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A training workshop for community pharmacist workforce: Caring for older adults

Saw PS, Lee SWH

Curr Pharm Teach Learn, 2020 01;12(1):95-102.
PMID: 31843172 DOI: 10.1016/j.cptl.2019.10.018

BACKGROUND AND PURPOSE: The increasing number of older adults worldwide challenges healthcare providers and policy makers to provide high quality care. To our knowledge, there has been little research on educational programs for community pharmacists on the provision of pharmaceutical care-based educational programs for elderly people, especially in Asian regions. The purpose of this study was to develop and describe the implementation of a structured educational program on geriatric care for community pharmacists.
EDUCATIONAL ACTIVITY AND SETTING: Community pharmacists attended a one-day workshop, supplemented with comprehensive training materials which enabled participants to conduct similar sessions with their peers at their own time. The workshop, consisting of case study discussion and role plays, was designed to be an engaging and interactive program that combined traditional didactic sessions and experiential, discussion-based learning. A pre- and post-workshop questionnaire were administered immediately before and after the event to all attending participants.
FINDINGS: Core concepts covered in the workshop included: (1) overview of an ageing population, (2) issues with ageing population, (3) medication review, and (4) dietary requirements and dosage forms in older adults. Participants' (n = 39) noted significant improvements in knowledge (mean score change 0.7, p 
Fulltext The Use of Building Blocks to Teach Communication and Social Skills to First-year Pharmacy Students

Lee SWH, Saw PS

Am J Pharm Educ, 2021 Sep;85(8):8464.
PMID: 34615624 DOI: 10.5688/ajpe8464

Objective. To conduct an innovative workshop activity using plastic building blocks to create a student-centric environment that encouraged development of creative thinking skills and self-reflection in undergraduate pharmacy students.Methods. Students were randomly allocated into small groups of four and assigned the role of either architect or team builder and tasked with creating a LEGO robot. Students were not allowed to speak during the activity. The architect was tasked with providing instructions to team builders on how to build the robot using nonverbal communication. After completion of the task, each group was asked to reflect on the exercise and share what they learned with the entire class. These discussions were video recorded and thematically analyzed.Results. The metaphorical models that students built served as a basis for discussion, problem-solving, and decision-making. Students described how this activity enabled them to mentally and visually link abstract concepts, such as decision-making and problem-solving, to actual practice. Three themes were identified from the qualitative study: thinking with hands, listening with eyes; linking theory to practice; and learning through reflection.Conclusion. This activity offered a non-confrontational way to support communication and the learning process. The use of an interactive game can be a useful teaching strategy to create an active-learning environment, helping pharmacy students improve their social and cognitive skills, such as decision-making, problem-solving, and communication.
Influencing factors and processes of interprofessional professional education (IPE) implementation

Wong PS, Chen YS, Saw PS

Med Teach, 2021 Jul;43(sup1):S39-S45.
PMID: 31603016 DOI: 10.1080/0142159X.2019.1672864

BACKGROUND: Interprofessional education (IPE) is an instructional approach for equipping health professions students with essential competencies needed to provide collaborative patient-centred care. The implementation and sustainability of IPE are challenging for many institutions. This qualitative study identified barriers and facilitators in the processes of IPE implementation.
METHODS: We conducted mixed focus groups (FGs) with faculty members from medicine, dentistry, pharmacy, nutrition and dietetics, nursing, chiropractic, Chinese medicine, and other health sciences programmes; who were involved in the planning of IPE at institutional or programme level, or who participated in IPE activity. Transcripts were analysed using grounded theory.
RESULTS: We identified 25 barriers and facilitators, clustered under five major categories of commitment, faculty engagement, IPE design, support, and delivery.
CONCLUSIONS: Successful implementation of IPE may hinge on actions in 5 stages; commitment, faculty engagement, IPE design, support, and delivery. The processes will require consistent leadership to break down professional silos and enhance collaborative effort in IPE implementation.
Fulltext Health care consumers' perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study

