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Zin CS, Nozid NR, Razak AA, Hashim SN, Mazlan NA, Daud N, Bux SH. Research on Nonsteroidal Anti-inflammatory Drugs in Malaysia: A Bibliometric Analysis. J Pharm Bioallied Sci 2020; 12:S707-S710. [PMID: 33828365 PMCID: PMC8021056 DOI: 10.4103/jpbs.jpbs_282_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/09/2020] [Accepted: 04/01/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common analgesics used for pain relief. Adverse effects of NSAIDs range from gastrointestinal tract disturbances to increased risk of bleeding, renal injury, and myocardial infarction. In Malaysia, the research productivity of NSAIDs is not well explored. Objective: This study examined research productivity of NSAIDs in Malaysia. Materials and Methods: This bibliometric study included all published research articles on NSAIDs from 1979 to 2018, which were conducted in Malaysia. The search databases such as Google Scholar, PubMed, ScienceDirect, and Scopus were used. Search terms included NSAIDs and specific drug names such as ibuprofen, celecoxib, and naproxen. Growth of publication, authorship pattern, citation analysis, journal index, type of studies, and geographical distribution of institutions publishing articles on NSAIDs were measured. Results: Overall, 111 articles were retrieved from 1979 to 2018. The annual productivity of articles throughout the study fluctuated in which the highest productivity was in 2018, 12.61% (n = 14). Majority of articles were multiple authored, 99.10% (n = 109), and University of Science Malaysia (USM) produced the highest number of articles (30 articles). Most of the articles were International Scientific Indexing-indexed, 52.25% (n = 58), and the main issue studied in most of the articles was the drug formulation of NSAIDs. Conclusion: The growth of NSAID research in Malaysia was slow, and the majority of research involved laboratory studies. Clinical studies evaluating the clinical outcomes of NSAIDs in patients, particularly using large healthcare databases are still lacking.
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Affiliation(s)
- Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norzaini Ros Nozid
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Amalia Athirah Razak
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Siti Nuraisyah Hashim
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nur Aimi Mazlan
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norhayati Daud
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Siti Halimah Bux
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Hwong WY, Lim YMF, Khoo EM, Sivasampu S. High-risk nonsteroidal anti-inflammatory drugs prescribing in primary care: results from National Medical Care Survey Malaysia. Int J Clin Pharm 2020; 42:489-499. [PMID: 31960271 DOI: 10.1007/s11096-020-00966-w] [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: 06/07/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
Background Information on the extent of high-risk prescribing for nonsteroidal anti-inflammatory drugs (NSAIDs) across developing countries is scarce. Objectives This study examines the prescribing pattern for NSAIDs in primary care, assesses the extent of high-risk NSAIDs prescribing and identifies associated factors. Setting 129 public and 416 private primary care clinics in Malaysia. Methods Data were derived from the National Medical Care Survey 2014, a cross-sectional survey on primary care morbidity patterns and clinical activities in Malaysia. Types of NSAIDs, indications for NSAIDs use and proportion of high-risk NSAIDs prescribing were assessed. Factors associated with high-risk NSAIDs prescribing were identified with a multivariable logistic regression. Weighted results, adjusted for sampling design and non-response were presented. Main outcome measures Prescribing pattern of NSAIDs, proportion of high-risk NSAIDs prescribing and its associated factors. Results Among the 55,489 patients who received NSAIDs, diclofenac was the most frequently prescribed NSAID (40.5%, 95% CI 40.1-40.9%), followed by mefenamic acid (29.2%, 95% CI 28.8-29.6%). The commonest indications for NSAIDs use were musculoskeletal condition and respiratory tract infection, both at 17.8% (95% CI 17.4-18.1%). A total of 22.9% (95% CI 22.6-23.3%) patients received high-risk NSAID prescriptions. Of these, 47.8% (95% CI 46.9-48.7%) did not receive adequate gastroprotection despite being at risk, 24.8% (95% CI 24.0-25.5%) were prescribed NSAIDs despite having cardiovascular comorbidities and 22.4% (95% CI 21.7-23.2%) were prescribed high-dose NSAIDs. The odds of receiving high-risk NSAID prescriptions increased with the number of drugs prescribed (OR 1.23, 95% CI 1.06-1.43) and the number of diagnoses in one visit (OR 2.21, 95% CI 1.71-2.86). The odds of being prescribed high-risk NSAID prescriptions were lower in patients with secondary (OR 0.52, 95% CI 0.35-0.77) and tertiary education (OR 0.39, 95% CI 0.22-0.68) compared to patients without formal education. Patients' citizenship, indication for NSAID prescriptions and whether a medical certificate was issued were also significantly associated with the likelihood of receiving high-risk NSAID prescriptions. Conclusions A quarter of NSAIDs prescribed in Malaysian primary care setting is categorised as high-risk prescribing. Targeted strategies are necessary to improve patient safety.
