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Rafhi E, Al-Juhaishi M, Stupans I, Stevens JE, Park JS, Wang KN. The influence of patients' beliefs about medicines and the relationship with suboptimal medicine use in community-dwelling older adults: a systematic review of quantitative studies. Int J Clin Pharm 2024; 46:811-830. [PMID: 38704779 PMCID: PMC11286706 DOI: 10.1007/s11096-024-01727-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/14/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Medication use in older adults is increasing, therefore, reducing the risk of suboptimal medicine use is imperative in achieving optimal therapeutic outcomes. Research suggests that factors such as personal beliefs and beliefs about medicines may be associated with non-adherence and inappropriate medicine use. AIM To systematically review and identify quantitative research on the influence of beliefs about medicines and the relationship with suboptimal medicine use in older adults. METHOD Searches were conducted on PubMed, EMBASE, CINAHL, and PsycINFO for quantitative studies (inception to March 2023). INCLUSION CRITERIA (1) exposure: participants' beliefs (personal, cultural, and medication-related), (2) outcomes: polypharmacy, potentially inappropriate medicines use, or non-adherence, and (3) participants: community-dwelling adults 65 years or above. Study selection, data extraction and quality appraisal (Joanna Briggs Institute critical appraisal checklist) were completed independently by two investigators. Data were combined in a narrative synthesis and presented in a summary of findings table. RESULTS Nineteen articles were included: 15 cross-sectional and four cohort studies. Outcomes of included papers were as follows; adherence (n = 18) and potentially inappropriate medicine use (n = 1). Ten studies found stronger beliefs in the necessity of medicines and/or fewer concerns led to better adherence, with one paper contradicting these findings. Three studies did not find associations between adherence and beliefs. One study confirmed an association between unnecessary drug use and a lack of belief in a "powerful other" (e.g. doctor). CONCLUSION Further investigation is necessary to (1) ascertain the importance of necessity or concern beliefs in fostering adherence and, (2) examine the influence of beliefs on polypharmacy and inappropriate medicine use.
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Affiliation(s)
- Eman Rafhi
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia.
| | - Malath Al-Juhaishi
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Julie E Stevens
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
- Adelaide Medical School, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - Joon Soo Park
- School of Allied Health, The University of Western Australia, Crawley, WA, 6009, Australia
- School of Engineering, Information Technology and Physical Sciences, Federation University Australia, Ballarat, VIC, 3350, Australia
| | - Kate N Wang
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
- School of Allied Health, The University of Western Australia, Crawley, WA, 6009, Australia
- Pharmacy Department, Alfred Health, Melbourne, VIC, 3000, Australia
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Christopher CM, Blebil AQ, Bhuvan KC, Alex D, Mohamed Ibrahim MI, Ismail N, Cheong Wing Loong M. Medication use problems and factors affecting older adults in primary healthcare. Res Social Adm Pharm 2023; 19:1520-1530. [PMID: 37574369 DOI: 10.1016/j.sapharm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND As the largest demographic group utilizing primary healthcare facilities, older adults often face the challenge of managing multiple chronic illnesses, leading to numerous medications. OBJECTIVE The present study aims to assess medication use problems among older adults and explore the factors affecting them in primary healthcare settings. METHODS A mixed-method study was conducted to establish a baseline understanding of the perspectives and challenges faced by older adults, with regards to medication use. Translated Medication Use Questionnaire (MedUseQ), a patient-centered tool, was distributed to older adults above 60 in primary healthcare settings to assess their frequency of problems related to medication use. Fifteen semi-structured interviews were conducted to explore this topic in depth. Descriptive and inferential analyses were conducted with quantitative data. Interviews were transcribed verbatim, and thematic analysis was conducted. Quantitative and qualitative findings data were triangulated. RESULTS The study involved 393 participants. The most common problems with regards to medication use were polypharmacy (55.4%), administration difficulties (48.4%), limited awareness about adverse drug events (47.3%), issues with adherence (46.5%), and accessibility to primary healthcare (42.7%). Approximately 55% were satisfied with the older adult-centered medication use services by pharmacist and doctors. The qualitative findings showed that major factors affecting medication use were forgetfulness, language barriers, lack of awareness, transportation problems, long waiting times, and multiple visits to healthcare facilities. CONCLUSION The findings of this study reveal that a significant proportion, around 50%, of the older adult population face challenges with medication use in Penang. These difficulties mainly stem from medication administration, adherence, accessibility, polypharmacy, and inadequate medication knowledge. The qualitative analysis further highlighted several factors that contribute to such medication-related problems. Given the rapidly aging Association of Southeast Asian Nations (ASEAN) population, it is essential to devise effective solutions and strategies to tackle medication use-related issues among older adults.
