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Fulltext Assessing the cost effectiveness of an anticoagulation clinic in comparison with the usual medical clinic In Kuala Lumpur Hospital [Abstract]

Thanimalai S, Shafie AA, Ahmad HM, Sinnadurai J

Value Health, 2014 Nov;17(7):A487.
PMID: 27201439 DOI: 10.1016/j.jval.2014.08.1428

Objectives: Systematic anticoagulation management clinic is now recommended to manage warfarinized atrial fibrillation (AF) patient. In Malaysia, the service is recently introduced as pharmacist managed Warfarin Medication Therapy Adherence Clinic (WMTAC). The objective of the present study was to assess the cost effectiveness of anticoagulation clinic in comparison with usual medical in Kuala Lumpur Hospital.
Methods: A Markov model built using the provider perspective and 20 year time horizon was used to assess the cost effectiveness. The base case analysis assumed a cohort of patients with AF 57 years of age with comorbid illnesses. Data sources include a 6 month retrospective cohort analysis of the effectiveness of the clinics, the cost of drugs, cost of personnel and space of the clinics, cost of monitoring and cost of adverse events were obtained from the local source and publications. The transition probabilities of these clinics outcomes were obtained from a literature search. Future costs were discounted by 3% to convert to present values. All costs were in Ringgit Malaysia (RM) based on year 2012.
Results: The results of a 20-year period model showed that UMC was dominated by the WMTAC in the same time period. The mean cost of the WMTAC was RM 5864 whereas the UMC cost was RM 6550. The sensitivity analysis showed that clinic treatment costs and effectiveness influenced the cost-effectiveness. If the cost of WMTAC was increased by 50% of the current cost, the WMTAC would not be a dominant intervention. WMTAC was also cost effective for a willingness to pay of RM32000.
Conclusions: The anticoagulation management service appears to cost less and provide greater effectiveness than usual care. In conclusion, the Markov model suggests that from the provider perspective the anticoagulation clinic is a more cost effective option than the usual medical clinic in Kuala Lumpur Hospital.
Study site: Medication Therapy Adherence Clinic, Hospital Kuala Lumpur, Malaysia
Fulltext Impact of pharmacist intervention on adherence and measurable patient outcomes among depressed patients: a randomised controlled study

Aljumah K, Hassali MA

BMC Psychiatry, 2015;15:219.
PMID: 26376830 DOI: 10.1186/s12888-015-0605-8

Adherence to antidepressant treatment is essential for the effective management of patients with major depressive disorder. Adherence to medication is a dynamic decision-making process, and pharmacists play an important role in improving adherence to antidepressant treatment in different settings within the healthcare system. The aim of this study was to assess whether pharmacist interventions based on shared decision making improved adherence and patient-related outcomes.
Fulltext Willingness to pay for voluntary community-based health insurance: findings from an exploratory study in the state of Penang, Malaysia

Shafie AA, Hassali MA

Soc Sci Med, 2013 Nov;96:272-6.
PMID: 23528670 DOI: 10.1016/j.socscimed.2013.02.045

Health care in Malaysia is funded primarily through taxation and is no longer sustainable. One funding option is voluntary community-based health insurance (VCHI), which provides insurance coverage for those who are unable to benefit immediately from either a social or private health insurance plan. This study is performed to assess the willingness of Malaysians to participate in a VCHI plan. A cross-sectional study was performed in the state of Penang between August and mid-September 2009 with 472 randomly selected respondents. The respondents were first asked to select their preferred health financing plan from three plans (out-of-pocket payment, compulsory social health insurance and VCHI). The extent of the household's willingness to pay for the described VCHI plan was later assessed using the contingent valuation method in an ex-ante bidding game approach until the maximum amount they would be willing to pay to obtain such a service was agreed upon. Fifty-four per cent of the participants were female, with a mean age of 34 years (SD = 11.9), the majority of whom had a monthly income of Int$1157-2312. The results indicated that more than 63.1% of the respondents were willing to join and contribute an average of Int$114.38 per month per household towards VCHI. This amount was influenced by ethnicity, educational level, household monthly income, the presence of chronic disease and the presence of private insurance coverage (p
Fulltext Knowledge and perceptions of prescribers regarding adherence to standard treatment guidelines for malaria: a comparative cross-sectional study from Pakistan

