Trends in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties: a three-year retrospective study in a tertiary hospital in Thailand.

OBJECTIVES: The study determined a comparative three-year trend in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties of a tertiary hospital. METHODS: Prescription data for three consecutive fiscal years (2016-2018) were extracted from a tertiary hospital electronic database, for the gastrointestinal, cardiovascular and orthopaedic outpatient specialties. The data collected were individual proton pump inhibitors, overall and individual prescribing volumes (capsule/tablet) and costs, stratified by specialty and fiscal year. KEY FINDINGS: Of the three specialties, the largest volume of proton pump inhibitor prescriptions, mostly for omeprazole, comes from the orthopaedic specialty (46%). In terms of prescribing costs, at the top is the cardiovascular specialty (45.75%). Lansoprazole, which is one of the proton pump inhibitors on in the national list of essential medicines, contributed most to the cost. Prescribing proton pump inhibitors that are not included in the national list of essential medicines were responsible for over 90% of the costs in the cardiovascular and gastrointestinal specialties. An escalating trend in prescribing varied proton pump inhibitors, that is, esomeprazole, lansoprazole, pantoprazole, dexlansoprazole and rabeprazole, all of which were not on the list of essential medicines, was evident in the latter. CONCLUSIONS: The highest volume of proton pump inhibitor prescribing-mostly of omeprazole, was issued by the orthopaedic specialty. The cardiovascular specialty was responsible for the largest amount of cost. The increases in the uses and costs of varying proton pump inhibitors which were outside the national list of essential medicines were notable in the gastrointestinal specialty.

Thai Patients' Drug Safety Knowledge and Perceptions Relating to Different Forms of Written Medicine Information: A Comparative Study.

Purpose: The aim of the study was to evaluate the medication safety knowledge, quality of the written medicine information (WMI), and perceptions of taking the medicines in patients receiving package inserts (PIs) in comparison with patient information leaflets (PILs). Methods: A cross-sectional, comparative study was conducted from December 2020 to May 2021 at two university hospitals in Thailand. Outpatients who visited the pharmacy departments and were prescribed one of the three medicines: atorvastatin, celecoxib, or metformin were randomly selected by a permuted block randomization. The medication safety knowledge was measured using a set of validated and closed questions. The quality of the WMI was measured by the Consumer Information Rating Form (CIRF). Satisfaction with information and perceptions of the benefits and risks of medications were rated by the participants using a visual analog scale (0 to 10). Results: Of the 1150 invited patients, 750 completed the questionnaires (65.2%). A higher proportion of respondents with high level of medication safety knowledge was found in those reading the PILs than the PIs (44.5% and 20.8%, respectively). The type of leaflet received was a significant predictor of the high knowledge level (p < 0.001). The mean CIRF scores were significantly higher among those reading the PILs than the PIs (p < 0.001). Patients reading the PILs were also more satisfied with the information and had more positive perceptions of the benefits from taking medicines and intention to adhere than those reading the PIs. Patients' perceptions of risks after reading both leaflets were moderate (median score = 5.0), with the PIL group having slightly more concern about risks than the PI group. Conclusion: The PILs showed superior effectiveness to the PIs in enhancing knowledge about medication safety, providing greater satisfaction with the information, and positive perceptions of benefit and intention to comply with the medications. PILs should be provided more frequently to patients receiving medicines than PIs.

Development and psychometric validation for evaluating written medicine information in Thailand: The Consumer Information Rating Form.

