6th NATIONAL PHARMACY R&D CONFERENCE - 2010
ORAL PRESENTATIONS
CLINICAL PHARMACY
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC1: INTRAVENOUS TO ORAL ANTIBIOTICS
COMMUNITY ACQUIRED PNEUMONIA
Y. E. Goh1, S. C. Heng1, S. N. Said1, T. C. Lee2
1 Pharmacy Department , Hospital Sultan Ismail, Johor Bahru,
Sultan Ismail, Johor Bahru
2
SWITCH
THERAPY
IN
Department of Internal Medicines, Hospital
INTRODUCTION: Switch therapy is defined as the early transition from intravenous to oral
antibiotics during treatment of infection. According to some authorities, nearly half of all patients
initiated on IV antibiotics can be stepped down to oral within 2-3 days. OBJECTIVES: This study
was to assess the impact of appropriate delivery of switching therapy in community acquired
pneumonia (CAP) at Hospital Sultan Ismail, Johor Bahru (HSIJB). METHOD: Patients who were
admitted to medical wards in HSIJB and diagnosed with CAP on admission from January 2007 to
December 2008 were retrospectively screened. Out of a total of 211 pneumonia admissions, only 47
patients who were prescribed with intravenous (IV) antibiotics and fulfilled both inclusion and
exclusion criteria were recruited. Each patient was screened for the suitability for switching
therapy based on the IV to oral antibiotic switch criteria formulated with established literatures
and clinical practice guidelines. Cost that can be saved with early switch therapy was calculated
for each infection episode. RESULTS: Out of 47 IV antibiotic courses, only 15 (31.9%) were
switched to an oral alternative in the ward, 25 (53.2%) were switched upon discharge. Earlier
switch was actually possible in 38 patients (80.9%). The median number of days taken for the
switch in wards was 6 days (range 2-13). Whereas for possible early switch based on the IV to oral
antibiotic switch criteria formulated in this study was 3 days (range 2-14). The total estimated
savings, in term of drug cost and consumables cost for IV preparation and administration, for these
47 courses was RM2397.67, which was approximately RM 51 per course. CONCLUSION: Based on
simple clinical and laboratory criteria, a significant proportion of hospitalised patients with CAP
(80.9%) can be considered for early switch from IV-to-PO. Drug acquisition cost and nursing time
can be reduced on each patient with early switch.
Keyword: Intravenous, oral, antibiotic, switch, community acquired pneumonia
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC2: A STUDY ON PROTON PUMP INHIBITORS DOSING TIME AMONG
OUTPATIENTS, PHARMACY DEPARTMENT, HOSPITAL MELAKA
A. Suhadah, V. Y. Chang, M. Y. Hong, S. P. Ng.
Pharmacy Department, Melaka Hospital
INTRODUCTION: The dosing time of Proton Pump Inhibitors (PPI) is deemed optimal up to 60
minutes before meal and preferably before the first meal of the day. Optimal PPI dosing time is
important to exert the maximum gastric anti-secretory effect. OBJECTIVES: The objectives of the
study are to determine the prevalence of sub-optimal PPI dosing time in outpatient pharmacy, to
investigate patient’s administration time of PPI in outpatient pharmacy and to investigate the
outcome of pharmacists’ intervention during dispensing towards patient’s PPI administration time.
METHOD: A descriptive, longitudinal study was carried out via questionnaire from January to
February 2009 starting from 7.30am to 10.00pm, 7 days a week in Farmasi Klinik Pakar (FKP),
Hospital Melaka. Follow-up through telephone conversation was conducted over a 2-month period,
from February to March 2009 for patients with uncontrolled symptoms and/or wrong dosing time.
Of the 122 who fulfilled the initial screening, 99 consented to join the study with a response rate
of 81.1%. RESULTS: The prevalence of sub-optimal PPI dosing time among outpatients, Pharmacy
Department, Hospital Melaka is high (53.5% out of 99 patients). The most common error among suboptimal doses was taking PPI after meal (64.2% or 34 patients) followed by 15 patients who were
unsure of the dosing time and 4 patients taking the medication more than 60 minutes after meals.
Out of 46 patients who dosed their PPI correctly, 63% of them (29 patients) took PPI 15 to 30
minutes before food, followed by 12 subjects who took PPI < 15 minutes before food and 5 patients
took PPI between 30 to 60 minutes before food. Pharmacist’s intervention showed significant
correct PPI dosing time up to 60 minutes before meal (p= 0.039). CONCLUSION: Pharmacists play
important role in educating patients on their optimal PPI dosing time.
Keyword: Proton Pump Inhibitors, correct dosing time, administration time of PPI
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC3: ENHANCING HEALTHCARE PROVIDERS’ COMPLIANCE TOWARDS
RENAL DOSING OF I.V. ANTIBIOTICS IN PATIENTS WITH CREATININE
CLEARANCE OF LESS THAN 50ML/MIN
S.C Chiew, Y.K Doon, K.I Wang, M.T Mastura, C.B Ng
Pharmacy Department , Seri Manjung Hospital
INTRODUCTION: Accurate antibiotic dosing in renal impairment was essential to reduce adverse
drug reaction risk. OBJECTIVES: The study was done to obtain baseline data on dosing adjustment
of I.V. antibiotics in renal impaired patients, to publish a renal dosing guideline for I.V. antibiotics
for Hospital Seri Manjung (HSM) and to enhance the knowledge, awareness and compliance of
healthcare providers on renal dosing of I.V. antibiotics. METHOD: This was an interventional study
conducted from December 2008 to September 2009 in HSM. The implemented interventions
included development of a guideline of renal dosing of I.V. antibiotics, CME session and renal alert
system. Data pre- and post-intervention from score of knowledge on renal dosing of I.V. antibiotics
by doctors (from questionnaires), total pharmaceutical care issues (PCIs) and drug information
requests on renal dosing of I.V. antibiotics were used to measure the effectiveness of the
interventions. RESULTS: Baseline data from July-December 2008 for percentage of PCIs and drug
information requests on renal dosing for I.V. antibiotics was 29.3% and 72.5% respectively. A renal
dosing guideline for I.V. antibiotics was published by adapting from National Antibiotic Guideline of
Ministry of Health and a few other guidelines. Percentage of subjects that scored more than 80% in
questionnaires improved from 25% (pre) to 94.60% (post-intervention). Percentage of PCIs on renal
dosing for I.V. antibiotics decreased from 29.3% (pre) to 15.9% (post-intervention). Drug
information requests on renal dosing of I.V. antibiotics reduced from 72.5% (pre) to 58.3% (postintervention). CONCLUSION: The knowledge, awareness and compliance to the guideline by
healthcare providers were enhanced by the interventions.
Keyword: Compliance, renal dosing, I.V. antibiotics
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC4:
RENAL FUNCTION CHANGES IN PATIENTS UPON INITIATION OF
ANGIOTENSIN CONVERTING ENZYME INHIBITORS
Y.W Lim, N. Mah, J.Y Choe, S. Fadzil
Pharmacy Department, Hospital Tuanku Fauziah, Kangar, Perlis.
INTRODUCTION: Angiotensin Converting Enzyme (ACE) inhibitors-induced nephrotoxicity is
increasingly reported and remained controversial. OBJECTIVES: The study was to investigate the
effect on patients’ serum creatinine (SrCr) and creatinine clearance (ClCr) following the
commencement of ACE inhibitors. METHOD: This prospective study was carried out among adult
patients who were newly prescribed with ACE inhibitors which include Perindopril, Captopril and
Enalapril in medical wards of Hospital Tuanku Fauziah (HTF) from June until September 2009.
Those treated with any nephrotoxic-induced drugs were excluded in this study. Three times SrCr
levels (baseline level versus in-patient phase level in Phase 1 study and baseline level versus 2
months out-patient visit level in Phase 2) of patients were collected using a designed data
collection form and the results were analysed. Patients with SrCr increased for more than 30% from
baseline level is characterised as renal function deterioration. RESULTS: A total of 20 patients (18
male & 2 female) were involved in this study. In Phase 1 study, there were 3 patients whose renal
profiles were not repeated during in-patient phase and were excluded. Seventeen patients did not
show an increased in SrCr level for more than 30% during in-patient phase as compared to baseline
data. In Phase 2 study, six patients were excluded because their renal profiles could not be traced
as a result of their follow-up at health clinics. Thirteen patients did not show an increased in SrCr
level for more than 30% after 2 months from baseline data. Nevertheless, one patient was stopped
from the continuation of ACE inhibitor therapy due to the high readings in SrCr. This was solely due
to the intervention of physician. CONCLUSION: All patients did not show an increased in SrCr level
for more than 30% after the initiation of ACE inhibitor therapy or even after 2 months of therapy.
Keywords: renal function changes, ACE inhibitors, serum creatinine levels
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC5: CARDIAC REHABILITATION PROGRAM 2008: POST MYOCARDIAL
INFARCTION PHARMACOTHERAPY STUDY
S.Jeyaindran 1, A.Fudziah, J.Nirmala 2, K.S. Lui, P.K. Chia
1 Medical Department, 2 Pharmacy Department, Hospital Kuala Lumpur
INTRODUCTION: Cardiac Rehabilitation Program (CRP) is a multi – disciplinary approach,
emphasizing on physician – pharmacist teamwork, employed to reduce the risk of recurrent
cardiovascular event and mortality post myocardial infarction (MI). Both international and national
guidelines recommend the use of antiplatelets, beta blockers, angiotensin – converting enzyme
(ACE) inhibitors or angiotensin II receptor blockers (ARBs) for ACE inhibitor intolerance, and
antilipemics for long term treatment of these patients, as it have been shown to be of benefit.
OBJECTIVES: To identify the risk factors, use of post MI pharmacotherapy, and average monthly
cost per patient among CRP patients in Kuala Lumpur Hospital (KLH). METHOD: A cross-sectional
retrospective observational study of all CRP MI patients enrolled in 2008 was conducted. All
patients who completely defaulted the program, died or tranferred out and had not attended any
CRP session were excluded. Data on post MI pharamcotherapy was extracted from the patients’
CRP files. RESULTS: One hundred and nineteen (119) patients’ data were analysed. Median age was
51 years and 91.6% male. 52.1% of patients are Malay, 10.1% Chinese and 27.7% Indian. 79% were
overweight, 57.1% had no family history, 72.3% were either current or past smoker and 21.8% had
no co-morbidities. 73.1% of patients are on all four post MI pharmacotherapy. Aspirin or other
antiplatelets regimen was prescribed in 99.2% patients, beta-blockers in 87.4%, angiotensinconverting enzyme inhibitors/ angiotensin-receptor blockers in 87.4% and antilipemics in 95%. The
most commonly used drug in each post MI pharmacotherapy group is aspirin, metoprolol,
perindopril and lovastatin. The average cost of post MI pharmacotherapy calculated was RM32.40
for a patient per month. CONCLUSION: CRP played a vital role in ensuring patients receive all the
recommended post MI pharmacotherapy, as per the guidelines.
Keyword: cardiac rehabilitation program, post myocardial infarction pharmacotherapy, antiplatelets, betablockers, angiotensin-converting enzyme inhibitors/ angiotensin-receptor blockers, antilipemics
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC6: EVALUATION OF PATIENT’S ADHERENCE TO HIGHLY
ANTIRETROVIRAL THERAPY IN HOSPITAL SERI MANJUNG
ACTIVE
W.H. Choong, S.M. Lee, A. Erin, W.A.K. Norashikin.
Pharmacy Department, Hospital Seri Manjung.
INTRODUCTION: Adherence to highly active antiretroviral therapy (HAART) is a significant
determinant of survival in Human Immunodefficiency Virus (HIV) patients. The increasing number
of drug resistance problem in HIV patients signify a particularly urgent reason to promote
adherence, since treatment failure represents not only on personal but also on public health cost.
OBJECTIVES: The study was to evaluate the adherence of HAART among HIV patients in Hospital
Seri Manjung, to identify factors that affect adherence and to identify the reasons of nonadherence. METHOD: A cross-sectional survey was conducted from March 2009 until May 2009 in
Hospital Seri Manjung. Patients who received HAART regimen for more than 2 months were
included in this study. Patient’s profiles were manually reviewed at medical out-patient
department (MOPD) and their appointment dates were obtained. Patient were face-to-face
interviewed by using a set of questionnaire during their MOPD follow up or prescription filling at
out-patient pharmacy. Medication identification chart was used to assist assessment. Data was
recorded and analysed. RESULTS: 33 patients out of 51 responded to the study. From 33 patients,
81.8% respondents were male and 18.2% were female, and were predominantly Chinese (63.6%).
Education level and patient’s income were poor predictors for adherence. Those who had good
family and social support (P=0.429), and knowledge about HAART (P<0.05) were found to be more
adherent to HAART. The common reasons for missed dose of antiretroviral were being away from
home and forgetfullness. CONCLUSION: Pharmaceutical care and interventions are needed to
promote the initiation and maintenance of effective medication adherence as well as to improve
patient’s adherence to their HAART.
Keyword: antiretroviral therapy, HAART, adherence, HIV, drug resistance
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC7: A STUDY ON USAGE OF THIRD GENERATION CEPHALOSPORINS IN
ORTHOPEDIC, SURGICAL AND MEDICAL DEPARTMENTS IN HOSPITAL
TUANKU JA’AFAR SEREMBAN
Y. N. Gan, C. Y. Kok
Pharmacy Department, Hospital Tuanku Ja’afar Seremban
INTRODUCTION: Rate of extended spectrum beta-lactamases (ESBL) occurrence has been rising
over the years and is widely associated with extensive use of third generation cephalosporins.
Hospital Tuanku Ja’afar Seremban (HTJS) has reported the highest ESBL rate in Malaysia in 2007
and an increasing usage pattern of third generation cephalosporins. OBJECTIVES: The study was
carried out to evaluate the use of third generation cephalosporins in orthopedic, surgical and
medical departments in HTJS. METHOD: A prospective, single-centred, observational study was
conducted from November 2008 to February 2009 at orthopedic, surgical and medical departments
in HTJS. A total of 224 patients receiving cefoperazone, sulperazone, ceftriaxone and ceftazidime
were identified and data was collected using an antibiotic audit form. Antibiotic prescribing
compliance to the National Antibiotic Guideline 2008 (NAG) was assessed while trends of antibiotic
usage in these departments were compared. Microsoft Excel was used to construct statistical data.
RESULTS: Orthopedic department (N=43) showed the lowest compliance (61%) to NAG, with
sulperazone as the most frequently used antibiotic (42%). 11 out of 19 cases with antibiotic given
based on culture and sensitivity test results (C&S) were sourced from swab sample (58%). Surgical
department (N=68) showed 93% compliance to NAG with high usage of cefoperazone (43%) and
sulperazone (32%). Medical department (N=113) showed the highest level of compliance to NAG
(93.3%), with ceftriaxone as the most frequently used antibiotic (73%). CONCLUSION: Choice of
antibiotic should not be based on swab C&S as it may indicate false positive. Our study highlights
poor antibiotic prescribing compliance in orthopedic department.
Keyword: Third generation cephalosporins, ceftriaxone, sulperazone, cefoperazone, ceftazidime, ESBL
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC8: STUDY ON PHARMACEUTICAL CARE OF ONCOLOGY PATIENTS IN
HOSPITAL SERI MANJUNG
L.K. Foo, J.K. Ong, H. Normi
Pharmacy Department, Seri Manjung Hospital
INTRODUCTION: Drug-related problems in cancer chemotherapy are due to high toxicity of
anticancer drugs which hindered patients from adhered to the treatment. This can be improved by
patient counseling before and during treatment cycles regarding drug therapy, adverse effects and
complementary treatment options. OBJECTIVES: The aim of this study was to evaluate the
pharmaceutical care of oncology patients in Hospital Seri Manjung, type of chemotherapy regime
given and to assess the patients’ knowledge regarding the disease and treatment. METHOD: This
study was a prospective descriptive study. The data was collected by using a questionnaire and 29
patients fulfilled the inclusion criteria. Assessment on patients’ knowledge on their medical
conditions, compliance and knowledge on chemotherapy was undertaken. Patients were being
interviewed regarding side effects developed after chemotherapy.
RESULTS: 29 patients with
mean age of 51 years old were selected. Majority of the patients were female (83%). There were 12
(41.4%) Malay, 12 (41.4%) Chinese and 5 (17.2%) Indian. The highest number of subjects being
studied were breast cancer patients (62%) followed by colorectal cancer patients (17%). About 83%
of patients didn’t even know the type of chemotherapy that was being administered. There is no
significant correlation between patient’s education background and knowledge on type of
chemotherapy they received (P = 0.146, P > 0.05). The most common type of side effects
encountered after chemotherapy were nausea and vomiting (33%). There were 10% (3 patients) felt
excellent after chemotherapy. 3% had very poor quality of life after chemotherapy. There is
significant correlation between patient’s daily life that is affected by level of depression (P=0.006,
P<0.05). CONCLUSION: Pharmaceutical care in oncology patients is a major concern for healthcare
providers in terms of improving patients’ quality of life.
Keyword: Oncology patients, pharmaceutical care, patient knowledge, chemotherapy side-effects
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC9 : THE OUTCOME OF PHARMACIST’S INTERVENTION ON GLYCEMIC
CONTROL AMONGST DIABETES MELLITUS PATIENTS ON INSULIN
THERAPY IN KULIM HOSPITAL
R. Jaya Muneswarao, H. Cheauly, C.L. Koo.
Pharmacy Department, Kulim Hospital, Kedah.
INTRODUCTION: Optimal glycemic control is fundamental to the management of Diabetes
Mellitus(DM). Pharmacists can play an important role in optimising insulin therapy, through various
intervention. OBJECTIVES: To improve the glycemic control amongst DM patients on insulin
through pharmacist’s intervention. METHOD: Prospective 12 months study in the Medical
Outpatient Department (MOPD) and Pharmacy Department of Kulim Hospital. The recruited DM
patients must be on insulin therapy for at least six months and their glycosylated hemoglobin level
(HbA1c) >7%. Patients were evaluated by pharmacists through face-to-face assessment 3 monthly
whereby their HbA1c level is measured. Patients were also counselled on compliance,
hypoglycemia management and insulin injection technique. Pharmacist also carried out
pharmaceutical review and made appropriate interventions to the doctors when necessary.
Patients were also referred to dietitians. Defaulted patients were monitored through the Home
Medication Review (HMR) program. RESULTS: A total of 41 patients were studied: 21 (51%) males
and 20 (49%) females, age 54 ± 12 years. At the end of follow-up, the mean HbA1c was reduced
from 9.21 ± 1.94 %(baseline) to 8.46 ± 1.56% (p<0.05). Patients’ compliance improved by 73% as the
mean Morisky Scale reduced from 2.05 ± 1.07 to 0.56 ± 0.67 (p< 0.05). There was a reduction of
60% in the number of hypoglycemic events (per month), from 7.20 ± 13.19 to 2.88 ± 5.25 events
after pharmacist’s intervention. The mean score for injection technique increased from 7.22 ± 1.15
(pre-intervention) to 9.05 ± 0.97 (post-intervention), the injection technique score improved by
25%. Pharmacist’s intervention contributed to the improvement of HbA1c (approximately 1%
reduction from the baseline HbA1c). This can be seen from the improvements in patient’s
compliance and injection technique. We also noted that our patients had less hypoglycemic events
which could have contributed to their compliance. CONCLUSION: Pharmacist intervention had
contributed to a significant improvement in glycemic control in DM patients on insulin therapy.
Keyword: Diabetes mellitus, insulin, HbA1c, pharmacist intervention, injection technique, compliance,
hypoglycemia.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC10: A STUDY ON ASSESSMENT IN UNDERSTANDING OF MDI AND IMPACT
OF EDUCATIONAL INTERVENTION ON MDI TECHNIQUE AMONG
PATIENTS IN HOSPITAL SULTAN ISMAIL, JOHOR BAHRU
S.S. Jia, M.S. Siti Norlina
Hospital Sultan Ismail, Johor Bahru
INTRODUCTION: Metered Dose Inhalers (MDIs) are devices designed to allow selective treatment of
the lungs directly by achieving high drug concentrations in the airway. One of the most important
disadvantages of MDI is that specific inhalation techniques are necessary to assure delivery of the
drug to the airways. Due to this reason, it has been observed that a significant number of patients
were unable to use MDI correctly. OBJECTIVES: to evaluate patient knowledge regarding usage of
MDI, and to find out the impact of educational intervention with the aid of printed guideline on
inhalation steps on proper use of MDI among patients in HSIJB. METHOD: This is a prospective
study to assess patients with chronic lung disease (asthma, COPD and bronchiectasis). Patients
were included in the study if they were using an inhaler therapy on admission to the outpatient
department or during their hospitalization period. A checklist was applied to patients to assess
their baseline understanding on MDI and MDI technique. Patients were then given demonstration on
correct MDI technique with the aid of printed guideline, followed by a re-test on their MDI
technique. RESULTS: A total of 60 patients were successfully included in this study. Only 1 patient
was able to perform all seven steps of inhaler technique correctly at enrollment. After counseling
and instruction with printed guideline given, 19 patients were able to perform all seven steps
correctly. The impact of educational intervention on inhaler technique of study subjects was
therefore considered statistically significant (p<0.001). CONCLUSION: This study highlighted the
high percentage of improper use of MDI technique among patients in HSIJB, regardless of before
educational intervention (only 1.6% with proper technique) as well as after educational
intervention (only 31.7% with proper technique). It is also clear from the study that educational
intervention is effective in improving inhaler technique.
Keywords: MDI techniques, Educational Intervention
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC11: MONITORING OF GENTAMICIN IN HOSPITAL TUANKU FAUZIAH
S.H. Ong, W.H. Woo, N.M. Nik Mah, S. Fadzil
Department Of Pharmacy, Hospital Tuanku Fauziah, Perlis.