Malik M, Hassali MA, Shafie AA, Hussain A

East Mediterr Health J, 2014 Apr;20(4):221-8.
PMID: 24952118

Despite the availability of standard treatment guidelines for malaria in Pakistan adherence to protocols by prescribers is poor. This descriptive, cross-sectional study aimed to explore the perceptions and knowledge of prescribers in Islamabad and Rawalpindi cities towards adherence to standard treatment guidelines for malaria. A questionnaire was distributed to a random sample of 360 prescribers; 64.7% were satisfied with the available antimalarial drugs and 41.3% agreed that antimalarial drugs should only be prescribed after diagnostic testing. Only half the prescribers had the guidelines available in their health facility. Almost all the prescribers (97.7%) agreed that there was a need for more educational programmes about the guidelines. Most prescribers were unaware of the correct standard treatment regimen for Plasmodium falciparum and P. vivax malaria. There were no differences in knowledge between males and females, but prescribers having more experience, practising as general practitioners and working in private health-care facilities possessed significantly better knowledge than their counterparts.
Students' Knowledge and Perceptions Towards Quality Use of Medicines: A Descriptive Analysis From Universiti Sains Malaysia

Verma AK, Hassali MA, Saleem F, Aljadhey H

Value Health, 2015 Nov;18(7):A744.
PMID: 26534167 DOI: 10.1016/j.jval.2015.09.2866
Assessment Of Pharmacist-Led Home-Based Educational Intervention Among Type 2 Diabetes Patients In The State of Penang, Malaysia

Chow EP, Hassali MA, Saleem F, Kumar R

Value Health, 2015 Nov;18(7):A866.
PMID: 26534635 DOI: 10.1016/j.jval.2015.09.519
Development, Test-Retest Reliability And Validity of the Pharmacy Value Added Services Questionnaire

Hoay TL, Hassali MA, Saleem F, Gan V

Value Health, 2015 Nov;18(7):A515.
PMID: 26532887 DOI: 10.1016/j.jval.2015.09.1559
A systematic review of the prevalence of limited health literacy in Southeast Asian countries

Rajah R, Hassali MAA, Murugiah MK

Public Health, 2019 Feb;167:8-15.
PMID: 30544041 DOI: 10.1016/j.puhe.2018.09.028

OBJECTIVES: Health literacy is increasingly recognized as a public health concern. Most of the literature on health literacy concentrate in the Western countries. Therefore, this study aimed to systematically review and examine the available studies on health literacy in Southeast Asian countries and estimate its prevalence in this region.
STUDY DESIGN: Systematic review.
METHODS: A search for relevant articles was carried out using Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE (via EBSCOhost), Scopus, Science Direct, PubMed and Google Scholar with multiple search terms. Inclusion criteria comprised articles published in English language and assessing general health literacy. Risk of bias reduced with the involvement of two independent reviewers in the screening of the literature and the quality assessment process.
RESULTS: A total of 11 studies were included, which only consist of studies from five countries out of 11 making up the Southeast Asian region. The overall prevalence of limited health literacy varied considerably, 1.6%-99.5% with a mean of 55.3% (95% confidence interval [CI]: 35.1%-75.6%). A much higher prevalence was noted in studies conducted in healthcare settings, 67.5% (95% CI: 48.6%-86.3%). The most common factors associated with limited health literacy were education attainment, age, income and socio-economic background. Other factors identified were gender and health behaviours.
CONCLUSIONS: In summary, despite the little evidence available and existences of high heterogeneity among studies, limited health literacy is still prevalent in Southeast Asian countries. Urgent strategies to improve and promote health literacy in the region are highly warranted. Besides, more studies on health literacy with better quality on the methodology aspect are needed.
Fulltext Awareness, knowledge and views of off-label prescribing in children: a systematic review

Balan S, Hassali MA, Mak VS

Br J Clin Pharmacol, 2015 Dec;80(6):1269-80.
PMID: 26314841 DOI: 10.1111/bcp.12750