OBJECTIVE: To translate and validate the consumer information rating form (CIRF) for use in Thai populations. DESIGN: The development of the CIRF was carried out in two phases: translation process and cognitive interview, and psychometric testing. SETTING: A university hospital and a tertiary hospital in northeast Thailand. PARTICIPANTS: 150 outpatients from medicine department: 30 for phase 1 and 120 patients for phase 2 study. METHODS: The CIRF was translated with cultural adaptation into Thai using cognitive interview technique in a sample of outpatients. A larger sample of outpatients then completed the CIRF in relation to either a package insert (PI) or a patient information leaflet (PIL) for one of three medicines: atorvastatin, celecoxib and metformin. Construct validity was assessed using principal component analysis (PCA) and internal consistency using Cronbach's α coefficient. Known group validity was assessed by comparing mean consumers' ratings for PIs and PILs. RESULTS: Thirty participants engaged in the cognitive interview and 120 participants completed the CIRF. The PCA found the 17 items of the CIRF were extracted into three factors: comprehensibility, utility and design quality scales, mirroring the original. Cronbach's α for the overall scale (0.904) indicated good internal consistency. Known-group validity demonstrated significant differences in consumers' rating between PIs and PILs for almost all items (p<0.001). CONCLUSION: Thai version of CIRF had acceptable validity and reliability for Thai consumers' ratings of written medicine information. The CIRF could be of practical use in the process of developing medicine information to ensure consumers' comprehension and their usefulness.

Patients' Experiences and Perspectives of Receiving Written Medicine Information About Medicines: A Qualitative Study.

PURPOSE: Written medicine information informs patients about the benefits and risks of medicines and supports their safe and effective use. In Thailand, patient information leaflets (PILs) are not obligatory and therefore not routinely supplied. This study aimed to explore the experiences and information needs of patients, their views on PILs and the likely impact of PILs on their knowledge, perceptions and behaviors towards medicines. These factors are important to establish the value of PILs. METHODS: Semi-structured interviews with outpatients who received simvastatin or atorvastatin were conducted exploring their experiences of receiving medicine information, their views on the utility of and need for PILs, the impact of PILs on their behaviors, and recommendations for how PILs could be improved. All interviews were audio-recorded, transcribed verbatim, and analyzed using a framework approach. RESULTS: Thirty interviews were conducted from which four themes emerged: experience of receiving medicine information, views of package inserts and PILs, impact of PILs on knowledge, perceptions and behaviors, and patients' need for medicine information. Most participants received verbal information from healthcare professionals, as well as written information. Verbal information was perceived as being particularly useful to inform about changes to medicine regimens or the long-term adverse effects of medicines. Patients perceived that the PILs had influenced their knowledge about medicines, and also their behaviors including safety awareness, adherence, and engagement with healthcare professionals. Participants suggested that the information in electronic format could provide an additional resource. Some changes to improve the content and general format of the PIL were identified. CONCLUSION: PILs are perceived as useful by patients and met their information needs, although they were viewed as an adjunct to verbal advice provided by healthcare professionals. PILs influenced patients' medicine taking behaviors and encouraged sharing of information with their physicians.

Experiences and Views of Medicine Information Among the General Public in Thailand.

PURPOSE: Written and electronic medicine information are important for improving patient knowledge and safe use of medicines. Written medicine information in Thailand is mostly in the form of printed package inserts (PIs), designed for health professionals, with few medicines having patient information leaflets (PILs). The aim of this study was to determine practices, needs and expectations of Thai general public about written and electronic medicine information and attitudes towards PILs. PATIENTS AND METHODS: Cross-sectional survey, using self-completed questionnaires, was distributed directly to members of the general public in a large city, during January to March 2019. It explored experiences of using information, expectations, needs and attitudes, the latter measured using a 10-item scale. Differences between sub-groups were assessed, applying the Bonferroni correction to determine statistical significance. RESULTS: Of the total 851 questionnaires distributed, 550 were returned (64.2%). The majority of respondents (88%) had received PIs, but only a quarter (26.2%) had received PILs. Most respondents (78.5%) had seen medicine information in online form. High educational level and income increased the likelihood of receiving PILs and electronic information. The majority of respondents (88.5%) perceived PILs as useful, but 70% considered they would still need information about medicines from health professionals. Indication, drug name and precautions were the most frequently read information in PIs and perceived as needed in PILs. Three-quarters of respondents would read electronic information if it were available, with more who had received a PIL having previously searched for such information compared to those who had not. All respondents had positive overall attitudes towards PILs. CONCLUSION: Experiences of receiving PILs and electronic medicine information in Thailand are relatively limited. However, the general public considered PILs as a useful source of medicine information. Electronic medicine information was desired and should be developed to be an additional source of information for consumers.