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Affiliation(s)
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia; Department of Pharmacy, Al Rafidain University College, Baghdad, Iraq
| | - K C Bhuvan
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Deepa Alex
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia; Department of Geriatrics and Healthy Living, KIMSHEALTH, Thiruvananthapuram, Kerala, India
| | | | | | - Mark Cheong Wing Loong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
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Selvakumar D, Sivanandy P, Ingle PV, Theivasigamani K. Relationship between Treatment Burden, Health Literacy, and Medication Adherence in Older Adults Coping with Multiple Chronic Conditions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1401. [PMID: 37629691 PMCID: PMC10456640 DOI: 10.3390/medicina59081401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/27/2023]
Abstract
A prospective study was conducted to investigate the impact of treatment burden and health literacy on medication adherence among older adults with multiple chronic conditions (MCC) and to explore the potential moderating effects of demographic and clinical factors. Face-to-face structured interviews were conducted among older adults aged 60 and above using the Burden of Treatment Questionnaire (TBQ-15), Short Form Health Literacy Questionnaire (HLS-SF12), and Malaysia Medication Adherence Assessment Tool (MyMAAT). This study included 346 older adults aged 60 years and above with two or more chronic conditions (n = 346). Hypertension (30.2%), hyperlipidemia (24.0%), and diabetes (18.0%) were the most reported chronic conditions among participants. The mean score of treatment burden was 53.4 (SD = 28.2), indicating an acceptable burden of treatment. The mean score of health literacy was 16.4 (SD = 12.6), indicating a limited health literacy level among participants; meanwhile, the mean score of medication adherence was 32.6 (SD = 12.3), indicating medication non-adherence among participants. Medication adherence was significantly correlated with treatment burden (r = -0.22, p < 0.0001), health literacy (r = 0.36, p < 0.0001), number of chronic conditions (r = -0.23, p < 0.0001), and age (r = -0.11, p < 0.05). The study findings emphasize that multimorbid older adults with high treatment burdens and low health literacy are more likely to have poor medication adherence. This underscores the importance for clinicians to address these factors in order to improve medication adherence among older adults with multiple chronic conditions (MCC).
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Affiliation(s)
- Dharrshinee Selvakumar
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Pravinkumar Vishwanath Ingle
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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Wu X, Tang F, Li H, Chen C, Zhang H, Liu X, Lai H, Li Q, Deng L, Ye Z. Development and validation of a nomogram model for medication non-adherence in patients with chronic kidney disease. J Psychosom Res 2023; 171:111385. [PMID: 37301180 DOI: 10.1016/j.jpsychores.2023.111385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The high prevalence of medication non-adherence in patients with chronic kidney disease places a tremendous burden on healthcare resources. The study was designed to develop and validate a nomogram model of medication non-adherence in patients with chronic kidney disease in China. METHODS A multicenter cross-sectional study was conducted. 1206 chronic kidney disease patients were consecutively enrolled from Be Resilient to Chronic Kidney Disease (registration number: ChiCTR2200062288) between September 2021 and October 2022 in four tertiary hospitals in China. The Chinese version of four-item Morisky Medication Adherence Scale was used to assess the medication adherence of the patients and associated factors consisted of socio-demographic information, self-designed medication knowledge questionnaire, the 10-item Connor-Davidson Resilience Scale, the Beliefs about Medicine questionnaire, the Acceptance Illness Scale, and the Family Adaptation Partnership Growth and Resolve Index. Least Absolute Shrinkage and Selection Operator regression was performed to select significant factors. Concordance index, Hosmer-Lemeshow test and decision curve analysis were estimated. RESULTS The prevalence of medication non-adherence was 63.8%. Area under the curves ranged from 0.72 to 0.96 in internal and external validation sets. The predicted probabilities of the model were consistent with those of the actual observations by Hosmer-Lemeshow test (all P > .05). The final model included educational level, occupational status, duration of chronic kidney disease, medication beliefs (perceptions of the need to take medications and concerns about adverse effects), and illness acceptance (adaptation and acceptance of the disease). CONCLUSIONS There is a high prevalence of medication non-adherence among Chinese patients with chronic kidney disease. A nomogram model based on five factors has been successfully developed and validated and could be incorporated into long-term medication management.
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Affiliation(s)
- Xiaona Wu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang Tang
- Chronic Disease Management Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Huanhuan Li
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cuiqing Chen
- Department of Nephrology, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Haiyan Zhang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Shaoyang University, Shanoyang, China
| | - Xiuzhu Liu
- Department of Gastroenterology, Puning People's Hospital, Puning, China
| | - Huijing Lai
- Department of Pulmonology, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Qiang Li
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lili Deng
- Nursing Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
| | - Zengjie Ye
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Yu-Ting Y, Yong-Wei Y, Miao Y, Qiong Y, Meng-Yu W, Ting L. Knowledge, attitude, behaviour, and influencing factors of home-based medication safety among community-dwelling older adults with chronic diseases: a cross-sectional study. BMC Geriatr 2023; 23:256. [PMID: 37118686 PMCID: PMC10148421 DOI: 10.1186/s12877-023-03966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Older adults with chronic diseases require long-term medication. However, due to lack of drug knowledge and hypomnesia, older adults with chronic diseases are prone to adverse drug events and increased medical costs. This study aimed to explore the status and influencing factors of home-based medication safety among community-dwelling older adults with chronic diseases in China to provide a basis for follow-up to conduct targeted health education. METHODS Overall, 427 community-dwelling older adults with chronic diseases participated in this study. The Knowledge, Attitude, and Behaviour of Medication Safety among Older Adults with Chronic Diseases Questionnaire was used to assess their home-based medication safety. Multivariate linear regression was used to identify the factors influencing knowledge, attitude, and behaviour regarding medication safety. RESULTS The average score of home-based medication safety among older adults with chronic diseases was 68.26 ± 8.96, indicating that they had a moderate grasp of medication safety. The scoring rate of each subscale was ranked from high to low as follows: behaviour (84.51%), knowledge (63.33%), and attitude (47.39%). Stepwise linear regression analysis showed that medication safety knowledge, attitudes, and behaviours were significantly associated with higher monthly income, adverse drug events, and taking medicine several times a day (p < 0.05). Additional influencing factors included having fewer chronic diseases, being female, higher educational attainment, taking medicines multiple kinds a day, better self-care ability, and non-hospitalisation for chronic illnesses (p < 0.05). CONCLUSION Medical staff and community workers should pay attention to the drug safety of older adults with different characteristics and mobilise their enthusiasm for participation to improve their medication self-management ability. TRIAL REGISTRATION Chinese Clinical Trial Register: ChiCTR2200060987 ; reg. date: 15/06/2022.