INTRODUCTION: Gentamicin is an antibiotic with a narrow therapeutic range. Thus, therapeutic
drug monitoring (TDM) can be used to obtain specific pharmacokinetic parameters to design an
individualized dosage to avoid underdosing or overdosing. OBJECTIVES: To evaluate the usefulness
of TDM for gentamicin and the need of frequent TDM in patient receiving gentamicin therapy in
Hospital Tuanku Fauziah (HTF). METHOD: This retrospective study reviewed the records of
gentamicin level among inpatients in HTF from Jan 2008 until Dec 2008. Gentamicin was given as
single daily dosing (SDD) or multiple daily dosing (MDD). SDD is an approach of administer
gentamicin for otherwise healthy individuals in a single daily dose by slow infusion (30min) while
MDD is an approach of administering gentamicin in slow bolus dosing in 8 hourly or 12 hourly
dosing. Patients with only 1 sample or insufficient information were excluded from the study. Both
peak and trough concentration for first monitoring and subsequent monitoring were collected. The
two point peak and trough pair concentrations of first assay for each patient were used to make an
appropriate dosage adjustment to achieve the desired therapeutic range (TR) when the measured
level is out of TR. The measured gentamicin level on first monitoring and subsequent monitoring
were compared. RESULTS: Of the 103 patients involved, 47.6% had both peak and trough
gentamicin levels within TR on first monitoring. After dosage adjustment, those attaining TR on
second monitoring increased overall from 47.6% to 53.1%. For 49 patients with gentamicin levels
within TR on first monitoring, 24 patients request for follow up gentamicin levels and we found
that 54.2% of these patient’s gentamicin levels were out of TR on subsequent monitoring. This
indicates the need for frequent monitoring. In this study, 62.3% of patient receiving SDD had
achieved TR while only 32.0% of patient receiving MDD had achieved TR. CONCLUSION: TDM play an
important role in monitoring of serum gentamicin concentrations and detect toxicity of gentamicin.
There is a need for frequent TDM when patient is on with gentamicin. The two point peak and
trough pair concentrations is vital in helping to adjust the most appropriate dosing regimen of
gentamicin. SDD regimen appeared to have better drug profile compared to MDD regimen (P<0.05).
Keywords: therapeutic drug monitoring, gentamicin, serum drug concentration, therapeutic range
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC12: ADHERENCE OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY
(HAART) REGIMEN ON ADULT HIV PATIENTS IN MEDICATION
THERAPY ADHERENCE HIV CLINIC (MTAC) IN HOSPITAL TUANKU
JA’AFAR (HTJ)
Y.N. Valice Wong, K. Mohd. Badri
Pharmacy Department, Tuanku Ja’afar Hospital
INTRODUCTION: Adherence to Highly Active Antiretroviral Therapy (HAART) regimen of 95% or
greater seems to be required for successful treatment of HIV. Efforts to improve adherence are
ongoing, including the pill counting, viral count and CD 4 cell count measurement. OBJECTIVES: To
determine the difference between before and after MTAC and to assess the association between
adherence of HAART regimen with the MTAC on adult HIV patients. METHOD: This study was a
retrospective, randomised and was done for 6 months in HTJ. Screening was done for 100 patients
who received HAART regimen and only 25 patients fulfilled the inclusion criteria. The CD 4 cell
count of these 25 patients were analysed accordingly to adherence of HAART regimen after
initiation of MTAC. RESULTS: The difference of CD 4 cell count before and after initiation MTAC
was compared and was statistically significant (P < 0.05). CONCLUSION: MTAC was effective in
improving of the adherence of HAART regimen in adult HIV patients.
Keyword: Adherence, HAART regimen, MTAC.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC13: STUDY ON KNOWLEDGE AND COMPLIANCE OF PATIENTS RECEIVING
WARFARIN THERAPY IN HOSPITAL RAJA PEREMPUAN ZAINAB
(HRPZ) II
K. Dir Rathna Masni, A. Hasliza, A.R. Fatihah, W.M.Y. Wan Musfirah , A.R. Hafiza
Pharmacy Department, Hospital Raja Perempuan Zainab II Kota Bharu
INTRODUCTION: Warfarin has a narrow therapeutic index. The safety and efficacy of warfarin
therapy are dependent on maintaining the INR within the target range for the indication.
Fluctuating levels of INR below and above the therapeutic range are associated with an increase
risk of thromboembolic and bleeding complications, respectively. Unexpected fluctuations in the
INR in a stable patient could be due to a change in diet, poor compliance, undisclosed drug use,
alcohol consumption, or self-medication. OBJECTIVES: This study is done to evaluate patients’
compliance and understanding towards warfarin therapy. METHOD: A cross sectional prospective
study was done in Pharmacy Outpatient Department. Patients were selected based on convenient
sampling from January till June 2009. Patients were interviewed using a set of questionnaire.
Morisky scale was used as a compliance screening tool. Descriptive and Statistical analysis were
performed using SPSS Version 13.5. The Spearman Regression statistical test and cross tabulation
were employed whenever appropriate. Statistical significance was set a p-value<0.05. RESULTS: 46
patients were enrolled in the study. 52.2% of them complied with warfarin therapy however only
47.8% of patients have good knowledge and understanding. 43% were counseled by doctors and 17%
by pharmacist. Unfortunately 28% claimed never been counseled before. In term of effectiveness of
counseling, 87.5% of patient showed good compliance after being counseled by pharmacist. Study
showed however only 26.1% achieved targeted INR. CONCLUSION: Only 52.2% complied to warfarin
therapy and 47.8% have good knowledge. The collaboration between health care providers is
essential to promote patients’ understanding and compliance towards warfarin therapy. Warfarin
clinic could effectively reduce the occurrence of adverse patients’ outcomes and lower total
healthcare expenses.
Keywords: warfarin, INR, therapeutic range, compliance
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC14: COMPARISON OF THE EFFICACY AND ADVERSE EFFECTS OF BETABLOCKERS AND CALCIUM CHANNEL-BLOCKERS AMONG ELDERLY
PATIENTS IN MUAR GOVERNMENT HOSPITAL AND POLYCLINIC
S. L. Tan, Z. Mohd Saman.
Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor.
INTRODUCTION: With the current global trend of ageing population, hypertension is rapidly
becoming one of the major concerns among healthcare professionals who specialise in treating
geriatric patients. OBJECTIVES: This study endeavours to make a comparison between the betablockers (BB) and calcium channel blockers (CCB) by examining blood pressure control, hospital
admission rates and frequency of adverse effects among geriatric patients. METHOD: A crosssectional study was carried out using questionnaires designed specifically to assess the patient’s
blood pressure control and also to identify the occurence of adverse effects experienced by the
patients during therapy. A total of 48 subjects (mean age=72 years old, male=25(52.1%) and
female=23(47.9%)) were recruited. Patients younger than 65 years old were excluded from this
study. Patients’ data were derived from the hospital’s computerized dispensing system (CDS) which
showed that they were on beta-blockers or calcium channel-blockers. The collection of responses
to the questionnaires was done from July to August 2008. Data analysis was carried out using SPSS
version 17. RESULTS: Among patients on calcium channel blockers, 36% achieved the target blood
pressure while 27.8% of patients on beta-blockers successfully attained the goal blood pressure.
The percentage of patients on calcium-channel blockers who were admitted to the hospital for
hypertension-related events was 24% while 27.8% of patients from the beta-blocker group were
hospitalised for the same reasons. In both the beta-blocker and calcium channel-blocker groups,
there was a higher incidence of side effects such as insomnia (38.89%(BB) compared to 36%(CCB)),
skin allergy (33.3%(BB) compared to 32%(CCB)) and lethargy (27.78%(BB) compared to 32%(CCB)).
CONCLUSION: In elderly patients, calcium channel-blockers are more effective than beta-blockers
in controlling blood pressure and preventing hypertension related hospital admissions. However,
calcium channel-blockers generally lead to more adverse side effects than beta-blockers.
Keyword: hypertension, beta-blocker, calcium channel-blocker, geriatric.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC15: AN OVERVIEW OF ANTIBIOTIC USAGE IN CONTINUOUS AMBULATORY
PERITONEAL DIALYSIS (CAPD) PERITONITIS
M.S.Siti Syaffurah, O.Khairul Muhaimin
Pharmacy Department, Sultanah Nur Zahirah Hospital, Kuala Terengganu
INTRODUCTION: Peritonitis is one of the main complications and main cause of failure in CAPD
patient. The types of organisms causing peritonitis and the susceptibility of those organisms to
antibiotics have also been changing. OBJECTIVES: The aims of this study were to determine the
CAPD peritonitis rate and empiric therapy used in CAPD peritonitis, to identify bacterial etiology of
CAPD-related peritonitis and to determine the antibiotic usage based on culture and sensitivity
(C&S) results. METHOD: A retrospective data were extracted from patient’s record from CAPD
Unit, Hospital Sultanah Nur Zahirah(HSNZ). A survey form was used in this study. All episode of
CAPD from 2004 to 2008 were included. RESULTS: There were 159 cases of peritonitis in 399
patients on CAPD, which equates to an overall incidence rate of peritonitis 0.4 case per patientyears. The rate was increase from 0.37 to 0.50 case per patient-year from 2004 to 2008. The most
common used of antibiotics as first line empiric therapy were Cloxacillin and Ceftazidime, 131(82%)
cases. Growth of Gram-positive organism was found in 48(30.2%) and of Gram-negative organism in
50(31.4%) cultures of the peritoneal dialysis effluent. Staphylococcus aureus,21(13.2%) was the
most common gram positive organism, where as Pseudomonas spp.17(10.7%) was the most common
Gram-negative organism to cause the episode of peritonitis. 104(65.4%) of episode of peritonitis
were found to be culture positive and the remaining of 55(34.6%) were culture negative. Cloxacillin
and Ceftazidime were the most common antibiotic used based on the susceptibility of the C&S
result. CONCLUSION: The incidence of peritonitis in CAPD patients was markedly increased during
the past 5 years. Therefore, the appropriate used of antibiotic in peritonitis among CAPD patients
should be strengthen to avoid the resistance rate.
Keywords: peritoneal dialysis, peritonitis, CAPD
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC16:
A RETROSPECTIVE STUDY ON VENTILATOR ASSOCIATED
PNEUMONIAE (VAP) IN INTENSIVE CARE UNIT (ICU), HOSPITAL
SULTANAH NUR ZAHIRAH, KUALA TERENGGANU.
M. Khulailah1, C.J. Khor1, W.A. Wan Mohd. Hafidz1, H. Aishah2.
1 Pharmacy Department, Hospital Nur Zahirah, Kuala Terengganu,
Lumpur.
2
Pharmacy Department, Hospital Kuala
INTRODUCTION: Ventilator Associated Pneumoniae (VAP) is the most common reported nosocomial
infection diagnosed in critical care unit. It continues to be an important cause of morbidity and
mortality. Malaysian National Audit on adult ICU (NAICU 2002-2003) reported VAP incidence in
fourteen major hospitals was 23.2% or 26.9% per 1000 ventilator days. OBJECTIVES: To determine
incidence of VAP, Vap rate, pathogens involved and mortality rate in VAP and non-VAP patients.
METHOD: All patients admitted to ICU, HSNZ from February to December 2008 were
retrospectively studied. VAP were defined as patients ventilated more than 48 hours and was
diagnosed with VAP during ICU stay. RESULTS: From a total number of two hundred and ten
patients, 17 patients (8.1%) diagnosed as VAP. More than 50% were male ( n=13, 76.5%) with
mean(±SD) age of 42(±24.7). VAP rate showed to be 18.4 days. Pseudomonas aeroginosa (23.5%)
was found to be the most common pathogen isolated, followed by Klebsiella pneumonia (17.8%)
and Acinetobacter spp. (17.6%). Mortality was shown to be higher in VAP patients than in non-VAP
patients, 35.3&% and 19,2% respectively. CONCLUSION: Although VAP incidence and rate in our
study were lower than NAICU but it is crucial to ensure strict infection control measures due to its
high morbidity and mortality.
Keywords: Ventilator associated pneumonia, intensive care unit, nosocomial infection
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC17: A SARAWAK EXPERIENCE: IS THE CLOPIDOGREL-PROTON PUMP
INHIBITOR COMBINATION A CONCERN?
Y.H. Lana Lai¹, L.L. Tiong², S.N. Rusli³, W.M. Lim ³, J.Y. Lou ¹, K.M. Lo ¹, S.K. Chuo ¹
1 Pharmacy Department, Sibu Hospital, 2 Clinical Research Centre, ³ Pharmacy Department, Sarawak General
Hospital
INTRODUCTION: Studies have reported that proton pump inhibitors (PPI) may decrease the platelet
inhibitory effects of clopidogrel, an antiplatelet commonly prescribed in patients with Acute
Coronary Syndrome (ACS). However, the clinical significance of these findings is unclear in our local
settings. OBJECTIVES: To compare the percentage of ACS patients prescribed with Clopidogrel-PPI
between a Cardiac Tertiary Referral Center (CTRC) and a District General Hospital (DGH), and to
evaluate the Major Adverse Cardiac Events (MACE) associated with this combination. METHOD: We
reviewed the ward and pharmacy documentations of 60 and 25 ACS patients admitted at the CTRC
and DGH respectively from 1/1/08 to 30/6/08. They were followed-up at the 3rd, 6th, 9th and 12th
month. The results were compared and analyzed using SPSS version 16.0. RESULTS: At baseline,
patient population in both centers was similar for ACS Stratum, laboratory investigations and
demographics, except for ethnicity, 46.7% were Malay in the CTRC while 40% were Iban in the DGH.
The use of Clopidogrel-PPI combination was compared between the CTRC and DGH, for STEMI
patients, 31.7% vs. 12.0%; NSTEMI patients, 10.0% vs. 12.0%; UA patients, 1.7% vs. 0.0%; and for
Unspecified ACS patients, 6.6% vs. 0.0% respectively. In the CTRC, at less than 6 months, 1 patient
(1.7%, n=60) had a MACE and 1 patient (1.7%, n=60) was re-hospitalized secondary to upper
gastrointestinal hemorrhage (UGIH). 3 patients in the DGH had a MACE, 2 of them (8.0%, n=25)
occurred at less than 3 months and 1 (4.0%, n=25) died at less than 12 months. Only one patient
with MACE in the DGH was on the Clopidogrel-PPI combination. None were significant (p=0.13).
Majority of the ACS patients in the CTRC and DGH were on a statin (96.7% vs. 100% respectively).
Usage of other CYP219 substrates and inhibitors in the CTRC and DGH were also considered (25% vs.
93.7% respectively). CONCLUSION: The Clopidogrel-PPI combination was more commonly
prescribed in CTRC compared to DGH. The occurrence of MACE associated with the combination in
both centers was insignificant.
Keywords: clopidogrel (Plavix), proton pump inhibitor, interaction, combination, major adverse cardiac events
(MACE), Tertiary Referral Center, District General Hospital, cytochrome P 450 2C19 inhibitors
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC18: A STUDY COMPARING THE EFFECTIVENESS OF BENZYDAMINECHLORHEXIDINE AND ASPIRIN-THYMOL MOUTHWASHES IN THE
MANAGEMENT OF RADIOTHERAPY-INDUCED MUCOSITIS AMONG
NASOPHARYNGEAL CANCER (NPC) PATIENTS.
E.L. Chuah, L. Jerry, F.C Monica Yam
Pharmacy Department, Queen Elizabeth Hospital
INTRODUCTION: The nasopharyngeal cancer patients in our hospital were prescribed with either
Benzydamine/Chlorhexidine mouthwash or Aspirin/Thymol gargle as part of their oral care regime.
However, uses of such mouthwashes combinations in the management of mucositis were not
addressed. OBJECTIVES: To compare the effectiveness of Benzydamine/Chlorhexidine mouthwash
and Aspirin/Thymol gargle in reducing the severity of mucositis in nasopharyngeal cancer (NPC)
patients. METHOD: This was a non-randomized open-label study. Subject recruited were
radiotherapy naive adult NPC patients scheduled to receive a cumulative dose of radiotherapy of at
least 70Gy per week in at least 20 fractions. Oral evaluations were performed by a masked oral
pathologist using WHO Mucositis Scale at the baseline (before radiotherapy started), 5 th, 10th, 15th
and 20th fraction of radiotherapy. Oral Mucositis Daily Questionnaires (OMDQ) was used to assess
mouth soreness and limitation on daily activities namely swallowing, drinking, eating, talking and
sleeping. Repeated Measure ANOVA was used to evaluate the effect of baseline mucositis risk
factors and influence of mouthwashes on the scores of OMDQ and WHO Mucositis Scale. RESULTS: A
total of 19 subjects were recruited into the Benzydamine/Chlorhexidine group and Aspirin/Thymol
group respectively (n=38). Baseline characteristics of both groups were not significantly different
except for the level of oral hygiene (p=0.005). All subjects experienced significant development of
mucositis. There were no significant differences between treatment groups recorded in WHO
scores[F(5.6,90.6)=1.4, p=0.2], mouth and throat soreness [F(8.04,124.6)=1.0, p=0.4], function
limitations [swallowing[F(6.9,110.4)=0.5, p=0.8], drinking[F(6.1, 98.3)=0.6, p=0.7], eating[F(5.9,
94.5)=0.3], talking[F(5.3,85.6)=0.6, p=0.6] and sleeping[F(5.1,79.6)=0.7, p=0.6]], overall mouth
throat soreness scores[F(2.8, 50.3)=0.2, p=0.8] and overall health scores[F(3.1, 50.3)= 0.4, p=0.7].
The different baseline oral hygiene between treatment groups did not significantly affect the study
results (Partial eta square<0.1). None of the subjects experienced diarrhea. CONCLUSION: Both
Benzydamine/Chlorhexidine and Aspirin/Thymol combinations did not differ in their ability to
reduce the severity of mucositis. The development of mucositis was not affected by either
combination given to NPC patients.
Keywords: Benzydamine/Chlorhexidine, Aspirin/Thymol gargle, mucositis, nasopharyngeal cancer
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC19: IMPACT OF PHARMACIST-RUN DIABETES CLINIC IN THE GENERAL
OUT-PATIENT CLINIC OF PENANG HOSPITAL
P.C. Lim, L. Kelvin, L.S. Chew, O.L. Lau, Y.F. Loh
Pharmacy Department, Hospital Pulau Pinang
INTRODUCTION: Collaborative management of diabetes between pharmacist and multidisciplinary
healthcare providers has been shown to improve the patients’ glycaemic control. In Penang
Hospital, pharmacists collaborated with physicians in diabetes care through a pharmacist-managed
Diabetes Medication Therapy Adherence Clinic (DMTAC) in the Endocrine Clinic, operational since
2006. OBJECTIVES: To determine whether additional DMTAC service added to the usual care would
improve glycaemic control in the out-patient clinic. METHOD: Multi-ethnic type 2 diabetes patients
with glycosylated haemoglobin (HbA1c) ≥8% were randomly divided into either the intervention
group (usual care plus DMTAC service) or the non-intervention group (usual care only). Patients in
the intervention group received diabetic booklet and were followed up by pharmacists for eight
consecutive visits at 2-week to 2-month intervals. During these visits, the pharmacists educated
and counselled patients regarding medications and diabetic treatment. Changes in HbA1c (%) and
fasting blood glucose (FBG, mmol/l) were measured. The pharmacists also assessed patients’
adherence level. RESULTS: A total of 76 patients (35 males, 41 females; 23 Malays, 31 Chinese, 22
Indians) were enrolled with 39 patients in the intervention group and 37 patients in the nonintervention group. There was significant difference in mean HbA1c reduction between the
intervention and non-intervention groups (-0.90% vs. -0.08%, p=0.011). The FBG was significantly
improved in the intervention group (-3.45 vs. +0.79, p=0.002)) as compared to the non-intervention
group. CONCLUSION: Additional pharmacist-managed DMTAC services have resulted in significant
improvement in glycaemic control in multi-ethnic diabetes patients in the Out-patient Clinic,
Penang Hospital.
Keywords:
DMTAC service, glycaemic control, type 2 diabetes, out-patient clinic
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC20:
RESPON PESAKIT KRONIK TERHADAP STATIN DI UNIT PESAKIT
LUAR DAN KLINIK PAKAR HOSPITAL DUNGUN
A.K. Norhayati1,C.K.H. Che Ku Nurhalisa1, Z. Halimatun Saedah2, W.A. Wan Norizah3
1Unit Farmasi, Hospital Dungun, 2Unit Farmasi, Hospital Hulu Terengganu, 3Bahagian Kesihatan Awam,
Jabatan Kesihatan Negeri Terengganu
PENGENALAN: Statin pada masa kini digunakan secara meluas di kementerian Kesihatan Malaysia
dan hampir semua pesakit terutama pesakit kronik menggunakan statin sebagai rawatan untuk
mengurangkan risiko serangan jantung. OBJEKTIF: Kajian ini dilakukan untuk melihat respon
pesakit di Unit Pesakit Luar dan klinik pakar terhadap penggunaan statin yang berbeza dan
mengkaji tahap kepatuhan kepada CPG bagi pesakit di Hospital Dungun. KAEDAH: Kajian ini
merupakan Kajian hirisan melintang. Semua preskripsi pada bulan Mac 2008 di saring dan semua
pesakit yang menggunakan Statin direkodkan dan dinomborkan. Setiap preskripsi ke 5 akan diambil
untuk dijadikan sampel. Kad-kad pesakit akan diambil berdasarkan nama dan no kad pengenalan
pada preskripsi ubat. Semua kad tersebut diambil dari Unit Pesakit Luar dan klinik pakar Hospital
Dungun. Semua data yang diambil direkod di dalam Borang Pengumpulan data dan dianalisa dengan
menggunakan SPSS. KEPUTUSAN: Hasil dari kajian menunjukkan 70.9% daripada pesakit
menggunakan Lovastatin, 9.9% bagi Pravastatin, 12.8% Atorvastatin dan 6.4% Simvastatin. 7.1%
daripada
sampel
menggunakan
Statin
bersama-sama
Gemfibrozil.
Daripada
kajian
juga
menunjukkan hanya 46.8% pesakit mempunyai Baseline Lipid Profile sebelum memulakan rawatan
Statin. Selain itu, hanya 21.3% sampel yang dilakukan Baseline LFT dan hanya 36.9% dilakukan LFT
selepas rawatan statin. Ujian penyaringan myopathy juga hanya dilakukan pada 9.9% sampel
manakala 90.1% lagi tidak dipantau. Daripada keseluruhan sampel, hanya 56% dilakukan ujian FLP
manakala 44.4% tidak dilakukan ujian tersebut selepas rawatan. Daripada 44 sampel yang
mempunyai kedua-dua data FLP(sebelum dan selepas rawatan), 79.5% mengalami penurunan
selepas pengambilan statin bagi Total Kolesterol (P<0.05),75% mengalami penurunan bagi LDL
(P<0.05), tetapi bagi HDL, hanya 54.5% sampel mengalami kenaikan paras HDL (P>0.05) dan TG
hanya 47% mengalami penurunan (P>0.05). KESIMPULAN: Daripada keseluruhan kajian, didapati
pesakit di unit Pesakit luar dan klinik pakar Hospital dungun mempunyai respon yang agak baik
dalam menurunkan paras LDL dan kolesterol selepas menggunakan statin, tetapi respon dalam
menurunkan HDL adalah tidak signifikan. Begitu juga tahap kepatuhan kepada CPG yang masih
belum menyeluruh di Unit Pesakit Luar berbanding klinik pakar.
