Search

Abstract Background Despite the existence of different screening methods, the response to cancer screening is poor among Malaysians. The current study aims to examine cancer patients’ perceptions of cancer screening and early diagnosis. Methods A qualitative methodology was used to collect in-depth information from cancer patients. After obtaining institutional ethical approval, patients with different types and stages of cancer from the three major ethnic groups (Malay, Chinese and Indian) were approached. Twenty semi-structured interviews were conducted. All interviews were audiotaped, transcribed verbatim, and translated into English for thematic content analysis. Results Thematic content analysis yielded four major themes: awareness of cancer screening, perceived benefits of cancer screening, perceived barriers to cancer screening, and cues to action. The majority of respondents had never heard of cancer screening before their diagnosis. Some participants reported hearing about mammogram and Pap smear tests but did not undergo screening due to a lack of belief in personal susceptibility. Those who had negative results from screening prior to diagnosis perceived such tests as untrustworthy. Lack of knowledge and financial constraints were reported as barriers to cancer screening. Finally, numerous suggestions were given to improve screening behaviour among healthy individuals, including the role of mass media in disseminating the message ‘prevention is better than cure’. Conclusions Patients’ narratives revealed some significant issues that were in line with the Health Belief Model which could explain negative health behaviour. The description of the personal experiences of people with cancer could provide many cues to action for those who have never encountered this potentially deadly disease, if incorporated into health promotion activities.

Background: The general problem is lack of inter-professional collaboration and the way private primary care responds to manage chronic diseases in Malaysia. Absence of prescription review, inadequate patient education, the highest percentage of prescribing errors and half of the chronic disease patients are nonadherent. Medicines are the most common and life long used interventions in chronic diseases. Hence, the need to manage medicine in chronic diseases becomes obligatory. As both general practitioner and community pharmacist can dispense medications, this has resulted in a business rivalry. There is a need to build consensus among various healthcare stakeholders for a collaborative medication therapy management model (CMTM) where community pharmacist has an active role in chronic care. Method: This study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response. Results: Response rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed. Conclusion: Overall, the study findings witnessed the expert panel’s support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysia. [ABSTRACT FROM AUTHOR]

To describe the process and role of health technology assessment (HTA) in the context of drug policy in Malaysia. We summarized the HTA process through review of documents and reports available in the public domain combined with the authors' experience. Health technology assessment plays an integral part in prioritizing treatment in public health facilities in Malaysia, particularly for the Ministry of Health Medicines Formulary (MOHMF). The MOHMF is the reference list of drugs allowed to be prescribed in the Ministry of Health (MOH) facilities. There are 2 organizations within the MOH that conduct HTA as their core activities, namely the Malaysian Health Technology Assessment Section and the Formulary Management Branch of Pharmacy Practice & Development Division. The assessment of pharmaceuticals for the purpose of listing medicines into the MOHMF is under the purview of the Formulary Management Branch. The evidence-based assessment focuses on safety, efficacy, effectiveness, and budget impact of the drug. Cost-effectiveness evidence is currently not mandatory but is of interest to the decision makers. The assessment outcomes are considered by the MOH Medicines List Review Panel for formulary decisions. Health technology assessment has supported formulary decisions in MOH. Evidence generation needs to progress beyond efficacy or effectiveness, safety, and budget impact to incorporate cost-effectiveness. Nevertheless, there are challenges to be met to achieve this. The impact of the HTA process is currently unknown and is yet to be evaluated formally. • There are 2 organizations conducting health technology assessment (HTA) activities in the Ministry of Health Malaysia with different scopes of activities. • Health technology assessment use for drug policy in the public sector is evident in the formulary decision-making process at the national level. • Though HTA is used as part of the Ministry of Health Formulary decision making process, there is still an avenue to improve the HTA process and expand its use in drug policy decisions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Hepatitis C is a chronic infectious liver disease that can lead to cirrhosis, liver cancer and liver failure. This study aimed to estimate the healthcare cost of treating chronic hepatitis C virus (HCV) from the perspective of Ministry of Health hospitals in Malaysia. Methods: The cost analysis study was conducted from the healthcare provider's perspective. Healthcare sector resource utilisations for managing patients with chronic hepatitis C were obtained from a retrospective cohort study of patients with hepatitis C at Sultanah Bahiyah Hospital, Malaysia, between December 2008 and 2014. These utilisations were organised by disease stage. When no patients were available for a specific stage, resource utilisations were estimated using expert opinions collected through iterative structured interviews with two gastroenterologists. Key findings: There were 112 patients included in the final analysis. Ninety‐one per cent of these were male, and patients had a mean age of 45.8 (SE 1.1) years. The mean (SE) annual total cost for ‘mild and moderate chronic HCV’ was GBP 338.08 (58.95), that for ‘compensated cirrhosis chronic HCV’ was GBP 493.39 (162.57), that for ‘recovered, no HCV, history of mild fibrosis’ was GBP 259.73 (30.79), that for ‘recovered, no HCV, history of moderate fibrosis’ was GBP 257.09 (31.10), that for ‘recovered, no HCV, history of severe fibrosis’ was GBP 359.92, that for ‘decompensated cirrhosis’ was GBP 512.89 (214.12), and that for ‘hepatocellular carcinoma’ was GBP 426.08. Conclusions: Chronic HCV infection is generally a progressively expensive condition. [ABSTRACT FROM AUTHOR]