AIM: The aim of this review was to provide an updated overview of awareness, knowledge and views of off-label prescribing in children.
METHOD: A literature search using electronic databases including PubMed, Medline, Scopus, Science Direct, Springer Link, Proquest, Ebsco Host and Google Scholar was conducted. Additional articles were identified by reviewing the bibliography of retrieved articles. The articles were searched with any of the following medical subject headings (MeSH) terms in the title: attitude, awareness, knowledge, experience, view, off-label, pediatric, paediatric and children. The inclusion criteria were full text articles published in English between January 2004 and February 2015 and reported outcome related to awareness, knowledge and views regarding off-label prescribing in children. Editorials, reviews, notes, conference proceedings, letters and studies reporting prevalence of off-label prescribing were excluded. The articles were scrutinized using thematic analysis.
RESULTS: Eleven studies conducted among doctors, community pharmacists, paediatric nurses, parents and children met the inclusion criteria. Nine themes were developed through document analysis which included main domains such as knowledge, awareness and views on off-label drug use in children, choice of information sources, reasons and suggestions to reduce off-label prescribing, concern regarding obtaining consent and participation in clinical trials.
CONCLUSION: The studies reviewed reported that the majority of doctors and community pharmacists were familiar with the term off-label prescribing but knowledge among parents was low. Awareness on off-label prescribing in children remains low among all study participants. There is a mismatch between views on off-label prescribing in children of study participants and the finding of previous studies.
Non-regulatory related factors leading to off-label prescribing in children: A concept map

Balan S, Hassali MA, Mak VSL

Res Social Adm Pharm, 2017 Nov;13(6):1219-1221.
PMID: 28576615 DOI: 10.1016/j.sapharm.2017.05.013
Contribution of pharmacy education to pharmaceutical research and development: critical insights from educators

Nouri AI, Hassali MA, Hashmi FK

Perspect Public Health, 2020 Jan;140(1):62-66.
PMID: 31165671 DOI: 10.1177/1757913919832927

AIMS: This article examines the outputs of pharmaceutical education with the development of the pharmacy profession and how that affects pharmaceutical innovation. It also discusses different models of collaboration between the academic and pharmaceutical industry in order to achieve a healthy collaboration between the stakeholders.
METHODS: The perspective, experiences and insights of educators from various backgrounds, origin and educational levels were sought regarding the role of pharmacy education in providing pharmaceutical research and development workforce.
RESULTS: Many countries around the world are currently undertaking major reforms in pharmacy education due to the changing landscape of health and healthcare delivery. These reforms must be accompanied by robust systems to assure that the quality of educational structures, processes and outcomes will produce competent pharmacy graduates in the future. It is also considered imperative that pharmacy academic institutions should establish collaboration with the drug development units, the pharmaceutical industry and government agencies for sustainability and positive research outcomes.
CONCLUSION: Shortcomings in pharmacy curricula need to be addressed and the authors have proposed the 'TARGET' approach for the development of integrated pharmacy curriculum to substantially contribute to pharmaceutical research and development.
Fulltext Drug attitude and adherence: a qualitative insight of patients with hypertension

Saleem F, Hassali M, Shafie A, Atif M

J Young Pharm, 2012 Apr;4(2):101-7.
PMID: 22754262 DOI: 10.4103/0975-1483.96624

The study is aimed to explore the perceptions and experiences of hypertensive patients toward medication use and adherence. The study was qualitative in nature conducted at Sandamen Provisional Hospital of Quetta city, Pakistan; a public hospital catering to the health needs of about 40% of the population. A qualitative approach was used to gain an in-depth knowledge of the issues. Sixteen patients were interviewed, and the saturation point was achieved after the 14(th) interview. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Thematic content analysis yielded five major themes. (1) Perceived benefits and risks of medications, (2) physician's interaction with patients, (3) perception toward traditional remedies, (4) layman concept toward medications, and (5) beliefs toward hypertension and its control. The majority of the patients carried specific unrealistic beliefs regarding the long-term use of medication; yet these beliefs were heavily accepted and practiced by the society. The study indicated a number of key themes that can be used in changing the beliefs and experiences of hypertensive patients. Physician's attitude, patient's past experiences, and knowledge related to hypertension were noted as major contributing factors thus resulting in nonadherence to therapy prescribed.
Fulltext Patient-physician Communication Barrier: A Pilot Study Evaluating Patient Experiences