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Affiliation(s)
- Yang Yu-Ting
- Nursing Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yang Yong-Wei
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yao Miao
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Ye Qiong
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
- Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China
| | - Wu Meng-Yu
- Community Health Service Center of Ninghua Street, Taijiang District, Fuzhou, Fujian, China
| | - Lin Ting
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China.
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Christopher CM, Loong MCW, Blebil AQ, Bhuvan KC, Alex D, Ibrahim MIM, Ismail N. Helping Older Adults With Their Medication Use Problems: A Qualitative Study on Perspectives and Challenges of Primary Health Care Providers. Arch Gerontol Geriatr 2023; 111:105007. [DOI: 10.1016/j.archger.2023.105007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
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Christopher CM, Blebil AQ, Kc B, Alex D, Mohamed Ibrahim MI, Rajakumar S, Ismail N. Medication Use Questionnaire for Older Adults in Malaysia: Translation, Cultural Adaptation, and Reliability. Value Health Reg Issues 2023; 35:34-41. [PMID: 36842337 DOI: 10.1016/j.vhri.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES This study aimed to translate the Medication Use Questionnaire into a Malay version, adapt it to Malaysia's culture, and verify its reliability among Malaysia's older adults. METHODS Methodological approaches were used to translate, validate, and modify the questionnaire. The subjects were older adults aged ≥ 60 years in primary care settings in Penang, Malaysia. Two forward translations (English to Malay) were developed, reviewed, and back translated to English. The reconciliation phase was conducted to compare the translated and original questionnaires. Five older adults were then interviewed for the cognitive debriefing of the reconciled questionnaire to assess the linguistic and cultural equivalence. Two experts assessed content validity, and the translated questionnaire was proofread and finalized. After that, pilot test was done to examine the internal consistency among 20 older adults. RESULTS Translation of the questionnaire was done with no major disagreements. The main issues identified in cognitive debriefing and content validity were terms, number of questions, and phrases used in the questionnaire. Most participants reported that the questionnaires were not difficult to complete during the cognitive debriefing phase. The issues were then judged and revised accordingly. Further pilot testing on 20 older adults demonstrated good internal consistency reliability, Cronbach α (0.902). CONCLUSIONS This study findings suggest promising data supporting the use of translated version of the Medication Use Questionnaire that can be used to identify medication use problems among older adults in Malaysia.
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Affiliation(s)
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia; Department of Pharmacy, Al Rafidain University College, Baghdad, Iraq.
| | - Bhuvan Kc
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Deepa Alex
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
| | | | - Sutha Rajakumar
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
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Lau ST, Liaw SY, Lau Y, Lopez V. "Seeing beyond the expected." Nursing students' experience in community practice and collaborative learning: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4617-e4627. [PMID: 35698735 DOI: 10.1111/hsc.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Rapidly ageing populations are putting a strain on healthcare due to their increasing chronic conditions and complex comorbidities. Community care is an important part of the healthcare system and community healthcare workers are under pressure to care for the growing ageing population. It is crucial to recruit healthcare workers in community care to address the ageing population. This study aimed to explore the nursing students' experiences in community care through their participation in a community collaborative programme. An exploratory qualitative study with purposive sampling was used. Thirty nursing undergraduate students who attended a 1-year Community Collaborative Programme, conceptualised by incorporating the IPE collaborative patient-centred practice conceptual framework, participated. Five focus group discussions were conducted using a semi-structured interview guide. Participants reflected on how their experiences influenced their perception of community care and their views on collaborative learning within an interprofessional team. Thematic analysis was used for the data analysis in this study. Four themes emerged from the data, namely (i) appreciating community care, (ii) developing community practice competence, (iii) valuing collaborative learning and (iv) managing constraints and barriers. Guidance from mentors during CCP allowed participants to develop the competencies needed to care for the ageing population, value interprofessional collaboration and manage constraints and barriers pertaining to community care. The participants understood the challenges and gained a deeper appreciation for community care. A non-hierarchal interprofessional relationship will prepare future nurses to meet the emerging healthcare need in the community, and will be beneficial to be included in future clinical curriculum.