Background: One major challenge in prioritizing health care using cost-effectiveness (CE) information is when alternatives are more expensive but more effective than existing technology. In such a situation, an external criterion in the form of a CE threshold that reflects the willingness to pay (WTP) per quality-adjusted life-year is necessary.Objectives: To determine a CE threshold for health care interventions in Malaysia.Methods: A cross-sectional, contingent valuation study was conducted using a stratified multistage cluster random sampling technique in four states in Malaysia. One thousand thirteen respondents were interviewed in person for their socioeconomic background, quality of life, and WTP for a hypothetical scenario.Results: The CE thresholds established using the nonparametric Turnbull method ranged from MYR12,810 to MYR22,840 (~US $4,000-US $7,000), whereas those estimated with the parametric interval regression model were between MYR19,929 and MYR28,470 (~US $6,200-US $8,900). Key factors that affected the CE thresholds were education level, estimated monthly household income, and the description of health state scenarios.Conclusions: These findings suggest that there is no single WTP value for a quality-adjusted life-year. The CE threshold estimated for Malaysia was found to be lower than the threshold value recommended by the World Health Organization. [ABSTRACT FROM AUTHOR]

Objective This study aimed to investigate the effect of calendar packaging (CP) on medication adherence among hypertensive patients in Malaysia. Setting Outpatient Pharmacy Department, Kulim Hospital. Methods This was a parallel randomized controlled trial of CP (intervention group) versus normal pack (control group) for patients who were on daily dose antihypertensive drug (amlodipine).The primary outcome was medication adherence to amlodipine, assessed by medication possession ratio (MPR), percentage of on-time refills and Malay Version Morisky medication adherence scales. Key findings Eighty-three patients participated. The mean age (standard deviation) was 55.85 (10.25) and 56.55 (10.42) for intervention and control group respectively. This study found that intervention group has better medication adherence score than the control group measured by MPR, Morisky medication adherence score ( P < 0.05) and percentage of on-time refills ( P < 0.01). Intervention group showed a significantly lower systolic and diastolic blood pressure ( P < 0.05) compared to control group. Intervention group was significantly associated with higher medication adherence measured by MPR (β = 0.006, P < 0.05), Morisky scale (β = 0.365, P < 0.05) and percentage of on-time refill (β = 0.063, P < 0.01); in addition lower systolic blood pressure (β = −4.4, P < 0.05) after controlling for the study period and patient age. Conclusions This study found that CP could improve adherence to medication among hypertensive patients. The results also suggest possible improvement in blood pressure with the use of CP. [ABSTRACT FROM AUTHOR]

