METHODS: A simulated patient method was used to evaluate pharmacist counseling practices in Sydney, Australia. Twenty community pharmacists received three simulated patient visits concerning antidepressant adherence-related scenarios at different phases of treatment: 1) patient receiving a first-time antidepressant prescription and hesitant to begin treatment; 2) patient perceiving lack of treatment efficacy for antidepressant after starting treatment for 2 weeks; and 3) patient wanting to discontinue antidepressant treatment after 3 months due to perceived symptom improvement. The interactions were recorded and analyzed to evaluate the content of consultations in terms of information gathering, information provision including key educational messages, and treatment recommendations.
RESULTS: There was variability among community pharmacists in terms of the extent and content of information gathered and provided. In scenario 1, while some key educational messages such as possible side effects and expected benefits from antidepressants were mentioned frequently, others such as the recommended length of treatment and adherence-related messages were rarely addressed. In all scenarios, about two thirds of pharmacists explored patients' concerns about antidepressant treatment. In scenarios 2 and 3, only half of all pharmacists' consultations involved questions to assess the patient's medication use. The pharmacists' main recommendation in response to the patient query was to refer the patient back to the prescribing physician.
CONCLUSION: The majority of pharmacists provided information about the risks and benefits of antidepressant treatment. However, there remains scope for improvement in community pharmacists' counseling practice for patients on antidepressant treatment, particularly in providing key educational messages including adherence-related messages, exploring patients' concerns, and monitoring medication adherence.
OBJECTIVE: The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making.
METHODS: A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia.
RESULTS: The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM.
CONCLUSION: Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM.
OBJECTIVE: This systematic review aimed to identify elements influencing user engagement metrics in social media posts by HCPs aimed to reduce lifestyle risk factors.
METHODS: Relevant studies in English, published between January 2006 and June 2023 were identified from MEDLINE or OVID, Scopus, Web of Science, and CINAHL databases. Included studies were those that examined social media posts by HCPs aimed at reducing the 4 key lifestyle risk factors. Additionally, the studies also outlined elements in social media posts that influenced user engagement metrics. The titles, abstracts, and full papers were screened and reviewed for eligibility. Following data extraction, narrative synthesis was performed. All investigated elements in the included studies were categorized. The elements in social media posts that influenced user engagement metrics were identified.
RESULTS: A total of 19 studies were included in this review. Investigated elements were grouped into 9 categories, with 35 elements found to influence user engagement. The 3 predominant categories of elements influencing user engagement were communication using supportive or emotive elements, communication aimed toward behavioral changes, and the appearance of posts. In contrast, the source of post content, social media platform, and timing of post had less than 3 studies with elements influencing user engagement.
CONCLUSIONS: Findings demonstrated that supportive or emotive communication toward behavioral changes and post appearance could increase postlevel interactions, indicating a favorable response from the users toward posts made by HCPs. As social media continues to evolve, these elements should be constantly evaluated through further research.
METHOD: This cross-sectional survey was conducted among community pharmacists in all 14 states of Malaysia between November 2021 and July 2022. The self-administered survey was shared to relevant groups through various social media platforms.
RESULTS: A total of 312 community pharmacists were involved in the survey. Majority of the respondents were females (66%), with a mean age (SD) of 32.9 (8.4) years. Most of the respondents showed satisfactory practice for patient counselling, but improvements are needed particularly in risk assessment and collaborative care aspect. Most of them expressed their interest for dyslipidemia management training (89.4%). Lack of access to medical records (71.2%) and lack of CVD-related educational materials (70.8%) were the two main perceived barriers identified.
CONCLUSION: Community pharmacists in Malaysia provide a satisfactory role in the provision of cardiovascular disease-related health promotion activities, especially in providing patient counselling. Strengthening collaborative care is essential for providing comprehensive and patient-centered intervention in dyslipidemia management. This requires ongoing efforts to address and overcome existing barriers for effective teamwork and coordination among healthcare professionals.
Methods: A descriptive, cross sectional-survey was conducted using a self-administered questionnaire comprising of sections that focused on public preferences and options on weight management approaches, perceived availability of extended services and resources provided by community pharmacists in relation to weight management, utilization of these services and resources, and factors influencing acceptability of weight management services provided by community pharmacists. The questionnaires were distributed to the general public aged 18 years and above in Klang Valley, Malaysia.
