of Essential Medicines to increase patient access to medicines, improve clinical outcomes and make medicines more affordable. Our objective was to examine whether the ‘high-cost medicines E2 access program’ achieved its goals. Design Interrupted time-series design study. Setting 3 tertiary hospitals in different regions of Thailand, January 2006 to December 2012. Participants Patients with target acute and chronic disease diagnoses who newly met E2 program criteria for selected study medicines. Intervention High-cost medicines E2 access program. Main outcomes measures Level and trend changes over time in the proportions of eligible patients who received the indicated E2 medicines and who improved clinically, as well as in costs of treatment. Results A total of 2024 patients were included in utilisation analyses and 1375 patients with selected acute diseases contributed to analyses of clinical outcome. After 1 year of the E2 program implementation, the percentage of eligible patients receiving the indicated E2 program medicines increased significantly (relative change 12.7% (95% CI 4.4% to 21.0%), especially among those insured by the governments universal coverage scheme (relative change 19.9% (95% CI 9.5% to 30.5%)). The increase in the proportion of clinically improved patients with acute conditions was not significant (relative change 6.2% (95% CI −1.9% to 15.1%)). Quarterly healthcare costs per patient dropped significantly (relative change −13.5% (95% CI −26.9% to −1.7%)). Conclusions In the study hospitals, the E2 access program seems to have facilitated patient access to specialty medicines, may have contributed to improved health outcomes, and decreased treatment costs. Routine monitoring is needed to assess effects of expanding the programme, including effects on quality of care and financial sustainability.

Effects of Centella asiatica (L.) Urb. on cognitive function and mood related outcomes: A Systematic Review and Meta-analysis

Centella asiatica (L.) Urb. has been used as an herbal brain tonic for mental disorders and enhancing memory, but no review of the overall evidence of C. asiatica and cognitive function has been conducted. This study aims to determine the effects of C. asiatica on cognitive function and its related properties. The current systematic review includes five randomized controlled trials (RCTs) conducted to determine the effect of C. asiatica alone and six RCTs conducted to determine the effect of C. asiatica-containing products. Meta-analysis indicated that there are no significant differences in all cognitive function domains of C. asiatica when compared to placebo. However, it could improve mood by increasing alert scores [SMD: 0.71 (95% CI; 0.01 to 1.41); I2 = 30.5%] and decreasing anger scores at 1 hour after treatment [SMD: −0.81 (95%CI; −1.51 to −0.09); I2 = 36.6%]. None of the studies reported adverse effects of C. asiatica. In conclusion, there is not strong evidence to support the use of C. asiatica for cognitive function improvement in each cognitive domain. C. asiatica could improve alertness and relieve anger. However, some limitations should be aware including dose regimen, plant preparation, standardization, and product variation. Future well-designed clinical trials using suitable doses of standardized C. asiatica are still needed.