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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]

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]