Background Around the globe, community pharmacy has always been a health care hub made accessible to the public. Aim This study was conducted to evaluate consumers' perceptions towards the role of the pharmacist as health educator ( HE) and hence to identify the barriers toward consumers' acceptance of the role. Method This qualitative study was conducted in four states of Malaysia where participants (>18 years old) were recruited using a convenience sampling method until saturation of themes. A semi-structured interview guide was used and face-to-face interviews with consenting participants were conducted for approximately 20 min by trained interviewers. All interviews were audio-recorded, transcribed verbatim and evaluated using a thematic content analysis approach. Results In all, 21 consumers were interviewed. Analysis of interview transcripts identified four major themes: understanding of the term ' HE', facilitators and barriers for consumers accepting pharmacists as HE, and strategies to overcome the barriers. Most respondents acknowledged and recognised the roles of community pharmacists in terms of giving clear advice and explanations about healthcare issues and medications, and the ability to educate the public. The major barriers included the experience of the pharmacist, consumers' preferences for general practitioners as their HEs, the unavailability of pharmacists on the premises and personal encounters with pharmacists with bad attitudes. Conclusion Consumers generally accept pharmacists as HEs. However, some barriers do exist. The pharmacy stakeholders in the country need to address these barriers in order to improve future utilisation of community pharmacists as HEs in the existing healthcare system. [ABSTRACT FROM AUTHOR]

Objective: To improve pharmaceutical care delivery in Malaysia, the Ministry of Health (MOH) had introduced the concept of value added services (VAS). Despite its reported convenience and advantages, VAS utilization rate is low in the country. The study aims to explore patients’ understanding, beliefs and expectations towards VAS in Malaysia using the theory of planned behaviour (TPB) as the theoretical model. Methods: A qualitative methodology was used whereby face‐to‐face interviews were conducted with 12 patients who collected partial medicine supplies from government pharmacies. Participants were recruited using purposive and snowball sampling method in the state of Negeri Sembilan, Malaysia. Interviews were audio‐recorded. Verbatim transcription and thematic content analysis were performed on the data. Results: Thematic content analysis yielded five major themes: (i) attitudes towards using VAS, (ii) subjective norms, (iii) perceived behavioural control, (iv) lack of knowledge and understanding of VAS and (v) expectations towards VAS. Conclusion: The interviews explored and informed new information about salient beliefs towards pharmacy VAS. The findings suggest that VAS is still in its infancy and a more robust and effective advertising and marketing campaign is needed to boost the adoption rate. Behavioural attitudes, subjective norms and perceived control elements were discussed and serve as important variables of interest in future study. Expectations towards VAS serve as an important guideline to further improve patient‐oriented services. [ABSTRACT FROM AUTHOR]

Background: Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors. Methods: All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.). Results: During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment. Conclusion: In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them. [ABSTRACT FROM AUTHOR]