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Affiliation(s)
- Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Yvonne Mei Fong Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia
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Mathews A, Azad AK, Abbas SA, Bin Che Rose FZ, Helal Uddin ABM. Study on the Perception of Staff and Students of a University on Community Pharmacy Practice in Ipoh, Perak, Malaysia. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2018; 10:226-231. [PMID: 30568380 PMCID: PMC6266647 DOI: 10.4103/jpbs.jpbs_80_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: In Malaysia, community pharmacies play an important and vital role in both urban and rural areas with approximately 30% of 12,000 registered pharmacists with annual retention certificate practicing in community pharmacies. The main objective of this study was to find the perception of respondents on the value and necessity of pharmacists. Materials and Methods: The questionnaire was divided into two sections: the first section assessed the visits to community pharmacies, purpose, interaction with pharmacy staffs, professional fee, and improvements to pharmacy practices; the second section evaluated the characteristics of respondents including an e-consent form. Data were analyzed using the Statistical Package for the Social Sciences software (version 11.5). Results: The highest number of respondents (66.1%) consulted with the pharmacists for cough and cold, 33.1% for gastric and stomach ailments, and 28.9% for diarrhea and constipation. Only 34% of cases were handled by the pharmacists, whereas 52.1% by the sales assistant. Approximately 88.5% showed satisfaction with the counseling provided. A total of 46.3% did not know whom they dealt with, whereas 51.2% wanted personal attention of the pharmacists instead of the sales assistants. However, 66.9% of respondents preferred to a private consultation room. Records of only 32.2% of respondents were secured by the pharmacies, whereas 42.1% showed interest to pay a professional fee. Moreover, 83.3% agreed the fee of RM5 only, whereas 20.8% agreed to RM10. Among the respondents, majority agreed to pay a fee willingly, but approximately 30% stayed neutral. Conclusion: There is a need for the community pharmacists to play vital roles firsthand at the front desk to serve the patients professionally instead of handing over the responsibilities to the sales assistant.
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Affiliation(s)
- Allan Mathews
- Faculty of Pharmacy, Quest International University Perak, Malaysia
| | - Abul Kalam Azad
- Faculty of Pharmacy, International Islamic University Malaysia (IIUM), 25200 Kuantan, Pahang, Malaysia
| | - Syed A Abbas
- Faculty of Pharmacy, Quest International University Perak, Malaysia
| | - Farid Z Bin Che Rose
- Faculty of Integrative Sciences and Technology, Quest International University Perak, Malaysia
| | - A B M Helal Uddin
- Faculty of Pharmacy, International Islamic University Malaysia (IIUM), 25200 Kuantan, Pahang, Malaysia
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Pok LSL, Shabaruddin FH, Dahlui M, Sockalingam S, Mohamed Said MS, Rosman A, Lau IS, Isa LM, Hussein H, Ng CT, Mahadeva S. Clinical and economic implications of upper gastrointestinal adverse events in Asian rheumatological patients on long-term non-steroidal anti-inflammatory drugs. Int J Rheum Dis 2018; 21:943-951. [PMID: 29314744 DOI: 10.1111/1756-185x.13256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the incidence and direct costs of NSAID-induced upper GI adverse events in Malaysian rheumatology patients. METHODS A retrospective, multi-centre, cohort study of rheumatology patients on long-term NSAIDs was conducted. Clinical data of patients treated between 2010 and 2013 were collected for a 24-month follow-up period. The costs of managing upper GI adverse events were based on patient level resource use data. RESULTS Six hundred and thirty-four patients met the inclusion criteria: mean age 53.4 years, 89.9% female, diagnosis of rheumatoid