Practices of healthcare professionals in communicating with nonsteroidal anti-inflammatory drug users in Thailand: a qualitative study.

OBJECTIVE: This study aimed to explore practices among healthcare professionals in nonsteroidal anti-inflammatory drug (NSAID) information provision. METHODS: In-depth interviews were conducted with orthopaedic physicians (OPs), hospital and community pharmacists (CPs) in northeastern Thailand. Ten hospitals and 20 pharmacies in five provinces were purposively selected. Interviews followed a topic guideline, were audio-recorded, transcribed verbatim and analysed using a framework approach. KEY FINDINGS: Fifty-one participants were involved: 13 OPs, 20 hospital pharmacists and 18 CPs. Four main themes emerged: general information, safety information, differences between new and regular NSAID users and non-selective and selective NSAID users. Pharmacists mostly provided information on administration and indication. While all three groups informed of adverse effects, this was selective, related to factors including trading, time available, patients' age and perceived ability to understand. Gastrointestinal adverse effect information was most commonly provided, with other side effects, drug interactions and need to monitor for adverse effects rarely mentioned. Variation was reported in provision of safety information depending on whether patients were using selective or non-selective NSAIDs, and new or long-term users. CONCLUSIONS: The content and frequency of NSAID information provision varied between health professionals. Greater awareness of NSAID risks is essential; therefore, strategies to improve information provision to Thai patients are desirable.

Development and evaluation of user-tested Thai patient information leaflets for non-steroidal anti-inflammatory drugs: Effect on patients' knowledge.

INTRODUCTION: Thai patients do not routinely receive patient information leaflets (PILs) with medicines, so awareness of safety issues is low. This study aimed: i) to develop Thai PILs for NSAIDs and subject these to user-testing, and ii) to assess the potential value of PILs from the patient perspective and effect on patient knowledge. METHODS: Four PILs for NSAIDs were developed and subjected to multiple rounds of user-testing by the general public. Self-administered questionnaires were distributed to orthopaedic out-patients prescribed one of these NSAIDs, assessing knowledge before and after providing a PIL. The follow-up questionnaire also sought use of and views on the PILs using a visual analogue scale (VAS). RESULTS: 1,240 baseline questionnaires were completed; only 13.5% of patients had good knowledge. 688 patients returned follow-up questionnaires (55.5%), of whom75% had good knowledge. In patients completing both questionnaires, mean knowledge score increased from 6.22±1.40 to 8.42±1.41 (p<0.001). Patients with high educational levels had high baseline scores (OR = 2.728) and showed greatest improvement in knowledge (OR = 5.628). 90% (625) of follow-up respondents indicated they read all information in the PILs. All also agreed that these PILs should distributed to all patients taking NSAIDs. The median VAS score for usefulness was 9.3 (IQR 8.6-10.0). CONCLUSIONS: User-testing of PILs was feasible in a Thai population and enabled the development of acceptable and desirable PILs. PILs could improve patients' knowledge about their medicine, particularly among those with higher educational level. User-tested PILS could meet the need for more written medicine information.

Evaluation of community pharmacists' roles in screening and communication of risks about non-steroidal anti-inflammatory drugs in Thailand.