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Affiliation(s)
- Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Queensland, Australia
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Christopher C, KC B, Shrestha S, Blebil AQ, Alex D, Mohamed Ibrahim MI, Ismail N. Medication use problems among older adults at a primary care: A narrative of literature review. Aging Med (Milton) 2022; 5:126-137. [PMID: 35783113 PMCID: PMC9245166 DOI: 10.1002/agm2.12203] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/09/2022] Open
Abstract
Appropriate medication use is one of the most significant challenges among the older population. Although medication use problems are well documented at the secondary and tertiary health care level, the evidence at the primary care level of OECD region is limited. A narrative review of existing literature was conducted through a nonsystematic search for original articles through electronic search databases, Ovid Medline, Google Scholar from 2001 to 2021, and a combination of citation references. Medication use problems are prevalent in older adults at the primary care level. The main issues of medication use identified were as follows; nonadherence, adverse drug events, accessibility, polypharmacy, inappropriate medications, belief about medications, lack of knowledge and awareness, and lack of deprescribing. In addition, the current review has identified the possibilities of the problems: many medications, forgetfulness, lack of deprescribing, lack of communication, poor understanding, and limited awareness of inappropriate medications. This review found that various medication use problems subclusters were identified to impact the health care need among older adults. Therefore, effective interventions targeting these issues need to be developed to reduce medication use problems among older adults at a primary care level.
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Affiliation(s)
| | - Bhuvan KC
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Sunil Shrestha
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Ali Qais Blebil
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Deepa Alex
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSubang JayaMalaysia
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Liew KB, Ming LC, Goh BH, Peh KK. Fast Melt Cocoa Butter Tablet: Effect of Waxes, Starch, and PEG 6000 on Physical Properties of the Preparation. Molecules 2022; 27:3128. [PMID: 35630605 PMCID: PMC9143478 DOI: 10.3390/molecules27103128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
A fast melt tablet (FMT) is well regarded as an alternative delivery system that might help resolve a patient's non-compliance issue. The main objective of this study was to develop a cocoa butter-based FMT. Additives, namely 5-15% of PEG 6000, beeswax, paraffin wax, and corn starch, were incorporated into the cocoa butter-based FMT to study the effects of these additives with the physical characteristic of a cocoa butter FMT. An optimum-based formulation was chosen according to the desired hardness and disintegration time and the taste masking property achieved with the model drug-dapoxetine. The analysis demonstrated that incorporating beeswax (15%) and paraffin wax (15%) could prolong the disintegration time by at least two-fold. On the contrary, the presence of corn starch was found to cause an increase in the hardness and reduction of the disintegration time. The disintegration mechanism might be presumed due to the synergistic effect of starch swelling and cocoa butter melting. The hardness value and in vitro disintegration time of the optimum formulation were recorded at 2.93 ± 0.22 kg and 151.67 ± 6.98 s. In terms of dissolution, 80% of dapoxetine was released within 30 min and the dissolution profile was comparable to the innovator product. The formulation was palatable and stable for at least 1 year. The exposure of the FMT formulation at 30 °C for 12 months was reported to be stable. Along with the sound palatability profile and high drug load capacity, the current formulation possesses the desired characteristics to be scaled up and marketed.
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Affiliation(s)
- Kai Bin Liew
- Faculty of Pharmacy, University of Cyberjaya, Cyberjaya 63000, Malaysia;
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei
| | - Bey-Hing Goh
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Kok Khiang Peh
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden 11800, Malaysia
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Al-Sanaani EA, Ismail A, Abdul Manaf MR, Suddin LS, Mustafa N, Sukor N, Alabed AAA, Alkhodary AA, Aljunid SM. Health insurance status and its determinants among patients with type 2 diabetes mellitus in a tertiary teaching hospital in Malaysia. PLoS One 2022; 17:e0267897. [PMID: 35511889 PMCID: PMC9070921 DOI: 10.1371/journal.pone.0267897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Even in a country with a tax-based healthcare financing system, health insurance can play an important role, especially in the management of chronic diseases with high disease and economic burden such as Type 2 Diabetes Mellitus (T2DM). The insurance coverage among T2DM patients in Malaysia is currently unclear. The aim of this study was to determine the insurance status of T2DM patients in public and private healthcare facilities in Malaysia, and the association between this status and patients’ sociodemographic and economic factors.
Methods
A cross-sectional study among T2DM patients seeking inpatient or outpatient treatment at a public tertiary hospital (Hospital Canselor Tuanku Muhriz) and a private tertiary hospital (Universiti Kebangsaan Malaysia Specialist Centre) in Kuala Lumpur between August 2019 and March 2020. Patients were identified via convenience sampling using a self-administered questionnaire. Data collection focused on identifying insurance status as the dependent factor while the independent factors were the patients’ sociodemographic characteristics and economic factors.
Results
Of 400 T2DM patients, 313 responded (response rate, 78.3%) and 76.0% were uninsured. About 69.6% of the respondents had low monthly incomes of <RM5000. Two-thirds of participants (59.1%) spent RM100–500 for outpatient visits whilst 58.5% spent <RM100 on medicines per month (RM1 = USD0.244). Patients who visited a private facility had five times more likely to have insurance than patients who visited a public facility. Participants aged 18–49 years with higher education levels were 4.8 times more likely to be insured than participants aged ≥50 years with low education levels (2 times).
Conclusions
The majority of T2DM patients were uninsured. The main factors determining health insurance status were public facilities, age of ≥ 50 years, low education level, unemployment, and monthly expenditure on medicines.