Kata kunci: Statin, penyakit jantung, kolesterol
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC21:
DETERMINATION OF APPROPRIATE DOSING REGIMEN FOR
GENTAMICIN IN NEONATES-A PROSPECTIVE STUDY AT HOSPITAL
SEBERANG JAYA
T.F. Teoh1 , L.H. Ooi1, C.H. Lim2, M.A. Hassali3
1Pharmacy Department, Hospital Seberang Jaya, 2Pediatric Department, Hospital Seberang Jaya, 3School of
Pharmaceutical Sciences, Universiti Sains Malaysia
INTRODUCTION: There were several neonatal gentamicin dosing regimens that have been
proposed. However, there is a wide variety among these protocols. It might be due to most of the
protocols were derived from pharmacokinetic data of different demographic of patient groups.
OBJECTIVES: The aim of the study was to validate the likelihood of the hypothetical dosing
regimen from the previous study to attain the desirable serum gentamicin concentration in
neonates in NICU. METHOD: A prospective study was conducted at the NICU from 16th April 2009
till 30th August 2009. Neonates with the aged ≤ 7 days, who had received gentamicin as an
empirical treatment for clinically suspected or high risk of sepsis and had no contraindication to
gentamicin usage were enrolled. The hypothetical dosing regimens were given accordingly based on
neonates’ body weight. Neonates with birth weight <1kg were given 2.5mg/kg/dose every 48 hours;
whereas 2.5mg/kg/dose every 36 hours for neonates with birth weight 1kg ≤ BW < 2.5kg. Neonates
with birth weight > 2.5kg were given 3mg/kg every 24 hours. Descriptive statistics were undertaken
to analyze the data collected. RESULTS: A total of 144 neonates were included in this study. The
hypothetical dosing regimens resulted in 97.4% of peak concentrations falling within the target
ranges in neonates with birth weight ≥2.5kg and 85.9% in neonates with birth weight 1kg ≤ BW <
2.5kg. In neonates’ birth weight < 1kg, there were 100% of peak concentration within the target
range. Overall the hypothetical dosing regimens resulted in 100% of trough and 92.4% of peak
concentration falling within therapeutic range. CONCLUSION: The results of this study suggest
improved gentamicin therapeutic concentration targeting range. Therefore, this dosing regimen
can be safely applied in neonates. A larger study with bigger sample size involvement of multicentre is required to confirm the statistical significance of our findings.
Keywords: gentamicin, neonates, dosing regimen, gentamicin concentration, therapeutic range
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC22:
ASSESSMENT OF ADHERENCE TO STANDARD TREATMENT
GUIDELINES FOR MANAGEMENT OF HEART FAILURE PATIENTS IN
PENANG HOSPITAL
S.A Sherene Tan1, P.Y. Siew 1, P.L. Kee1, H.Y. Tan 1, H.M. Teh1 , W.S. Choo 2
1Pharmacy Department, 2Cardiology Department, Penang Hospital, Penang.
INTRODUCTION: ACE-I, ARB, beta-blockers and spironolactone were recommended by clinical
practice guidelines due to their benefits of improving survival whereas digoxin was recommended
for its benefits of reducing hospitalizations. Despite these, studies conducted in Europe, America
and Israel consistently suggested that there was a suboptimal utilization of these medications.
OBJECTIVES: To assess the adherence of management among heart failure patients to Malaysia
Heart Failure Clinical Practice Guidelines 2007 in Penang Hospital. METHOD: 92 patients admitted
to cardiology wards due to heart failure were recruited in this observational cohort study
conducted in April to December 2009. Patients’ baseline characteristics and discharge medications
were recorded in a data collection form. A patient registry was created and the results analysed
using the SPSS version 13.0 program. RESULTS: The mean age of patients was 63 ± 11.2 years,
(male 54% and female 46%). 76% and 83% patients were prescribed an ACEI/ARB and beta-blocker
upon discharge respectively. The remaining patients were not prescribed ACEI/ARB mainly due to
renal impairment and hypotension. For beta-blockers, the reasons were mainly due to hypotension
and asthma. 74.1% of patients with LVEF < 40% were prescribed spironolactone (p < 0.001).
Spironolactone was prescribed to patients according to increasing NYHA class I to IV; 25% in class I,
37.8% in class II, 41.4% in class III and 50% in class IV (p = 0.956). 32.6% patients were discharged
with digoxin with increased usage with increasing NYHA class II to IV (p = 0.064); 24.4% in class II,
41.4% in class III and 100% in class IV. CONCLUSION: ACEI/ARBs and beta-blockers in Penang
Hospital were well utilized. Although spironolactone and digoxin were prescribed in accordance to
treatment guidelines, results obtained were insignificant due to limitations of the study. Thus, the
adherence to the guidelines of these two medications remains inconclusive.
Keywords: heart failure, adherence, ACEI/ARB
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC23: THE IMPACT OF ADHERENCE TO CLOPIDOGREL: THE EVALUATION
OF REHOSPITALIZATION INCIDENCE AMONG PATIENTS RECEIVING
ONE-YEAR THERAPY FOR CARDIOVASCULAR EVENTS IN HOSPITAL
SULTANAH BAHIYAH
H.K. Chan, N. Farah Aina, Y. Faridah, H. Khairiah, S. Noor Amalia
Pharmacy Department, Hospital Sultanah Bahiyah, Alor Star
INTRODUCTION: Clopidogrel is indicated to prevent cardiovascular events as recommended by
Malaysian Clinical Practice Guideline of Unstable Angina and NSTEMI (2002) and STEMI (2007).
Patients receiving one-year therapy of clopidogrel In Hospital Sultanah Bahiyah, will only be
supplied for the first 28 days and will get the subsequent refills from the private pharmacy for the
next 48 weeks. Hence, adherence of patients is totally dependent on their own knowledge and selfmotivation level without further intervention from the hospital pharmacists. OBJECTIVES: This
study was to assess the association of rehospitalization incidence due to Acute Coronary Syndrome
(ACS) within one year after the initiation of therapy with the motivation and knowledge levels
among patients receiving clopidogrel for one year in Hospital Sultanah Bahiyah. Also to identify the
factors associated with both the motivation and knowledge levels of the patients. METHOD: A
cross-sectional study was conducted through a telephone interview to assess the motivation and
knowledge level of 185 patients (N=232) warded during 1/8/2008-31/12/2008 and receiving oneyear therapy of clopidogrel by using a Modified Morisky Scale (MMS) validated by Case Management
Society of America (CMSA) in 2004. Hospitalization history and baseline characteristics of patients
were studied using e-HIS (Electronic Hospital Information System) in Hospital Sultanah Bahiyah.
RESULTS: From 185 interviewed patients, 35.5% (66) were identified to be with low motivation
level and 39.5% (73) with low knowledge level. The findings showed that both the low motivation
and low knowledge levels were associated with higher incidence of rehospitalization (p<0.0001).
However, there was no association between the tested patients’ characteristics and their
motivation or knowledge level (p>0.05) including age, gender, ethnic group, cigarette smoking and
indication for clopidogrel. CONCLUSION: This study was found to support pharmacist’s future role
to educate patients in taking clopidogrel irrespective of patients’ characteristics. Larger and longer
trials may be conducted to assess the relationship between the patient’s adherence to clopidogrel
and the clinical outcomes.
Keywords: unstable angina, clopidogrel, Acute Coronary Syndrome
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OC24:
DRUG USE EVALUATION OF INDOMETHACIN FOR PATENT DUCTUS
ARTERIOSUS (PDA) PROPHYLAXIS IN PREMATURE INFANTS IN
NICU, SELAYANG HOSPITAL
M.A. Norliza, L.F. Elaine, Z. Puteri Juanita, B.K. Law, S. Shamsiah, H. Halmy
Pharmacy Department, Selayang Hospital
INTRODUCTION: Premature neonates with patent ductus arteriosus (PDA) are at increased risk of
severe
and
prolonged
respiratory
distress
syndrome,
intraventricular
haemorrhage,
bronchopulmonary dysplasia and death. Prophylactic intravenous indomethacin use in extremely
low birth weight neonates attempts to improve clinical outcomes. OBJECTIVES: To evaluate the
use of intravenous indomethacin administration and to observe the clinical outcomes. METHOD: All
patients prescribed with intravenous indomethacin for PDA prophylaxis from August 2008 to May
2009 were selected. Drug utilisation study was assessed in this study group based on three main
criteria which were set according to the protocol; justifications of the drug being prescribed,
process indicators and outcome indicators. RESULTS: A total of 52 premature neonates were
prescribed with indomethacin for PDA prophylaxis during the study period. We observed all subject
were prescribed with prophylactic intravenous indomethacin according to the approved indications
from the protocol. Slightly more than half of the study group were given the prophylactic dose
within 2 to 6 hour of life (54%, n=28); twelve hourly renal profile were monitored (58%, n=30);
dosing of 0.1mg/kg of body weight (86%, n=45) and completion of three doses (82%, n=43). In
reviewing the clinical outcome, 86% (n=44) had not experienced any of adverse drug reactions and
88% (n=46) had absence of clinical patent ductus arteriosus. CONCLUSION: The use of prophylactic
indomethacin for PDA closure is justified. Regular surveillance on indomethacin use in NICU should
be done in order to improve adherence in accordance to the protocol.
Keywords: premature neonates, patent ductus arteriosus (PDA), intravenous indomethacin
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
ORAL PRESENTATIONS
PHARMACY PRACTICE
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP1:
ANTIBIOTIC AUDIT ON PRESCRIBING OF ANTIBIOTICS IN
COMMUNITY ACQUIRED PNEUMONIA AND HOSPITAL ACQUIRED
PNEUMONIA IN INPATIENT SETTING AT HOSPITAL TENGKU
AMPUAN AFZAN
I. Penwalla Nazia, P.P. Ooi, A.R. Maryam, W.R. Choy, W.C. Leong, M. Rozita
Pharmacy Department,Hospital Tengku Ampuan Afzan
INTRODUCTION: Infection is one of the major principle causes of admission to Hospital Tengku
Ampuan Afzan (HTAA) over the past years. Accordingly, various antibiotics had been widely
prescribed to treat these infections bringing about antibiotic-resistant organisms. Thus, two valid
antibiotic guidelines namely the HTAA Guide to Antimicrobial Therapy 2004 and the National
Antibiotic Guidelines 2008 are made available to ensure antibiotics are prescribed appropriately for
the specific indications. OBJECTIVES: The study was conducted to determine whether the
prescribing of antibiotics in Community Acquired Pneumonia (CAP) and Hospital Acquired
Pneumonia (HAP) cases were in line with the two antibiotic guidelines. METHOD: A prospective,
single-centered based antibiotic audit was conducted from 1 st April 2009 to 30th April 2009 focusing
into CAP and HAP cases admitted in all adult medical wards and the Intensive Care Unit of HTAA.
The four major criteria outlined to determine the degree of compliance in prescribing of antibiotics
were choice of antibiotic, dose, frequency and duration. RESULTS: A total of 84 pneumonia cases
were identified whereby prescribers showed 83.3% compliance to guidelines in terms of the choice
of antibiotic prescribed. On the other hand, only 44% compliance was seen in terms of antibiotic
prescribing for an ideal duration of 7 days. For the dose and frequency criteria, a compliance of
95.2% was observed. CONCLUSION: As an average of all the four criteria, 79.4% overall compliance
to the available guidelines was observed. The recommendations in the National Antibiotic
Guidelines were better adhered compared to the HTAA Guidelines with the combination of
Amoxycillin-Clavulanate and Erythromycin Ethyl Succinate being the most popular combination
prescribed for CAP.
Keyword: Antibiotics,Community Acquired Pneumonia(CAP),Hospital Acquired Pneumonia (HAP), Guidelines
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP2:
MEDICAL AND ECONOMICS OUTCOMES OF COMMUNITYACQUIRED PNEUMONIA PATIENTS IN HOSPITAL SERI MANJUNG
J. M. Tan, Y. J. Hu, M.A. Zuraida, S.T. Ee
Pharmacy Department, Hospital Seri Manjung
INTRODUCTION: The National Antibiotic Guidelines has been published for the empirical treatment
of community-acquired pneumonia (CAP). Past studies have shown that adherence to treatment
guidelines improves prognosis of CAP, reduces the need of hospitalisation, and shortens length of
hospitalisation. Nevertheless, there are limited findings on the effect of adherence on costs.
OBJECTIVES: To assess the following factors: (1) the adherence to the published guidelines; (2) the
influence of adhering to the guidelines on the length of stay (LOS) and antibiotics cost in Hospital
Seri Manjung (HSM); (3) time of initiation of antibiotic treatment; and (4) the effect of antibiotic
initiation time on LOS and antibiotics cost. METHOD: Patients were categorized according to the
prognostic rule of Fine et al (1997), and the initial empirical antibiotic regime was evaluated as to
whether it adhered or not to the treatment guidelines. Time taken for the initiation of empiric
therapy were divided into 2 categories, i.e. antibiotic time (Ab time) ≤ 1 hour and Abtime > 1 hour.
RESULTS: Costs of antibiotics were significantly reduced (P = 0.023) when antibiotics guideline
were adhered to in risk class III. However, there were no significant differences in antibiotics cost
in other risk classes. Rapid antibiotics regime initiation (Ab time ≤ I hour) led to significant reduction
in total antibiotics cost in risk class IV (P = 0.015) but not in other risk classes. LOS was neither
significantly affected by adherence to guidelines and time of initiation of antibiotic therapy.
CONCLUSION: The present retrospective study found that guideline adherence and timely
antibiotics initiation reduced antibiotics cost only in risk class III and IV respectively. LOS was only
reduced by rapid antibiotics treatment initiation in risk class I while effects of guidelines
adherence on LOS were not noticeable in this study.
Keyword: Community-acquired pneumonia, guideline, antibiotic
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP3:
PATIENT MEDICATION RETURN STUDY: PROBING INTO THE ISSUE
OF EXCESSIVE SUPPLY IN PUTRAJAYA HOSPITAL USING
COMPUTERIZED PHYSICIAN ORDER ENTRY
E.H. Madeline Leong, M.W. Ching
Pharmacy Department, Putrajaya Hospital
INTRODUCTION: Medication wastage is now a concern to the health care system because of its
enormous cost. The cost of medication wastage in 2007 was estimated to be £6-8 million in United
Kingdom. A study done in 2008 in Putrajaya hospital showed that the main contributing factor to
medication wastage was due to excessive supply. OBJECTIVES: (1) To investigate the reasons of
medication being supplied excessively to patient (2) To investigate the contributing factors to
excessive supply (3) To recommend remedial action to reduce medication wastages. METHOD: This
cross-sectional study was carried out retrospectively in Putrajaya Hospital. A total of 41 patients
who returned medication to the pharmacy due to excessive supply from 2006-2008 were included in
this study. Patient’s Electronic Medical Records (EMR) and Pharmacy Information System (PIS) were
reviewed to investigate the cause of medications being supplied excessively to the patients. SPSS
was used to analyze the data collected. RESULTS: Reasons of excessive supply included excessive
order (57%, n=31), hospitalization prior to next appointment (TCA) (28%, n=15), duplicate orders
from multiple disciplines (6%, n=3) and medications prescribed as ‘as needed basis’ (8%, n=5). Most
patients (69.4%) received prescription with excessive duration of 1 month or less. There was no
correlation between the duration of TCA and the number of prescription being ordered excessively
(p=0.053). There was no correlation (p>0.05) between the length of TCA and hospitalization prior
to next appointment. CONCLUSION: Incorporation of additional elements in the existing computer
system which include patient’s TCA, prohibition of medication being prescribed more than TCA
duration as well as detection of duplicate prescription is recommended to reduce the extent of this
problem.
Keywords: medication wastage, cost, excessive supply, excessive order
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP4:
ROLE OF PHARMACISTS IN PREVENTING PRESCRIPTION ERRORS IN
HOSPITALISED PATIENTS THAT IS USING A COMPUTERISED
PHYSICIAN ORDER ENTRY (CPOE)
A.H. Sivapatham, C.C. See
Pharmacy Department, Putrajaya Hospital
INTRODUCTION: Computerised Physician Order Entry (CPOE) can eliminate problems in manual
prescribing by reducing the occurrence of illegible orders, inappropriate doses and incomplete
orders. Gandhi in his study mentioned that medication ordering errors among inpatients are
common and it is occurring as high as 1.5-5.3 per 100 orders. This however can be prevented by
CPOE. OBJECTIVES: (1) To determine the incidence and type of prescription errors in CPOE. (2) To
determine
the
percentage
of
pharmacist-prescriber
intervention
for
prescription
error
confirmation. METHOD: A cross-sectional retrospective study was done from 1 February 2009 to 30
April 2009 in the In-Patient Pharmacy Department, Putrajaya Hospital. All CPOE prescriptions
received through the Pharmacy Information System (PIS) during the study period were included.
Each prescription was then manually screened and any prescription error detected was
differentiated into four main groups according to a classification used in Neville’s study. The four
main groups were Type A: potentially serious to patients, Type B: major nuisance to both
pharmacist and prescriber, Type C: minor nuisance to both pharmacist and prescriber and Type D:
trivial matter. Type A, Type B and Type C needed pharmacist-prescriber intervention for
prescription confirmation. RESULTS: Of a total of 8619 prescriptions received during the study
period, only 512 (5.94%) were detected to contain prescription error. Type B error recorded the
highest incidence with 480 (93.8%) out of the total detected prescription errors. This is then
followed by Type C error with 13 (2.5%), Type A error with 12 (2.3%) and lastly, Type D error with 7
(1.4%). From the results above, 505 (98.5%) of the detected prescription error needed pharmacistprescriber intervention for confirmation. CONCLUSION: Even with the CPOE system, pharmacists
had detected prescription errors and the majority of these prescription errors, intervention
between pharmacist-prescriber is needed for prescription confirmation.
Keywords: computerized prescribing, pharmacist, prescription error, medication error
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP5:
INTERVENTION OF NEAR WRONGLY DISPENSED MEDICATIONS VIA
‘UNIT OF USE’ PRESCRIPTION IN HOSPITAL PAKAR SULTANAH
FATIMAH MUAR
N. Abd Kadir, H. S. Tan, B. Noor Azwin, J. S. Low, W. S. Lee, A. Md Lassim
Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor
INTRODUCTION: In Hospital Pakar Sultanah Fatimah, near wrongly dispensed medications via ‘Unit
of Use’ (UOU) prescription is one of the common problems in the in-patient pharmacy.
OBJECTIVES: The study was to measure the incidence of near wrongly dispensed medications via
‘UOU’ prescriptions at ward supply pharmacy; identify the contributing factors to the near wrongly
dispensed medications and to determine if remedial action taken able to reduce the near wrongly
dispensed medication. METHOD: A prospective cross-sectional study was carried out from May to
August 2009 at In-Patient Pharmacy. The checking of UOU medication cassettes was performed by
pharmacists to identify dispensing errors before supplying to the wards. The contributing factors
were identified through questionnaire and survey. Remedial actions were taken from June to
August 2009 by improving the labelling and filling work areas, strengthening the counterchecking
process, continous education to pharmacy staff and nurses, developing procedures of intervention
and written work process. RESULTS: In May 2009, pharmacists detected 33 errors (0.11 %) for a
total of 29,014 UOU prescription received. The most common error were incorrect type of drug
(n=20, 60.6%), drug strength (n=7, 21.2%), drug label (n=4, 12.1%) and drug quantity (n=2, 6.1%).
Factors contributing to errors were confused arrangement of medications (67%), similar physical
appearance of medications (53%) and uncomfortable working environment (6%). After the remedial
actions taken, the percentages of errors were 0.07%, 0.06% and 0.02% for the month of June, July
and August respectively. CONCLUSION: Although 33 (0.11%) errors were detected in May 2009, it
was reduced to 0.02% after conributing factors were identified and addressed. However, there is
still room for improvement as the Ministry of Health sets zero error for all dispensed medications.
Keyword:
Medication
error,
Unit
of
Use,
intervention,
near
wrongly
dispensed
medications.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP6:
PATIENTS’ COMPLIANCE AND KNOWLEDGE TOWARDS DIABETIC
MEDICATION
AND
DISEASE
IN
MEDICAL
OUTPATIENT
DEPARTMENT, HOSPITAL SERI MANJUNG
W.L. Lim, I. Rokiah, A. Azlinda
Pharmacy Department, Seri Manjung
INTRODUCTION: The socioeconomic implications of diabetes are alarming and therefore,
prevention of diabetes and its complication would be a major challenge. Insufficient knowledge
and non-adherence among diabetic patients often lead to poor self-management skills.
OBJECTIVES: This study was carried out to determine knowledge on diabetes, its medication; and
adherence to oral hypoglycemic agents among patients follows up in Medical Outpatient
Department (MOPD) in Hospital Seri Manjung (HSM). METHOD: A cross-sectional study involving 34
diabetic patients aged 18-year-old and above was carried out in MOPD, HSM from July to August
2009. A questionnaire adapted from DKQ-24 was used as a guide during the interview and data
were collected and analyzed. RESULTS: The respondents enrolled in this study were 60.5 (±9.0)
years old. The mean score for DKQ-24 was 51.2 marks and there were only 29.4% of the
respondents who complied to their medications. Significant differences (Pearson x 2 = 14.193, df=4,
p=0.007) were found between patients with different duration of being diabetic with DKQ-24
grade; and between respondents’ educational levels with DKQ-24 grade (Pearson correlation =
0.457, p=0.007). Besides, there was significant relationship between adherence to oral
hypoglycemic agents with HbA1c control (Pearson correlation=0.366, p=0.033). CONCLUSION:
There was no association between diabetes knowledge and HbA1c control but patients with higher
adherence to oral hypoglycemic agents had better HbA1c control.
