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Christopher CM, Blebil AQ, Bhuvan KC, Alex D, Ibrahim MIM, Ismail N, Cheong MWL. Assessing feasibility of conducting medication review with follow-up among older adults at community pharmacy: a pilot randomised controlled trial. Int J Clin Pharm 2024:10.1007/s11096-024-01711-3. [PMID: 38635115 DOI: 10.1007/s11096-024-01711-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Medication review with follow-up is essential for optimising medication utilisation among the older adult population in primary healthcare. AIM This study aimed to evaluate the feasibility of implementing medication reviews with follow-up for older adults in community pharmacies and examined potential outcomes on medication use. METHOD A pilot randomised controlled trial was conducted with 4 cluster-randomised community pharmacies to assess the feasibility of the intervention. Two community pharmacies served as intervention and control groups. Both groups recruited older adults over 60 who were followed over 6 months. The translated Medication use Questionnaire (MedUseQ) was administered at baseline and 6 months for both groups. The outcomes were to assess the feasibility of conducting medication review with follow-up and the probable medication use outcomes from the intervention. RESULTS The intervention and control groups comprised 14 and 13 older adults. A total of 35 recommendations were made by pharmacists in the intervention group and 8 in the control group. MedUseQ was easily administered, providing some evidence the feasibility of the intervention. However, there were feasibility challenges such as a lack of pharmacists, collaborative practice, difficulties with the tool language, time constraints, and limited funds. Questionnaire results provided a signal of improvement in medication administration, adherence, and polypharmacy among intervention participants. The incidence of drug related problems was significantly higher in the control group (median = 1) after 6 months, U = 15, z = - 2.98, p = 0.01. CONCLUSION Medication review with follow-up is potentialy practical in community pharmacies, but there are feasibility issues. While these challenges can be addressed, it is essential to study larger sample sizes to establish more robust evidence regarding outcomes. CLINICAL TRIAL REGISTRY ClinicalTrials.Gov NCT05297461.
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Affiliation(s)
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
| | - 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, QLD, 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
| | | | - Norhasimah Ismail
- Bayan Lepas Health Clinic, Ministry of Health, Bayan Lepas, Penang, Malaysia
| | - Mark Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
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Folayan A, Cheong MWL, Fatt QK, Su TT. Health insurance status, lifestyle choices and the presence of non-communicable diseases: a systematic review. J Public Health (Oxf) 2024; 46:e91-e105. [PMID: 38084086 PMCID: PMC10901270 DOI: 10.1093/pubmed/fdad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/05/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Although health insurance (HI) has effectively mitigated healthcare financial burdens, its contribution to healthy lifestyle choices and the presence of non-communicable diseases (NCDs) is not well established. We aimed to systematically review the existing evidence on the effect of HI on healthy lifestyle choices and NCDs. METHODS A systematic review was conducted across PubMed, Medline, Embase, Cochrane Library and CINAHLComplet@EBSCOhost from inception until 30 September 2022, capturing studies that reported the effect of HI on healthy lifestyle and NCDs. A narrative synthesis of the studies was done. The review concluded both longitudinal and cross-sectional studies. A critical appraisal checklist for survey-based studies and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies were used for the quality assessment. RESULT Twenty-four studies met the inclusion criteria. HI was associated with the propensity to engage in physical activities (6/11 studies), consume healthy diets (4/7 studies), not to smoke (5/11 studies) or take alcohol (5/10 studies). Six (of nine) studies showed that HI coverage was associated with a lowered prevalence of NCDs. CONCLUSION This evidence suggests that HI is beneficial. More reports showed that it propitiated a healthy lifestyle and was associated with a reduced prevalence of NCDs.