Saw PS, Nissen LM, Freeman C, Wong PS, Mak V

Patient Prefer Adherence, 2015;9:467-77.
PMID: 25834411 DOI: 10.2147/PPA.S73953

BACKGROUND: Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs) in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists' involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers' views on the integration of pharmacists within private GP clinics in Malaysia.
METHODS: A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10.
RESULTS: A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1) pharmacists' role viewed mainly as supplying medications, 2) readiness to accept pharmacists in private GP clinics, 3) willingness to pay for pharmacy services, and 4) concerns about GPs' resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy information on the use and potential side effects of medications and screening for medication misadventure. The potential increase in costs passed on to consumers and GPs' reluctance were perceived as barriers to integration.
CONCLUSION: This study provides insights into consumers' perspectives on the roles of pharmacists within private GP clinics in Malaysia. Consumers generally supported pharmacist integration into private primary health care clinics. However, for pharmacists to expand their capacity in providing integrated and collaborative primary care services to consumers, barriers to pharmacist integration need to be addressed.
KEYWORDS: Malaysia; general practitioners; health care consumer; pharmacist integration; private clinic
Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia: a cross-sectional questionnaire study. A Comment

Kua KP, Saw PS, Lee SWH

Int J Clin Pharm, 2019 Oct;41(5):1131-1132.
PMID: 31444688 DOI: 10.1007/s11096-019-00891-7

Understanding older adult and caregiver attitudes towards deprescribing will contribute to medication optimization in clinical practice. The objectives of this study were to explore quantitatively the attitudes and beliefs of older adults and caregivers towards deprescribing and identify participant characteristics that were associated with willingness to have a medication deprescribed. This study was conducted in a government-led primary care health clinic and three private community pharmacies in Malaysia with older adults and caregivers of older adults. The revised patients' attitudes towards deprescribing (rPATD) questionnaire was administered. The rPATD questionnaire had four factors in both older adults' and caregivers' versions of the questionnaire (with four to five questions retained in each factor) alongside two global questions that were not included in any of the scoring factors. Our revised statement of main findings now states that most of older adult (n = 340, 67.7%) and caregiver (n = 34, 65.4%) participants agreed or strongly agreed that they would be willing to stop one or more of their or their care recipient's medications if their or their care recipient's doctor said it was possible to do so.
Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia: a cross-sectional questionnaire study

Kua KP, Saw PS, Lee SWH

Int J Clin Pharm, 2019 Jun;41(3):793-803.
PMID: 31020599 DOI: 10.1007/s11096-019-00829-z

Background Deprescribing describes a process of medication regimen optimization with the aim to reduce adverse events and improve quality of life. There is limited research on perceptions of older adults, defined as those 60 years of age and older, about their willingness to cease a medication in developing countries. Objective To ascertain patients' attitudes, beliefs, perceptions, and experiences regarding the number of medications they were taking and their opinions regarding deprescribing. Setting A primary care health clinic and three community pharmacies in Malaysia. Method A multicenter cross-sectional study was conducted by administering the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to older adults aged 60 years and over or caregivers attending a health clinic and three community pharmacies in Malaysia. Descriptive results were reported for participants' characteristics and questionnaire responses. Analysis of correlation between participant characteristics and their responses was performed using Spearman's correlation. Main outcome measure Patients' and caregivers' attitudes and beliefs towards reducing medications and characteristics of patients such as age, gender, education level, number of medication taken and number of medical center managing the patient. Results 650 participants were approached and the response rate was 85.2%. A total of 554 participants completed the questionnaire (502 older adults and 52 caregivers). Older adults in the study were taking a median of three medications and/or supplements compared to four in caregiver recipients. 88.1% of older adults were satisfied with their current medication regimen and 67.7% would like to try stopping or reducing the dose of their medicines when their doctor recommended. 82.7% of caregivers were satisfied with their care recipient's current medications and 65.4% were willing to stop taking or reduce the number of drugs taken by their care recipient's upon doctor's recommendation. Older adults (p = 0.003) and those with lower education level (p
A practical approach toward teaching ethics to community pharmacists

Saw PS, Chuah LH, Lee SWH

Int J Clin Pharm, 2018 Oct;40(5):1131-1136.
PMID: 30078173 DOI: 10.1007/s11096-018-0707-8