Objectives The aims of the study were to assess job satisfaction and organisational commitment among pharmacists working in the public sector and its influence on their likelihood to stay within the public workforce. Methods A cross-sectional survey was conducted among all fully registered pharmacists ( FRPs) in the northern states of Malaysia in 2009 ( n = 467). The questionnaire consisted of three sections to capture the demographic characteristics of the respondents, assess job satisfaction and organisational commitment of the respondents and their likelihood of staying in public service. Key findings A total of 247 FRPs (response rate 52.9%) in the northern region of Malaysia participated in this survey. Majority of the respondents were women ( n = 205, 83.0%), of Chinese ethnicity ( n = 155, 62.8%), graduates from public universities ( n = 173, 70.0%), single ( n = 172, 69.6%), with a median age of 27 years (interquartile range ( IQR) 2.0) and had worked with the Ministry of Health for a median of 2.75 years ( IQR 1.63). The mean job satisfaction and organisational commitment score were 58.09 (standard deviation ( SD) 11.83) and 53.46 ( SD 6.65) respectively out of a maximum possible score of 90. Majority of the respondents claimed that they were likely to stay in public service ( n = 176, 71.3%). Their likelihood of staying in public service was affected by respondents' gender, ethnicity, job satisfaction and organisational commitment. Conclusions The findings from this study provide stakeholders with evidence on factors and issues affecting pharmacists' job satisfaction and commitment in the public workforce as well as the likely turnover rate with an early cohort of pharmacists affected by the compulsory service. [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization’s recent report, in Malaysia, tuberculosis (TB) treatment success rate for new smear positive pulmonary tuberculosis (PTB) patients is still below the global success target of 85%. In this study, we evaluated TB treatment outcome among new smear positive PTB patients, and identified the predictors of unsuccessful treatment outcome and longer duration of treatment (i.e., > 6 months). Methods: The population in this study consisted of all new smear positive PTB patients who were diagnosed at the chest clinic of Penang General Hospital between March 2010 and February 2011. During the study period, a standardized data collection form was used to obtain socio-demographic, clinical and treatment related data of the patients from their medical charts and TB notification forms (Tuberculosis Information System; TBIS). These data sources were reviewed at the time of the diagnosis of the patients and then at the subsequent follow-up visits until their final treatment outcomes were available. The treatment outcomes of the patients were reported in line with six outcome categories recommended by World Health Organization. Multiple logistic regression analysis was used to find the independent risk factors for unsuccessful treatment outcome and longer treatment duration. Data were analyzed using the PASW (Predictive Analysis SoftWare, version 19.0. Armonk, NY: IBM Corp). Results: Among the 336 PTB patients (236 male and 100 female) notified during the study period, the treatment success rate was 67.26% (n = 226). Out of 110 patients in unsuccessful outcome category, 30 defaulted from the treatment, 59 died and 21 were transferred to other health care facilities. The mean duration of TB treatment was 8.19 (SD 1.65) months. In multiple logistic regression analysis, risk factors for unsuccessful treatment outcome were foreign nationality, male gender and being illiterate. Similarly, risk factors for mortality due to TB included high-grade sputum and presence of lung cavities at the start of treatment, being alcoholic and elderly. Likewise, concurrent diabetes, presence of lung cavities at the start of the treatment and being a smoker were the significant predictors of longer treatment duration. Conclusion: Our findings indicated that the treatment success rate among the new smear positive PTB patients was less than the success target set by World Health Organization. The proportion of patients in the successful outcome category may be increased by closely monitoring the treatment progress of the patients with aforementioned high risk characteristics. Similarly, more aggressive follow-up of the treatment defaulters and transferred out patients could also improve the TB treatment success rate. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the health-related quality of life (HRQOL) among nonprescription medicine customers in Malaysia and the factors that affect it. Methods: A nationwide cross-sectional survey was conducted among pharmacy customers in 59 randomly selected community pharmacies in Malaysia. The self-administered questionnaire included the EuroQoL five-dimensional (EQ-5D) questionnaire, the EuroQol visual analogue scale (EQ-VAS), nonprescription medicines purchase, and demographic questions. Data were analyzed by using the multivariate analysis of variance and multiple logistic regressions. Results: A total of 2729 customers enrolled in this study, with a mean EQ-5D questionnaire score of 0.92±0.15 and a mean EQ-VAS score of 69.92±24.80. Compared with the Malaysian adult population, nonprescription medicine customers have a lower mean EQ-5D questionnaire score (t =−4.49, P<0.01) and EQ-VAS score (t =−25.87, P<0.01). We found that pain/discomfort (25.6%) and anxiety/depression (13.7%) were the major HRQOL problems. Locality, age, ethnicity, household income per month, type of occupation, and type of nonprescription medicine purchased were associated with health status of nonprescription medicine customers (F 22,5286 = 2.555; Wilks’ lambda = 0.979; P< 0.01). Conclusions: The HRQOL of nonprescription medicine customers is lower than that of the general Malaysian population. Lower health status was independently associated with older age, living in rural areas, having low income and education level, and purchasing blood and blood-forming medicines from community pharmacy. [Copyright &y& Elsevier]

Abstract: Purpose: Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population. Method: This was a prevalence-based retrospective chart review that included patients who attended a pediatric neurology clinic in a tertiary referral center in Malaysia. The total first-year medical care costs were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardized for the year 2010 (One Malaysian Ringgit MYR is equivalent to 0.26 Euro or 0.32 USD). Results: The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalization and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the first-year medical care costs. Similarly, child development, seizure type, therapy type (i.e., polytherapy versus monotherapy), and therapeutic drug monitoring utilization were also not associated with the cost of management. The first-year medical care costs positively correlated with seizure frequency (r s =0.294, p =0.001). However, the only variable that significantly predict the first-year medical care costs was the type of antiepileptic drugs (R 2 =0.292, F =7.772, p <0.001). Conclusion: This investigation was the first cost analysis study of epilepsy in Malaysia. The total first-year medical care costs for 120 patients with structural-metabolic epilepsy were MYR 202,816 (i.e., MYR 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management. [Copyright &y& Elsevier]