Results: A total of 730 respondents with a median age of 31 years participated in this study. Majority of respondents ranked dieticians as their preferred first line of consultation, with only about a quarter of respondents ranking community pharmacists as their preferred first or second line of consultation. Although more than half show of the study respondents perceived that community pharmacies they had visited offered services for measuring weight, height, blood pressure, blood glucose and blood cholesterol, fewer perceived that community pharmacies provided advice on physical activity and healthy eating to achieve weight loss. Additionally, majority of the respondents indicated that they had not utilized these services. However, most respondents perceived that community pharmacists should provide weight management services. The main factors influencing acceptability show of services included training of pharmacists, payment, waiting time and the issue of privacy.
Conclusion: The findings of this study demonstrated that the majority of respondents were in support of weight management services in community pharmacy; however only a low percentage reported utilizing these services. Factors influencing acceptability of services included payment, waiting time and the issue of privacy. With adequate training among pharmacists and increased awareness of services among the public, community pharmacists could play a larger and important role in addressing the issue of obesity in Malaysia.
PURPOSE: To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia's general public.
MATERIALS AND METHODS: A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data.
RESULTS: Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57±4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26±4.40 versus had engaged: 8.11±4.00, p<0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03±4.25 versus neutral: 6.62±3.91 versus disagree/strongly disagree: 8.29±4.00, p<0.001).
CONCLUSION: Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.
OBJECTIVE: To compare clinical outcomes, specifically changes in haemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels, between DM patients who completed the pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) sessions and those who did not, and to identify risk factors associated with non-completion of DMTAC.
METHODS: This multicenter, retrospective study included patients with DM attending DMTAC at five Ministry of Health centers from January 2018 to December 2020. Patients were categorized based on their completion of DMTAC sessions: those who completed at least four sessions and those who did not as per DMTAC protocol. The changes in HbA1c and FBS levels between the groups were analyzed. Logistic regression was employed to identify risk factors for non-completion of DMTAC.
RESULTS: A total of 198 patients were included, comprising 49% male with a mean age of 56.52, ±12.91 years. The complete group consisted of 49% (n=99) of the patients, while the did not complete group included 50.5% (n=100). A statistically significant reduction in FBS levels from initial to final measurements was observed in the complete group compared to the did not complete group (P=0.024). Female gender, higher education levels, and a longer duration since DM diagnosis were significantly associated with non-completion of DMTAC.
CONCLUSION: Diabetic patients attending at least four DMTAC sessions showed potential improvements in FBS levels. To enhance attendance at DMTAC sessions, healthcare professionals should focus on patients identified with risk factors for non-completion of DMTAC.
Purpose: To determine the level of adherence to opioid analgesics in patients with cancer pain and to identify factors that may influence the adherence.
Patient and Methods: This was a cross-sectional study conducted from March to June 2018 at two tertiary care hospitals in Malaysia. Study instruments consisted of a set of validated questionnaires; the Medication Compliance Questionnaire, Brief Pain Inventory and Pain Opioid Analgesic Beliefs─Cancer scale.
Results: A total of 134 patients participated in this study. The patients' adherence scores ranged from 52-100%. Factors with a moderate, statistically significant negative correlation with adherence were negative effect beliefs (rs= -0.53, p<0.001), pain endurance beliefs (rs = -0.49, p<0.001) and the use of aqueous morphine (rs = -0.26, p=0.002). A multiple linear regression model on these predictors resulted in a final model which accounted for 47.0% of the total variance in adherence (R2 = 0.47, F (7, 126) = 15.75, p<0.001). After controlling for other variables, negative effect beliefs were the strongest contributor to the model (β = -0.39, p<0.001) and uniquely explained 12.3% of the total variance.
Conclusion: The overall adherence to opioid analgesics among Malaysian patients with cancer pain was good. Negative effects beliefs regarding cancer pain and opioids strongly predicted adherence.
METHODS: A semistructured interview study was conducted among 17 patients and 18 pharmacists in three tertiary hospitals in Malaysia. All interviews were audiotaped and transcribed verbatim. Themes were developed using a constant comparison approach and thematic analysis.