AimThis study aimed to explore community pharmacists' roles on screening for risk factors, providing safety information-related non-steroidal anti-inflammatory drugs (NSAIDs) to patients. BACKGROUND: NSAIDs are widely dispensed without a prescription from pharmacies in Thailand, while they are frequently reported as causing adverse events. METHODS: Self-administered questionnaires were distributed to all accredited pharmacies in Thailand, inviting the main pharmacist in each pharmacy to participate in this study.FindingsOut of 406 questionnaires distributed, 159 were returned (39.2%). Almost all pharmacists claimed to engage in NSAID dispensing practice, but not all of them provided relevant good practice, such as, screening for risk factors (56.3-95.5%), communication on adverse drug reactions (ADRs) (36.9-63.2%) and ADR management (58.9-79.7%), history of gastrointestinal (GI) problems was frequently mentioned for screening, but many pharmacists did not screen for history of NSAID use (24.7-35.5%), older age (45.2-48.9%), concomitant drug (63.7%), and problems of cardiovascular (24.1%), renal (34.9-43.3%), and liver systems (60.3-61.0%). Male pharmacists were significantly less likely to inform users of non-selective NSAIDs about ADRs [odds ratio (OR) 0.44], while provision of information about selective NSAID ADRs was higher among pharmacy owners (OR 2.28), pharmacies with more pharmacists (OR 3.18), and lower in pharmacies with assistants (OR 0.41). Screening for risk factors, and risk communication about NSAIDs were not generally conducted in Thai accredited community pharmacists, nor were NSAID complications fully communicated. Promoting of community pharmacists' roles in NSAID dispensing should give priority to improving, especially in high-risk patients for taking NSAIDs.

Physicians' communication of risks from non-steroidal anti-inflammatory drugs and attitude towards providing adverse drug reaction information to patients.

RATIONALE, AIMS, AND OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for orthopaedic conditions, therefore this study aimed to explore orthopaedic physicians' perceptions of their role in NSAID-risk communication, their attitudes towards the necessity of informing patients about adverse drug reactions (ADR), and factors associated with these. METHODS: Self-administered questionnaires were mailed to all 206 orthopaedic physicians working at hospitals in Northeastern Thailand. Attitudes were assessed using 17 statements and total scores classed as poor, moderate and good attitude. RESULTS: Sixty-six questionnaires were returned (32.04%). The responses showed that 75% of physicians claimed to communicate NSAID ADR information, more frequently about gastrointestinal (GI) complications, than about renal and cardiovascular (CVS) complications. ADR management (36%) and monitoring (30%) were not frequently communicated. The time spent with patients was associated with provision of ADR and monitoring advice. Renal function was the risk factor of greatest concern for prescribing any NSAID, followed by history of GI complications, and allergy for non-selective NSAIDs, and history of CVS diseases and age for selective COX-2 NSAIDs. Most physicians (41) had moderate attitude towards providing information and 24 good attitude. Fewer physicians working in tertiary hospitals than general and community hospital physicians considered that time limitations prevented counseling and that patient information leaflets offered easily accessible information. Additionally, more physicians who did not inform patients about ADRs agreed that ADR communication can lead to anxiety and discontinuing treatment. CONCLUSION: The study indicates that, although orthopaedic physicians had positive attitudes towards providing ADR information to patients, improvement is needed in communicating NSAID risk information.

Knowledge and perceptions of the risks of non-steroidal anti-inflammatory drugs among orthopaedic patients in Thailand.

Background There is a high incidence of adverse effects from non-steroidal antiinflammatory drugs (NSAIDs) in Thailand, but patients' perceptions and knowledge of NSAID risks is unknown. Objective This study aims to assess patients' perceptions and knowledge of NSAID risks and factors affecting them. Setting University hospital in North-East of Thailand. Method A Cross-sectional study conducted over 4 months, using a self-administered questionnaire. Patients prescribed NSAIDs for at least one month duration from orthopaedic clinic were recruited using systematic random sampling. Main outcome measure Patients' perceptions on NSAID risks, knowledge on risk factors, and their associated factors. Results A total of 474 questionnaires were assessed. Overall perceptions of risks was low (scoring below five on a 0-10 visual analogue scale), with risks associated with the renal system scoring highest. Perceived risk of gastrointestinal problems differed between patients using non-selective and selective NSAIDs (3.47 ± 2.75 vs 2.06 ± 2.98; P < 0.001). Receiving side effect information from a health professional was associated with higher risk perception. Most patients (80 %) identified high doses, renal disease and gastrointestinal ulcer increased risks of NSAIDs, but fewer than half recognized that use in the elderly, multiple NSAID use, drinking, hypertension and cardiovascular disease also increased risk of adverse events. Having underlying diseases and receiving side effect information were associated with 1.6-2.0 fold increased knowledge of NSAID risks. Conclusion Perceptions and knowledge concerning NSAID risks was generally low in Thai patients, but higher in those who had received side effect information. Risk-related information should be widely provided, especially in high-risk patients.