Objectives The current study aims to compare the retail prices of the 10 most prescribed drugs in Northern Malaysia and Australia. Methods A cross-sectional study was conducted to compare the retail prices of the 10 most used prescription medications in Penang, Malaysia, with the retail prices of the same drugs in Australia. Data collection was done using a standard form. Percentage difference was calculated using simple mathematical formulae in Microsoft Excel. Key findings Findings demonstrate that the mean retail drug prices in Penang, Malaysia, were 30.30-148.28% higher than the mean retail prices in Australia. In addition, variation between retail prices was also noticed between pharmacies in Penang, with a difference between highest and lowest of 80%. Conclusion Malaysia has average higher retail prescription drug prices compared to Australia due to the lack of pharmaceutical market regulation, which could impose limits on prices, profits and total spending on pharmaceuticals. [ABSTRACT FROM AUTHOR]

Summary: The role of pharmacists has transformed significantly because of changes in pharmacists'' training and population health demands. Within this context, community pharmacists are recognized as important health personnel for the provision of extended health services. Similarly, in Malaysia, the need to transform community pharmacy practice has been discussed by all interested parties; however, the transition has been slow due in part to the nonexistence of a dispensing separation policy between pharmacists and medical doctors in private community practices. For decades, medical doctors in private community practices have had the right to prescribe and dispense, thus diluting the role of community pharmacists because of overlapping roles. This article explores dispensing separation in Malaysia and, by taking into account the needs of health professionals and health care consumers, suggests a mechanism for how dispensing separation practice can be implemented. [Copyright &y& Elsevier]

Objective To evaluate the Malaysian community pharmacists' views on generic medicines. Setting A sample of 1419 Malaysian community pharmacies with resident pharmacists. Method A cross-sectional nationwide survey using a self-completed mailing questionnaire. Main outcome measure Pharmacists' views on generic medicines including issues surrounding efficacy, safety, quality and bioequivalence. Results Responses were received from 219 pharmacies (response rate 15.4%). Only 50.2% of the surveyed pharmacists agreed that all products that are approved as generic equivalents can be considered therapeutically equivalent with the innovator medicines. Around 76% of respondents indicated that generic substitution of narrow therapeutic index medicines is inappropriate. The majority of the pharmacists understood that a generic medicine must contain the same amount of active ingredient (84.5%) and must be in the same dosage form as the innovator brand (71.7%). About 21% of respondents though that generic medicines are of inferior quality compared to innovator medicines. Most of the pharmacists (61.6%) disagreed that generic medicines produce more side-effects than innovator brand. Pharmacists graduated from Malaysian universities, twinning program and overseas universities were not differed significantly in their views on generic medicines. Additionally, the respondents appeared to have difficulty in ascertaining the bioequivalent status of the marketed generic products in Malaysia. Conclusion The Malaysian pharmacists' have lack of information and/or trust in the generic manufacturing and/or approval system in Malaysia. This issue should be addressed by pharmacy educators and relevant government agencies. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess and compare the knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang. Subjects and Methods: A cross-sectional survey was conducted from February 5 to March 15, 2008. 384 participants were conveniently selected and interviewed face to face by a trained researcher (M.A.H.) using a validated questionnaire. Participants were required to answer 22 questions concerning knowledge of breast cancer and 5 questions on the perception of breast cancer management and treatment outcomes. Results: The mean total score of knowledge was 59.1%, with Indian women having significantly less knowledge than the Chinese and Malay women (p < 0.001). Only 117 (32.3%) and 120 (33.0%) women were aware of the recommended breast self-examination (BSE) and clinical breast examination (CBE) guidelines, respectively. Multiple regression analysis showed that ethnicity, age, level of education and employment status were major determinants of breast cancer knowledge. Conclusion: The current study has demonstrated that women in the state of Penang have serious knowledge deficits about breast cancer and poor awareness of BSE and CBE guidelines. This study has highlighted the need of an intensive breast cancer awareness campaign which should also stress the importance of early detection and reporting of breast cancer. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Generic medicines play a key role in the affordability of pharmaceuticals. This study aims to compare price and to document the actual savings that can be achieved if generics are used by consumers in the state of Penang, Malaysia. This is a cross-sectional pilot study on the price of innovator and generic medicines for the 20 most-used medications in Malaysia. Upon consent, 20 retail pharmacies were conveniently selected. A pre-validated data collection form was used to collect their selling price from the community pharmacist. The analysis was limited to medicines in the same dosage form and dose. Those still under patent protection or combined with other active ingredients were excluded from the study. This study found that most innovator drugs are 27–90 per cent more expensive than generics. Some generic drugs are, however, more expensive than their innovator counterparts (40 per cent higher). Some locally produced generics are also more expensive than foreign products. The current findings suggest that consumers can save up to 90 per cent of the cost of their medication by using generic products. Further investigation is needed to explore the causality of the observed differences in price of products in order to increase their accessibility to the general population.Journal of Generic Medicines (2008) 6, 35–42. doi:10.1057/jgm.2008.25; published online 21 October 2008 [ABSTRACT FROM AUTHOR]