Keyword: Diabetic, questionnaires, adherence to medication
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP7 :
PHARMACIST MANAGED BREAST CANCER PATIENTS IN HOSPITAL
MELAKA: ASSESSING THE IMPORTANCE OF PRE-CHEMOTHERAPY
EDUCATION IN PATIENT CARE.
S.S. Lai1, C.F. Low1, A. Mardhiah, C.C. Dang
Department of Pharmacy, Hospital Melaka.
INTRODUCTION: Pre-chemotherapy education is important as patients are often not satisfied with
the information they received, as they tend to forget or misunderstand the information they
received. OBJECTIVES: The study was to assess the effectiveness of pre-chemotherapy counseling
for breast cancer patients in Hospital Melaka. Other objectives includes to determine demographic
relationship with knowledge, assessing patients’ adherence towards their chemotherapy
appointment date, determining patient’s ability to recall the information after being counseled and
finally to determine impact of pharmacist role in pre-chemotherapy education. METHOD: A
prospective, single-centered study was conducted from January 2009 to Jun 2009 at Day Care
Centre (DCC) Hospital Melaka. A total of 38 breast cancer patients were randomised into either
study or control group and were interviewed using a structured questionnaire. RESULTS: Compared
to the control group, patients who were counseled by the pharmacists had better knowledge and
understanding of their chemotherapy side effects (p< 0.05, CI= (0.115, 3.004). In addition they
were able to recall the information at the sixth cycle and had better knowledge compared to the
control group (p<0.05, CI= (0.014, 2.377). The knowledge scores of the patients (p<0.05) were
affected by the patients education level. Pharmacist counseling to the patients did not affect
patients’ adherence to chemotherapy as the adherence level was similar for both groups. Despite
pharmacist’s counseling session, 17% of the patients were still unaware and unable to identify
pharmacists as the source of information. CONCLUSION: In short the study has shown that prechemotherapy education improves patient’s knowledge and abilities to recall the information on
their chemotherapy. Pharmacist plays a crucial role in educating patients for their chemotherapy
treatment.
Keyword: Pre-chemotherapy education, pharmacist, counseling, breast cancer
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP8:
MEDICATION ERRORS AT OUTPATIENT PHARMACY, HOSPITAL SLIM
RIVER
P.C Doreen Yap, H.Y. Wong, P.L. Chuah
Pharmacy Department, Slim River Hospital
INTRODUCTION: Medication errors can lead to patient mortality and morbidity. Medication errors
must not be overlooked and systematic procedures for screening, dispensing and counseling
medications should be established to prevent medications errors. OBJECTIVES: To identify the
magnitude and types of medication errors at outpatient pharmacy, Hospital Slim River. METHOD:
This study was conducted at outpatient pharmacy from July-December 2009 and we performed a
prospective analysis. Prescriptions were screened by pharmacist concurrent with a questionnaire
survey to assess the patient knowledge and compliance on medication regimen. RESULTS: From a
total of 12315 prescriptions screened by the pharmacists, 1352 (11.0%) prescriptions were detected
to contain at least one or more medication errors. A total of 1818 different errors were identified
in the 1352 prescriptions giving an average of 1.3 errors per prescription. Overall, prescribing error
was recorded to be the highest (45%) which include inappropriate drug selection, drug dose, dosage
form and illegible handwriting. This was followed by compliance error (11%), wrong time error
(10%), administration technique error (7%), route of administration error (5%) and other medication
errors (22%). CONCLUSION: Medication errors are the contributing factors for preventable adverse
drugs effects, strategies to improve procedure of pharmacist screening, dispensing and counseling
had to be established to reduce medication errors and to improve patient quality of life. In the
future, pharmacist can implement a plan to prevent the occurrence of medication errors through
detection and evaluation.
Keyword: Medication errors, adverse drugs effect
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP9:
A PILOT STUDY: ASSESSMENT OF PATIENT MEDICATION
ADHERENCE IN GOVERNMENT HEALTH CLINICS OF KUALA
LUMPUR
C.H. Yong, W.Y. Tew, M.K. Tan, S.W. Lai, P.J. Yew, S.H. Gan, P.L.Tan, W.M.Yip
Pharmaceutical Service Division, Health Department of Federal Territories of Kuala Lumpur & Putrajaya
INTRODUCTION: Non-adherence to medications remains a persistent problem for patients. In
recent years, the increased number of pharmacists in government health clinics has improved
medication counseling services. Nevertheless, there is limited local information on the impact of
pharmacists’ counseling in medication adherence. OBJECTIVES: This study was to assess patient
adherence to medications before and after medication counseling was done by pharmacists and to
determine association of medication adherence with the demographic data. METHOD: A
prospective, multi-centred, longitudinal study was conducted from April 2009 to August 2009 at 12
government Health Clinics of Kuala Lumpur. This study recruited 523 patients but only 422 patients
completed the survey. Patients aged 58±10 years old who were taking 5 to 7 chronic medications
were assessed by using Modified Morisky Scale to determine patient medication adherence level
after pharmacists counseling sessions. RESULTS: This study has shown that the patients have
achieved significant medication adherence improvement (p<0.01)
p<0.01) and third visit
in second (Z=-15.86, N=349,
(Z=-10.14, N=381, p<0.01) compared with the first visit medication
adherence assessment. In addition, patients’ medication adherence has shown significant
association with age (p= 0.031, r=-0.11), patient education level (p=0.03, r=0.104) and total
number of medications taken by the patients (p=0.026, r= 0.109). During the first visit, patients
who have been counseled by the pharmacist have shown better medication adherence level
compared with those who were not counseled (Z=-2.784, p=0.05). CONCLUSION: This study has
shown that patient medication adherence has improved after pharmacist counseling sessions.
Furthermore, pharmacists should take into account the age, patient education level and the
number of medications as these factors affects their medication adherence.
Keyword: pharmacists, counseling, adherence
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP10: THE UNDERSTANDING OF INSTRUCTIONS ON PRESCRIPTION DRUG
LABELS
A.S. Abdul Munis, N.M. Nik Mah, T.H. Pin
Pharmacy Department, Tuanku Fauziah Hospital
INTRODUCTION: Health literacy has been increasingly viewed as a patient safety issue and may
contribute to medication errors. OBJECTIVES: This study was conducted to determine the
understanding of patients’ and Person Accompany Patient- PAPs’ towards the instructions found on
envelope labels of common prescription medications and the instruction format that has been using
at HTF. METHOD:
The Cross-sectional study and the structured interviews were done at Out
Patients Department (Pharmacy) and in wards Hospital Tuanku Fauziah, Perlis on June 2009.By
using Convenience Sampling, study involved with 125 subjects but only 118 Malay-speaking patients
consent to take participate. Evaluation of the correct understanding of instructions on 6 envelope
labels including demonstration of label’s dosage instructions was done. Patient literacy was
assessed by using the Rapid Estimate of Adult Literacy in Medicine (REALM), a reading recognition
test comprising 66 health-related words. All statistical analyses were performed by using SPSS
software, version 16.0. RESULTS: Correct understandings of the 6 labels were ranged from 12.7 %
to 85.6 %. The correct instruction of taking drug on the envelopes showed a result ranged from 61.0
% to 99.2 %. The correct time and method of taking the drug were ranged from 58.5 – 98.3 % and
50.8 – 95.8%. A low literacy level (0-18 scores) was found to be 12.7%. The level of moderate and
high literacy level were 48.3 % and 33.1 %, respectively. The literacy level was statistically
significant associated with the understanding of instruction labels (p <0.005). Respondents’ reading
at or below the fourth-grade level (low literacy) were not able to understand all 6 label
instructions. Only 42.4 % of respondents had attentiveness to the auxiliary label on the envelopes.
CONCLUSION: The literacy and the format of instruction were factors that affect the understanding
the instructions on prescription medication labels.
Keywords: Literacy, Understanding, Instruction, Label
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP11:
IMPROVING
PATIENTS’
COMPLIANCE
TO
THROUGH CARDIAC REHABILITATION PROGRAMME
MEDICATIONS
J.L. Ong, M.Y. Noorsidah, H. Normi, C.S. Wong
Pharmacy Department, Seri Manjung Hospital
INTRODUCTION: Coronary heart disease (CHD) has lead to worldwide health burden associated
with high mortality and morbidity rate. Cardiac Rehabilitation Programme (CRP) is recognized as
essential part of comprehensive care in CHD patients and has been shown to improve physical
health and reduce the mortality and morbidity rate. OBJECTIVES: Various studies have been
conducted to determine the beneficial effects of Cardiac Rehabilitation Programme (CRP) but most
of the studies focused on the outcomes such as exercise tolerance, reduction in cardiac risk factor,
psychological well being as well as health-related quality of life. Limited studies were carried out
to determine the effectiveness of CRP towards enhancing medication compliance among CHD
patients. This study was conducted to determine the association between CRP and medication
compliance among CHD patients. METHOD: A pre-study was conducted on 23 patients admitted to
Medical Wards from January to August 2009 in Hospital Seri Manjung due to acute myocardial
infarction, unstable angina and NSTEMI. They were interviewed using a validated questionnaire to
evaluate medication compliance, their knowledge on CHD and medication. Post-intervention study
was carried out at the out-patient pharmacy. RESULTS: Most patients were between the age range
of 46-55 (34.8%) and 56-65 (34.8%), male patients predominates (91.3%), and majority are Malay
patients (43.5%). Study demonstrated that degree of compliance in CHD patients had improved
after CRP, in which the number of patients in ‘compliant’ category (based on Morisky scale) had
increased from 21.7% to 43.5%. Percentage of patients getting more than 80% scores for the
knowledge on indications, doses and frequencies of their medications increased from 34.8% to
47.8%. 17 (73.9%) patients had an improved blood pressure reading after CRP. CONCLUSION: In
conclusion, patients who undergo CRP did have better compliance profile as well as their
knowledge on CHD and medications compared with the results before CRP.
Keyword: Medication compliance, cardiac rehabilitation programme, knowledge on medication
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP12:
COST ANALYSIS OF ANTIBIOTICS IN PATIENTS WITH DOSAGES
ADJUSTED FOR RENAL FUNCTION IN ICU, HOSPITAL RAJA
PEREMPUAN ZAINAB II
K.Y. Wong, M.N Nik Afzan Iftitah, E. L. Lim.
Pharmacy Department, Hospital Raja Perempuan Zainab II Kota Bharu
INTRODUCTION: Patients admitted to the Intensive Care Unit (ICU) are frequently treated with
antibiotics and for renal failure patients, some of the antibiotics need dosage adjustment.
Antibiotic prescribing without dosage adjustment is indirectly associated with increased costs of
medical care, high incidence of treatment failure and adverse events. Therefore, using an optimal
course of antibiotics can be effective and economical. OBJECTIVES: To determine the cost saved
through pharmacist’s intervention in dosage adjustment for renal failure patients. METHOD: A
cross-sectional study was conducted in the ICU of HRPZ II from January to June 2009. Patients with
estimated creatinine clearance value of 50 ml/min or less and were on antibiotic were included in
the study. Patient’s data were collected using a data collection form. A paired t-test was done
using Minitab with a confidence interval of 95%. RESULTS: Out of 352 patients, 37 patients (24.1%)
with antibiotics adjusted according to their renal function were studied. The most adjusted
antibiotics were Meropenem (44%), followed by Piperacillin/Tazobactam (14.6%), Fluconazole
(14.6%), and Ciprofloxacin (10%). The commonest cost saved for antibiotic dosage adjustments
were Meropenem, RM2618.73 (62%); Piperacillin/Tazobactam, RM466.70 (11%); Fluconazole,
RM429.93 (10%); and Ciprofloxacin, RM308.00 (7%). The total cost saved for antibiotics in the 37
patients were RM4234, accounting 50.78% of the overall cost of antibiotics used (p<0.13).
CONCLUSION: This study shows that dosage adjustments for renal failure patients results in
substantial reduction of inappropriate drug regimens and also medical expenditure. Therefore,
pharmacists can play a significant role in implementing immediate and direct feedback strategy in
the ward.
Keywords: Antibiotics, Intensive Care Unit, dosage adjustment, renal failure.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP13:
COMPARISON OF THE COMPLIANCE TOWARDS ANTIHYPERTENSIVE
MEDICATIONS IN PATIENTS WITH CARDIOVASCULAR DISEASES
USING MEMORY PAC VERSUS CONVENTIONAL PILL ENVELOPE AT
HOSPITAL SULTAN ABDUL HALIM
C.W. Ng, R. Datcayani, N.A. Md. Sakre
Pharmacy Department ,Hospital Sultan Abdul Halim , Sungai Petani, Kedah
INTRODUCTION: Poor compliance to medication regimens accounts for substantial worsening of
disease and increased healthcare costs. However, the use of medication packing system can
improve
medication
compliance.
OBJECTIVES:
To
compare
the
compliance
towards
antihypertensive medications in patients with cardiovascular diseases using Memory Pac versus
conventional pill envelope in Hospital Sultan Abdul Halim (HSAH). METHOD:
A prospective,
intervention study was conducted between December 2008 and May 2009. Sixty outpatients with
cardiovascular disease aging more than 30 years old and prescribed with more than 4 medications
were selected using the convenient sampling method. During the 1 st visit,30 patients were given
medication in the conventional pill envelope (control group), while another 30 were given the
Memory Pac (subject group). During the 2nd visit, each patient’s compliance level was evaluated
using a scale formulated from a combination of 3 compliance assessing methods (Morisky scale, pill
count, blood pressure measurement). From the 2nd visit, non-compliant patients from the control
group were then considered as subject-control group and given medication in Memory Pac with
their compliance reevaluated during the 3rd visit. RESULTS: 90% patients (n=30) in the subject
group were compliant, while 20% patients (n=30) in the control group were compliant. Overall
compliance rate between subject group and control group was statistically significant (p <0.05). In
the subject-control group, 83.3% were found to be compliant, 4.2% were non-compliant while
12.5% patients dropped out from the study. CONCLUSION: Patient’s medication compliance was
significantly improved using Memory Pac compared to conventional pill envelope. However, it is
necessary to conduct further research on the cost-effectiveness of using Memory Pac.
Keyword: compliance, antihypertensive, Memory Pac.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP14: METHADONE DEFAULTER SURVEY AT METHADONE CLINIC HOSPITAL
TENGKU AMPUAN AFZAN
P.W. Chua, E.W. Kwan, J.E. Quah, R. Aida Roziana
Pharmacy Department, Hospital Tengku Ampuan Afzan, Kuantan
INTRODUCTION: Methadone is the most widely prescribed form of long acting oral replacement
therapy to treat opiod addiction. The objective of Methadone maintenance treatment is to manage
opiod dependence and reduce illicit drug use. The problem arises as the patient defaults the
treatment and tends to relapse to illicit drug use. OBJECTIVES: This study was to identify the
possible reasons of default among methadone clients and to compare the retention rate between
Jan-May 2008 and Jan-May 2009 after the commencement of new interventions. METHOD: A
retrospective study was conducted by using the survey forms to obtain information from the
clients’ case notes from January to May 2009 at Methadone Clinic. 200 methadone clients under
follow up of methadone clinic with Registration Number: C120001 to C120200 were recruited. The
new interventions which were conducted in January 2009 including flexible dispensing hours,
regular counselling, home visit and no witholding after positive urine test. Statistical evaluations
were conducted using Chi-square test. RESULTS: Quit voluntarily was the main reason of default
among the 76 clients (37.8%). In Jan-May 2008, the retention rate was 64%. After the
commencement of new interventions, the retention rate in Jan-May 2009 was improved to 66%.
Flexible
dispensing
hours
[χ2
(1,N=200)=5.271,
p<0.05]
and
regular
counseling
[χ 2
(1,N=200)=27.501, p<0.05] significantly improved the retention rate. However, home visit [χ 2
(1,N=200)=15.873, p<0.05] significantly reduce the retention rate. No withholding of methadone
dose after positive urine test [χ2 (2,N=200)=2.522, p>0.05] showed no benefits in improving
retention rate. CONCLUSION: The reasons of default among the clients were identified. The
retention rate of Jan-May 2009 was improved compared to Jan-May 2008 after the commencement
of new interventions. Flexible dispensing hours and regular counselling were shown to improve the
retention rate. Further studies are required to establish the effectiveness of no witholding after
positive urine test and home visit in improving the retention rate.
Keyword: methadone, defaulter, retention rate
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP15: INR OUTCOMES AND SATISFACTION OF PHARMACIST MANAGED
WARFARINISED ATRIAL FIBRILLATION PATIENTS STUDY
M.S. Siti Jamiza, N.L. Foo, T. Subramaniam, J. Nirmala, S.H. Chong.
Pharmacy Department , Kuala Lumpur Hospital
INTRODUCTION: It has been established that pharmacist-managed anticoagulation services can
prevent warfarin-related hospital admissions and improve the overall quality of patient care.
Several studies showed that patient education by pharmacists in clinics has improved patients'
understanding of their anticoagulation therapy and probably increased patient compliance.
OBJECTIVES: To measure the outcome of Warfarin Medication Therapy Adherence Clinic (WMTAC)
in terms of International Normalized Ratio (INR) target achievement and to identify patient’s
satisfaction towards overall pharmacist managed warfarin clinic. METHOD: An observational study
was conducted at WMTAC, Hospital Kuala Lumpur (HKL) from February 2009 until July 2009. Atrial
fibrillation patients, eighteen years old and above, patients who have kept to the scheduled
appointment, and patients with at least four INR readings were included. Data was collected from
patients’ file and warfarin book. A validated Likert Scale based questionnaire was used to assess
the patient’s satisfaction towards WMTAC. Analyses of the data were performed using Microsoft
Excel 2007 and Statistical Package for Social Scientist (SPSS) Version 16.0. RESULTS: A total of 174
patients who met the inclusion criteria were enrolled in the study. There was a 16% increased in
the number of patients falling within the targeted INR range (2-3) as compared to an earlier study
done in 2008 at HKL. 93.7% (n=163) of the patients completed the WMTAC satisfaction
questionnaire. Most patients (90%) were satisfied with WMTAC services. CONCLUSION: Pharmacist
managed anticoagulation clinic is able to provide better anticoagulant management and most
patients were satisfied with the services provided.
Keyword: WMTAC, INR, satisfaction, warfarin
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP16:
MEDICATION ERROR: INCIDENCE OF ORAL MEDICATION
ADMINISTRATION ERRORS IN MEDICAL AND SURGICAL WARDS IN
HOSPITAL MELAKA
W.C. Tan, M.T. Nur Hidayah, Y. Noorazlinda, L.K. Teo
Pharmacy Department, Malacca Hospital
INTRODUCTION: The National Coordinating Council for Medication Error and Prevention defines a
medication error as any preventable event that may cause or lead to inappropriate medication use
or patient harm, while the medication is in the control of the health care professional, patient, or
consumer. Prescribing errors can still be intercepted but not the administration stage. Thus,
medication administration process is a priority area for quality improvement. OBJECTIVES: The
objectives of this study are to study the prevalence of medication administration error (MAE) in
medical and surgical ward in Hospital Melaka, to identify the type of drugs with the highest
number of errors, to identify contributing factors for administration errors and to recommend
preventive measures to minimise medication errors. METHOD: A prospective disguised directobservation technique was used whereby the nurses have been aware of the observation but
unaware of its true purpose. Two medical wards and two surgical wards were involved in the study.
All nurses (56) in the studied wards were asked to participate in a survey to identify the
contributing factors and preventive measures. RESULTS: The error rate with timing errors for
medical ward is 28.7% [95% CI 24.1–33.3] while surgical ward is 6.7%. [95% CI 4.4–9.0]. There is
statistically difference for errors with or without timing error in medical and surgical wards
(p=0.003). The class of drugs associated with the highest number of errors is cardiovascular drugs,
53 out of 180 errors (29.4%). The main contributing factors for MAE include high workload (83.9%),
work environment (7.2%) and ethical problems (7.2%). Preventive measures to minimise MAE are to
increase number of staff nurses in the ward (51.8%) and to develop Standard Practice Guidelines
for oral medications (46.4%).CONCLUSION: Medical wards have higher prevalence of errors
compared to surgical wards and Department of Pharmacy will develop Standard Practice Guidelines
for administration of oral medications to minimise MAE.
Keywords: Medication errors, oral medication, direct-observation technique
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP17:
ANTIBIOTIC AUDIT ON THE USAGE OF ANTIBIOTICS IN SURGICAL
PROPHYLAXIS IN HOSPITAL TENGKU AMPUAN AFZAN, KUANTAN
P. L. Neu, S. T. Choy, S. Lashviny, W. C. Leong
Pharmacy Department, Hospital Tengku Ampuan Afzan, Kuantan
INTRODUCTION: Risk of infection from surgical procedures poses a significant impact on patients’
and community healthcare. Surgical site infection (SSI) developed following a surgical procedure
increases the likelihood of intensive care upon readmission and mortality rate. OBJECTIVES: To
evaluate the adherence of antibiotic use in surgical prophylaxis in General Operation Theatre
(GOT) and Orthopedic Operation Theatre (OOT) in terms of choice, dose, timing and duration
against local Hospital Tengku Ampuan Afzan (HTAA) and 2008 National Antibiotic Guideline (NAG).
METHOD: Data of this prospective study was collected by reviewing the antibiotic usage in these
theatres, using a designated data collection form. All patients above 12 years old scheduled for
elective surgery in May 2009 were included. RESULTS: Seventy one samples were collected
comprising 41 (57.7%) GOT and 30 (42.3%) OOT cases. They consisted of equal percentages of men
(56.3%) and women (43.7%); ranging from 12 to 83 years old. In both theatres, the occurence of SSI
was similar (approximately 16%). GOT and OOT showed 70.7% and 16.7% adherence to either of the
guidelines, respectively. Of these cases, GOT adhered better to NAG (96.6%) in terms of antibiotic
choice and dose compared to HTAA guideline. OOT, however, showed better adherence to HTAA
guideline (100%) in the choice and dose of antibiotic used. In all procedures, 83.3% of antibiotic
administration timing was concordant to the recommended 30 minutes time-frame prior to
procedure. The use of antibiotic continued two days post-operatively in 12% GOT cases; and up to
seven days post-operatively in 58.6% OOT cases. CONCLUSION: GOT generally showed better
adherence to these guidelines; whilst the poor adherence in OOT needs to be looked into. Better
effort among surgeons and professionals at both national and local levels should be taken to reach
a consensus in improvising the guideline to improve the quality and efficacy of antibiotic usage in
surgical prophylaxis.