Experiences of and attitudes towards receiving information about non-steroidal anti-inflammatory drugs: a cross-sectional survey of patients in Thailand.

OBJECTIVE: To determine sources of information about NSAIDs used by out-patients, factors related to receipt of information and patient attitudes towards receiving safety information. RESEARCH DESIGN AND METHODS: Cross-sectional survey, using self-completed questionnaires distributed directly to 500 outpatients prescribed any NSAIDs from an orthopaedic clinic in Thailand, over a 4-month period. RESULTS: There were 548 patients approached and 474 completed questionnaires returned (94.8%). The most frequent aspects of medicines information that were provided related to administration (97.2%), mostly provided by pharmacists, and indication (85.8%), mostly provided by physicians. Information on identifying, monitoring and managing adverse effects was received by fewer than 50% of patients. Safety information was received significantly more frequently by younger patients (P<0.01), those using non-selective COX-2 inhibitors (P<0.001), intermittent NSAIDs (P<0.05) and fewer concomitant medicines (P<0.05). Only 14.1% patients used additional information sources. Attitudes towards receiving medicines safety information were positive. Most patients agreed they should know about ADRs (98.1%) and receive information leaflets with first prescription (96.8%). CONCLUSIONS: Patients received medicines information mostly from healthcare professionals, but safety information was limited. Type of NSAIDs, regularity of NSAID use and age affected receipt of safety information about NSAIDs. Provision of more medicine information is needed, particularly written documents.

Medicine information leaflets for non-steroidal anti-inflammatory drugs in Thailand.

BACKGROUND: The importance of promoting the use of patient-oriented medicines leaflets is recognized in many countries. Leaflets should include basic information plus specific warnings, and be provided with all medicines, but there is little attempt at enforcement of these requirements in Thailand. OBJECTIVE: To determine content and availability of Thai information leaflets for nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: Leaflets for all NSAIDs available for purchase from 34 pharmacies in a large city were evaluated against a checklist and number of leaflets assessed against number of medicine packs available in each pharmacy. RESULTS: Of the 76 leaflets for ten different NSAIDs, 67 (88 %) were for locally manufactured products. Only 22 % of 76 leaflets were sufficient in number for distribution with medicines, while only 4 % had patient-oriented leaflets. No leaflet covered all topics in the checklist. Less than half included safety information, such as contraindications (46 %), precautions (47 %), and adverse drug reactions (34 %). Locally-produced leaflets provided less information than those for originator products and no leaflet included all the warnings required by Thai regulations. CONCLUSION: This study illustrates the variable availability and quality of NSAID information leaflets. The lack of accessible essential information about medicines in Thailand requires urgent attention to enable patients to minimise adverse reactions.

Hospital pharmacists' roles and attitudes in providing information on the safety of non-steroidal anti-inflammatory drugs in Thailand.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for patients to manage pain and inflammation, especially in older adults. Failure to cope with some adverse drug reactions (ADRs) of NSAIDs could lead to more serious symptoms, therefore, providing useful information about medicine is an important step in protecting patients from developing serious ADRs. The pharmacy service should be a frequent source of medicine information for patients, however in Thailand, little is known about pharmacists' provision of safety information to patients for management and prevention of these ADRs. OBJECTIVE: Aims of this study were to determine Thai hospital pharmacists' roles in providing drug safety information and to assess their attitudes towards the importance of giving drug safety education to patients. SETTING: All government hospitals in north-eastern Thailand. METHODS: This study was a cross-sectional survey. A total of 761 pharmacists in 287 hospitals in north-eastern Thailand were selected by stratified random sampling. Self-administered questionnaires were sent by post, with two reminders. MAIN OUTCOME MEASURES: Proportion of hospital pharmacists providing ADR information on NSAIDs to patients, factors affecting this provision, and pharmacist attitudes towards drug safety education for patients. RESULTS: The response rate was 54.8% (N = 417), the majority of respondents worked in community hospitals (57.2%). A total of 347 pharmacists (83.6%) had informed patients about ADRs, although less than half had informed patients about ADR monitoring and management (36.6% and 44.1% respectively). The proportion of time spent in direct patient contact, type of hospital, and other routine work were associated with the frequency of drug safety information provision. Pharmacists had moderately good attitudinal scores towards drug safety education (62.2 ± 5.4), with significantly higher scores found in those who provided most ADR information to patients (60.3 ± 5.2 vs. 62.6 ± 5.4, P = 0.002). The majority (82.2%) agreed that patient information leaflets should be provided. CONCLUSIONS: Thai hospital pharmacists' provision of ADR information for NSAIDs may occur less frequently than is desirable. However, their positive attitude towards provision of ADR information suggests that drug safety education by pharmacists should be routinely provided to patients, particularly patients at high risk of NSAID use.