Background Pharmacists as highly qualified professionals face ethical dilemmas and conflicts in their daily practice. These issues manifest themselves in the daily practice of pharmacists, which require pharmacists to have the competencies to manage these dilemmas but there is limited formal training in ethical decision making during undergraduate pharmacy education. Objective To describe the implementation and evaluation of a methodological approach to managing ethical dilemma workshop for community pharmacists in Malaysia. Setting Community pharmacists in Klang Valley, Malaysia. Method During the workshop, pharmacists were provided insights into how they could use and apply a methodological approach towards managing a dilemma, followed by a case study and panel discussion. All participants were invited to complete a pre- and post-workshop questionnaire Main outcome measure Number and proportion of respondents answering questions related to practice of ethics and workshop effectiveness Results A total of 37 participants attended the workshop. Most of the participants reported that they had no formal training in professional ethics and often used their own approach to solve an ethical issue. Some of the most common issues mentioned include changing medication to generic. More than three quarter of participants agreed and strongly agreed the content was relevant to their job and they will be able to use what they learned in the program. Conclusion The evidence suggests that a module in ethical decision making should be introduced to community pharmacists in Malaysia. This module can be easily adapted for use in other countries and will help ensure that pharmacist can make a good professional judgement and deliver the deeds of beneficence to all their patients.
A qualitative study on pharmacists' perception on integrating pharmacists into private general practitioner's clinics in Malaysia

Saw PS, Nissen L, Freeman C, Wong PS, Mak V

Pharm Pract (Granada), 2017 Jul-Sep;15(3):971.
PMID: 28943979 DOI: 10.18549/PharmPract.2017.03.971

BACKGROUND: Private general practitioners in Malaysia largely operates as solo practices - prescribing and supplying medications to patients directly from their clinics, thus posing risk of medication-related problems to consumers. A pharmacy practice reform that integrates pharmacists into primary healthcare clinics can be a potential initiative to promote quality use of medication. This model of care is a novel approach in Malaysia and research in the local context is required, especially from the perspectives of pharmacists.
OBJECTIVE: To explore pharmacists' views in integrating pharmacists into private GP clinics in Malaysia.
METHODS: A combination of purposive and snowballing sampling was used to recruit community and hospital pharmacists from urban areas in Malaysia to participate either in focus groups or semi-structured interviews. A total of 2 focus groups and 4 semi-structured interviews were conducted. Sessions were audio recorded, transcribed verbatim and thematically analysed using NVivo 10.
RESULTS: Four major themes were identified: (1) Limited potential to expand pharmacists' roles, (2) Concerns about non-pharmacists dispensing medicines in private GP clinics, (3) Lack of trust from consumers and private GPs, (4) Cost implications. Participants felt that there was a limited role for pharmacists in private GP clinics. This was because the medication supply role is currently undertaken in private GP clinics without the need of pharmacists. The perceived lack of trust from consumers and private GPs towards pharmacists arises from the belief that healthcare is the GPs' responsibility. This suggests that there is a need for increased public and GP awareness towards the capabilities of pharmacists' in medication management. Participants were concerned about an increase in cost to private GP visits if pharmacists were to be integrated. Nevertheless, some participants perceived the integration as a means to reduce medical costs through improved quality use of medicines.
CONCLUSION: Findings from the study provided a better understanding to help ascertain pharmacists' views on their readiness and acceptance in a potential new model of practice.
Fulltext Perceptions and attitudes towards dementia among university students in Malaysia

Griffiths AW, Cheong WL, Saw PS, Parveen S

BMC Med Educ, 2020 Mar 20;20(1):82.
PMID: 32192471 DOI: 10.1186/s12909-020-1972-5

BACKGROUND: One of the major challenges worldwide is the stigma associated with dementia. There is limited dementia awareness within Malaysian communities, including levels of confusion regarding the differences between dementia and the usual ageing progress, which can lead to delays in support seeking. The need for additional training and education for healthcare professionals has been highlighted. The present study aimed to evaluate the benefits of a one-hour dementia education session (Dementia Detectives workshop) for pharmacy and medicine undergraduate students at a Malaysian university.
METHODS: Participants attended the workshop and completed pre- (Time 1) and post-workshop (Time 2) questionnaires consisting of validated measures exploring attitudes towards dementia and older people more broadly.
RESULTS: A total of 97 students were recruited. Attitudes towards people with dementia showed significant positive changes between Time 1 and Time 2, whereas no differences were found for attitudes towards older people.
CONCLUSIONS: As medical and pharmacy students develop theoretical knowledge, practical skills and professional attitudes during their undergraduate studies, it is important for students to also learn about the humanistic side of diseases and conditions through workshops such as the one presented here. Further research should now be conducted to consider how Dementia Detectives can be delivered to non-healthcare students and what the barriers and facilitators to wider delivery are.
Prevalence of potentially inappropriate medications among geriatric residents in nursing care homes in Malaysia: a cross-sectional study