Keyword: Antibiotic, surgical prophylaxis, General Operation Theatre, Orthopedic Operation Theatre
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP18:
COMPARISON OF WARFARIN KNOWLEDGE AND WAITING TIME
AMONG WARFARIN MEDICATION THERAPY ADHERENCE CLINIC
AND USUAL PHYSICIAN CLINIC PATIENTS
T. Subramaniam, Carol Ling, U. Kogilam, S.Y. Agnes Heng, B.S. Chan, C.K. Chan
Pharmacy Department, Hospital Kuala Lumpur
INTRODUCTION: Clinical pharmacists’ active involvement in the anticoagulation clinic and has
significantly reduced the hemorrhagic and thromboembolic complications. Warfarin Medication
Therapy Adherence Clinic (WMTAC) was introduced in Hospital Kuala Lumpur. OBJECTIVES: The
purpose of this study is to assess the warfarin knowledge and waiting time among WMTAC and usual
physician clinic (UPC) patients. METHOD:
A total of 150 alternate patients attending each of the
clinics were sampled from February to June 2009. A data collection form was attached to the
warfarin book to collect the waiting time at 4 different sites. As for the knowledge assessment,
only adult patients with at least 4 clinic visits were enrolled and they answered a questionnaire
which was validated in a pilot study. RESULTS: A total of 100 complete samples were obtained for
both waiting time and knowledge analysis. Most patients (94%) who gave venous blood samples in
UPC for their International Normalization Ratio (INR) results waited for more than 1 hour and the
average waiting time was 64 minutes. The use the Point of Care Testing (POCT) in WMTAC ensured
receipt of INR results in 1 minute and reduced the average waiting time to 1 minute. There was
also significant difference in the terms of waiting time to obtain a prescription between the two
clinics (p-value= 0.000). Most WMTAC patients (87%) obtained their warfarin supply in 10 minutes,
while most UPC patients (65%) took more than 10 minutes. As for knowledge assessment, 50% of the
WMTAC patients were able to answer at least 16 out of 18 questions correctly, whereas only 30% of
the UPC patients were able to do the same. CONCLUSION: Introduction of WMTAC has reduced the
overall clinic waiting time. Education by pharmacist has increased the patient’s knowledge of
warfarin therapy.
Keywords: warfarin, knowledge, waiting time, warfarin medication adherence clinic
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP19 :
KAJIAN PEMAHAMAN PESAKIT YANG MENGGUNAKAN SUBLINGUAL
GLYCERYL TRINITRATE DI UNIT PESAKIT LUAR HOSPITAL DUNGUN
C.K.H. Che Ku Nor Halisa, M. Nurul Azila, A.K. Norhayati
Unit Farmasi, Hospital Dungun
PENGENALAN: Kegagalan pesakit untuk memahami maklumat dan arahan yang diberikan oleh
anggota kesihatan sering menjadi faktor utama menyumbang kepada kemasukan semula pesakit ke
dalam wad. OBJEKTIF: Kajian ini dilakukan untuk menentukan tahap pengetahuan dan pemahaman
pesakit yang menerima rawatan menggunakan Sublingual Glyceryl Trinitrate (SL GTN) serta
mengenalpasti aspek kelemahan pengetahuan dan pemahaman pesakit dalam rawatan mengunakan
SL GTN. KAEDAH: Merupakan Kajian Prospektif dengan Hirisan Melintang yang bermula pada 1 Jun
hingga 30 September 2008 dan merangkumi sampel pesakit seramai 80 orang dari Unit Pesakit Luar
Hospital Dungun. Pesakit dipilih berdasarkan preskripsi yang mengandungi SL GTN. Pesakit
ditemubual untuk mendapatkan maklumat dan direkodkan ke dalam Borang Pengumpulan Data
yang diubahsuai berdasarkan Paisley LHCC-3rd Cycle (Final Report) 2005 dan Drug Counselling
Guide Cardiovascular System oleh Pharmaceutical Services Division, Bil. 2/2001. Data dianalisa
menggunakan Microsoft Excel 2003 dan dinilai menggunakan Sistem Pemarkahan (Skor) dan
Piawaian. KEPUTUSAN: 85% pesakit mengaku pernah menerima perkhidmatan kaunseling individu
berkenaan SL GTN, 100% pesakit mengaku pernah menerima arahan cara pengambilan SL GTN dan
95% pesakit mengaku pernah mendapat maklumat berkenaan SL GTN daripada anggota kesihatan.
Namun, hanya 10% pesakit faham kesemua masa pengambilan, cara pengambilan dan cara
penyimpanan SL GTN yang betul. Manakala, tiada (0%) pesakit faham kesemua kesan sampingan
yang mungkin dialami. KESIMPULAN: Berdasarkan kajian, didapati 95% pesakit menunjukkan tahap
pengetahuan dan pemahaman yang rendah walaupun kebanyakan pesakit (85%) pernah menerima
perkhidmatan kaunseling individu berkenaan SL GTN. Dari segi aspek kelemahan pula, pengetahuan
dan pemahaman tentang kesan sampingan yang mungkin dialami adalah sangat lemah berbanding
yang lain.
Kata kunci: tahap pengetahuan dan pemahaman, Sublingual Glyceryl Trinitrate (SL GTN)
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP20:
IMPACT OF WARFARIN PROTOCOL IN INR CLINIC - MOVING
TOWARDS PHARMACIST MANAGED CARE
V. S. Yong1, E.V. Low1, M. Z. Noraniza1, Y.P. Ng1, M. Suzana1, H. B. Liew2
1Department of Pharmacy, 2Department of Medicine,Queen Elizabeth Hospital
INTRODUCTION: Warfarin is a Vitamin K antagonist and the only oral anticoagulant up to date. As a
result of its effectiveness in preventing and treating arterial and venous thrombosis warfarin is one
of the most prescribed drugs to this day. OBJECTIVES: To assess the effectiveness of a warfarin
protocol in attaining target International Normalised Ratio (INR) and clinician compliance in terms
of dose titration, review scheduling and setting target INR. METHOD: This audit includes
outpatients attending the weekly Warfarin Clinic between March-December 2009. In Phase 1
(March-May 2009) data were collected for patients’ achievement of target INR and clinician
compliance in terms of dose titration, review scheduling and setting of target INR. These data were
then analysed based on the Queen Elizabeth Hospital (QEH) guidelines; and formed the basis of the
warfarin clinic audit. Phase 2 (July-December 2009) was conducted to address the shortfalls
identified from the audit. Feedback to clinicians on findings was given. A warfarin protocol
incorporating guidelines from QEH, Singapore General Hospital and the Pharmaceutical Service
Division, Ministry of Health was then developed. This protocol to standardise dose titration, target
INR setting and review schedules in the warfarin clinic of a local setting. RESULTS: Improvement in
setting target INR is seen after the introduction of the new protocol (16.6%, p<0.05). Compliance
to dose titration increased by 8.5% (p>0.05) while review scheduling increased by 16.9% (p<0.05). A
marginal uptrend of 2.2% (p>0.05) in the percentage of patients within INR target was noted. There
was also an increase in the percentage of patients with INR over its target range (9.1%, p>0.05).
CONCLUSION: The developed protocol sees improvement in achieving target INR among patients, as
well as clinicians’ compliance to this protocol. It is hoped that further confirmatory data will be
available in the future to obtain validation from the Pharmaceutical Services Division, Ministry of
Health, Malaysia.
Keywords: warfarin, anticoagulants, INR
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP21:
PATIENTS’ PERCEPTION ON GENERIC MEDICINE AND ITS EFFECT
ON ADHERENCE AT TUANKU JA’AFAR HOSPITAL, SEREMBAN.
M. K. Amanda Tee, S. L. Lee.
Pharmacy Department, Hospital Tuanku Ja’afar Seremban.
INTRODUCTION : The increase of drug expenses is an issue of great concern for our governments.
Decreasing the total cost of drug therapy while improving outcomes of patient has become a
challenging responsibility for the health care provider. Therefore, generic substitution for brand
name drugs becomes a common practice nowadays. OBJECTIVES: To assess the knowledge of
generic medicines among the patient, patient’s compliance on generic drugs substitution and
patient’s perception towards generic drugs. METHOD: This is a descriptive study. A set of
questionnaire is used during this study. The research was conducted in Out-patient Department of
Tuanku Ja’afar Hospital, Seremban, from February to May of 2009. The inclusion criteria of the
sample are patients who has regular medical follow up in Tuanku Ja’afar Hospital, Seremban and
switched from innovator drugs to generic drugs. Only subjects who knew about generic medicine
will be further interview by using the questionnaire. Ten types of active ingredients were studied
in this research. RESULTS: From the total respondents of 121 patients who switched from innovator
to generic medicines, only 56 (46.3%) of them knew about generic medicines in depth. From the 56
respondents, 4 (7.1%) of them have good knowledge on generic medicines. 45 (80.4%) of the
respondents agreed on generic substitution and complied with their therapy because generic
medicines can control their condition as the innovator medicine. However, 51 (91.1%) of the
patients still have concern about the safety, efficacy, and quality of the generic medicines
although reassurance be given by pharmacist.
CONCLUSION: Majority of subjects have better
knowledge on generic medicines. Most of the subjects agree on changing their medications from
innovator products to generic medicines. However, patients still concern about safety, efficacy and
quality of generic medicines even though reassurance was given by pharmacist.
Keywords: perception, generic, adherence
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OP22:
EFFECT OF PHARMACIST INTERVENTIONS ON COST OF DRUG
THERAPY IN SURGICAL WARDS
S.H. Heng1, A.K.B. Gunn2, H.S. Liew1, Y.C. Lim1
1 Pharmacy Department, 2 Surgery Department, Hospital Sultanah Aminah, Johor Bahru
INTRODUCTION: Pharmacist’s role has shifted from a primary focus on medication dispensing to
providing patient care. Direct involvement of a clinical pharmacist on physician rounds, drug
reconciliation at admission or discharge, and medication therapy adherence clinic helps to reduce
the frequency of adverse drug events and medication errors. The services provided also improve
medication
adherence,
patients’
knowledge
about
their
medications,
and
medication
appropriateness. OBJECTIVES: The aim of this study was to determine the types of clinical
pharmacist interventions in two surgical wards and to estimate the actual cost savings arising from
the interventions. METHOD: This was a 2-month prospective, cross-sectional study conducted on
two surgical wards in a Malaysian government funded hospital, between 1 st January and 28th
February 2009. All the interventions and therapeutic drug classes involved were documented on the
standard Ministry of Health clinical pharmacy form (CP3). The results of interventions were
categorized into discontinuation of, initiation of, change in drug therapy, interventions involving
therapeutic duplication, the detection and avoidance of problems-related to drug therapy and the
suggestion on laboratory monitoring and serum drug concentration determinations. The effect of
these interventions on the costs of drug therapy was evaluated by utilizing drug acquisition costs.
RESULTS: A total of 402 pharmacist interventions were documented during the study period and
368 interventions of these resulted in cost savings of RM 11,499.51. Intervention involving
antimicrobial agents had the greatest cost savings. The common types of interventions were
discontinuation of unnecessary drug therapy (30%), changes in dose regime (16.9%) and
modification in route of administration (14.4%). Fifteen (3.7%) interventions resulted in the
avoidance of adverse drug events (ADEs). CONCLUSION: Clinical pharmacist interventions in the
surgery department produced economic benefits, improved the overall patient’s medication
management and also support the expansion of clinical pharmacy services.
Keywords: clinical pharmacy services, pharmacist interventions, cost saving
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
ORAL PRESENTATIONS
OTHERS
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO1:
COMPLIANCE TOWARDS LABELLING OF DISPENSED MEDICINE
REQUIREMENT UNDER POISON ACT 1952 IN KUALA LUMPUR.
A.L. Nurhairani, S. Shafilliza, N. Norita, A. Mohd Ridzuan, L.S. Lim
Pharmacy Enforcement Branch, Federal Territory of Kuala Lumpur & Putrajaya State Health Department
INTRODUCTION: Correct and adequate labelling of dispensed medicines is important to prevent
medication errors, improve patients’ compliance and ensure patients’ safety. OBJECTIVES: To
determine the level of compliance of private healthcare professionals towards labeling of
dispensed medicines under Regulation 12 of Poison Act 1952. METHOD: A prospective crosssectional study using ‘Simulated Client Visit’ by trained agent provocateur who acted as patients
with back pain symptom. Sample studies were selected randomly from two clusters of 208
Community Pharmacies (CP) and 694 Private Clinics (PC) in Kuala Lumpur. Data were collected for
3 months starting from March to June 2009. All dispensing label received will be recorded in a data
collection form based on 8 criteria stipulated by Regulation 12 Poison Act 1952. Each criteria
complied will get 1 mark with maximum score of 8. Then, the score collected were analyzed
descriptively and statistically. RESULTS: From the visits, a total of 229 labels were collected from
68 CP and 86 PC. None of CP and PC complied fully with the stipulated regulation. However median
score for PC are higher than CP (PC=5; CP=3). Meanwhile, percentage of premises who did not
comply at all with total score of 0 were higher in CP than PC (CP=23.6%; PC=1.3%). Comparison for
each criteria between CP and PC revealed that PC were better (p<0.05) in terms of labelling
medication errors, improve patients’ compliance and ensure patients’ safety.. for the supplier’s
name (PC=90.4%; CP=79.2%), supplier’s address (PC=84.7%; CP=69.4%), patient’s name (PC=96.2%,
CP=31.9%), name of medicine (PC=87.3%, CP=65.3%), and date of supply (PC=84.7%; CP=37.5%).
CONCLUSION: Both CP and PC in Kuala Lumpur did not comply with the stipulated regulation on
labelling for dispensed medicines. However, PC is more complied compared with the CP.
Therefore, more action should be taken to raise awareness and compliance of CP and PC towards
labelling for dispensed medicines to prevent medication errors, improve patients’ compliance and
ensure patients’ safety.
Keywords: compliance, labelling, dispensed medicine, private clinics, community pharmacies
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO2:
PREVALENCE SURVEY OF MEDICINAL PRODUCT SOLD IN KUANTAN
FELDA SETTLEMENT
O. Fadli Noor, O. Kamaruzzaman, M.N. Mohd Adib, H. Muhammad Hafrizan, S. Salina
Pharmacy Enforcement Branch, Pahang State Health Department
INTRODUCTION: All medicinal products must be registered with the Drug Control Authority (DCA)
before being imported, manufactured, sold or supplied in Malaysia as required under the Control of
Drug and Cosmetics Regulation 1984. The registered product has been evaluated and tested for its
quality, efficacy and safety. Every registered medicinal product must bear a MAL registration
number and affix with a security label Hologram Meditag™. OBJECTIVES: This survey is was to
gather basic data regarding medication sold in Kuantan FELDA Settlement. METHOD: A prospective
study was conducted to 23 FELDA settlements in Kuantan from May 2009 to September 2009. All
medicinal products sold in the premises were identified and classified into registered and
unregistered medicinal products as well as the awareness of the businessperson regarding the
requirement of selling only the registered medicinal product based on Sales of Drug Act 1952. All
the data is gathered using structured questionairre.
RESULTS: A total of 63 premises were
inspected from 23 FELDA settlements. In these premises, 69% of the medicine sold are registered
with DCA while 31% not. The unregistered medicinal product sold comprised of traditional (37%),
non-poison (20%), scheduled poison (11%), and cosmetic containing scheduled poison (3%)
respectively. CONCLUSION: Basic data regarding medicinal product sold in Kuantan FELDA
settlement have been gathered and these data can be used to develop consumer education
strategy to increase awareness on the importance use of registered medicinal products in Pahang
FELDA settlement.
Keywords: Registered Medicine, Unregistered Medicine, Control of Drugs and Cosmetics Regulation 1984, Sales
of Drug Act 1952, Kuantan FELDA Settlements.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO3:
A
STUDY
ON
PHARMACEUTICAL
TERENGGANU
THE
PREVALENCE
OF
UNREGISTERED
PRODUCTS IN FELDA AND FELCRA OF
A.R. Norlida, S. Azura, N. Nor Akmal, M. Khaironi, Z.Y. Muhammad Ghazali, T.K.Tg. Amirul Kamal
Pharmacy Enforcement Branch, Terengganu Health Department
INTRODUCTION: In respect to selling, manufacturing, supplying, importing, possessing or
administering of any products, everyone must comply with the Regulation 7(1) of Control of Drugs
and Cosmetics Regulations 1984 which requires pharmaceutical products to be registered with Drug
Control Authority. Every registered products marketed must bear a registration number (MAL
xxxxxx A, X, or T) and affix with a security label Hologram Meditag™. However, during routine
inspections done by Terengganu Pharmacy Enforcement Branch between 1998 to 2002, 82% of the
total premises inspected were found to sell unregistered products. OBJECTIVES: The study was to
determine the distribution of unregistered pharmaceutical products in FELDA and FELCRA of
Terengganu, to identify the types of unregistered pharmaceutical products sold and to identify
factors contributing the selling of unregistered pharmaceutical products in FELDA and FELCRA.
METHOD: A prospective, random sampling was conducted from February 2009 to June 2009 in
FELDA and FELCRA. Notice of Seizure (Notis Rampasan) in accordance to Section 4(2) Sale of Drugs
Act 1956 and questionnaires distributed to the sellers were analysed. RESULTS: A total of 92
premises were inspected. However, 46 (50%) premises were found to sell unregistered products.
The distribution of products seized in Felda Ketengah Jaya was the highest (52%) while Felda
Tenang was the lowest (17%). The most common pharmaceutical products to be seized were
poisons, over-the-counter products and traditional medicine. The latter was found to be the most
seized products (72.62%).
The study also shows that 42.43% of unregistered pharmaceutical
products sold were due to reduce consumer’s demand. CONCLUSION: Pharmacy Enforcement
Officers in Terengganu play a vital role to educate consumers in FELDA and FELCRA. Nevertheless,
strengthening the enforcement activities is also crucial to reduce unregistered products in FELDA
and FELCRA.
Keyword: Unregistered pharmaceutical products, FELDA and FELCRA settlement, Pharmacy Enforcement
Officers.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO4:
KAJIAN KEFAHAMAN DOKTOR, AHLI FARMASI DAN PENJUAL UBAT
DI NEGERI PERLIS TERHADAP CIRI-CIRI PRODUK BERDAFTAR
DENGAN PIHAK BERKUASA KAWALAN DADAH
O. Asiah, M.R.N. Roziana, K.S. Lee, M.R. Ruhaya, Y.S. Mariani, H.N. Shafiz, S.M. Ong, A.S.A. Munis, A.N.Syafini
Cawangan Penguatkuasa Farmasi Negeri Perlis
PENGENALAN: Doktor, ahli farmasi dan penjual ubat merupakan sumber utama orang ramai
mendapatkan bekalan ubat. Kefahaman kumpulan ini terhadap ciri-ciri produk berdaftar adalah
penting untuk melindungi para pengguna daripada penggunaan ubat-ubatan tidak berdaftar yang
mungkin membawa kesan buruk. OBJEKTIF: Kajian ini dijalankan untuk mengetahui tahap
kefahaman di kalangan doktor, ahli farmasi, serta penjual ubat mengenai ciri-ciri produk berdaftar
dengan Pihak Berkuasa Kawalan Dadah (PBKD) dan keperluan undang-undang berkaitan. KAEDAH:
Kajian ini merupakan kajian prospektif keratan rentas dan dikendalikan menggunakan borang
soalselidik berstruktur. Persampelan adalah secara persampelan bukan rawak bertujuan (purposive
sampling). Data dikutip dalam tempoh sebulan iaitu Januari 2010 melibatkan tiga kawasan Parlimen
Negeri Perlis iaitu Padang Besar, Kangar dan Arau. Responden diminta untuk menjawab soalansoalan berkaitan ciri-ciri produk berdaftar, mengenal nombor pendaftaran dengan betul, ciri-ciri
pada hologram, implikasi perlanggaran undang-undang berkaitan dan aktiviti pendidikan berkaitan
produk berdaftar yang pernah diikuti. Responden yang menjawab dengan betul bagi soalan-soalan
tersebut dikategorikan sebagai faham ciri-ciri produk berdaftar. KEPUTUSAN: Sejumlah 200 orang
responden terlibat dalam kajian ini. 79.5% responden tahu terdapatnya undang-undang mengawal
ubat-ubatan di Malaysia dan 75.5% tahu semua produk perlu berdaftar dengan PBKD. Sebanyak 28%
responden daripada kajian ini dapat mengenalpasti 2 ciri produk berdaftar dengan tepat.
Keputusan menunjukkan hanya 11% responden faham tentang ciri-ciri produk berdaftar. Daripada
jumlah itu, ahli farmasi mencatatkan bilangan responden yang faham tertinggi iaitu sebanyak 35.7%
diikuti dengan penjual ubat (30%), doctor (22.2%), dan penjual di kedai runcit (7.1%). 80%
responden tahu bahawa menjual produk tidak berdaftar adalah satu kesalahan, namun hanya 40.5%
yang tahu denda yang dikenakan jika disabit dengan kesalahan. KESIMPULAN: Kajian ini
menunjukkan tahap kefahaman dikalangan doktor, ahli farmasi dan penjual ubat terhadap ciri-ciri
produk berdaftar adalah rendah. Maklumat kajian ini penting bagi Cawangan Penguatkuasa Farmasi
dan bahagian pendidikan pengguna untuk merangka pelan pendidikan yang lebih teliti
disampaikan pada ahli profesional dan juga penjual ubat.
Kata kunci: Produk berdaftar, Nombor Pendaftaran, Hologram, Faham
bagi
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO5:
A COMPARISON STUDY ON SALES OF MEFENAMIC ACID BETWEEN
PRIVATE DOCTORS AND COMMUNITY PHARMACISTS IN MALACCA
S. Siti Hufaidah, A. Nur Hasanah, C.W Neoh, O. Nurhayati
Pharmacy Enforcement Branch, Melaka State Health Department
INTRODUCTION: Mefenemic Acid is listed as Group C Poison in First Schedule under Poisons Act
1952. The Sales of Mefenamic Acid therefore must comply with Poisons Act 1952 and its regulations
in the aspect of dispensing (Section 19), recording (section 24) and labeling (Regulation 12). Nonadherence to the law and its regulations causes the consumers in getting inaccurate information
and might lead to wrong and dangerous usage of the medicine. OBJECTIVES: This study was to
compare the knowledge of private doctors and pharmacists regarding sales of Mefenamic Acid
under Poisons Act 1952 and its adherence in private clinics and community pharmacies in Malacca.