Khan T, Hassali M, Al-Haddad M

J Young Pharm, 2011 Jul;3(3):250-5.
PMID: 21897668 DOI: 10.4103/0975-1483.83778

This study aims to identify the patient-physician communication barriers in the primary healthcare setting in Pulau Penang, Malaysia. A cross-sectional study was designed to attain the objectives of the study. A self-developed 17-item study tool was used to explore respondent's perception about the barriers they have faced while communicating with physician. The reliability scale was applied and internal consistency of the study tool was estimated on the basis of Cronbach's alpha (α = 0.58). The data analysis was conducted using statistical package for social sciences students SPSS 13(®). Chi Square test was used to test the difference between proportions. A total of n = 69 patients responded to this survey. A higher participation was seen by the male respondents, 39 (56.5%). About 52 (76.5%) of the respondents were satisfied with the information provided by the physician. In an effort to identify the patient-physician barriers, a poor understanding among the patients and physician was revealed. 16 (23.5%) respondents disclosed lack of satisfaction from the information provided to them. Overall, it is seen that lack of physician-patient understanding was the main reason that result hindrance in the affective communication. Moreover, there is a possibility that a low level of health literacy among the patients and inability of the physician to affectively listen to patients may be the other factors that result in a deficient communication.
Fulltext General Public Expectation from the Communication Process with their Healthcare Providers

Hassali M, Shafie A, Khan T

J Young Pharm, 2012 Jul;4(3):193-8.
PMID: 23112539 DOI: 10.4103/0975-1483.100028

The current study aimed to explore the public views and expectation about a successful communication process between the healthcare providers/physicians and patients in Penang Island, Malaysia. A cross-sectional study was conducted in Penang Island using a 14-item questionnaire. Statistical Package for Social Sciences (SPSS) software version 15.0(®) were used to analyze the collected data. A nonparametric statistics was applied; the Chi-square test was applied to measure the association among the variables. P-values less than 0.05 were considered statistically significant. A total of N (500) respondents have shown willingness to participate in the study with a response rate of 83.3%. The majority 319 (63.9%) have disclosed to communicate with their healthcare providers in the Malay language and about 401 (80.4%) of the respondents were found satisfied with the information provided by the physician. It was a common expectation by the most of the sample to focus more on the patient history before prescribing any medicine. Moreover, about 60.0% of the respondents expected that the healthcare providers must show patience to the patient's queries. The level of satisfaction with the information shared by the healthcare providers was higher among the respondents with a higher education level. Furthermore, patients with higher level of education expect that physician shouldwell understand their views and medical history to prescribe a better therapeutic regimen.
A pilot study measuring knowledge and attitudes towards diabetes mellitus In Kedah, Malaysia [Abstract]

Saleem F, Hassali MA, Verma AK, Aljadhey H

Value Health, 2015 Nov;18(7):A614-5.
PMID: 26533446 DOI: 10.1016/j.jval.2015.09.2138

Objectives: An adequate disease-related knowledge is important in treatment and management of ailments. Within this context, patients are needed to have correct knowledge and positive attitude especially when they are faced with an emergence of chronic diseases. The aim of this study therefore is to assess the level of type 2 diabetes mellitus (T2DM) awareness and disease related attitude among general population at Bujang Valley, Merbok, Kedah, Malaysia.
Methods: A questionnaire based, cross sectional study was conducted. The Diabetes Attitude Scale was used to assess the knowledge and attitude of respondents towards T2DM. Data was described descriptively and SPSS v.22 was used for data analysis.
Results: Out of three hundred and seventy seven respondents, majority of the respondents (n=156, 41.4%) were in age group of more than 40 years old and the cohort was dominated by Malay ethnic group. Females subjugated over males (n=229, 60.7%) and the highest number of respondents were working as businessman (n=115, 30.5%). Corresponding to the marital status, majority of the respondent were married (n=247, 65.5%). Majority of the respondents (n=274, 72.7%) were reported as healthy with no chronic disease. The respondents reported certain misapprehensions where they believed that T2DM have lesser complications, blood glucose control is needed for Type 1 Diabetes Mellitus only and the emotional effects of T2DM are minor.
Conclusions: The study reported insufficient level of knowledge among the respondents in management of T2DM. General population needs to have good collaboration with healthcare professionals to get more education and knowledge related to T2DM for their empowerment.
Challenges in pediatric drug use: A pharmacist point of view