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Affiliation(s)
- Adeola Folayan
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Malaysia
| | | | - Quek Kia Fatt
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Malaysia
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Malaysia
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Folayan A, Fatt QK, Cheong MWL, Su TT. Healthcare cost coverage inequality and its impact on hypertension and diabetes: A five-year follow-up study in a Malaysian rural community. Health Sci Rep 2024; 7:e1880. [PMID: 38361803 PMCID: PMC10867688 DOI: 10.1002/hsr2.1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background and Aims Inequality in health care access is a socioeconomic driver for non-communicable disease related risk factors. This study examined the inequality trend in healthcare cost coverage (HCC) compared to private health insurance (PHI) coverage, a subtype of HCC, over 5 years. The study will also determine the association between HCC (and PHI) and the status of hypertension and diabetes diagnosis. Method The rich-poor ratio, concentration curve and concentration index were derived to determine the level of inequality. Furthermore, logistic regression was done to determine the association between HCC and the status of hypertension and diabetes. Results The PHI group (rich-poor ratio: 1.4 [rich: 454, poor: 314] and 2.6 [rich: 375, poor: 142]; concentration index: 0.123 [95% confidence interval, CI: 0.093-0.153] and 0.144 [95% CI: 0.109-0.178] in 2013 and 2018, respectively) has relatively higher inequality compared with the HCC group (rich-poor ratio: 0.9 [rich: 307, poor: 337] and 1.1 [rich: 511, poor: 475]; concentration index: -0.027 [95% CI: -0.053 to -0.000] and -0.014 [95% CI: -0.033 to 0.006] in 2013 and 2018, receptively). Contrasting to the observation with the HCC group, PHI was associated with higher odds for hypertension (adjusted odds ratio [aOR] = 1.252, p = 0.01, 95% CI: 1.051-1.493) and diabetes (aOR = 1.287, p = 0.02, 95% CI: 1.041-1.590) in 2018. Conclusion Over 5 years, the inequality in PHI coverage remained higher compared with HCC, which suggests that the rich enjoyed private healthcare more. Furthermore, those with PHI were more likely to report known hypertension and diabetes in 2018. It is reasonable to assume that those with PHI are more likely to have earlier diagnoses compared to others and are more likely to be aware of their condition. Policymakers need to identify strategies that can narrow the existing gap in quality and type of service between the private and public health sectors.
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Affiliation(s)
- Adeola Folayan
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaJalan Lagoon SelatanBandar SunwaySelangorMalaysia
| | - Quek Kia Fatt
- Global Public Health, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaJalan Lagoon SelatanBandar SunwaySelangorMalaysia
| | - Mark Wing Loong Cheong
- Department of Pharmacy Practice, School of PharmacyMonash University MalaysiaJalan Lagoon SelatanBandar SunwaySelangorMalaysia
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaJalan Lagoon SelatanBandar SunwaySelangorMalaysia
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Yong ASJ, Lim KK, Fox-Rushby J, Ismail F, Hamzah E, Cheong MWL, Teoh SL. A Longitudinal Evaluation of the Preferences of Patients With Advanced Cancer for Quality of Life and Survival in Malaysia: A Discrete Choice Experiment. Value Health 2023; 26:1772-1781. [PMID: 37741445 DOI: 10.1016/j.jval.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES This study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time. METHODS A discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay. RESULTS One hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in "severe" health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents' preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost. CONCLUSIONS As QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Ka Keat Lim
- Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, King's College London, London, England, UK
| | - Julia Fox-Rushby
- Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, King's College London, London, England, UK
| | - Fuad Ismail
- Department of Radiotherapy & Oncology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak
| | | | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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Yong ASJ, Cheong MWL, Hamzah E, Teoh SL. A qualitative study of lived experiences and needs of advanced cancer patients in Malaysia: Gaps and steps forward. Qual Life Res 2023:10.1007/s11136-023-03401-5. [PMID: 36964453 PMCID: PMC10038386 DOI: 10.1007/s11136-023-03401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Due to the high burden of cancer-related suffering, it is paramount to understand the gaps in cancer care that lead to suffering. Advanced cancer patients have unmet needs and challenges that differ from those with early-stage cancer due to the rapid disease progression. By exploring advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects, this study aims to identify gaps in the Malaysian health system and propose contextualised measures to improve cancer care. METHODS Semi-structured, in-depth interviews were conducted to explore advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects. The interviews were then transcribed and coded. Themes were developed from the codes using iterative thematic approach. RESULTS The lived experiences and needs of nineteen patients converged into four major themes: disruption to daily lives, psychosocial and spiritual support system, information needs, and financial needs. This study described predominantly how cancer impacted patients' lives and livelihood, how patients coped with their psychological conditions after diagnosis, the need for effective communication and trust in a multicultural society, and how finance affected access to and experience of cancer care. CONCLUSION Advanced cancer patients had different needs beyond receiving medical treatments. A concerted effort is required from clinicians, allied health professionals, social workers, support groups, and family members to understand and fulfil these needs.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | | | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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Chee PY, Tan LV, Lee CCW, Choo BBN, Cheong MWL. The stress, satisfaction and fulfilment of early career pharmacists - a qualitative analysis of a survey on their professional and personal lives. Int J Pharm Pract 2023; 31:250-256. [PMID: 36738266 DOI: 10.1093/ijpp/riad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aims to examine and develop a better understanding of (1) the factors that affect the stress of both their professional and personal lives, (2) the aspects of professional and personal life that affect their satisfaction and fulfilment and (3) what they need to achieve satisfaction and fulfilment in their professional and personal lives. METHODS A cross-sectional study using a questionnaire was developed. The questionnaire contained 8 questions designed to collect qualitative data on the factors affecting the stress, satisfaction and fulfilment in the professional and personal lives of early career pharmacists (ECPs). Questionnaire responses were analysed using a qualitative content analysis approach and themes describing influential factors were developed. KEY FINDINGS Some of the factors that contribute to the stress, satisfaction and fulfilment of ECPs were identified. The stressors identified include the workplace environment and relationships with colleagues, the demands of a pharmacist career, the lack of career advancement pathways, job insecurity, relationships and their weaknesses. Factors contributing to satisfaction and fulfilment included supportive work environments and relationships, being appreciated and making a difference, growth, supportive relationships and self-care. CONCLUSIONS Supporting the well-being of ECPs is important for a resilient, engaged and effective pharmacy workforce. Key interventions include eliminating job insecurity, establishing clear career pathways, improving work environments and relationships and investing in the development of clinical, technical, communication and managerial skills.
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Affiliation(s)
- Pui Ying Chee
- School of Pharmacy, Monash University Malaysia, Puchong Jaya, Malaysia
| | - Li Vern Tan
- School of Pharmacy, Monash University Malaysia, Puchong Jaya, Malaysia
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Yong ASJ, Lim YH, Cheong MWL, Hamzah E, Teoh SL. Willingness-to-pay for cancer treatment and outcome: a systematic review. Eur J Health Econ 2022; 23:1037-1057. [PMID: 34853930 DOI: 10.1007/s10198-021-01407-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding patient preferences in cancer management is essential for shared decision-making. Patient or societal willingness-to-pay (WTP) for desired outcomes in cancer management represents their preferences and values of these outcomes. OBJECTIVE The aim of this systematic review is to critically evaluate how current literature has addressed WTP in relation to cancer treatment and achievement of outcomes. METHODS Seven databases were searched from inception until 2 March 2021 to include studies with primary data of WTP values for cancer treatments or achievement of outcomes that were elicited using stated preference methods. RESULTS Fifty-four studies were included in this review. All studies were published after year 2000 and more than 90% of the studies were conducted in high-income countries. Sample size of the studies ranged from 35 to 2040, with patient being the most studied population. There was a near even distribution between studies using contingent valuation and discrete choice experiment. Based on the included studies, the highest WTP values were for a quality-adjusted life year (QALY) ($11,498-$589,822), followed by 1-year survival ($3-$198,576), quality of life (QoL) improvement ($5531-$139,499), and pain reduction ($79-$94,662). Current empirical evidence suggested that improvement in QoL and pain reduction had comparable weights to survival in cancer management. CONCLUSION This systematic review provides a summary on stated preference studies that elicited patient preferences via WTP and summarised their respective values. Respondents in this review had comparable WTP for 1-year survival and QoL, suggesting that improvement in QoL should be emphasised together with survival in cancer management.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Yi Heng Lim