METHOD: This is a cross-sectional study conducted from October 2008 to January 2009. In this
study, all mefenamic acid were bought over the counter (test buy) by enforcement officers from
the assistants in randomly selected private clinics and community pharmacies in Malacca. The
labels of all Mefenamic Acid bought were thoroughly inspected and the private doctors and
community pharmacists were then interviewed using structured questionnaire.
Each question
carries a score whereby a higher total score reflects a higher level of knowledge and adherence.
RESULTS: A total number of 50 clinics and 35 community pharmacies were involved in the study.
The results show that pharmacists had a better knowledge about Poisons Act 1952 if compared to
private doctors (p<0.001). However, the adherence to Poisons Act 1952 is higher among doctors if
compared to pharmacists. (p=0.001). The result of this study has been presented at a dialogue
session with community pharmacists to increase their adherence to the laws. The same session will
be conducted to the general practitioners. CONCLUSION: In conclusion, pharmacists had better
knowledge on Poisons Act 1952 if compared to private doctors but the adherence to Poisons Act
1952 is higher among doctors if compared to pharmacists.
Keyword: Mefenamic Acid, Poisons Act 1952, Dispensing, Recording, Labeling
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO6: TECHNETIUM-99M TETROFOSMIN: FRACTIONATION OF MYOVIEW™
(TETROFOSMIN) COLD KIT
M. Mohd Husnizaen1, L. Y. Chee1, C. S. Ng2
1Pharmacy Department, 2Nuclear Medicine Department, Sultanah Aminah Hospital
INTRODUCTION: Fractionation of expensive radiopharmaceutical cold kits has been shown to be
reliable and cost-effective practice. OBJECTIVES: The objectives of this study are to assess the
feasibility of fractionating commercially available product of Myoview™ (tetrofosmin) into 1:5 and
1:10, checking its sterility as well as evaluating the effect of adding different radioactivity towards
the radiochemical purity of the fractionated cold kits. METHOD: This study was carried out in two
parts with one month duration for each phase. In phase one, two vials of Myoview ™ were
fractionated into 1:5 meanwhile in phase two, one vial of Myoview™ was fractionated into 1:5 and
another vial into 1:10 whereby all followed by storage at -20oC. All analyses of radiochemical purity
were done at 15 minutes and 6 hours after reconstitution with Technetium-99m pertechnetate in
radioactivity less than 3.2 GBq per vial. Instant thin-layer chromatography was employed in
determining the radiochemical purity of Technetium–99m tetrofosmin. In each phase, a portion of
fractionated vials were sent for sterility testing. RESULTS: The radiochemical purity remained at
an average of 96.04±1.44% (n=18) up to 6 hours after reconstitution with sodium Technetium-99m
pertechnetate of radioactivity less than 1 GBq/ml. The radiochemical purity maintained above 90%
when the radioactivity added was less than 1.2GBq/ml. All sterility testing results came out
negative for any microbial growth. CONCLUSION: The subdivision of the Myoview™ kit into 1:5 and
1:10 with storage at -20oC in a nitrogen atmosphere has been shown to be feasible and sterile. .
The fractionated cold kits are stable for up to 1 month provided less than 1.2GBq/ml Technetium99m pertechnetate was added to total of 3.2GBq radioactivity per fractionated vial. This provides
Technetium-99m tetrofosmin that can be used cost-effectively, especially when there is low
patient use.
Keywords: fractionation, Myoview™, radiochemical purity, technetium-99m
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO7:
NON-COMPLIANCE
OF
DISPENSED
MEDICINE
LABELLING
REQUIREMENTS AMONG PRIVATE PHARMACIES AND PRIVATE
CLINICS IN SABAH
O. M. Joseph, D. Lee, W. Abdullah, P.S.L. Teng, D.G.Jimmy
Pharmaceutical Services Division, Sabah
INTRODUCTION:
Good medicine labelling practice is vital to ensure safe use of medicines and
non-compliance to labelling standards is a potential source of medication errors OBJECTIVES: To
study the legal compliance of dispensed medicine labelling among private pharmacies and private
clinics in Sabah. METHOD: This is a multicenter cross-sectional exit survey assessing dispensed
medicine labels obtained from respondent in Kota Kinabalu, Sandakan and Tawau patronizing 20
clinics and 20 pharmacies selected through random systematic sampling. Study tools for data
collectors include questionnaire and a checklist to measure labelling compliance from respondent
chosen through convenience sampling. Required labelling details namely ‘Supplier Name and
Address’, ‘Patient Name’, ‘Medicine Name’, ‘Direction of Use’, ‘Date Supplied’, ‘Serial Number’
and ‘Controlled Medicine Label’ were assess in a point score of a maximum 7 points for each
compliant label. The study was conducted from 16 March to 16 May 2009. Data were analyzed using
Statistical Package for Social Sciences (SPSS ®) version 16 (CPF Sabah). RESULTS: A total of 312
dispensed medicine obtained from 161 respondents were analyzed. Non-adherence to labelling
requirements with a score of 0 points involves 14.74% (46) of the dispensed medicines (n=312).
Only 0.03% (9) of the study subject achieved a 7 point score. The highest frequency score is 5
points involving 29.81% (93) of the total dispensed medicines. Common labelling details not being
complied with were ‘Serial Number’ (92.63%), ‘Patient Name’ (58.01%) and ‘Medicines Name’
(53.52%). Labelling compliance mean score percentage for private clinics (59.04%, n=195) is
significantly higher than private pharmacies (42.74%, n=117) (unpaired t-test, P<0.05).
CONCLUSION: Compliance to legal requirement for dispensed medicine labelling among private
pharmacies and private clinics in Sabah is unsatisfactory.
Keywords: Medicine Labelling, Medicines Law, Dispensed Medicine, Labelling Compliance
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OO8:
PRELIMINARY STUDY ON THE VALIDITY OF THE DECLARED
DOCUMENTS FOR THE IMPORTATION OF PHARMACEUTICAL
PRODUCTS, CHEMICALS AND OTHER RELATED PHARMACY
CONTROL PRODUCTS THROUGH THE CUSTOMS AT THE ENTRY
POINTS IN SELANGOR
C. Paul1, C.W. Chow1, M. Pilus2, L.F. Lee3, W.Y. Loh4,
1North Port, Pharmacy Enforcement Branch, 2West Port, Pharmacy Enforcement Branch, 3Pharmaceutical
Services Division, Selangor. 4Pharmacy Enforcement Forensic Laboratory, Pharmaceutical Services Division,
Ministry of Health Malaysia.
INTRODUCTION: Selangor has six entry points for importation of products via custom declaration.
Ever since the enforcement of pharmacy laws at entry points was introduced, no chemical analysis
was done on the imported products; approval of imports for pharmaceutical related products and
chemicals was based solely on screening of custom declared documents and some random visual
examinations of the products. OBJECTIVES: The objectives of this study were to create awareness
amongst importers about pharmacy enforcement activities, to identify unethical importers and to
provide feedbacks to the Royal Malaysian Customs and other government authorities. METHOD: 100
samples were taken, based on certain inclusion and exclusion criteria. The chemical identification
tests were done by the Pharmacy Enforcement Forensic Laboratory using portable Fourier
Transform Infrared Spectrophotometer (FTIR) and precursor test kits.
RESULTS: None of the
samples tested were found to contain any controlled substances. In this study, 57.28% of the
samples were identified conclusively as per the declaration in custom forms. CONCLUSION: More
samples have to be taken to be significant and to ensure that confirmatory identification tests are
carried out on the imported products. The facilities at the current forensic laboratory have to be
enhanced through the 10th Malaysia Plan. This study shows that there is a need to conduct random
sampling of the imported goods for chemical analysis to complement documentary screening at the
entry points.
Keywords: Validity, Declared, Pharmaceutical, Imports, Entry Points
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
ORAL PRESENTATIONS
POSTGRADUATE
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM1:
ANALYTICAL METHOD VALIDATION FOR THE DETERMINATION OF
CADMIUM IN HERBAL MEDICINES BY GRAPHITE FURNACE ATOMIC
ABSORPTION SPECTROPHOTOMETRY
H. Azrina1, A.B. Kartini2, V.K.M Sulaikah1
1Centre for Quality Control, National Pharmaceutical Control Bureau, 2 Department of Chemistry, University
of Malaya
INTRODUCTION: Medicinal herbs and their preparation may be potentially contaminated with toxic
heavy metals. In Malaysia, the limit of cadmium content in herbal products as approved by the
Drug Control Authority (DCA) and adopted from WHO guideline is not more than 0.3 ppm.
OBJECTIVES: The objective of the study is to validate an in-house method used for testing
cadmium in traditional medicines. Samples consist of dosage forms which include tablet, capsule,
liquid, ointment/cream, pill, powder and tea/leaves. METHOD: Samples were digested with 69%
nitric acid and hydrogen peroxide in a microwave digestor and trace metal digestor. Digested
samples were analyzed by graphite furnace atomic absorption spectrophotometer at 228 nm. The
validation was carried out according to the International Conference on Harmonisation (ICH)
guideline and acceptance criteria were adopted from Association of Analytical Communities (AOAC)
Peer Verified Methods Program. RESULTS: Linearity was evaluated in the range of 0.8 µg/L – 4.0
µg/L with R2 = 0.9983. For accuracy parameter, the % RSD range will be from 60% - 115%. % RSD for
intermediate precision for 2.0 µg/L cadmium solution was found to be 3.49%, 3.40% and 3.12% for
three consecutive days. % RSD for system precision was found to be 3.12%. %RSD for method
precision varied according to the matrix of the samples. Limit of quantification for this method was
0.0375 µg/L. CONCLUSION: Different matrices of traditional medicines were used in this study and
the method is specific and linear. The cadmium also can be quantitated from 0.0375 µg/L. The
concentration of cadmium solution analyzed was in parts per billion levels thus the acceptance
criteria for certain parameters in ICH Guideline are difficult to be fulfilled. It can be concluded
that an in-house analytical method for determination of cadmium in traditional medicines by
graphite furnace AAS can be used in routine analysis after the method being validated according to
the ICH Guideline which include the parameter linearity and range, precision, accuracy and limit of
quantification.
Keywords: Validation, cadmium in-house method, herbal products, graphite furnace atomic absorption
spectrophotometer (gf-aas)
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM2:
THE DETERMINATION OF LOVASTATIN AS A NATURALLY OCCURING
SUBSTANCE WITH CHOLESTEROL LOWERING EFFECT IN SELECTED
HERBAL MEDICINES CONTAINING RED YEAST RICE
A.R. Nor Hayati1, C.H. Chua2, V.K.M. Sulaikah1
1Centre for Quality Control, National Pharmaceutical Control Bureau, 2 Department of Chemistry, University
of Malaya
INTRODUCTION: Red yeast rice is highly used as traditional herbal medicine. However some
countries have regulated this product due to the presence of naturally occurring cholesterol
lowering effect compound that are similar to lovastatin. OBJECTIVES: The study was to determine
and quantify the amount of lovastatin in selected herbal medicines products containing red yeast
and provide a validated method using High Performance Liquid Chromatography (HPLC). METHOD:
Twenty five registered herbal medicines claim to contain red yeast rice and 5 raw materials of red
yeast rice powder were provided by National Pharmaceutical Control Bureau and analysed for the
presence of lovastatin within 6 months study in year 2008. Analytical method involved solid phase
extraction system using SPE C8 column, detection by gas chromatography mass spectrophometry
(GC-MS) with DB5MS capillary column, and quantification by (HPLC) with Hypersil ODS column.
RESULTS: A total of 29 (97%) samples found to contain lovastatin and only 1 (3%) sample showed
negative result for lovastatin. The concentration of the lovastatin in registered herbal medicines is
varies from 0.0008% w/w to 2.05% w/w. This variation also occurred in raw materials sample
whereby the concentration varies from 0.60% to 2.68% w/w. The validation of the analytical
method was carried out using HPLC according to the International Conference on Harmonisation
(ICH) Guideline. The results for specificity, linearity and range, precision and accuracy were within
the acceptable limits. CONCLUSION: This study has shown that HPLC method can be used to detect
and quantify the presence of lovastatin in selected herbal medicine containing red yeast rice.
Keywords: Red yeast rice, lovastatin, herbal products, gas chromatography mass spectrophometry (GC-MS),
High Performance Liquid Chromatography (HPLC)
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM3:
ISOLATION, PURIFICATION AND STRUCTURAL IDENTIFICATION OF
AN ACETILDENAFIL ANALOGUE IN HERBAL PRODUCT
R. Zarina1, G.H. Tan2, V.K.M. Sulaikah1
1Centre for Quality Control, National Pharmaceutical Control Bureau, 2 Department of Chemistry, University
of Malaya
INTRODUCTION: Some herbal products had been found to contain synthetic PDE-5 inhibitors,
namely sildenafil, vardenafil, tadalafil, and their analogues. It is dangerous for public to consume
these analogues due to unknown safety and toxicity profile. Hence, detection of such analogues is
important. OBJECTIVES: This study was to isolate, purify and identify acetildenafil analogue from
herbal product. METHOD: Thirty capsules from an adulterated herbal product, received by the
NPCB from the Enforcement Division were chosen as sample. Six capsules were weighed and
extracted with water and chloroform. The identification of the adulterant in the sample was
analysed by TLC and IR. The extracted residues were purified by column chromatography packed
with silica gel 60 using isocratic mobile phase. The isolated compound obtained was further
identified by HPLC equipped with photodiode array detector using C8 column. Confirmation of the
isolated compound is done by NMR. The study was carried out from July to October 2008.
RESULTS: Chromatographic and spectroscopic methods used showed the similarities in the main
structure and functional groups of the unknown compound in sample with that of acetildenafil
standard. Proton (1H) and carbon-13 (13C) NMR spectrums were used to confirm the identity of the
compound as nor-acetildenafil. CONCLUSION: The methods used in this study demonstrated that it
is possible to isolate, purify and identify the adulterants in herbal products and provide an avenue
for obtaining working standards from adulterated samples as alternative reference materials.
Keyword: actildenafil analogue, herbal product, High performance liquid chromatography (HPLC), Nuclear
Magnetic Resonance (NMR)
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM4:
ISOLATION, PURIFICATION AND STRUCTURAL DETERMINATION OF
AN ANALOGUE OF TADALAFIL FOUND AS ADULTERANT IN
HEALTH PRODUCT
J. Nik Juzaimah1, G.H. Tan2, V.K.M. Sulaikah1
1 Centre for Quality Control, National Pharmaceutical Control Bureau,
of Malaya
2
Department of Chemistry, University
INTRODUCTION: The success of PDE5 inhibitors (sildenafil, tadalafil and vardenafil) in the
treatment of erectile dysfunction has led to their widespread use as adulterants in herbal products,
health dietary supplements and food. Consumption of adulterated products poses a serious health
risk particularly the analogues since they have not been subjected to clinical trials and no safety
and toxicity profiles available. OBJECTIVES: The study was to isolate, purify and elucidate the
structure of an analogue of tadalafil that has been reported to be used as adulterant. METHOD: A
product of specified adulterated candy was obtained from the enforcement unit and only 18
candies (a total of 76 g sample) were used. The adulterant was identified using TLC and HPLC,
purified by gravity column chromatography and structural elucidation was done by FTIR and NMR.
The study was carried out from July to November 2009. RESULTS: The isolated and purified
adulterant (130 mg or 0.17%) showed fairly similar molecular structure to that of tadalafil. The
differences in the structure were confirmed using proton and carbon-13 NMR. Proton-proton and
proton-carbon correlation was further highlighted using 2-D NMR. The evidence obtained from this
study together with literature information concluded that the isolated adulterant is an analogue of
tadalafil and was determined to be aminotadalafil. Purification process using gravity column
chromatography was time consuming and skilled was required when packing the column.
Adulterants are usually added in small quantities; therefore a bigger sample size is needed in order
to isolate more compounds. CONCLUSION: The method used was able to isolate, purify and
subsequently determine the structure of an adulterant. This study has demonstrated that the
isolation and purification method can be used as potential alternative for obtaining working
standards from adulterated samples in the absence of reference materials.
Keyword: Isolation, purification, structural determination, analogue, adulterant, health product
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM5: IMPACT OF DIFFERENT INITIATION TIME OF APPROPRIATE INITIAL
ANTIMICROBIAL THERAPY IN CRITICALLY ILL PATIENTS WITH
NOSOCOMIAL PNEUMONIA
A.K. Rahela1, M.B. Mohd2, H.I. Farida2
1 Pharmaceutical Services Division2, Universiti Kebangsaan Malaysia
INTRODUCTION: Inappropriate initial antimicrobial therapy for nosocomial pneumonia infection is
usually linked to extended intensive care unit stay (ICU) and associated with increased risk of
mortality. OBJECTIVES: This study evaluates the impact of three different initiation time points of
appropriate initial antimicrobial therapy on the length of ICU stay and the risk of mortality and the
co-predictors that influence the outcome. METHOD: This retrospective study was conducted in an
intensive care unit of a teaching hospital. 65 patients with the diagnosis of nosocomial pneumonia
and pneumonia were identified for inclusion. 21patients were excluded due to the diagnosis of
community-acquired pneumonia, viral pneumonia and incomplete susceptibility results. The three
different time points were defined as the initiation of appropriate antimicrobial therapy at 24
hours, between 24-48 hours and at more than 48 hours after the culture was obtained. RESULTS:
The age of the 44-subjects ranges from 20 to 84 years old with the mean age of 58.2 ± 15.9 years.
The subjects had either hospital-acquired pneumonia (47.7%), ventilator associated pneumonia
(40.9%) or aspiration pneumonia (11.36%). The lengths of ICU stay ranges from 1 to 52 days with
the mean and median length of stay of 9.78 ±10.02 days and 7 days respectively. Subjects who
received appropriate antimicrobial agent at 24 hours had significant shorter length of ICU stay
(5.62 days, p<0.001) compared to patients who received between 24-48 hours (9 days) and at more
than 48 hours (15.8 days). However, the impact on increased risk of mortality was not
demonstrated. The co-predictors that contributed to an extended ICU stay were time of availability
of susceptibility results and concomitant diseases, namely cancer and sepsis. The only predictor for
ICU death was cancer. CONCLUSION: The results support the need for early appropriate initial
antimicrobial therapy in nosocomial pneumonia infections for better patient outcome.
Keywords: antimicrobials, nosocomial pneumonia, critical care
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM6:
THE IMPACT OF MARKET ORIENTATION ON NEW SERVICE
DEVELOPMENT AND FINANCIAL PERFORMANCE OF HOSPITAL
INDUSTRY IN MALAYSIA CONTEX.
K.O. Lee
Pharmacy Department, Klinik Kesihatan Seremban.
INTRODUCTION: Nowadays, hospitals are facing new challenges due to the increased competition
and the need for efficiency and are undergoing a radical change phase of so far unknown
magnitude. OBJECTIVES: The purpose of this study is to determine the critical factors of market
orientation (MO) and to measure its effect on new service development (NSD) and financial
performance of hospital industry in Malaysia. METHOD: Data were collected from a sample of
privately-held general hospitals within the cities of Malaysia by using a self-administered
questionnaire. The survey attracted 124 fully-useable hospital respondents after 2 months of data
collection (from August to October 2009). The response rate was approximately 82.7 percent.
RESULTS: The results show that MO has a direct impact ( = 0.089; p > 0.1) and can increase the
financial performance of hospitals but insignificant. The study also shows NSD-performance
increases the financial performance significantly ( = 0.349, p < 0.05). Besides that, financial
performance is indirectly positively affected by MO through moderating impact of employee’s
training but insignificant ( = 0.222, p > 0.1). The findings show that service quality (  = -0.389, p
> 0.1) does not moderate the relationship between MO and financial performance. CONCLUSION: It
is clear that a strong commitment to both the NSD-performance and marketing areas is essential
for improving the financial performance of hospitals. It should also be cautioned with the relatively
small sample size when interpreting the results. In additions, the response is mainly relied on the
subjective evaluations of executives. Therefore, it would be useful to replicate the results with
objective measures of performance indicators.
Keywords: Market orientation, Financial performance, Service quality, Employee’s training, Hospitals,
Malaysia
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM7:
1A.G.
1Biro
EURYCOMA LONGIFOLIA JACK (TONGKAT ALI) TRADITIONAL
MEDICINE PRODUCTS (TMP): AUTHENTICATION ANALYSIS USING
EURYCOMANONE CHEMICAL MARKER
Zakiah, 1V.K.M. Sulaikah, 2G.H. Tan, 1A.M. Nadia, 1M.A. Azlene, 1M.H.M. Rashid, 1Y.S..Wong
Pengawalan Farmaseutikal Kebangsaan, 2Universiti Malaya
INTRODUCTION: Tongkat Ali is one of the most popular medicinal herbs in Malaysia. However there
are 4 species of herb Tongkat Ali, namely Eurycoma longifolia, Eurycoma apiculata, Polyathia
bullata and Goniothalamus sp. OBJECTIVES: This study was done to provide a screening tool for
ensuring that Eurycoma longifolia root used in various TMP marketed in Malaysia is authenticated.
METHOD: The analytical method for this research was adapted from the researches done by K.L.
Chan et al. (1998) and R.Seetha (2006) with some modifications. Thirty one samples were collected
from Klang Valley randomly from January to June 2009 which includes tablet, capsules, liquid and
pill. High Performance Liquid Chromatography (HPLC) with Diode Array Detector (DAD) was used.
All samples were simply extracted using Ethanol. Eurycomanone has been chosen as the marker
compound because of its highest concentration presence in the root part. RESULTS: From the 31
samples analyzed with this method, 15 products (48.9%) were found positive containing
Eurycomanone while 11 products (35.48%) found negative and the remaining (15.62%) produced
doubtful results. Therefore, a second analytical method using High Performance Thin Layer
Chromatography (HPTLC) with Ultra Violet Detector was then employed. Five samples which had
doubtful peak and 1 sample positive with Eurycomanone were analyzed using HPTLC. As the result,
the five samples also confirmed negative using HPTLC. The negative samples might be because of
the raw material used was not Eurycoma longifolia or the part used was not root or the herb was
not matured enough. CONCLUSION: From this study, it can be concluded that the authenticity of
Eurycoma longifolia Jack can be determined in TMP.