Lifestyle changes for prehypertension with other cardiovascular risk factors: findings from Thailand.

OBJECTIVE: To evaluate a model for community pharmacists to screen and recommend lifestyle changes for patients with prehypertension/hypertension and other elevated modifiable cardiovascular risk factors. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: One accredited community pharmacy in Hat Yai, Thailand, between October 2008 and January 2009. PARTICIPANTS: Individuals 35 years or older without any previous diagnosis of hypertension and other cardiovascular disease. INTERVENTION: Measurement of blood pressure, blood glucose, total cholesterol, and body mass index; history taking for smoking and physical exercise; laboratory referral; assessment of readiness to adopt lifestyle changes; and provision of verbal advice and an education pamphlet on cardiovascular risk factors and recommended lifestyle modifications. MAIN OUTCOME MEASURES: Number of prehypertensive/hypertensive participants, patient return rate at 3-month follow-up, rate of laboratory referral uptake, confirmed glucose intolerance and dyslipidemia, and changes from baseline in blood pressure level. RESULTS: 263 of 400 people eligible for screening were found to have prehypertension or hypertension. Of these patients, 57% returned at 3-month follow-up. Mean (±SE) systolic (6.5 ± 0.89 mm Hg [95% CI 4.7-8.2], P < 0.001) and diastolic (2.2 ± 0.82 [0.54-3.77], P = 0.009) blood pressure were lowered. Compared with baseline (39.3%), the percentage of normotensive participants increased significantly at 3-month follow-up (51.8%; P < 0.001). The overall laboratory referral uptake was 36% (50 of 138). Glucose intolerance was confirmed in 2 of 21 participants. Of the 42 patients accepting laboratory confirmation, total and low-density lipoprotein cholesterol were confirmed to be above the normal range in 100% and 78.6%, respectively. Among these participants, those who returned at follow-up were rescreened for blood glucose and total cholesterol. Both values were found to be in the normal range. Although more participants reported lifestyle changes at 3 months, the smoking rate and amount of physical exercise were not changed. CONCLUSION: Community pharmacists, through the use of point-of-care testing and referrals for laboratory testing, can detect patients who are at risk of developing or already have hypertension, diabetes, and/or dyslipidemia. Lifestyle advice from pharmacists can have a positive effect on these risk factors.

Screening for pre-hypertension and elevated cardiovascular risk factors in a Thai community pharmacy.

OBJECTIVES: To identify subjects with pre-hypertension and elevated cardiovascular risk factors in a community pharmacy and to assess their readiness to adopt lifestyle changes. SETTING: An accredited community pharmacy in Songkla province, Thailand. METHOD: Subjects aged >or= 35 years old and reporting no hypertension or other cardiovascular disease were included. Blood pressure was measured using the Microlife BP 3AC1-1. Those with pre-hypertension or hypertension defined by the JNC 7, and reporting no diabetes and/or dyslipidemia, were checked for blood glucose and/or total cholesterol with the Accutrend GCT monitor. Other risk factors were collected. Their readiness to adopt healthy lifestyles was evaluated. MAIN OUTCOME MEASURE: The prevalence of pre-hypertension and elevated cardiovascular risk factors. RESULTS: 350 subjects met the study criteria. Approximately 36 and 29% were pre-hypertensive and hypertensive, respectively. Two of these had blood glucose > 200 mg/dl but about 47% had total cholesterol > 200 mg/dl. Most common modifiable cardiovascular risks were inadequate exercise and elevated body mass index (approximately 52% each). Almost 40% were ready to adopt healthy lifestyles within 1-6 months. CONCLUSION: Subjects at risk for hypertension and cardiovascular disease can be identified by community pharmacists, with the use of point-of-care devices and careful interview.