arthritis (RA; 59.3%), osteoarthritis (OA; 10.3%) and both RA and OA (30.3%). Three hundred and seventy-one (58.5%) patients were prescribed non-selective NSAIDs and 263 (41.5%) had cyclo-oxygenase-2 inhibitors. Eighty-four upper GI adverse events occurred, translating into a risk of 13.2% and an incidence rate of 66.2 per 1000 person-years. GI adverse events comprised: dyspepsia n = 78 (12.3%), peptic ulcer disease (PUD) n = 5 (0.79%) and upper GI bleeding (UGIB) n = 1 (0.16%). The total direct healthcare cost of managing adverse events was Malaysian Ringgit (MR) 37 352 (US dollars [USD] 11 419) with a mean cost of MR 446.81 ± 534.56 (USD 136.60 ± 163.42) per patient, consisting mainly of GI pharmacotherapy (33.8%), oesophagoduodenoscopies (23.1%) and outpatient clinic visits (18.2%). Mean cost per patient by GI events were: dyspepsia, MR 408.98 ± 513.29 (USD125.03 ± 156.92); PUD, MR 805.93 ± 578.80 (USD 246.39 ± 176.95); UGIB, MR 1601.94 (USD 489.74, n = 1). CONCLUSION The economic burden of GI adverse events due to long-term NSAIDs use in Malaysian patients with chronic rheumatic diseases is modest.
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Affiliation(s)
- Lydia Say Lee Pok
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sargunan Sockalingam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Azmillah Rosman
- Department of Medicine, Selayang Hospital, Selangor, Malaysia
| | - Ing Soo Lau
- Department of Medicine, Selayang Hospital, Selangor, Malaysia
| | - Liza Mohd Isa
- Department of Medicine, Putrajaya Hospital, Putrajaya, Malaysia
| | | | - Chin Teck Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,l-NUS Medical School, Singapore, Singapore
| | - Sanjiv Mahadeva
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Lee HL, Chua SS, Mahadeva S. Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital. Ther Clin Risk Manag 2016; 12:1649-1657. [PMID: 27877048 PMCID: PMC5110204 DOI: 10.2147/tcrm.s119722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and purpose Clinical guidelines recommend the prescribing of gastroprotective strategies in nonsteroidal anti-inflammatory drug (NSAID) users with risk factors for gastrointestinal (GI) ulcer or ulcer complications. However, these guidelines are not often translated into clinical practice. Therefore, the aim of this study was to investigate the utilization of gastroprotective strategies for NSAID-induced upper GI events in at-risk users in a major teaching hospital. Patients and methods A cross-sectional, observational, pharmacy-based study was conducted in a major Asian institution with both primary and secondary health care services. This study involved the screening of prescriptions for regular NSAIDs, and patients who met the inclusion criteria were recruited and interviewed using a questionnaire. Results Of the 409 participants recruited, 83.1% had at least one GI risk factor, of whom 70.3% did not receive appropriate gastroprotection. The most common GI risk factor was the use of high-dose NSAIDs (69.2%), followed by participants aged 65 years and older (22%) and concomitant use of low-dose aspirin (11.7%). Appropriate gastroprotective strategies utilized consisted of the use of a cyclooxygenase (COX)-2 inhibitor alone or a nonselective NSAID plus a proton pump inhibitor (PPI) in the moderate-risk group and a COX-2 inhibitor plus a PPI in the high-risk group. Gastroprotective strategies were underutilized in 67.1% of at-risk participants and overutilized in 59.4% of those without risk factors. Co-prescription of a histamine-2 receptor antagonist at lower-than-recommended doses constituted 59% of the inappropriate gastroprotective agents used. Logistic regression analysis revealed patients aged 65 years and older (odds ratio, 1.89; 95% CI =1.15–3.09) as a predictor for the prescribing of gastroprotection by the clinicians. Conclusion Approximately 70% of at-risk NSAID users, mainly on high-dose NSAIDs, were not prescribed appropriate gastroprotective strategies. Further measures are warranted to improve the safe prescribing of regular NSAIDs.
