The Prevalence and Impact of Clinical Pharmacists' Intervention on Drug-Related Problems in Patients With Chronic Kidney Disease.

Chronic kidney disease (CKD) is a global health issue of growing concern. According to projections from the Worldwide Health Observatory, it is currently one of the rapidly increasing contributors to global mortality. The prevalence of CKD and end-stage renal disease (ESRD) is increasing globally. The objective was to evaluate the prevalence and impact of clinical pharmacist intervention in resolving drug-related problems (DRPs) among patients with CKD. A single-arm, pre- and post-intervention study design was used, which was assessed to be suitable in testing for the feasibility of the implementation of an intervention in clinical practice. With this study pre- and post-intervention variables of interest were measured before and after an intervention in the same patients to evaluate the impact of clinical pharmacists on ambulatory patients with CKD. The findings of this study indicate a high prevalence of DRPs, with every patient experiencing at least one DRP. The mean DRP per patient was found to be 2.903 with STD ± 1.148. The study assessed the considerable influence of clinical pharmacist intervention on DRPs. The predominant form of DRP was drug interaction 167 (45.1%) which was reduced to 76 (20.5%) after intervention carried out by clinical pharmacists statistically significant (p = 0.032). Another common DRP was found to be poor compliance issues in pre-interventions (n = 144 (38.9%)) and was reduced to 80 (21.6%) at post-intervention significantly (p = 0.042). Untreated indications were noticed in 137 cases (37.0%), after pharmacist intervention, this number was significantly reduced to 27 cases (7.3%), with a statistically significant difference (p = 0.004). However, it is noteworthy that medication compliance among patients in our study was unsatisfactory and fell below expectations. As a clinical pharmacist played an important role in reducing the prevalence of poor medication adherence to lower levels in these CKD outpatients. This research emphasizes the vital role of clinical pharmacists in mitigating DRPs among CKD patients, resulting in improved medication management and potentially better health outcomes.

Risk-taking in consumers' online purchases of health supplements and natural products: a grounded theory approach.

BACKGROUND: Health supplements and natural products are widely used by the general public to support physical function and prevent disease. Additionally, with the advent of e-commerce, these products have become easily accessible to the general public. Although several theoretical models have been used to explain the use of health supplements and natural products, empirical evidence on how consumers make decisions to purchase online health supplements and natural products remains limited. METHODS: In this study, a grounded theory approach was used to develop a substantive theoretical model with the aim of investigating the decision-making process of consumers when purchasing health supplements and natural products online. Malaysian adult consumers who had purchased these products via the Internet were either purposively or theoretically sampled. A total of 18 virtual in-depth interviews (IDIs) were conducted to elicit participants' experiences and priorities in relation to this activity. All the IDIs were audio-recorded and transcribed verbatim. The data were analysed using open coding, focus coding and theoretical coding. The analytical interpretations and theoretical concepts were recorded in research memos. RESULTS: Consumers' decisions to purchase a health supplement or natural product over the Internet are based on a series of assessments regarding the perceived benefits and risks of this activity, which may be related to the product or the process. In the online marketplace, consumers attempt to choose products, online sellers, sales platforms and/or purchase mechanisms with lower perceived risk, which ultimately enhances their confidence in five elements related to the purchase: (1) product effectiveness, (2) product safety, (3) purchase convenience, (4) fair purchase and (5) online security. Consumers take an acceptable level of risk to purchase these products online, and this acceptable level is unique to each individual and is based on their perception of having control over the potential consequences if the worst-case scenario occurs. CONCLUSIONS: In this study, a substantive theoretical model is developed to demonstrate how consumers decide to purchase online health supplements and natural products by accepting an acceptable level of risk associated with the product or process. The emerging model is potentially transferable to other populations in similar contexts.

Implementing a chatbot on Facebook to reach and collect data from thousands of health care providers: PharmindBot as a case.