Keyword: Eurycoma longifolia, HPLC, DAD, HPTLC, Eurycomanone
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM8:
ATTITUDE AND BELIEF OF ALTERNATIVE MEDICINE AMONG
GENERAL
PUBLIC
ATTENDIN
GOVERNMENT
HOSPITAL
PHARMACIES IN SABAH
V. Bubuyan1, M.B. Bahari2, Khairunisa1, B.K. Lee3, S. Marcellus3, E.V. Low3, F. Chong4, H.M. Hasrul4, M.M.
Hong5, Y.L. Yeo5, L. Halimah 6, K.C. Cho6, H. Soffhan7, L. Dymphna8, F. S. Fong8, M. Sarawati9, A.R. Firdaus10,
M. Ronalan11, S.Y. Shim12, L. Grace12, Y.M. Taufik13, P.H. Hiew14.
Pharmacy Department, 1Hospital Keningau, 3 Hospital Queen Elizabeth, 4 Hospital Likas, 5 Hospital Duchess of
Kent, 6 Hospital Tawau, 7 Hospital Lahad Datu, 8 Hospital Keningau, 9 Hospital Kota Marudu, 10 Hospital
Tenom, 11 Hospital Ranau, 12 Hospital Kota Belud, 13 Hospital Semporna, 14 Hospital Beluran, 2 Department of
Clinical Pharmacy, USM.
INTRODUCTION: There is great diversity in complementary and alternative medicine (CAM)
therapies and CAM use worldwide.
The growing interest in CAM prompted the Malaysian
government of integrating alternative medicine in the healthcare system. A study on our public
attitude and belief toward alternative medicine may provide information for further improvement
in the implementation of integrating alternatives medicine in the government hospital.
OBJECTIVES: This study was conducted to assess attitude and belief toward alternative medicine
among general public attending government hospital pharmacies in Sabah, Malaysia. METHOD: A
cross sectional survey using a validated structured questionnaire was conducted among general
public visited the pharmacy counter in 13 government hospitals in Sabah.
This survey was
conducted by self-administered questionnaire in 4 weeks from 01 st - 27th April 2008. Respondents
were required to answer 14 statements on attitude and belief based on Likert Scale. Out of 1765
questionnaires were distributed, one thousand four hundred and fourty-four (n=1444) respondents
returned the questionnaire (81.8 % response rate). RESULTS: The result showed the male and those
with chronic disease believed that alternative medicine is only effective when use together with
conventional medicine (p-value=0.048, p-value= 0.004 respectively). Sixty eight percent of the
respondent agreed to inform their healthcare professional if they are using alternative medicine.
Sixty nine percent of the respondents agreed or strongly agreed in integrating of modern and
alternative medicine in healthcare system.
Over two-third of respondents (71.6%) agreed or
strongly agreed with government support to alternative medicine. CONCLUSION: This study showed
respondents had positive attitude and belief toward alternative medicine.
Keywords: Complementary and alternative medicine, attitude, belief.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM9:
COMPARISON OF FOURIER TRANSFORM INFRARED ATTENUATED
TOTAL REFLECTION (FTIR-ATR) AND FOURIER TRANSFORM NEARINFRARED (FT-NIR) METHODS FOR SCREENING IMITATION OF
VIAGRA OR SUSPECTED COUNTERFEIT VIAGRA
I. Ida Syazrina, A.J. O’neil
Faculty of Science, School of Pharmacy and Chemistry, Kingston University, United Kingdom.
INTRODUCTION: Counterfeit and substandard drug issues are now serious threat to global health.
The fast screening methods for counterfeits are vital necessity in order to combat the distribution
of counterfeits around the world. OBJECTIVES: A comparative study between Fourier Transform
Infrared Attenuated Total Reflection (FTIR-ATR) and Fourier Transform Near-Infrared (FT-NIR) with
chemometric technique was carried out to determine the rapid, non-destructive sample analysis
and the ability to develop qualitative determination of tablet authentication. METHOD: 8 batches
of authentic Viagra and 5 batches of imitation Viagra as potential counterfeit were analyzed using
FTIR Spectrometer with Universal Attenuated Transmittance Reflection (UATR) and Antaris II FTNIR Analyzer.
The chemometric pre-treatment of all spectral data analysis, modeling and
classification was performed using Unscrambler 9.8. RESULTS: The FTIR-ATR provides a strong,
sharp peaks and sensitive detection technique but it requires destructive analysis. The FT-NIR
offers a non-destructive testing of samples but difficulty in spectral interpretation. Results showed
that data pre-processing methods, Principal Component Analysis (PCA) and Soft Independent
Modelling by Class Analogy (SIMCA) is powerful technique in discriminating each authentic and
imitation Viagra. The variance plots for authentic Viagra using FTNIR reported higher value (93%)
than the imitation Viagra (84%). The SIMCA classification by Cooman’s Plot is useful to determine
the origin, formulation and the quality of medicines. CONCLUSION: Both methods are preferred
because of the rapid, ease of use and reliability result. The non-destructive analysis by FT-NIR have
successfully distinguishes the different sources of Sildenafil Citrate product and give more
promising result compared to FTIR-ATR. This approach will benefit the regulatory authority for the
fast screening method during the investigation of counterfeit.
Keywords: screening, qualitative determination, tablet authentication, FTIR, FTNIR and chemometric
techniques
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM10: DETERMINATION OF CALCIUM AND LEAD IN CALCIUM SUPPLEMENTS
BY ATOMIC ABSORPTION SPECTROPHOTOMETRY (AAS)
O. Nurhayati1, G.H. Tan2, V.K.M. Sulaikah3
1 Centre for Post Registration, BPFK, 2 Chemistry Departments, University of Malaya3, Centre for Quality
Control, BPFK
INTRODUCTION: Despite popularity of calcium supplements, there were raised concerns over the
quality and safety of them especially due to self regulatory in most countries. Contamination of
calcium supplements with lead and substandard calcium supplements have been reported on
various occasions. Registered calcium supplements products in Malaysia were only tested during
post marketing surveillance programme. OBJECTIVES: This study aims to determine calcium and
lead content in calcium supplements as a measure of quality and safety of calcium supplements
registered in Malaysia. METHOD: Fourteen registered calcium supplements products available in
local market were included in this study. All samples were digested with nitric acid. Calcium
content was analysed by Flame Atomic Absorption Spectrophotometry (FAAS), while lead content
was determined by Graphite Furnace Atomic Absorption Spectrophotometry (GFAAS). In-house
methods were used for both analyses. RESULTS: The range of the calcium content measured in the
analysis was 151.20 - 630.25 mg per tablet. Lead content found was ranged from 0.141 ppm to
1.171 ppm. Out of 14 products analysed, 13 products (92.86%) comply and only 1 product (7.14%)
failed to comply with the manufacturer’s finished product specifications. Although there was 1
product failed, the calcium content was still within the limit (upper limit at 1400 mg) allowed by
Malaysian Drug Control Authority (DCA). Lead content in all calcium supplements were within the
limit of 10 ppm. Estimated amount of lead allowed to be ingested per day was 0.506-4.136 mcg and
within the limit established by United States Food & Drug Administration (USFDA). CONCLUSION:
This study showed that calcium supplements marketed in Malaysia complied with the requirements
by DCA in term of quality and safety.
Keywords: Calcium supplement; calcium content; lead content
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
OM11: EFFECT OF PARENTERAL NUTRITION IN PROMOTING WEIGHT GAIN
IN PRETERM NEONATES
M. Ezatul Mazuin Ayla
Pharmacy Department,Hospital Sultanah Aminah, Johor Bahru
INTRODUCTION: Parenteral Nutrition (PN) allows preterm neonate’s nutritional requirement for
growth and development to be met. OBJECTIVES: To assess the appropriate indication and
regimen of PN in promoting weight gain in low birth weight (LBW) neonates, very low birth weight
(VLBW) neonates and extremely low birth weight (ELBW) neonates. METHOD:
A total of 82
patients received PN at Hospital Sultanah Aminah Johor Bahru in year 2008 were included in this
retrospective study. Clinical data related to the growth (weight gains) and nutrition were obtained
from case notes and compared. Data were analysed using SPSS version 15.0. RESULTS: Majority of
patients was Malay (58.5%), followed by Chinese (26.8%), Indian (13.4%) and other races (1.2%).
63.4% patients were male. Mean ± SD of birth weight was 1132 ± 345.32 g. 86.6% received
appropriate PN regimen as recommended by ASPEN. Patients received PN at mean age of 4.63 ±
3.87 days which was later than recommendation. Mean ± SD of weight gain per day during the
whole regimen of PN was 2.92 ± 9.78 g which was lower compared to other study. There were no
significant difference in the weight gain between three different birth weight group (ELBW, VLBW
and LBW) (p=0.095). There was a significant substantial main effect for weight gain during three
time frames nutrition given (during PN only; during PN and enteral nutrition in combination; and
during the whole regimen of PN) (p<0.05). There was a significant association between birth weight
group and complications related to PN (p<0.05). ELBW group has higher percentage of PN
complication which is 93.9% compare to VLBW group (85%) and LBW group (33.3%). CONCLUSION:
Findings from this study were able to provide information regarding PN in promoting weight gain of
preterm neonates, thus current practice can be improved in order to improve patient outcome.
Keywords: Parenteral Nutrition (PN), low birth weight (LBW), very low birth weight (VLBW), extremely low
birth weight (ELBW).
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
POSTER PRESENTATIONS
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P1:
EVALUATION OF PHARMACIST-MANAGED DIABETES MEDICATION
THERAPY ADHERENCE CLINIC (DMTAC)
P.C. Lim, L. Kelvin
Pharmacy Department, Penang Hospital
INTRODUCTION: Patient adherence to prescribed medication regimes is important in diabetes care
to prevent or delay complications. In Penang Hospital, pharmacists collaborate with physicians in
diabetes care through a pharmacist-managed Diabetes Medication Therapy Adherence Clinic
(DMTAC) in the Endocrine Clinic, operational since 2006. OBJECTIVES: To evaluate the
effectiveness of pharmacist-managed DMTAC program in improving glycemic control and patients’
medication adherence. METHOD: A retrospective study among patients enrolled in the DMTAC
program was conducted between September 2007 and December 2008. Data of patients with
glycosylated haemoglobin (HbA1c) > 8% and had completed 8 visits with the pharmacists were
included. Medical records and DMTAC forms that provided patients’ information, adherence and
laboratory parameters as well as pharmacists’ interventions were reviewed. HbA1c, fasting blood
glucose (FBG) and low-density lipoprotein cholesterol (LDL) were compared using a paired t-test.
Documented data of patients’ adherence to medication regime [Modified Morisky Medication
Adherence Score (MMMAS); non-adherent if >4] was also compared. RESULTS: Out of 43 patients
that were included as subjects, 46.5% were males and 53.5% were females that comprised 46.5%
Malays, 44.2% Chinese and 9.3% Indians. A mean reduction of HbA1c of 1.73% (p<0.001) from 10.82%
to 9.09%, mean reduction in FBG of 2.65mmol/l (p=0.01) and mean reduction in LDL cholesterol of
0.384mmol/l (p=0.007) were achieved. Patients’ adherence to medication regimes improved
significantly with a mean MMMAS of 4.04 dropping to 0.20 (p<0.001) after completion of the DMTAC
program. CONCLUSION: Pharmacist-managed DMTAC program resulted in significant improvements
in HbA1c, glucose and LDL cholesterol levels as well as patients’ adherence in medication regime in
patients with diabetes.
Keywords:
DMTAC program, diabetes care, patient’s adherence, glycemic control
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P2:
A STUDY ON BROAD SPECTRUM ANTIBIOTICS USAGE IN HOSPITAL
PUTRAJAYA: A COMPARISON BETWEEN DISCIPLINE/DEPARTMENT
R. Shantini, H. Nazariah
Pharmacy Department, Putrajaya Hospital
INTRODUCTION: Broad spectrum antibiotics (BSAs) are costly and prone to be misused. Since BSAs
often constitute the last line of defense against nosocomial infections, their appropriate use is vital
to
avoid
resistance.
Piperacillin/tazobactam,
Imipenem/Cilastatin,
Cefepime
and
Cefoperazone/Sulbactam are preferred for high risk infection with multi-drug resistant (MDR)
organisms. OBJECTIVES: This study was done to evaluate the prescribing pattern of selected broad
spectrum antibiotics among hospitalised adult patients in Putrajaya Hospital and to compare the
selected BSAs usage between disciplines/department. METHOD: A retrospective study on BSAs
usage for 3 months (Jan-March 2009) among hospitalised adult patient in Putrajaya Hospital (n=56)
and comparison between three departments (medical, surgical and ICU) were done using the
“defined daily dosages” (DDDs) per 100 admissions of the World Health Organization. Sample
population was all hospitalised adult patients on the selected four antibiotics. The sample selection
was done using convenience sampling. Male and female patients were 46.60% and 56.60%
respectively (n=56). Paediatric patients were excluded. RESULTS: This study has shown that the
most
frequently
used
BSA
among
hospitalised
patients
in
Hospital
Putrajaya
were
Piperacillin/tazobactam (DDD per 100 admissions =27), Imipenem/Cilastatin (DDD per 100
admissions =21.5), Cefepime (DDD per 100 admissions =4.5), Cefoperazone/Sulbactam (DDD per
100 admissions =1) respectively. Piperacillin/tazobactam was mostly prescribed for nosocomial
pneumonia (72.7%) and sepsis (21.2%) followed by Imipenem/Cilastatin (53.3%) and (46.7%). In
addition, Cefepime was used mostly for febrile neutropenia (50%) and nosocomial pneumonia
(50%). CONCLUSION:
In short,Piperacillin/tazobactam is highly used in medical department.
However, both Imipenem/Cilastatin and Cefepime were highly used in ICU department.
Cefoperazone/Sulbactam usage was the lowest as its usage has already been restricted in HPJ for
Acinetobacter spp. infection.
Keyword: Broad spectrum antibiotics, BSA, DDDs
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P3:
IMPACT OF CLINICAL PHARMACIST’S INTERVENTION ON COST OF
RENALLY EXCRETED ANTIBIOTICS THERAPY IN MEDICAL WARDS,
QUEEN ELIZABETH HOSPITAL, SABAH
S.F. Yew, P. Adela Marie, K.F. Lai, C.H. Yap
Pharmacy Department, Queen Elizabeth Hospital
INTRODUCTION: Renal impairment, which affects drug clearance, leads to the need for dosage
adjustment to maximise therapeutic efficacy, reduce additional costs and minimise risk of toxicity.
Pharmacist’s participation in clinical rounds on renal dosage adjustment has been shown to reduce
overall drug costs and prevent adverse drug reactions. OBJECTIVES: The aim of the study was to
investigate the impact of clinical pharmacist’s intervention on cost of renally excreted intravenous
antibiotics therapy. METHOD: A prospective and single-centred study was conducted in medical
wards from February to June 2009. Patients with renal impairment and receiving at least one of the
selected intravenous antibiotics were enrolled. Data collection sheet was used to obtain patient’s
data, serum creatinine and antibiotics prescribed. Cost saving was determined by calculating the
difference between the costs of full course therapy and adjusted renal dosage. RESULTS: A total of
80 patients were evaluated in this study. Subjects are mostly between 45-71 years old (age range:
18-90). 51.3% and 35% of patients showed moderate (10-30mL/min) and severe renal impairment
(<10mL/min) respectively, whereas 13.8% were classified as mild renal impairment (31-50mL/min)
based on Cockcroft and Gault equation. A total of 97 antibiotic prescriptions required renal dosage
adjustment. Only 82 of the prescriptions (84.5%) were adjusted appropriately and pharmacists
contributed to 64.6% of the renal dosage adjustments. Prescribers accepted 53 of the total of 68
interventions
(78%)
by
pharmacists.
Pharmacist-generated
recommendations
successfully
contributed to a cost saving of approximately RM 12662.985. CONCLUSION: Clinical pharmacist’s
interventions during ward rounds are vital in promoting appropriate prescribing of antibiotics with
renal dosage adjustment and reducing the cost of patients’ overall pharmacotherapy.
Keyword: Antibiotics, renal impairment, dosage adjustment, cost saving
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P4:
PHARMACOKINETIC PROPERTIES OF GENTAMICIN IN NEONATES AT
HOSPITAL SULTAN HAJI AHMAD SHAH, TEMERLOH
W.H. Adrian Chong, S. Aziarani, M.T. Siti Masyitah, R. Suriani, M.F. Yvonne Lim
Pharmacy Department , Hospital Sultan Haji Ahmad Shah, Temerloh.
INTRODUCTION: Gentamicin is one of the most frequently used antibiotics in the NICU setting for
the treatment of confirmed or presumed sepsis. The clinical use of gentamicin in neonates requires
close monitoring, primarily due the immaturity of the renal function in this population.
Pharmacokinetic properties of gentamicin have been observed to vary with different patient
populations. OBJECTIVES: The objectives of the current study are to determine the
pharmacokinetics parameters in newborns treated with gentamicin at Hospital Sultan Haji Ahmad
Shah and their correlation with various physiological covariates. METHOD: Data was collected
retrospectively by compiling routine therapeutic drug monitoring (TDM) results which fulfil the
inclusion criteria of the present study. The pharmacokinetic data for 105 neonates was classified
into 3 groups based on gestational age (GA): GA≤ 32 weeks, 32 < GA ≤ 37 weeks and GA > 37 weeks.
RESULTS: 64 % (n = 67) of subjects experienced toxic serum gentamicin concentrations. The
pharmacokinetic parameters of gentamicin determined as mean ±SD were:
elimination rate
-1
constant, Ke = 0.0864 ± 0.3111 h , elimination half life, t1/2 = 9.09 ±3.46 hours, apparent volume of
distribution, Vd = 1.72±1.27 L, and gentamicin clearance, Cl = 0.14±0.11 Lh -1. Findings showed wide
inter-patient
variability
of
gentamicin
pharmacokinetics.
The
mean
gentamicin
dosage
recommendations derived from routine TDM were 2.59 mg/kg/day for neonates with GA of 32
weeks or younger, 3.07 mg/kg/day for newborns of 32 weeks’ gestation up to 37 weeks and 3.96
mg/kg/day for those older than 37 weeks. CONCLUSION: These results were found to be in line
with the dosage regimen currently adopted at another well-established healthcare institution in
Malaysia.
Keywords: Gentamicin, pharmacokinetic, neonates.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P5:
UNDER-REPORTING OF ADVERSE DRUG REACTIONS (ADRs): FACTORS
AND PROBLEMS
C.M. Cher1, A.R. Maharita1, O. Noor Mariati1, M.T. Siti Masyitah1, T.M. Teh1, Ahmed Awaisu2
1 Pharmacy Department , Hospital Sultan Haji Ahmad Shah, Temerloh. 2Kulliyyah of Pharmacy, International
Islamic University Malaysia (IIUM), Kuantan.
INTRODUCTION: Adverse Drug Reactions (ADR) remains an important issue in drug development
and clinical use. Healthcare professional play an important role in ADR reporting. However, know
that ADR is under-reporting. OBJECTIVES: This study was to evaluate the ADR reporting activity in
Hospital Sultan Haji Ahmad Shah (HoSHAS); to evaluate the understanding of HoSHAS professional
towards ADR reporting and to identify factors contributing to ADR. METHOD: A verified
questionnaire was distributed to all healthcare professional in all wards of the HoSHAS from
February 2008 to May 2008. The questionnaire was analyzed using SPSS. RESULTS: Out of 140
respondents, 69 (49%) respondents were able to identify ADR and only 47 (68%) from the
encountered ADR reported. A total of 56 (40%) respondents understand ADR concept and 51 (36%)
respondents knew the ADR reporting process. The study revealed that 26% respondents were unsure
that any lead to the ADR, followed by 18% respondents who do not know how to report and 17%
respondents thought the adverse reaction were too common. CONCLUSION: Under-reporting of
ADRs in HoSHAS might be due to lack of ADR knowledge, lack of awareness on the importance of
ADR reporting. Further could be constitutive strategy is indeed needed in order to have better ADR
reporting by healthcare professional.
Keywords: adverse drug reactions, under- reporting, healthcare providers, awareness.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P6:
PHARMACIST
INTERVENTION
TO
IMPROVE
ADHERENCE IN ATRIAL FIBRILLATION PATIENTS
MEDICATION
Y.S. Lau.
Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor.
INTRODUCTION: Atrial Fibrillation (AF) is the most common arrhythmia encountered in clinical
practice nowadays. One of the ways in which patients could manage their diseases in a better way
is by adhering to their medication regimens. However, study showed that only 50% of chronic
disease patients actually follow treatment recommendations. OBJECTIVES: To assess patient’s
knowledge about disease, medications and their medication adherence level before and after
pharmacist intervention. METHOD: A prospective, cross-sectional study was conducted from July
until August 2008 at out-patient pharmacy of Hospital Pakar Sultanah Fatimah (HPSF), Muar. This
study was divided into two phases, where Phase I assessed patient’s medication adherence before
counseling and Phase II assessed patient’s medication adherence after counseling. AF patients who
were collecting and managing medications on their own and have not been counseled were
included. Eligible patients were interviewed by using questionnaire. The level of medication
adherence was assessed using “Modified Morisky Medication Adherence Scale”. A score of 4 to 11
was defined as non-compliant while a score of 3 and below was defined as compliant. The primary
end point was the percentage of improvements in medication adherence after counseling. Data
were analyzed using SPSS program. RESULTS: A total of 40 patients (41-70 years; male=19 (47.5%),
female=21 (52.5%)) were recruited. Upon pharmacist counseling, patient’s knowledge on disease
and medications increased significantly from 27.5% to 67.7% (p value = 0.001) and 20.0% to 55.9% (p
value = 0.001) respectively. Meanwhile, the percentage of patients who were compliant increased
significantly from 15.0% to 52.9% (p value = 0.001) after pharmacist counseling. Another 47.1% of
the patients were still non-compliant, but their scores improved as compared to their first visit.
CONCLUSION: Pharmacist intervention was proven effective as the patient’s knowledge on disease,
medications and adherence level were significantly improved upon counseling.
