Impact of a pharmacist-led education and follow-up service on anticoagulation control and safety outcomes at a tertiary hospital in China: a randomised controlled trial.

OBJECTIVES: This study was designed to evaluate the impact of a pharmacist-led anticoagulation service on international normalised ratio (INR) control and other outcomes among patients receiving warfarin therapy at a tertiary hospital in Zhuhai, China. METHODS: In this randomised controlled trial, adult patients who were newly initiated on warfarin with intended treatment duration of at least 3 months were recruited. Participants were randomly allocated to receive the pharmacist-led education and follow-up service (PEFS) or usual care (UC). Anticoagulation control was calculated as the proportions of time within the target INR range (TTR) and time within the expanded target range (TER). KEY FINDINGS: A total of 152 participants (77 in the PEFS group and 75 in the UC group) were included. Within 180 days after hospital discharge, the PEFS group spent more TER than the UC group (54.4% versus 42.0%; P = 0.024), whereas the difference in TTR did not reach statistical significance (35.9% versus 29.5%; P = 0.203). No major bleeding events were observed, and the cumulative incidences of major thromboembolic events (6.5% versus 9.3%) and mortality (1.3% versus 1.3%) were similar between the two groups (P> 0.05). At 30 days postdischarge, the PEFS group had better warfarin knowledge by answering 57.5% of questions correctly, compared with the UC group (43.0%) (P = 0.003). CONCLUSIONS: The PEFS markedly enhanced anticoagulation control and warfarin knowledge but there was room for improvement. The expansion of pharmacists' clinical role and the development of more effective education and follow-up strategies are warranted to optimise anticoagulation management services in China.

Breast cancer screening behavior, attitude, barriers among middle-aged Chinese women in Macao, China.

Background: Breast cancer is the third leading cause of death from cancer among females in Macao, but little is known about local practice of breast cancer screening. The study aims to evaluate breast cancer screening behaviors and to identify the predictors of insufficient knowledge and attitudes towards breast cancer and its screening among female residents. Methods: This was a cross-sectional study conducted from April to June 2016 in Macao. Quota sampling of women completed the modified Chinese Breast Cancer Screening Beliefs questionnaire (CBCSB) to assess their breast cancer-related perceptions, screening attitudes and behaviors. Univariate and multivariate logistic regressions were performed to identify the predictors of poor-screening practices, attitudes, knowledge and perceived barriers to mammography. Result: A total of 417 women (mean age±SD: 50.5±5.7) completed surveys, with 160 (38.4%), 196 (47.0%) and 103 (24.7%) women received breast self-examination, clinical breast examination and mammography as recommended, respectively. Nulliparity (OR=2.56, 95% CI = 1.14-5.73) and low education (OR = 1.72, 95% CI = 1.04-2.84) were significantly associated with negative attitude towards health check-ups. Women did not know anyone with breast cancer (OR = 2.30, 95% CI = 1.50-3.55) were more likely to have insufficient knowledge about breast cancer. Low education (OR = 1.95, 95% CI = 1.25-3.04) and not knowing anyone with breast cancer (OR = 2.02, 95% CI = 1.31-3.13) were identified as predictors for perceived barriers to mammography. Conclusion: Recommendations for breast cancer screening are poorly followed by the residents in Macao, and a culturally tailored educational program is urgently needed to raise the public's awareness of the disease and the screening practices.

Underdiagnosis of depression in an economically deprived population in Macao, China.