BACKGROUND: The world is moving fast toward digital transformation as we live in the artificial intelligence (AI) era. The COVID-19 pandemic accelerates this movement. Chatbots were used successfully to help researchers collect data for research purposes. OBJECTIVE: To implement a chatbot on the Facebook platform to establish connections with health care professionals who had subscribed to the chatbot, provide medical and pharmaceutical educational content, and collect data for online pharmacy research projects. Facebook was chosen because it has billions of daily active users, which offers a massive potential audience for research projects. PRACTICE DESCRIPTION: The chatbot was successfully implemented on the Facebook platform following 3 consecutive steps. Firstly, the ChatPion script was installed on the Pharmind website to establish the chatbot system. Secondly, the PharmindBot application was developed on Facebook. Finally, the PharmindBot app was integrated with the chatbot system. PRACTICE INNOVATION: The chatbot responds automatically to public comments and sends subscribers private responses using AI. The chatbot collected quantitative and qualitative data with minimal costs. EVALUATION METHODS: The chatbot's auto-reply function was tested using a post published on a specific page on Facebook. Testers were asked to leave predefined keywords to test its functionality. The chatbot's ability to collect and save data was tested by asking testers to fill out an online survey within Facebook Messenger for quantitative data and answer predefined questions for qualitative data. RESULTS: The chatbot was tested on 1000 subscribers who interacted with it. Almost all testers (n = 990, 99%) obtained a successful private reply from the chatbot after sending a predefined keyword. Also, the chatbot replied privately to almost all public comments (n = 985, 98.5%) which helped to increase the organic reach and to establish a connection with the chatbot subscribers. No missing data were found when the chatbot was used to collect quantitative and qualitative data. CONCLUSIONS: The chatbot reached thousands of health care professionals and provided them with automated responses. At a low cost, the chatbot was able to gather both qualitative and quantitative data without relying on Facebook ads to reach the intended audience. The data collection was efficient and effective. Using chatbots by pharmacy and medical researchers will help do more feasible online studies using AI to advance health care research.

Determinants of the choice of provisionally registered pharmacist (PRP) training in Malaysia: a qualitative insight.

OBJECTIVE: In Malaysia, due to provisional registered pharmacist (PRP) training places in government hospitals being oversubscribed, pharmacy graduates wait for about a year before starting their training. Therefore, a policy was implemented to allow pharmacy graduates to select their preferred areas of PRP training. This study was conducted to explore the perception and preferences of final year pharmacy students on the current PRP training system. METHODS: This qualitative interview study was conducted among final year pharmacy students. Participants were recruited using convenience sampling until data saturation (i.e., when additional interviews didn't lead to any new themes). All interviews were audio-recorded, transcribed verbatim, and evaluated by thematic analysis. KEY FINDINGS: Twenty-two final year pharmacy students were interviewed. Fifteen of them preferred the government sector as their choice training, three chose the community sector, two preferred private hospitals and another two preferred the pharmaceutical industry. The majority of the students gave positive feedback towards the liberalization of PRP training sites. Most of them chose clinical pharmacy as their preferred training site despite knowing of the saturation issue in government hospitals. This was mainly due to the opportunity to gain clinical experience and knowledge from the government sector. A small number of students preferred the pharmaceutical industry based on their personal interests and opportunities for career advancement. CONCLUSION: Pharmacy students generally chose their PRP training site based on personal interest, future career advancement and working environment. A better understanding of career pathways and opportunities in the pharmaceutical industry by the students is required.

Perspectives of the public on the consumption of unregistered health products in Malaysia.