Liew NY, Chong YY, Yeow SH, Kua KP, Saw PS, Lee SWH

Int J Clin Pharm, 2019 Aug;41(4):895-902.
PMID: 31073975 DOI: 10.1007/s11096-019-00843-1

Background Polypharmacy has been associated with an increased risk of morbidity and mortality among older adults especially those living in nursing homes. Explicit criteria to evaluate the appropriateness of medications have recently been updated. Objective To estimate and compare the prevalence of potentially inappropriate medications (PIMs) among older adults in nursing homes using screening tool for older people's prescription (STOPP-2) and the 2015 Beers criteria. Setting Nursing care homes in the Klang Valley, Malaysia. Method A cross-sectional survey of medications used among residents living in nursing homes was performed. The 2015 Beers criteria and STOPP-2 criteria were used to evaluate the use of PIMs among this population. These PIMs were subsequently classified using the Pharmaceutical Network Europe classification (PCNE). Main outcome measure Number of PIMs among residents using both criteria. Results A total of 155 residents were recruited into the study. The prevalence of PIMs was 9.7% using the STOPP-2 criteria, 17.6% using the 2015 Beers criteria and 21.3% when both tools were used in combination. The PCNE criteria identified a total of 198 drug related issues, with an average of 1.27 issue per resident. Factors associated with higher risk of having PIM include multiple medication use and history of psychiatric disorder. Conclusion The 2015 Beers criteria was able to identify more PIM's compared to STOPP-2 criteria. The findings also support the expansion of pharmacists' services in nursing homes in Malaysia.
Fulltext Factors influencing intention to obtain the HPV vaccine in South East Asian and Western Pacific regions: A systematic review and meta-analysis

Santhanes D, Yong CP, Yap YY, Saw PS, Chaiyakunapruk N, Khan TM

Sci Rep, 2018 02 26;8(1):3640.
PMID: 29483541 DOI: 10.1038/s41598-018-21912-x

Since licensing in 2006, there has been poor uptake of the HPV vaccine among the targeted population in the South East Asia Region (SEAR) and Western Pacific Region (WPR). A systematic review was conducted to identify the studies exploring the relationship between factors and intention for HPV vaccination among women in SEAR and WPR countries. Nineteen studies were identified as suitable for qualitative synthesis, and three as suitable for meta-analysis. Most women had a positive intention to have an HPV vaccine (range 57%-85%). Having a positive intention to vaccinate was significantly higher among women not aware of HPV infection (OR: 1.34, 95% CI: 1.02-1.76) and HPV vaccine (OR: 1.57, 95% CI: 1.26-1.96). Lower knowledge level and less confidence in safety and efficacy of the vaccine, negatively affected intention to vaccinate. Perceiving the vaccine to be expensive, low perception of contracting HPV infection and cervical cancer, and lack of concrete recommendations from healthcare providers also negatively affected intention to vaccinate. This review suggests the decision-making processes of women in SEAR and WPR is influenced by the cost of vaccination, perceived efficacy and safety of vaccine, provision of information on vaccination, and the awareness about HPV infection and the HPV vaccine.
Fulltext Digitalization enhancement in the pharmaceutical supply network using a supply chain risk management approach

Wong WP, Saw PS, Jomthanachai S, Wang LS, Ong HF, Lim CP

Sci Rep, 2023 Dec 15;13(1):22287.
PMID: 38097696 DOI: 10.1038/s41598-023-49606-z

One major issue in pharmaceutical supply chain management is the supply shortage, and determining the root causes of medicine shortages necessitates an in-depth investigation. The concept of risk management is proposed in this study to identify significant risk factors in the pharmaceutical supply chain. Fuzzy failure mode and effect analysis and data envelopment analysis were used to evaluate the risks of the pharmaceutical supply chain. Based on a case study on the Malaysian pharmaceutical supply chain, it reveals that the pharmacy node is the riskiest link. The unavailability of medicine due to unexpected demand, as well as the scarcity of specialty or substitute drugs, pose the most significant risk factors. These risks could be mitigated by digital technology. We propose an appropriate digital technology platform consisting of big data analytics and blockchain technologies to undertake these challenges of supply shortage. By addressing risk factors through the implementation of a digitalized supply chain, organizations can fortify their supply networks, fostering resilience and efficiency, and thereby playing a pivotal role in advancing the Pharma 4.0 era.
Community Pharmacists' Views on Their Roles in Mental Health Screening and Management in Malaysia

Mok SL, Chuah JY, Lee KJ, Lim YD, Appalasamy JR, Saw PS, et al.