- School of Biosciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Mark Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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Cheong MWL, Piedagnel JM, Khor SK. Ravidasvir: equitable access through an alternative drug development pathway. The Lancet Global Health 2021; 9:e1496-e1497. [DOI: 10.1016/s2214-109x(21)00357-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022] Open
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Siow YC, Cheong MWL, Lim KS, Mahalinggam S, Teoh CCO. Training physicians to provide basic-level palliative care: an evaluation of a novel training programme. Progress in Palliative Care 2021. [DOI: 10.1080/09699260.2021.1963175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yen Ching Siow
- Department of Palliative Medicine, Hospital Selayang, Batu Caves, Malaysia
| | | | - Kai Siang Lim
- Department of Palliative Medicine, Hospital Selayang, Batu Caves, Malaysia
| | | | - Cindy Cy Oun Teoh
- Department of Palliative Medicine, Hospital Selayang, Batu Caves, Malaysia
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Cheong MWL. 'To be or not to be in the ward': The Impact of Covid-19 on the Role of Hospital-Based Clinical Pharmacists - A Qualitative Study. J Am Coll Clin Pharm 2020; 3:1458-1463. [PMID: 32838225 PMCID: PMC7436366 DOI: 10.1002/jac5.1315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022]
Abstract
Introduction The coronavirus disease 2019 (COVID‐19) pandemic has significantly affected health care systems around the world. In many hospitals and health care facilities, services and health care workers have been reorganized and restructured to meet the demands of the pandemic. The impact of the pandemic on hospital‐based clinical pharmacists and their ability to deliver pharmaceutical care is currently unknown. Objective This study aimed to explore the impact of the COVID‐19 pandemic on hospital‐based clinical pharmacists working in Malaysia and the implications on how clinical pharmacy is perceived as a health care service. Methods A qualitative study was designed to meet the research objectives. Nineteen hospital‐based clinical pharmacists consented and participated in one‐on‐one, semi‐structured interviews. The interviews were transcribed and analyzed using an iterative thematic analysis approach. Results The experiences and views of the participants were reported. Three main themes were developed: “Reassignment and other changes in clinical pharmacist roles,” “Adapting clinical pharmacy services to COVID‐19,” and “The need for clinical pharmacists in the ward.” The findings indicate that in many cases, clinical pharmacy services were fully or partially withdrawn from the ward to reduce the risk of infection and to conserve the usage of personal protective equipment. Despite this, clinical pharmacists continued to support patient care in hospitals through the use of technology. The withdrawal of clinical pharmacy services, however, raises concern that the role of clinical pharmacists is still poorly recognized. Conclusion Clinical pharmacists in hospitals continue to support patient care despite the disruption caused by the COVID‐19 pandemic. Greater support and recognition of their role is required in order to empower and enhance their ability to deliver pharmaceutical care.
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Affiliation(s)
| | - Pascale Allotey
- United Nations University – International Institute for Global Health, Cheras, Kuala Lumpur, Malaysia
| | - Daniel D. Reidpath
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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Cheong MWL, Brock T, Karwa R, Pastakia S. COVID-19 and Clinical Pharmacy Worldwide - A Wake Up Call and a Call to Action. J Am Coll Clin Pharm 2020; 3:860-863. [PMID: 32838222 PMCID: PMC7323236 DOI: 10.1002/jac5.1286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/15/2022]
Affiliation(s)
| | - Tina Brock
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Australia Parkville Victoria Australia
| | - Rakhi Karwa
- College of Pharmacy, Center for Health Equity and Innovation, Indianapolis Purdue University Indiana
| | - Sonak Pastakia
- College of Pharmacy, Center for Health Equity and Innovation, Indianapolis Purdue University Indiana
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