OBJECTIVE: Unregistered medications which are lacking regulation in terms of safety, efficacy and quality may cause unpredictable adverse drug reactions (ADRs) in consumers. Therefore, this study aimed to assess the public knowledge, attitude and practice of consuming and purchasing unregistered health products in Malaysia. METHODS: A cross-sectional study involving members of the Malaysian public was carried out using the convenience sampling method. Descriptive statistics were used to summarise the socio-demographic characteristics of the respondents. Associations between knowledge items/scores and other items were assessed using Spearman's rank correlations and Cramer's V. Regression analyses were carried out to determine whether the socio-demographic characteristics of the respondents influenced knowledge and practice relating to unregistered medications. KEY FINDINGS: A total of 649 respondents completed the questionnaire with the majority being female (66.1%), unmarried (66.5%), Malay (52.5%) and possessing a bachelor's degree (53.5%). The knowledge of the public surveyed regarding unregistered (unlicensed) medications was lacking, especially in being able to identify a registered health product in Malaysia and formally complaining if necessary. The respondents agreed that currently, there are insufficient laws and educational programmes to tackle the issue. The respondents exhibited good practice habits by purchasing their medications from healthcare professionals. Mean knowledge score was positively correlated to practice scores at rs  = 0.423 (P-value < 0.001). Ethnicity and education level were significant predictors of knowledge scores, while ethnicity, age and income group influenced practice-related items. CONCLUSION: While respondents generally had good medication purchasing practices, their knowledge about and attitude to unregistered medications indicated the need for more educational awareness of the issues.

The rate of progression of type 2 diabetes mellitus to end stage renal disease - A single centred retrospective study from Malaysia.

INTRODUCTION: In Malaysia, 61% of dialysis cases are secondary to diabetes. To date, we are still lacking of data on the rate of progression of type 2 diabetes mellitus (T2DM) to end stage renal disease (ESRD) in Malaysia. MATERIALS AND METHODS: This was a retrospective study conducted at nephrology unit of a tertiary hospital in Kedah. All diabetic ESRD patients who fulfilled the inclusion criteria were identified and recruited for analysis. RESULTS: The mean duration of DM to ESRD was found to be 14.37 ±â€¯4.42 years. Mean duration for the onset of diabetic nephropathy was 8.73 ±â€¯3.37 years. There was a relative short duration from diabetic nephropathy to ESRD noted, which was 5.63 ±â€¯2.06 years. The mean duration of DM to ESRD for patients receiving RAAS blocker was found to be 18.23 ±â€¯2.38 years as compared to 11.41 ±â€¯2.94 years for those who did not (95% CI: -0.64 to -2.46). For different type of RAAS blockers, namely ACE inhibitor and angiotensin receptor blocker (ARB), there was no significant difference observed pertaining to mean duration of DM to ESRD; 17.89 ±â€¯1.97 years for ACEi and 19.00 ±â€¯4.16 years for ARB (95% CI: -4.74 to 2.52). DISCUSSION: Time frame from diabetic nephropathy to ESRF among Malaysian population was shorter as compared to findings from other countries with an average period of 15 to 25 years. RAAS blockers should be initiated early in diabetic patients.

Job satisfaction, organisation commitment and retention in the public workforce: a survey among pharmacists in Malaysia.

OBJECTIVES: The aims of the study were to assess job satisfaction and organisational commitment among pharmacists working in the public sector and its influence on their likelihood to stay within the public workforce. METHODS: A cross-sectional survey was conducted among all fully registered pharmacists (FRPs) in the northern states of Malaysia in 2009 (n = 467). The questionnaire consisted of three sections to capture the demographic characteristics of the respondents, assess job satisfaction and organisational commitment of the respondents and their likelihood of staying in public service. KEY FINDINGS: A total of 247 FRPs (response rate 52.9%) in the northern region of Malaysia participated in this survey. Majority of the respondents were women (n = 205, 83.0%), of Chinese ethnicity (n = 155, 62.8%), graduates from public universities (n = 173, 70.0%), single (n = 172, 69.6%), with a median age of 27 years (interquartile range (IQR) 2.0) and had worked with the Ministry of Health for a median of 2.75 years (IQR 1.63). The mean job satisfaction and organisational commitment score were 58.09 (standard deviation (SD) 11.83) and 53.46 (SD 6.65) respectively out of a maximum possible score of 90. Majority of the respondents claimed that they were likely to stay in public service (n = 176, 71.3%). Their likelihood of staying in public service was affected by respondents' gender, ethnicity, job satisfaction and organisational commitment. CONCLUSIONS: The findings from this study provide stakeholders with evidence on factors and issues affecting pharmacists' job satisfaction and commitment in the public workforce as well as the likely turnover rate with an early cohort of pharmacists affected by the compulsory service.