Community Ment Health J, 2024 Aug 12.
PMID: 39133358 DOI: 10.1007/s10597-024-01337-9

Community pharmacists (CPs) are vital as primary healthcare providers, particularly in the screening and management of mental health issues. This study aimed to explore CPs' views on mental health support for patients and the potential challenges in delivering mental health services. Malaysian CPs were recruited through purposive and snowballing sampling. Semi-structured interviews were recorded and transcribed verbatim. Data was thematically analyzed using NVivo 12 management software. Twenty CPs from Peninsular Malaysia were interviewed. Participants emphasized the importance of high-quality resources, comprehensive training and standardized tools to effectively provide mental healthcare services. Challenges identified were lack of knowledge and skills, absence of screening tools and social stigma and conservatism, particularly among older individuals. This study underscores the willingness of CPs taking a primary role in mental health services. However, collaboration with relevant stakeholders is crucial, aligning with national strategic plans for the program to be successful.
Fulltext Cross-cultural adaptation and exploratory factor analysis of the Person-centred Practice Inventory - Staff (PCPI-S) questionnaire among Malaysian primary healthcare providers

Balqis-Ali NZ, Saw PS, Jailani AS, Fun WH, Mohd Saleh N, Tengku Bahanuddin TPZ, et al.

BMC Health Serv Res, 2021 Jan 07;21(1):32.
PMID: 33413325 DOI: 10.1186/s12913-020-06012-9

BACKGROUND: The Person-centred Practice Inventory-Staff (PCPI-S) instrument was developed to measure healthcare providers' perception towards their person-centred practice. The study aimed to explore the influence of culture, context, language and local practice towards the PCPI-S instrument adaptation process for use among public primary care healthcare providers in Malaysia.
METHODS: The original PCPI-S was reviewed and adapted for cultural suitability by an expert committee to ensure conceptual and item equivalence. The instrument was subsequently translated into the local Malay language using the forward-backward translation by two independent native speakers, and modified following pre-tests involving cognitive debriefing interviews. The psychometric properties of the corresponding instrument were determined by assessing the internal consistency, test-retest reliability, and correlation of the instrument, while the underlying structure was analysed using exploratory factor analysis.
RESULTS: Review by expert committee found items applicable to local context. Pre-tests on the translated instrument found multiple domains and questions were misinterpreted. Many translations were heavily influenced by culture, context, and language discrepancies. Results of the subsequent pilot study found mean scores for all items ranged from 2.92 to 4.39. Notable ceiling effects were found. Internal consistency was high (Cronbach's alpha > 0.9). Exploratory factor analysis found formation of 11 components as opposed to the original 17 constructs.
CONCLUSION: The results of this study provide evidence regarding the reliability and underlying structure of the PCPI-S instrument with regard to primary care practice. Culture, context, language and local practice heavily influenced the adaptation as well as interpretation of the underlying structure and should be given emphasis when translating person-centred into practice.
Fulltext Protocol for a cross-sectional study measuring person-centredness among healthcare providers in Malaysian primary care clinics: the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) Questionnaire

Balqis-Ali NZ, Saw PS, Jailani AS, Yeoh TW, Fun WH, Mohd-Salleh N, et al.

BMJ Open, 2020 03 26;10(3):e034128.
PMID: 32220914 DOI: 10.1136/bmjopen-2019-034128

INTRODUCTION: Person-centred care (PCC) has become a global movement in healthcare. Despite this, the level of PCC is not routinely assessed in clinical practice. This protocol describes the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) tool that will be used to assess person-centred practices of primary healthcare providers in Malaysia.
METHODS AND ANALYSIS: To ensure conceptual and item equivalence, the original version of the PCPI-S will be reviewed and adapted for cultural context by an expert committee. The instrument will subsequently be translated into Malay language using the forward-backward translation method by two independent bilingual speaking individuals. This will be pretested in four primary care clinics and refined accordingly. The instrument will be assessed for its psychometric properties, such as test-retest reliability, construct and internal validity, using exploratory and confirmatory factor analysis.
ETHICS AND DISSEMINATION: Study findings will be disseminated to healthcare professionals and academicians in the field through publication in peer-reviewed journals and conference presentations, as well as at managerial clinic sites for practice improvement. The study was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (KKM/NIHSEC/ P18-766 (14) and Monash University Human Research Ethics Committee (2018-14363-19627).

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