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Affiliation(s)
- Essam Ali Al-Sanaani
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Ministry of Public Health and Population, Sana’a, Yemen
| | - Aniza Ismail
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Mohd Rizal Abdul Manaf
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Leny Suzana Suddin
- Faculty of Medicine, Department of Community Health, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Norlaila Mustafa
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Alabed Ali A. Alabed
- Faculty of Medicine, Department of Community Medicine, Lincoln University College, Kota Bharu, Malaysia
| | - Ahmed Abdelmajed Alkhodary
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
- Faculty of Public Health, Department of Health Policy and Management, Kuwait University, Kuwait, Kuwait
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Wahab MSA, Zaini MH, Ali AA, Sahudin S, Mehat MZ, Hamid HA, Mustaffa MF, Othman N, Maniam S. The use of herbal and dietary supplement among community-dwelling elderly in a suburban town of Malaysia. BMC Complement Med Ther 2021; 21:110. [PMID: 33794868 PMCID: PMC8017757 DOI: 10.1186/s12906-021-03287-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of herbal and dietary supplement (HDS) in health and disease management has gained global attention. HDS are generally accepted by the public and are associated with positive health behaviours. However, several reports have been documented with regards to their potential adverse effects and interaction with conventional medicines. Limited data is currently available on the use of HDS among elderly population in Malaysia. This present study aims to investigate the prevalence of and pattern of HDS use among a sample of community-dwelling elderly in a suburban town in Malaysia. METHODS A cross-sectional survey was conducted between March and May 2019 among the elderly aged ≥60 years old. The participants with the following criteria were included in the study: aged ≥60 years, residing in Puncak Alam and able to understand Malay or English language. Data were collected using a pre-validated questionnaire. All statistical analysis was conducted using IBM SPSS ver. 23. RESULTS Overall, 336 out of 400 elderly responded to the survey, achieving a response rate of 84%. This study observed that almost 50% of the respondents were using at least one type of HDS in the past one month of the survey. Among HDS non-users, most of them preferred to use modern medicines (62.6%, 114/182). Among the HDS users, 75.3% (116/154) were using at least one type of modern medicine (prescription or over-the-counter medicine). Multivariate analysis showed that having good to excellent perceived health (adjusted OR = 2.666, 95% CI = 1.592-4.464), having felt sick at least once in the past one month (adjusted OR = 2.500, 95% CI = 1.426-4.383), and lower body mass index (adjusted OR = 0.937, 95% CI = 0.887-0.990) were associated with HDS use. It was noted that only a small percentage of HDS users (16.2%, 25/154) had informed healthcare providers on their HDS use. CONCLUSION The use of HDS is common among the elderly sampled. Hence, healthcare providers should be more vigilant in seeking information of HDS use for disease management in their elderly patients. Campaigns that provide accurate information regarding the appropriate use of HDS among the elderly are pertinent to prevent misinformation of the products.
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Affiliation(s)
- Mohd Shahezwan Abd Wahab
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia.
| | - Muhammad Helmi Zaini
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Aida Azlina Ali
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Shariza Sahudin
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Muhammad Zulfadli Mehat
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
| | - Hafizah Abdul Hamid
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
| | - Mohd Faiz Mustaffa
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Noordin Othman
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, 30001, Saudi Arabia
- Faculty of Pharmacy, PICOMS International University College, 68100, Batu Caves, Kuala Lumpur, Malaysia
| | - Sandra Maniam
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia.
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Chang CT, Ang JY, Islam MA, Chan HK, Cheah WK, Gan SH. Prevalence of Drug-Related Problems and Complementary and Alternative Medicine Use in Malaysia: A Systematic Review and Meta-Analysis of 37,249 Older Adults. Pharmaceuticals (Basel) 2021; 14:ph14030187. [PMID: 33669084 PMCID: PMC7996557 DOI: 10.3390/ph14030187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 01/18/2023] Open
Abstract
Drug-related problems (DRPs) in the elderly include polypharmacy, potentially inappropriate medications, nonadherence, and drug-related falls. In this systematic review and meta-analysis, the prevalence of DRPs and complementary and alternative medicine (CAM) use among the Malaysian elderly was estimated. PubMed, Scopus, Web of Science, and Google Scholar databases were searched to identify studies published since their inception up to 24 August 2020. A random-effects model was used to generate the pooled prevalence of DRPs along with its corresponding 95% confidence interval (CI). The heterogeneity of the results was estimated using the I2 statistics, and Cochran’s Q test and sensitivity analyses were performed to confirm the robustness of the results. We identified 526 studies, 23 of which were included in the meta-analysis. (n = 29,342). The pooled prevalence of DRPs among Malaysian elderly was as follows: (1) polypharmacy: 49.5% [95% CI: 20.5–78.6], (2) potentially inappropriate medications: 28.9% [95% CI: 25.4–32.3], (3) nonadherence to medications: 60.6% [95% CI: 50.2–70.9], and (4) medication-related falls 39.3% [95% CI: 0.0–80.8]. Approximately one in two Malaysian elderly used CAM. The prevalence of polypharmacy and potentially inappropriate medications among the Malaysian elderly population was high, calling for measures and evidence-based guidelines to ensure the safe medication use.
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Affiliation(s)
- Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh 30400, Perak, Malaysia;
- Correspondence: (C.-T.C.); or (M.A.I.)
| | - Ju-Ying Ang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh 30400, Perak, Malaysia;
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (C.-T.C.); or (M.A.I.)