Prescribing metformin in type 2 diabetes with a contraindication: prevalence and outcome.

OBJECTIVES: (1) To determine the prevalence of metformin prescribing in type 2 diabetes with a contraindication and (2) to explore whether metformin use on top of contraindications modified the risks of lactic acidosis, hospitalization, and death in type 2 diabetes. SETTING: Ambulatory diabetic clinics of the secondary-level care General Hospital of Hatyai district, Songkhla province, South Thailand. METHOD: A cross-sectional study was carried out for the objective (1). A retrospective cohort study was applied to meet the objective (2). Out-patient medical case notes were reviewed for metformin use, number of hospitalizations, lactic acidosis cases, death cases, and the presence of contraindications, which were limited to: (1) chronic renal impairments, (2) chronic liver diseases, and (3) cardiac failure. Only documented diagnoses of the above conditions were counted. MAIN OUTCOME MEASURE: The prevalence of metformin use in type 2 diabetes with a contraindication; odds ratios (ORs) of the occurrences of lactic acidosis, hospitalization, and death in type 2 diabetes with a contraindication modified by metformin use. RESULTS: A total of 1,630 type 2 diabetic outpatients were identified; 19.3% (315/1,630) had at least one contraindication to metformin use, with chronic renal impairment being the most frequent risk (78%, 246/315). Of those with a contraindication, 84.4% (266/315) were metformin users. Compared to non-metformin users, there were no significant differences in the number of hospitalizations and deaths. No cases of lactic acidosis were evident. Metformin use in the presence of contraindications did not affect the risks of hospitalization (OR 0.73, 95% confidence interval [CI] 0.38-1.4, P = 0.34) or death (OR 0.58, 95% CI 0.11-3.15, P = 0.53). Other patient factors, such as the female gender or having diabetes-related complications, had significant influences on both outcomes. CONCLUSION: The prevalence of type 2 diabetes receiving metformin despite having a contraindication was over 80%. However, metformin use in such conditions did not appear to increase the risks of hospitalization and death. No lactic acidosis was reported. Other patient factors than metformin affect the risks of hospitalization and death.

Effects of the pharmacist's input on glycaemic control and cardiovascular risks in Muslim diabetes.

AIMS: To determine whether an extended pharmacy service would improve glycaemic control and cardiovascular risks in diabetic Muslims. METHODS: Ambulatory literate adult diabetic Muslims with A1C >7% were randomly assigned to either a study group (usual care plus added pharmacist input, N=63) or a control group (usual care only, N=67). On four consecutive visits, at 2-month intervals, the study group met a pharmacist who educated and discussed with each patient regarding medication uses and diabetic treatment. This was accompanied by providing a diabetic pamphlet. Changes in A1C (mg/dL), lipid parameters (mg/dL), medication adherence (% pill count) and diabetic knowledge scores were measured. RESULTS: There was no difference in A1C reduction between the study and the control groups (-0.8 vs. -0.6, p=0.56). Total cholesterol and LDL-C improvements were greater in the study group than in the control group (-31.6 vs. -1.2, p=0.000; -15.0 vs. +9.1, p=0.002, respectively). The percent pill count (+6.8 vs. -2.8, p=0.004) and diabetic knowledge scores (+2.1 vs. +0.6, p=0.002) were increased in the study group but not in the control group. CONCLUSION: The pharmacist' s one-on-one education on diabetes accompanied by its pamphlet, in Muslim patients with diabetes did not affect glycaemic outcome but reduction in cardiovascular risks through lowering total cholesterol and LDL-C was found. The strategies may also improve diabetic knowledge and medication adherence.