RESULTS: Five main themes emerged from the data, namely, achieving mutual understanding, recognizing individuality, communication style, information giving, and medication decision making. For both pharmacists and patients, a PCC consultation should promote mutual understanding and non-judgmental discussions. Communication was an important element to bridge the gap between patients' and pharmacists' expectations. Patients emphasized the importance of emotional aspects of the consultation, while pharmacists emphasized the importance of evidence-based information to support patient engagement and information needs.
CONCLUSIONS: Comparison of pharmacists' and patients' views provided insight towards important aspects of PCC in pharmacist-patient consultations. It was suggested that PCC is not a one-sided approach but rather a patient-provider collaboration to optimize the consultation. Further research can be done to improve the integration of PCC in the local health care context, including pharmacist consultations.
Subjects and methods: A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t-test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients' self-efficacy in decision making.
Results: A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p<0.001). Patients had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients' perceived level of involvement, and attitudes toward concordance are significant predictors of patients' self-efficacy in decision making (p<0.05).
Conclusion: Patients who felt involved in their consultations had more positive attitudes toward concordance and higher confidence in making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients' involvement in medication-related decision making.
METHODS: A cross-sectional study was conducted by distributing self-administered questionnaires among pharmacy students in Malaysia. Descriptive statistics, the Mann-Whitney test, the Kruskal-Wallis test, and the Spearman's correlation test were used for analysis.
RESULTS: A total of 328 pharmacy students enrolled in this study, and 84.1% (n = 276) had video game experience. Students usually played video games using mobile phones (n = 231, 70%). Pharmacy students showed positive perceptions regarding serious games with a mean score of 3.69. However, limited awareness and knowledge of serious games was observed among pharmacy students. The most preferred game genres were role-playing and strategy (n = 174, 53%). Pharmacy students also preferred playing a cooperative game style (n = 113, 34.5%) with scores as a reward system (n = 204, 62.6%). Over three quarters (n = 292, 89.3%) wanted to see the results of the assessment after the game.
CONCLUSIONS: This research provided information on serious games preferences of local pharmacy students. Further study should evaluate the acceptance and effectiveness of the implementation of serious games among pharmacy students in Malaysia.
OBJECTIVE: To explore the perceptions of Malaysian hospital pharmacists and patients on the barriers and facilitators of a PCC approach in pharmacist consultations.
DESIGN: This study employed a qualitative, explorative semi-structured interview design.
SETTING AND PARTICIPANTS: Interviews were conducted with 17 patients and 18 pharmacists from three tertiary hospitals in Malaysia. The interviews were audiotaped and transcribed verbatim. Emerging themes were developed through a constant comparative approach and thematic analysis.
RESULTS: Three themes were identified in this study: (i) patient-related factors (knowledge, role expectations, and sociocultural characteristics), (ii) pharmacist-related factors (personalities and communication), and (iii) healthcare institutional and system-related factors (resources, continuity of care, and interprofessional collaboration). Pharmacists and patients mentioned that factors such as patients' knowledge and attitudes and pharmacists' personality traits and communication styles can affect patients' engagement in the consultation. Long waiting time and insufficient manpower were perceived as barriers to the practice of PCC. Continuity of care and interprofessional collaboration were viewed as crucial in providing supportive and tailored care to patients.
CONCLUSION: The study findings outlined the potential factors of PCC that may influence its implementation in pharmacist consultations. Strategic approaches can be undertaken by policymakers, healthcare institutions, and pharmacists themselves to address the identified barriers to more fully support the implementation of PCC in the pharmacy setting.
PARTICIPANTS AND METHODS: A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients' involvement in treatment decision-making, and patients' preference for behavioral involvement and information related to their disease.
RESULTS: The majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient-physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3-5) and 2 (IQR =2-3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients' preferred role in the process of treatment decision-making and the patients' preference for information seeking (p>0.05). However, only educational qualification (p=0.004) was significantly associated with patients' preference for information seeking in multivariate analysis.
CONCLUSION: Physicians failed to understand patients' perspectives and preferences in treatment decision-making. The concordance between physicians' perception and patients' perception was quite low as the physicians perceived that more than half of the patients were active in treatment decision-making. In actuality, more than half of patients perceived that they shared decision-making with their physicians.