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, Bandar Alor Setar, Alor Setar 05460, Kedah, Malaysia;
| | - Wee-Kooi Cheah
- Clinical Research Centre, Hospital Taiping, Ministry of Health, Taiping 34000, Perak, Malaysia;
- Medical Department, Hospital Taiping, Ministry of Health, Taiping 34000, Perak, Malaysia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor, Malaysia;
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14
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Islahudin F, Lee FY, Tengku Abd Kadir TNI, Abdullah MZ, Makmor-Bakry M. Continuous medication monitoring: A clinical model to predict adherence to medications among chronic kidney disease patients. Res Social Adm Pharm 2021; 17:1831-1840. [PMID: 33589374 DOI: 10.1016/j.sapharm.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND An adherence model is required to optimise medication management among chronic kidney disease (CKD) patients, as current assessment methods overestimate the true adherence of CKD patients with complex regimens. An approach to assess adherence to individual medications is required to assist pharmacists in addressing non-adherence. OBJECTIVE To develop an adherence prediction model for CKD patients. METHODS This multi-centre, cross-sectional study was conducted in 10 tertiary hospitals in Malaysia using simple random sampling of CKD patients with ≥1 medication (sample size = 1012). A questionnaire-based collection of patient characteristics, adherence (defined as ≥80% consumption of each medication for the past one month), and knowledge of each medication (dose, frequency, indication, and administration) was performed. Continuous data were converted to categorical data, based on the median values, and then stratified and analysed. An adherence prediction model was developed through multiple logistic regression in the development group (n = 677) and validated on the remaining one-third of the sample (n = 335). Beta-coefficient values were then used to determine adherence scores (ranging from 0 to 7) based on the predictors identified, with lower scores indicating poorer medication adherence. RESULTS Most of the 1012 patients had poor medication adherence (n = 715, 70.6%) and half had good medication knowledge (n = 506, 50%). Multiple logistic regression analysis determined 4 significant predictors of adherence: ≤7 medications (constructed score = 2, p < 0.001), ≤3 co-morbidities (constructed score = 1, p = 0.015), absence of complementary/alternative medicine use (constructed score = 1, p = 0.003), and knowledge score ≥80% (constructed score = 3, p < 0.001). A higher total constructed score from the prediction model indicated a higher likelihood of adherence (odds ratio [OR]: 2.41; 95% confidence interval [CI]: 2.112-2.744; p < 0.001). The area under the receiver operating characteristic (ROC) curve of the developed model (n = 677) had good accuracy (ROC: 0.867, 95% CI: 0.840-0.896; p < 0.001). The validated model (n = 335) also had good accuracy (ROC: 0.812, 95% CI: 0.765-0.859; p < 0.001). There was no significant difference between the development and validation groups (p = 0.11, Z-value:1.62, standard error: 0.034). CONCLUSION The score constructed from the medication adherence prediction model for CKD patients had good accuracy and could be useful for identifying patients with a higher risk of non-adherence, to ensure optimised adherence management.
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Affiliation(s)
- Farida Islahudin
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Fei Yee Lee
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia; Clinical Research Centre, Hospital Selayang, Ministry of Health Malaysia, Selangor, Malaysia; Hospital Selayang, Lebuhraya Selayang-Kepong, 68100, Batu Caves, Selangor, Malaysia
| | - Tengku Nur Izzati Tengku Abd Kadir
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia; Pharmacy Department, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Malaysia; Pharmacy Department, Hospital Sultanah Nur Zahirah, 20400, Kuala Terengganu, Terengganu, Malaysia
| | - Muhammad Zulhilmi Abdullah
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
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Prevalence and Associated Factors of Self-Treatment among the Elderly-A Comparative Study between Empty and Non-Empty Nesters in Shandong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217880. [PMID: 33121139 PMCID: PMC7662221 DOI: 10.3390/ijerph17217880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022]
Abstract
(1) Objectives: With an aging society in China, self-treatment now plays an important role in health care among older adults, but it can be problematic. This study aims to explore and compare the self-treatment behavior among empty and non-empty nesters. (2) Methods: Using a multi-stage stratified random cluster sampling method, a total of 4366 elderly people aged 60 and above from Shandong Province, China, were enrolled in this study. Data were collected through a structured questionnaire. Binary logistic regression was used to analyze the associated factors of self-treatment. (3) Results: The prevalence of self-treatment in empty nesters was significantly lower than that in non-empty ones (74.0% vs. 83.3%). Binary logistic regression analysis showed that higher educational level and poorer self-rated economic status were negatively associated with self-treatment in empty nesters, while unemployed and urban and rural residents' basic medical insurance were positively associated with self-treatment in non-empty ones. (4) Conclusions: The study indicated that empty nesters had lower likelihood of self-treatment than non-empty ones. Empty nesters with better socioeconomic status were more likely to use self-treatment; by contrast, non-empty nesters with relatively poorer socioeconomic status were more inclined to self-treatment. Targeted interventions should be developed to maximize the effectiveness of self-treatment and reduce health risks.