INTRODUCTION: Previous literature revealed an association between low income and depression. Despite the availability of effective treatments, depression is often underdiagnosed and undertreated. This study was designed to evaluate the prevalence of depressive symptoms and their impact on health-related quality of life (HRQoL) in a low-income population in Macao. METHODS: This cross-sectional study targeted the adult beneficiaries of local food bank program. The program was established to provide food assistance to the residents who had low income but were ineligible for government financial assistance. All data were collected through interview and questionnaires. The Patient Health Questionnaire (PHQ-9) was used for assessing depressive symptoms. Information about depression diagnosis was obtained by the self-report method. HRQoL levels were measured by the 12-item Short-Form Health Survey, Version 2.0. RESULTS: A total of 272 study participants were included for analysis. Based on the PHQ-9 scores, 27.6% of the participants suffered from moderate to severe depressive symptoms. Among them, 76% were not diagnosed with depression. Those with moderate to severe depressive symptoms had significantly lower levels of HRQoL (P < 0.001). Anxiety disorders (OR = 9.71, 95% CI = 2.36-40.06), migraine (OR = 3.88, 95% CI = 1.55-9.73), and poor to fair self-rated health (OR = 6.30, 95% CI = 1.95-20.40) were the independent factors associated with moderate to severe depressive symptoms. DISCUSSION: Underdiagnosis of depression was prevalent in this low-income population. There is a need to raise their awareness of mental disorders and improve their access to mental health services.

Potentially inappropriate prescribing and drug-drug interactions among elderly Chinese nursing home residents in Macao.

BACKGROUND: The ageing of the population has become a concern all over the world, including Macao. In general, older people are more prone to adverse drug events which can result from potentially inappropriate medication (PIM) use and drug-drug interactions (DDIs). OBJECTIVE: This study was designed to evaluate the prevalence of PIM use and DDIs among elderly nursing home residents in Macao, and to find out the factors associated with these drug-related problems. SETTING: This study was conducted in the largest nursing home in Macao, with a bed capacity of 168. METHOD: All data of this cross-sectional study were collected from medical charts and medication administration records. PIM use was determined by the screening tool of older person's prescription (STOPP) criteria and potential DDIs were detected using the preset criteria of two compendia, Drug-Reax and Lexi-Interact. Multivariate logistic regression analysis was performed to identify the independent factors associated with each drug-related problem. MAIN OUTCOME MEASURES: The proportions of elderly nursing home residents who regularly used PIMs and who were exposed to DDIs. RESULTS: A total of 114 elderly residents were eligible for PIM analysis. They consumed an average of 6.9 ± 3.1 different medications. About 46.5 % of them regularly used one or more PIMs. The prevalence of DDIs was 37.8 % among the 111 elderly residents who consumed at least two different medications. An increased number of drugs used was identified as the independent factor associated with PIM use and DDIs (p < 0.05). However, the use of STOPP-related PIMs did not appear to raise the likelihood of DDIs among the study population. CONCLUSION: Both PIM use and DDIs are common among elderly nursing home residents in Macao. Further studies should be conducted to evaluate the clinical outcomes of pharmacist-led interventions for elderly residents in the local nursing home setting.

A comparison of tenofovir-associated renal function changes in HIV-infected African Americans vs Caucasians.

BACKGROUND: The effects of tenofovir on renal function have been measured in multiple studies. Although African Americans are at a higher risk of developing chronic kidney disease, there are limited data examining the influence of race on tenofovir-related nephrotoxicity. METHODS: This was a retrospective study of human immunodeficiency virus (HIV)-infected patients at a university-affiliated HIV clinic who were prescribed tenofovir between July 1, 2001, and January 31, 2009. The primary outcome was mean change in creatinine clearance. Secondary endpoints assessed the odds of tenofovir discontinuation secondary to nephrotoxicity, and prevalence of grade 2 to 4 serum creatinine elevation and hypophosphatemia during treatment. MAIN FINDINGS: A total of 65 African American and 186 Caucasian patients were included. There were no statistically significant differences in mean change in creatinine clearance, as estimated by the Cockcroft-Gault (-14.2 mL/min vs -15.9 mL/min [P = .525]) and modification of diet in renal disease formulas (-17.2 mL/min/1.73 m2 vs -15.6 mL/min/1.73 m2 [P = .585]) between African Americans and Caucasians. Rates of tenofovir discontinuation secondary to nephrotoxicity were 6.2% and 1.6%, respectively (P = .076). Elevated baseline serum creatinine and female gender may be potential predictors for tenofovir discontinuation. CONCLUSION: There were no statistically significant differences in tenofovir-related renal function changes by race as observed in our HIV patient population.