Balan S, Hassali MA, Mak VSL

Res Social Adm Pharm, 2017 May-Jun;13(3):653-655.
PMID: 27493130 DOI: 10.1016/j.sapharm.2016.06.014

The pediatric population is an enormously diverse segment of population varying both in size and age. The diversity caused pharmacists face various challenges primarily related to procuring, provision as well as use of drugs in this group of patients. Pediatric dose calculation is particularly a concern for pharmacists. Another challenge faced by pharmacists is unavailability of suitable formulations for pediatric use. This has also led many pharmacists to prepare extemporaneous liquid preparations, even though stability data on such preparations are scarce. Some extemporaneous preparations contain excipients which are potentially harmful in children. Besides that, inadequate labeling and drug information for pediatric drug use had not only challenged pharmacists in recommending and optimizing drug use in children, but also inadvertently caused many drugs used outside the approved terms of the product license (off-label use). Pharmacists are striving to stay connected to overcome the common and comparable challenges faced in their day to day duties and strive to maximize the safe and effective use of medicines for children.
A Pilot Study Evaluating the Stigma and Public Perception about the Causes of Depression and Schizophrenia

Khan T, Hassali M, Tahir H, Khan A

Iran J Public Health, 2011;40(1):50-6.
PMID: 23113054

To evaluate public perceptions towards the causes of depression and schizophrenia and identifications of factors resulting stigma towards mental ill.
Fulltext Effect of Health Education Program on Knowledge, Attitude, Practice and Health Related Quality of Life in Hepatitis-B Patients

Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Iqbal Q

Value Health, 2014 Nov;17(7):A807.
PMID: 27203043 DOI: 10.1016/j.jval.2014.08.529
Fulltext Determination of Cost-Effectiveness Threshold For Malaysia

Lim YW, Shafie AA, Chua GN, Hassali MA

Value Health, 2014 Nov;17(7):A438.
PMID: 27201168 DOI: 10.1016/j.jval.2014.08.1137
Psychometric properties and osteoprotective behaviors among type 2 diabetic patients: osteoporosis self-efficacy scale Malay version (OSES-M)

Abdulameer SA, Syed Sulaiman SA, Hassali MA, Subramaniam K, Sahib MN

Osteoporos Int, 2013 Mar;24(3):929-40.
PMID: 22790611 DOI: 10.1007/s00198-012-2071-1

In type 2 diabetic patients (T2DM), only 22 % have normal bone mineral density and almost three quarters of the sample population had low self-efficacy towards osteoporosis. These results reflect the need for screening and educational programs to increase the awareness of T2DM towards osteoporosis.
INTRODUCTION: Our aim was to translate and examine the psychometric properties of the Malay version of the osteoporosis self-efficacy scale (OSES-M) among T2DM and to determine the best cut-off value with optimum sensitivity and specificity. In addition, to assess factors that affects diabetic patients' osteoporosis self-efficacy.
METHODS: A standard "forward-backward" procedure was used to translate the OSES into Malay language, which was then validated with a convenience sample of 250 T2DM. The sensitivity and specificity of the OSES-M was calculated using receiver operating characteristic curve analysis. Bivariate and multivariate approaches were used to examine multiple independent variables on each dependent variable.
RESULTS: The mean score of OSES-M was 731.74 ± 197.15. Fleiss' kappa, content validity ratio range, and content validity index were 0.99, 0.75-1, and 0.96, respectively. Two factors were extracted from exploratory factor analysis and were confirmed through confirmatory factor analysis. Internal consistency and test-retest reliability were 0.92 and 0.86, respectively. The optimum cut-off point of OSES-M to predict osteoporosis/osteopenia was 858. Regression analysis revealed that knowledge, health belief, and some demographic data had an impact on OSES-M.
CONCLUSIONS: The results show that the OSES-M is a reliable and valid instrument for measuring osteoporosis self-efficacy in the Malaysian clinical setting.

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