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Hamdan NKA, Lean QY, Neoh CF, Abdullah AH, Lim SM, Ramasamy K, Al-Worafi YM, Goh KW, Goh HP, Ming LC, Lua PL. Knowledge and Perception of Facial Candling for Allergic Rhinitis among University Staff and Students. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:5713134. [PMID: 32831870 PMCID: PMC7422475 DOI: 10.1155/2020/5713134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/27/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Facial candling is a traditional method used for relieving symptoms of allergic rhinitis (AR). This study aims to investigate the knowledge and perception of facial candling in a sample of staff and students in a public university in Malaysia. METHODS An online questionnaire survey method was used. Based on sample size calculation, a total of 1,508 UiTM staff and students from ten selected campuses of Universiti Teknologi MARA (UiTM) were invited to participate in this survey. An up-to-date e-mail list of staff in the selected campuses was used as the sampling frame for the study, whereas the students were recruited from the official university student Facebook portal. RESULTS A total of 788 respondents participated in this survey, 72.2% of them knew about facial candling, though only 35.4% had tried the treatment. Approximately one-fifth of respondents agreed that facial candling might treat AR. It was found that a higher number of users than nonusers agreed that facial candling was a traditional medicine (78.9% vs 55.0%); could be used on the face and ears (83.5% vs 45.4%); and could be self-administered at home (83.5 vs 45.4%). Interestingly, more than half of them were uncertain about its long-term effects and adverse reactions. CONCLUSION This study confirms the facial candling use among patients with AR although the percentage is low. The patients and general public need to be better informed about the use of facial candling in AR and its associated risks.
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Affiliation(s)
- Nurul Khaleeda Athiraah Hamdan
- Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
| | - Qi Ying Lean
- Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Pulau Pinang, Bertam Campus, Kepala Batas, Pulau Pinang, Malaysia
- Vector-borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
- Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Amir Heberd Abdullah
- Vector-borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
- Department of Environmental Health, Faculty of Health Sciences, Universiti Teknologi MARA, Bertam Campus, Kepala Batas, Pulau Pinang, Malaysia
| | - Siong Meng Lim
- Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
- Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Kalavathy Ramasamy
- Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
- Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Yaser Mohammed Al-Worafi
- College of Pharmacy, University of Science and Technology, Sana'a, Yemen
- College of Pharmacy, University of Science and Technology Faujairah, Fujairah, UAE
| | - Khang Wen Goh
- Faculty of Science and Technology, Quest International University Perak, Ipoh, Perak, Malaysia
| | - Hui Poh Goh
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
| | - Long Chiau Ming
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
| | - Pei Lin Lua
- Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut, Terengganu, Malaysia
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Tan CS, Hassali MAA, Neoh CF, Ming LC. Beliefs about medicine and medication adherence among hypertensive patients in the community setting. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00744-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ting CY, Ahmad Zaidi Adruce S, Lim CJ, Abd Jabar AHA, Ting RSK, Ting H, Osman NA, Ngau E, Talin BA, Muhammad M, Loo SC, Lim SE, Hassali MA. Effectiveness of a pharmacist-led structured group-based intervention in improving medication adherence and glycaemic control among type 2 diabetes mellitus patients: A randomized controlled trial. Res Social Adm Pharm 2020; 17:344-355. [PMID: 32327398 DOI: 10.1016/j.sapharm.2020.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A pharmacist-led structured group-based intervention (MEDIHEALTH) was formulated to improve medication adherence among Malay type 2 diabetes mellitus (T2DM) patients in the Malaysian state of Sarawak. OBJECTIVES The objective of this study was to examine the effectiveness of MEDIHEALTH and its mechanism of impact for improving medication adherence and the glycated haemoglobin (HbA1c) level. METHODS A two group and parallel randomised controlled trial with a twelve months follow-up period was conducted at two primary health clinics in Malaysia that were surrounded by Malay communities. Malay T2DM patients whose HbA1c was >7% and total score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was <26 were recruited and parallelly randomised to the MEDIHEALTH or usual care (control) groups. The extended theory of planned behaviour was employed to test the mechanism of impact. Repeated measure analysis of variance was used to assess the difference in the estimated marginal mean of the SEAMS scores and HbA1c level between the intervention and control groups at different times. RESULTS A total of 142 participants were recruited and randomised; three from the intervention group and eight from the control group withdrew before receiving any treatment. Hence, 68 participants in the intervention group and 63 in the control group were included for analyses. The MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p < 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at one, three, six and twelve months post-intervention (p < 0.001). These improvements were mediated by enhancements in perceived behavioural control and knowledge about medications. CONCLUSIONS The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients.
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Affiliation(s)
- Chuo Yew Ting
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia; Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Shahren Ahmad Zaidi Adruce
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia; Faculty of Cognitive Science and Human Development, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore.
| | | | - Rachel Sing-Kiat Ting
- Monash University, Jeffrey Cheah School of Medicine and Health Sciences, Selangor, Malaysia.
| | - Hiram Ting
- Sarawak Research Society, Sarawak, Malaysia; Faculty of Hospitality and Tourism Management, UCSI University, Malaysia.
| | - Nor Anizah Osman
- Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Esther Ngau
- Pharmacy Department, Petra Jaya Health Clinic, Petra Jaya, Kuching, Ministry of Health, Malaysia.
| | - Benodict Apok Talin
- Pharmacy Enforcement Division, Sarawak State Health Department Sarawak, Ministry of Health, Malaysia.