Copyright of Pharmacy Practice (1886-3655) is the property of Centro de Investigaciones y Publicaciones Farmaceuticas S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Treatment with antiepileptic drugs is commonly guided by serum level monitoring. Such monitoring requires expensive laboratory equipment and products. However, well-conducted studies on the cost-effectiveness of therapeutic drug monitoring for antiepileptic drugs are lacking particularly in patients with structural-metabolic epilepsy. The study aims to assess the cost-effectiveness of serum level monitoring services in the management of children with structural-metabolic epilepsy during the first year of diagnosis. A retrospective cost-effectiveness analysis was conducted from the provider perspective. It included patients attended a paediatric neurology clinic. The effectiveness measures used in this analysis were the number of patients that achieved ≥50% reduction in seizure frequency, and the number of patients with 3-month seizure free. Medical records of the patients were reviewed for the required information. Medical chart/billing data obtained from the hospital were collected to estimate the resources used (One Malaysian Ringgit MYR is equivalent to 0.31 USD). The recruited children were followed for one year following their first visit. The average cost effectiveness ratio for the monitored patients (MYR 2735 per patient that achieved a ≥50% reduction in seizure frequency) was lower than that for non-monitored patients (MYR 2921 per patients that achieved a ≥50% reduction in seizure frequency), with incremental cost-effectiveness ratio of MYR 2357 per one additional patient that achieved a ≥50% reduction in seizure frequency. The average cost effectiveness ratios for monitored and non-monitored group were MYR 8279 and MYR 6433 per patient with a 3-month seizure-free period, respectively, with incremental cost-effectiveness ratio of MYR 29,666 per one additional patient with a 3-month seizure-free period. In terms of the effectiveness measures used, serum level monitoring of antiepileptic drugs was found to be cost-effective. However, the incremental cost-effectiveness ratio was found to be sensitive to the cost of management. [Copyright &y& Elsevier]

Introduction: Public knowledge and attitudes towards antibiotics play a vital role in the success of the treatment process. This study aimed to assess public knowledge and attitudes toward antibiotic usage which could serve as baseline data for future studies within a government hospital setting in Malaysia. Methodology: A self-administered cross-sectional survey involving 408 respondents was conducted using a validated questionnaire at an outpatient pharmacy department in Penang Hospital, Malaysia, from February to March 2009. Results: Nearly 55% of the respondents had a moderate level of knowledge. Three quarters of the respondents (76.7%) could correctly identify that antibiotics are indicated for the treatment of bacterial infections. However, 67.2% incorrectly thought that antibiotics are also used to treat viral infections. About 59.1% of the respondents were aware of antibiotic resistance phenomena in relation to overuse of antibiotics. With regard to attitudes, 38% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 47.3% expected antibiotics to be prescribed for common cold symptoms. Age, race and educational level were among the demographic characteristics significantly associated with knowledge and attitudes toward antibiotic use. Poor level of knowledge was found in less than one-third of the respondents whereas more than one-third of the respondents wrongly self-medicate themselves with antibiotics once they have a cold. Conclusion: Educational interventions are needed to promote prudent use of antibiotics among the public. [ABSTRACT FROM AUTHOR]