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Affiliation(s)
| | | | - Sanjiv Mahadeva
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Risk factors associated with dyspepsia in a rural Asian population and its impact on quality of life. Am J Gastroenterol 2010; 105:904-12. [PMID: 20179699 DOI: 10.1038/ajg.2010.26] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The epidemiology and impact of dyspepsia in rural Asia remains uncertain. We aimed to determine the prevalence epidemiology and impact of dyspepsia in a rural Malaysian community. METHODS A door-to-door survey was conducted in a representative rural population in Malaysia. Dyspepsia was defined according to the Rome II criteria, and health-related quality of life (HRQOL) was assessed using the Euroqol (EQ-5D) instrument. RESULTS Of 2,260 adults, 2,000 (88.5%) completed the survey. The mean age of respondents was 40.4+/-15.3 years, 62.7% were women, 79.0% were ethnic Malays, 8.4% had been educated up to the tertiary level, 49.7% were unemployed, and 63.4% resided in village-type housing with 49.1% having >8 residents per household. Dyspepsia was prevalent in 292 (14.6%) adults, and they had lower mean EQ-5D utility scores compared with healthy controls (0.91+/-0.17 vs. 0.97+/-0.08, P<0.0001). Dyspepsia was found to be associated with female gender (15.8 vs. 12.7% males, P=0.058), Chinese ethnicity (19.7 vs. 14.2% non-Chinese), higher education levels, medium-range incomes (19.1% medium range vs. 13.3% low range), non-village-type housing (16.3 vs. 13.5% village-type house, P=0.08), nonsmokers (18.7 vs. 13.7%, P=0.015), non-tea drinkers (19.5 vs. 12.3%, P<0.0001), regular analgesia intake (27 vs. 12.7%, P<0.0001), and adults with chronic illness (26.6 vs. 11.1%, P<0.0001). Logistic regression analysis showed that higher levels of education, i.e., secondary (odds ratio (OR) 2.13, 95% confidence interval (CI)=1.15-3.93) and tertiary (2.70, 95% CI=1.30-5.62) education, non-village housing (OR 1.36, 95% CI=1.02-1.80), regular analgesia (OR 2.22, 95% CI=1.60-3.09), and chronic illness (OR 2.83, 95% CI=2.12-3.77) were independent risk factors for dyspepsia. Conversely, regular tea drinking (OR 0.59) seemed to have an inverse relationship. CONCLUSIONS Dyspepsia in rural Malaysians is associated with a lower HRQOL. Epidemiological risk factors include a higher socioeconomic status, regular analgesic consumption, and chronic illness.
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Chua SS, Ramachandran CD, Paraidathathu TT. Response of community pharmacists to the presentation of back pain: a simulated patient study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.14.3.0003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To assess the response of community pharmacists to the presentation of back pain.
Method
The researcher posed as a customer to obtain medication for back pain for her grandfather, and the consultations were recorded in a pretested data collection form.
Setting
The study was conducted in 100 randomly selected community pharmacies located within the Klang Valley in Malaysia. This includes Kuala Lumpur, the capital city of Malaysia and its surrounding suburban areas.
Key findings
In 85% of the consultations, pharmacists asked at least one question before recommending a treatment. The patient's medical history was the most frequently asked question by the pharmacists (60%). In general, a median of only five counselling elements were addressed by the pharmacists out of 13 recommended. The most common element of counselling addressed was the route of administration (98%), followed by the frequency and dose to be taken (92% and 88%, respectively). None of the pharmacists asked the ‘customer’ whether she required any further information. The number of counselling elements addressed was significantly associated with the age of the pharmacist, duration of consultation and the types of medication recommended (P < 0.05). Most of the pharmacists (88%) recommended at least an oral non-steroidal anti-inflammatory drug or a selective cyclooxygenase-2 inhibitor for the treatment of acute back pain. Diclofenac was the most commonly recommended medication for back pain (55% of consultations), followed by meloxicam (15%). The cost of treatment for back pain ranged from RM2.00 to RM38.00 with a median of RM10.00.
Conclusion
This study demonstrates that the extent of information gathering and counselling varied among community pharmacists in Malaysia and that in general, this appeared to be suboptimal. Professional bodies such as the Malaysian Pharmaceutical Society should create awareness among pharmacists regarding their responsibility to counsel patients or their caregivers.
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Affiliation(s)
- Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Malaysia
| | | | - Thomas T Paraidathathu
- Department of Pharmacy, Faculty of Allied Health Sciences, National University of Malaysia
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