| | - Munira Muhammad
- Pharmaceutical Services Division, Ministry of Health, Malaysia.
| | - Shing Chyi Loo
- Pharmacy Enforcement Division, Sarawak State Health Department Sarawak, Ministry of Health, Malaysia.
| | - Su Ee Lim
- Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Mohamed Azmi Hassali
- Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
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Hussain N, Said ASA, Khan Z. Influence of Health Literacy on Medication Adherence Among Elderly Females With Type 2 Diabetes in Pakistan. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 41:35-44. [PMID: 31886737 DOI: 10.1177/0272684x19896724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Health literacy is how well the patients are able to attain, deal with, and understand basic health information. This is particularly important when it comes to comprehending prescribed medication instructions. To improve the communication strategies for health-care professionals during patient counseling, our study aimed to assess the influence of health literacy and medication adherence in older patients. The objectives of the study were to evaluate associations that occur between the level of health literacy and medication adherence. This study used a convenience sampling method of females (older than 60 years) attending the diabetic clinic in two hospital settings (N = 524). All study participants filled three validated questionnaires: these were the Literacy Assessment for Diabetes, the Diabetes Numeracy Test, and a modified Brief Adherence Rating Scale. To assess the spectrum of health literacy differences, we used χ2 analysis and linear regression analysis. Individuals with adequate health literacy were more likely to remember to take their medications compared with those with inadequate health literacy, χ2(4) = 11.6, p = .04. Adequate literacy level study participants were more likely to not change the dose of their medications without medical advice (12.3%) compared with those individuals with inadequate health literacy (2.8%), χ2(4) = 11.13, p = .03. The results in our study suggest that health-care professionals should focus on appropriate communication attuned to the assessment of health literacy levels particularly in older female patients when discussing medication instructions.
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Affiliation(s)
- Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University of Science and Technology, UAE
| | - Amira S A Said
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University of Science and Technology, UAE
| | - Zainab Khan
- Department of Internal Medicine, Punjab Care hospital, Lahore, Pakistan
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Ting CY, Ahmad Zaidi Adruce S, Hassali MA, Ting H, Lim CJ, Ting RSK, Abd Jabar AHA, Osman NA, Shuib IS, Loo SC, Sim ST, Lim SE, Morisky DE. Effectiveness and sustainability of a structured group-based educational program (MEDIHEALTH) in improving medication adherence among Malay patients with underlying type 2 diabetes mellitus in Sarawak State of Malaysia: study protocol of a randomized controlled trial. Trials 2018; 19:310. [PMID: 29871651 PMCID: PMC5989376 DOI: 10.1186/s13063-018-2649-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Amidst the high disease burden, non-adherence to medications among patients with type 2 diabetes mellitus (T2DM) has been reported to be common and devastating. Sarawak Pharmaceutical Services Division has formulated a pharmacist-led, multiple-theoretical-grounding, culturally sensitive and structured group-based program, namely "Know Your Medicine - Take if for Health" (MEDIHEALTH), to improve medication adherence among Malay patients with T2DM. However, to date, little is known about the effectiveness and sustainability of the Program. METHODS/DESIGN This is a prospective, parallel-design, two-treatment-group randomized controlled trial to evaluate the effectiveness and sustainability of MEDIHEALTH in improving medication adherence. Malay patients who have underlying T2DM, who obtain medication therapy at Petra Jaya Health Clinic and Kota Samarahan Health Clinic, and who have a moderate to low adherence level (8-item Morisky Medication Adherence Scale, Malaysian specific, score <6) were randomly assigned to the treatment group (MEDIHEALTH) or the control group. The primary outcome of this study is medication adherence level at baseline and 1, 3, 6 and 12 months post-intervention. The secondary outcomes are attitude, subjective norms, perceived behavioural control, intention and knowledge related to medication adherence measured at baseline and 1, 6 and 12 months post-intervention. The effectiveness and sustainability of the Program will be triangulated by findings from semi-structured interviews with five selected participants conducted 1 month after the intervention and in-depth interviews with two main facilitators and two managerial officers in charge of the Program 12 months after the intervention. Statistical analyses of quantitative data were conducted using SPSS version 22 and Stata version 14. Thematic analysis for qualitative data were conducted with the assistance of ATLAS.ti 8. DISCUSSION This study provides evidence on the effectiveness and sustainability of a structured group-based educational program that employs multiple theoretical grounding and a culturally sensitive approach in promoting medication adherence among Malays with underlying T2DM. Both the quantitative and qualitative findings of this study could assist in the future development of the Program. TRIAL REGISTRATION National Medical Research Register, NMRR-17-925-35875 (IIR). Registered on 19 May 2017. ClinicalTrials.gov, NCT03228706 . Registered on 25 July 2017.
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Affiliation(s)
- Chuo Yew Ting
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | | | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hiram Ting
- Sarawak Research Society, Sarawak, Malaysia
| | - Chien Joo Lim
- Clinical Research Center, Sarawak General Hospital, Sarawak, Malaysia
| | - Rachel Sing-Kiat Ting
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | | | - Nor Anizah Osman
- Pharmacy Practice and Development Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Izzul Syazwan Shuib
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Shing Chyi Loo
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Sui Theng Sim
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Su Ee Lim
- Pharmacy Practice and Development Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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