Keyword: Pharmacist intervention, medication adherence, atrial fibrillation
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P7:
ASSESSMENT OF PATIENT’S OWN MEDICATIONS IN THE MEDICAL
WARDS AT HOSPITAL SULTANAH NUR ZAHIRAH, KUALA
TERENGGANU
C.W.A.C. Wan Mohd Hafidz, C.I. Mohd Adnan, M.S. Siti Syaffurah, T.A.K.Tg Nur Izzati
1Pharmacy Department, Hospital Sultanah Nur Zahirah, Kuala Terengganu .
INTRODUCTION: Patient’s own medications (POMs) are defined as the prescribed medications that
patient brought to the hospital during admission. Some advantages of POMs are providing better
medication history, ensuring medication safety, reducing medication wastage, avoiding medication
duplication as well as promoting treatment continuity. OBJECTIVES: The objectives are to
determine the percentage of patients that bring their POMs during admission, to evaluate
conditions of POMs, and to find the correlation between socio-demographic with the POMs
condition. METHOD: This cross sectional prospective study was conducted from January to April
2008 using convenient sampling in medical wards involving patients with chronic diseases
(Hypertension, Diabetes Mellitus and Cardiovascular disorders). Patients were interviewed and
POMs were checked during admission by using modified checklist based on algorithm from North
Staffordshire Hospitals (NSH) Trust by Sean Fradgley et al. Spearman correlations were used to
correlate socio-demographic data and the POMs condition. RESULTS: A total of 104 patients aged
from 24 to 82 year old were included in this study. Only 66% (n=68) patients brought POMs during
admission which resulted in the inspection of 317 medications. Only 54% (n=171) of POMs were in
good condition and could be reused. The remaining of 46% (n=146) of POMs were not suitable to be
reused due to improper storage, damaged and exceeded the expiry date. Medications condition
showed no significant correlation (p>0.05) between age, gender, occupation and patient’s
education but there was significant correlation with monthly income (p<0.05). CONCLUSION:
Stringent assessment of POMs is necessary to ensure the POMs are in good condition to be used by
the patients. Assessing POMs is time consuming but it can reduce health care cost.
Keyword: Patient own medication(POM), medication condition
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P8:
ANALYSIS OF PROTON PUMP INHIBITORS USAGE IN SURGICAL
WARDS, HOSPITAL KUALA LUMPUR
S.Y Julian Lim, Preethi, T. Subramaniam, J. Sivakami
Pharmacy Department, Kuala Lumpur General Hospital
INTRODUCTION: Proton pump inhibitors (PPIs) are widely used in hospitals. There is an increasing
trend of inappropriate use of PPIs in recent years. OBJECTIVES: The study was to identify the
usage and prescribing trends, the appropriate use in terms of approved indications by Ministry of
Health (MOH) Drug Formulary among surgical ward patients in Hospital Kuala Lumpur (HKL).
METHOD: A prospective study was carried out from April to June 2009 in surgical wards in HKL. A
total of 66 patients were recruited following a predetermined inclusion criteria. A data collection
form was used to review patients’ medical records, medication charts and endoscopy reports. The
total cost of savings was determined if interventions in terms of dosage, frequency, and route of
administration were calculated and recorded. RESULTS: Approximately 10% of patients in the
surgical wards in HKL were prescribed PPIs. The most commonly prescribed PPIs is pantoprazole,
followed by omeprazole and esomeprazole. A total of 75% of PPIs were given via appropriate route
of administration. This study showed that 38% of the PPIs were used for indications which are not in
accordance to the approved indications in MOH Drug Formulary. The total cost of savings totaled up
to an amount of RM690.52 on the day of intervention if an intervention was carried out.
CONCLUSION: Conversion of intravenous to oral route of administration immediately when
appropriate provides the most savings for PPIs use.
Keyword: proton pump inhibitor, appropriate use, drug formulary
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P9:
A STUDY ON EFFECT OF PATIENTS’ WARFARIN KNOWLEDGE ON
QUALITY OF LIFE
Y.I. Rose Ling, L.Y. Lim, Y.S. Lim
Pharmacy Department, Seremban Hospital
INTRODUCTION: Warfarin as an anticoagulant requires patients’ knowledge and adherence to
ensure full expected outcome to prevent formation of clots. OBJECTIVES: The study was to
determine the correlation of patients’ demographic variables on their warfarin knowledge and to
determine the quality of life during warfarin therapy. METHOD: A cross-sectional observational
survey was carried out at Warfarin Clinic in Hospital Tuanku Jaafar, Seremban. Patients attending
the warfarin clinic from January to March 2009 were randomly picked and interviewed using
questionnaires to determine the demographic characteristics (age, gender, race, marital status,
level education, employment status). Subjects were assessed on warfarin information and their
quality of life during warfarin therapy. SPSS version 11.5 was used for statistical analysis. RESULTS:
Approximately 183 patients responded to the study, completing a total of 148 questionaires. On
average, 63% of the subjects had scores indicative of sufficient knowledge of warfarin therapy. Age
is negatively related to warfarin knowledge (P<0.01). Patients with incomes greater than RM 10,000
(p = 0.005), having secondary school education or higher (p=0.009), and who were employed or
self-employed (p= 0.007) have significantly higher warfarin knowledge scores. Patient’s age and
employment status are found significantly associated with the patient’s quality of life on warfarin
therapy (p= 0.027, p= 0.04, respectively). The knowledge of warfarin is significantly correlated
with the quality of life (p<0.05).CONCLUSION: From the study, age, income, and educational level,
were significantly correlated with the patient’s knowledge of anticoagulation. Successful
anticoagulation therapy is dependent on the patients’ knowledge which leads to better compliance
and control of International Normalised Ratio. Although hospital provides basic knowledge of
warfarin, attention needs to be placed to ensure patients have easy access to patient education.
Keywords: warfarin, patient’s knowledge, quality of life
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P10:
ANTIBIOTIC USE AND MICROBIAL RESISTANCE PATTERN IN THE
GENERAL MEDICAL WARDS IN HOSPITAL PAKAR SULTANAH
FATIMAH
J.S. Low1, A.K. Zahrina1, L.M. Ho2, U. Mohd Helmi3
1Pharmacy
Department, 2Department of Medicine, 3Pathology Department, Sultanah Fatimah Specialist
Hospital, Muar, Johor
INTRODUCTION: Antimicrobial resistance poses a major problem to healthcare institutions
worldwide. Studies have reported the association of antibiotic use with the emergence of
antimicrobial resistance. OBJECTIVES: (i) To quantify the use of antibiotics in the general medical
wards, (ii) to identify the most common bacterial isolates and (iii) to identify the resistance
patterns for specific virulent strains. METHOD: A retrospective review of antibiotic usage and all
patients’ culture & sensitivity data from the general medical wards from January to December 2006
was conducted. Data was obtained from computer records of the in-patient pharmacy and
microbiology unit. Antibiotic use was quantified in defined daily doses (DDD) per 100 admissions
and a total of 1666 isolates were included in the study. Microbial resistance was determined by the
microbiology unit and results were interpreted based on the Clinical Laboratory Standards Institute
(CLSI) guidelines. RESULTS: The antimicrobial group with the highest consumption was the betalactam antibacterials, penicillins (J01C) with 187.48 DDD per 100 admissions. Amoxicillin/clavulanic
acid (117.34), clarithromycin (70.87) and erythromycin (54.81) were the top three antimicrobial
agents used based on DDD per 100 admissions. The most common organisms isolated in the general
medical wards were Klebsiella pneumoniae (19.45%), Pseudomonas aeruginosa (15.91%),
Escherichia coli (12.67%), Acinetobacter baumannii (7.92%) and Staphylococcus aureus (6.90%). The
prevalence of specific virulent strains was multi-drug resistant Acinetobacter baumannii (2.52%),
Methicillin-resistant Staphylococcus aureus (1.74%) and multi-drug resistant Pseudomonas
aeruginosa (0.48%). CONCLUSION: This study has provided useful information on antibiotic usage
and the microbial resistance in the medical wards which acts as a feedback guide for clinicians.
Further studies are necessary to analyze possible correlations between antibiotic usage and
resistance pattern; and to serve as a surveillance system towards judicious use of antimicrobials
and prevention of the emergence and dissemination of resistant bacterial strains.
Keyword: Antibiotic use, microbial resistance
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P11: DIABETES MEDICATION KNOWLEDGE AMONG TYPE 2 DIABETIC AT
OUTPATIENT PHARMACY HOSPITAL PUTRAJAYA
F.X. Lim, M. Noraini
Pharmacy Department, Putrajaya Hospital
INTRODUCTION: The major problem in treating illness today is patients’ failure to take prescribed
medications correctly. Lack of medication knowledge is a contributing factor for treatment failure
in diabetes patients. Therefore, patient’s medication knowledge is essential for effective selfmanagement of diabetes. OBJECTIVES: The study was to determine diabetes medication
knowledge among type 2 diabetes patients in outpatient pharmacy, Hospital Putrajaya (HPJ) and to
identify possible factors that correlate with patient’s medication knowledge. METHOD: This crosssectional study was conducted from April to May 2009. Structured questionnaire was modified from
Medication Knowledge Survey of Case Management Adherence Guidelines 2004 and Diabetes
Knowledge Test by Diabetes and Hormone Center of the Pacific and a pilot study was done.
Convenient sampling was used to recruit type 2 diabetes patients who refill diabetes medication at
the outpatient pharmacy, HPJ. Indicator of knowledge level was the total score obtained from the
questionnaire. Each correct answer was given one mark, partly correct answer given half mark
while no marks for incorrect answers. Knowledge level was divided into poor (score 0-2), average
(score 2.1-4), and good (4.1-6) level. Data obtained was analyzed using SPSS 14.0. RESULTS: A total
of 42 patients were recruited and 66.7% (n=28) of them showed good knowledge on diabetes
medication. The mean knowledge score of patients was 4.5±1.21 out of 6 marks, which is
considered as a good level of knowledge. The results found that diabetes medication knowledge
was not significant influenced by patient’s age, race, gender, education level, duration of diabetes
and counseling. However, patient’s medication knowledge level significantly influenced HbA1c
level (r= - 0.312; p=0.044).The higher knowledge level on diabetes medication correlates with
better glycemic control. CONCLUSION: Majority of the patients on follow-up in HPJ have a good
level of knowledge on diabetes medication. Future study is warranted to evaluate patient’s
adherence towards diabetes medication because knowledge alone does not ensure adherence to
the therapy.
Keywords: Type 2 diabetes, patient knowledge, medication, HbA1c
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P12:
AWARENESS AND UNDERSTANDING OF ASTHMATIC PATIENTS
TOWARD THEIR DISEASE AND USAGE OF INHALED CORTICOSTERIOS,
HOSPITAL SULTANAH BAHIYAH
A. Syaziyah, S.T. Khor, H. Humaira, R. Norain.
Pharmacy Department, Sultanah Bahiyah Hospital
INTRODUCTION: Poorly controlled asthma may affect patients’ quality of life. Inadequate patients’
awareness and understanding regarding the disease and its treatment may be one of the
contributing factors to uncontrolled asthma. OBJECTIVES: The study was to access the awareness
and understanding of asthmatic patients toward the disease and the usage of ICS in HSB, to explore
the association between asthma awareness with social demographic profile and with asthma
control. METHOD: This study was conducted by using prospective cross sectional study in chest
clinic between February 2008 and May 2008 and subjects were included by using convenient
sampling method. Data was retrieved from clinic follow up notes and by interviewing asthmatic
patients by using a structured questionnaire. Independent-Samples t test and One-Way ANOVA
were used to test the relationship and a p-value of < 0.05 was considered to be significant.
RESULTS: There were 51 patients who responded to the study. The number of female subjects is
much higher than male in this study and Malay is the largest ethnic group. The mean score for the
disease awareness and the ICS awareness were 10.3 out of 16 and 4.5 out of 7 respectively. The
highest awareness goes to the dose where all of the subjects answered their dose correctly (100%)
followed by medication colour (88.2%) and the need to rinse the mouth after the use of ICS
(80.4%). In this study, there was no significant difference in mean score of awareness with respect
to socio demographic properties (p>0.05). Besides, there is no significant association between
degree of awareness and asthma control (p>0.05). CONCLUSION: This study revealed an inadequate
awareness towards the disease and ICS in the subjects. It is recommended to conduct a further
study with a larger sample size to reassure other factors contributing to asthma control.
Keyword: Asthma awareness, Inhaled corticosteriod
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P13:
EVALUATION OF HUMAN ALBUMIN USAGE IN CRITICALLY ILL
PATIENT IN HOSPITAL SULTANAH BAHIYAH 2007
S. Azmira, A.R. Rozita, S.L. Ooi, P.T. Wan.
Pharmacy Department, Hospital Sultanah Bahiyah
INTRODUCTION: The usage of human albumin in Hospital Sultanah Bahiyah is increasing from 2006
(2392) to 2007 (3221). However, there is controversy on the albumin administration in critically ill
patients. OBJECTIVES: The study was to evaluate the usage of human albumin in critically ill
patients in Hospital Sultanah Bahiyah in year 2007. The study was also to compare the mortality
and the length of stay in ICU, CCU and HDW among patients receiving two duration of human
albumin treatment (≤3days to >3days). METHOD: A retrospective study was conducted on all
patients (65) who were started with albumin treatment from January to December 2007 in ICU,
CCU and HDW Hospital Sultanah Bahiyah. A standard data collection form was designed for this
study. RESULTS: Forty six (46) of 65 patients were included in this study. Of 46 patients, 34 (73.9%)
patients are from ICU, 11(23.9%) patients were from HDW and 1 (2.2%) from CCU. Surgeon
prescribed human albumin most frequently (74%) and it was followed by medical specialist (11%).
Human albumin was mostly indicated for hypoalbuminemia (52%), followed by cirrhosis and
paracentesis (9%), postsurgical hypotension and hypovolemia (7%), nonhemorrhagic shock (4%).
Liver transplant (postoperative) (4%), impending hepatorenal syndrome (2.2%) and others (22%).
The result showed that there were no significant difference in mortality (p=0.4136) between the
patients
given
two
duration of
human albumin (≤3days
to
>3days)
in treatment
of
hypoalbuminemia. There were also no significant difference (p=0.229) in length of stay in ICU, HDW
and CCU between patients given two duration of human albumin (≤3days to >3days) in treatment of
hypoalbuminemia. CONCLUSION: There were no evidence showed longer than 3 days albumin
administration was asociated with increase the survival and decrese the length of stay in ICU, HDW
and CCU in treatment of hypoalbuminemia among critically ill patients.
Keyword: human albumin usage, length of stay, mortality, hypoalbuminemia
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P14:
UTILIZATION OF PARENTERAL NUTRITION IN CRITICAL & NON
CRITICAL PATIENTS IN HOSPITAL KUALA LUMPUR
T. Noridayu, M. Jivanthi, C.K. Wei, M.H. Hairul
Pharmacy Department, Kuala Lumpur Hospital
INTRODUCTION: Parenteral Nutrition (PN) is the primary mode for providing nutritional support in
some specialties. In severely nourishment depleted patients, PN has improved nutritional status
and clinical outcome. OBJECTIVES: The study was to determine utilization of PN among critical
and non-critical patients in Hospital Kuala Lumpur (HKL) in terms of indications for PN, duration
and cost of IV Glutamine and the effect of IV Glutamine supplemented PN (gsPN) in reducing
hyperglycaemia. METHOD: A cross sectional study was conducted among 119 patients in HKL and
only 93 patients met the selection criteria. All adult patients who received PN from January to July
2009 were recruited. Data was extracted from the patients bed head ticket and pharmacy records.
RESULTS: Indications for PN either due to preparation for surgery and/or post-surgery accounted
for 35.5% (n=33). 26.8% patients (n=25) were under intensive care, followed by non-surgical
oncology patients (17.2%, n=16) and gastroenterology patients (13.9%, n=13). Glutamine
supplemented PN (gsPN) accounted for 32.3%. Four patients received 3 to 4 days of gsPN
(RM717.25±319.53), 15 patients were on 5 to 10 days gsPN (RM1491.60±474.09), and 4 patients
were on 11 to 15 days of gsPN (RM2798±777.49), 7 patients had the highest cost
(RM5240.14±2586.83) because they were on more than 15 days of gsPN.
No differences in
hyperglycaemia reduction between day 1 and day 5, were found between the gsPN and non-gsPN
group (p=0.844). CONCLUSION: PN is mainly used in surgical patients undergoing hemicolectomy
and in critically ill patients with sepsis. PN supplemented with glutamine has no impact in lowering
hyperglycaemia.
Keyword: Glutamine, Parenteral Nutrition, Critical ill.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P15:
PATIENT KNOWLEDGE AND PERCEPTION ON UPPER RESPIRATORY
TRACT INFECTIONS, ANTIBIOTICS INDICATION AND RESISTANCE IN
HOSPITAL TUANKU FAUZIAH, PERLIS
A. M. Kasyfun Naeimi, H. Hazlin Syafinar, N. M. Nik Mah, S. Fadzil
Pharmacy Department , Hospital Tuanku Fauziah, Perlis.
INTRODUCTION: Based on evidence-based guidelines on the management of Upper respiratory
tract infection (URTI), it is recommended to restrict the use of antibiotics in URTI. The unnecessary
prescribing of antibiotic in URTI adds the burden to the community, and contributes to
antimicrobial resistance. OBJECTIVES: To determine patient’s knowledge and perception on URTI,
antibiotic treatment and resistance. METHOD: A cross-sectional prospective study involving one
hundred (100) patients was conducted at Out-patient Pharmacy Department (OPD) in Hospital
Tuanku Fauziah from May to July 2009. Patients were randomly selected during their visit to OPD.
The patients were interviewed by using a modified interviewer-administered questionnaire adapted
from Filipetto et al. The questionnaire includes three parts: first part is demographic data of
participants, educational level and ethnicity. Second part involves patients’ perception to URTI and
its treatment and the final part is related to patients’ knowledge about URTI, antibiotic treatment
and resistance. Result was compiled and analysed. RESULTS: Approximately 98% of patients from
this study believed that antibiotics are helpful in treating URTI and 82% of patients perceived that
infection caused by viruses requires antibiotics treatment. Besides, 14% of patients requested for
antibiotics. From this study, 95% of patients satisfied with the statement that antibiotic treatment
is not necessary for URTI after advised by doctor. The antibiotics compliance was poor with only
55% patient continued taking their antibiotic after feeling well and did not complete the entire
course. On the other hand, more than half of patients have inadequate knowledge about
antimicrobial resistance. CONCLUSION: This study shows that patients in Perlis have inadequate
knowledge and misconception on antibiotic use for URTI, indication and resistance. Healthcare
providers can play an important role in controlling antibiotic use and resistance by educating
patients. Increased antibiotic use among those believing antibiotics to be effective for viral
illnesses suggests that improvements are needed in communications to patients and the public
about antibiotic appropriateness.
Keyword: Antibiotic resistance, antibiotic indications, upper respiratory tract infection, patient knowledge,
patient education
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P16:
AN EVALUATION OF ANGIOTENSIN CONVERTING ENZYME INHIBITOR
(ACEi) AND ANGIOTENSIN II RECEPTOR BLOCKER (ARB) IN HEART
FAILURE (HF) PATIENTS AT MEDICAL WARDS HOSPITAL TENGKU
AMPUAN AFZAN, KUANTAN.
M.J. Nur Eizera Herlena, P.K. Eng, N.A.R. Nik Najibah, M. Sahimi
Pharmacy Department, Hospital Tengku Ampuan Afzan, Kuantan
INTRODUCTION: Heart Failure (HF) is the end stage of most diseases of the heart. It is an essential
cause of hospitalization in Malaysia. About 40% of patients with HF died within a year of initial
diagnosis. According to Ministry of Health (MOH) Clinical Practice Guideline (CPG) of Heart Failure,
Angiotensin Converting Enzyme Inhibitor (ACEi) is the first line agent for pharmacological
management of HF unless contrandicated. Angiotensin II Receptor Blocker (ARB) is an alternative
first line agent for patients who cannot tolerate ACEi. OBJECTIVES: The study was to evaluate
utilization of ACEi or ARB at time of discharge for hospitalized HF patients and adherent of
prescribers to MOH guideline. METHOD: A retrospective patients’ case notes review was done for
discharged patients from medical wards in Hospital Tengku Ampuan Afzan with a diagnosis of HF
during the period of March to June 2009. Patients were included if they were hospitalized with a
primary or secondary diagnosis of HF and were more than 18 years of age.Prescribers were
classified as adherent if an ACEi or ARB was prescribed at discharge or if otherwise contraindicated
in the guideline. RESULTS: A total of 52 patients who complied the inclusion criteria were
recruited for this study. Twenty nine of 52 patients (55.77%) were taking ACEi or ARB at admission.
At the time of hospital discharge, 32 (61.5%) of HF patients were given ACEi or ARB. Eighteenth
(90%) of 20 patients who did not receive ACEi or ARB had a documented contraindication in the
patients case notes.Out of 29 patients who received ACE, 21 (72.4%) were not discharged with
maximum dose of ACEI. From 52 case notes reviewed, 50 (96.15%) HF patient were prescribed
according to MOH guideline. CONCLUSION: Most of HF patients received ACEi which is concurrent
with MOH guideline. Majority of prescribers are adherent to the guideline.
Keyword: Heart Failure, Angiotensin Converter Enzyme Inhibitors (ACEi), Angiotensin Receptor II Blocker
(ARB), Ministry of Health (MOH) guideline.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P17:
A STUDY ON THE USE OF NSAIDS POST-PARTUM FOR PAIN
MANAGEMENT
P.H. Lau, A. Sarah
Pharmacy Department, Hospital Putrajaya
INTRODUCTION: Non Steroidal Anti-inflammatory Drug (NSAIDs) is a group of drug commonly used
for pain management including post-partum pain. There is an increasing trend in the prescribing of
celecoxib for post-partum pain management in 2008. The Malaysian Guidelines for Pain control
states that mefenamic acid is indicated for pain after childbirth but celecoxib is not indicated.
OBJECTIVES: This study is to identify the types of analgesic used for post partum pain
management in Putrajaya Hospital and assess appropriateness of indication of each analgesic used
for post partum pain management. METHOD: A retrospective, cross-sectional study was conducted
from January to March 2009. Samples were chosen from O & G wards in Putrajaya Hospital by
convenient sampling. Data was collected based on the review of patient’s clinical notes (EMR) and
prescription orders in Pharmacy Information System (PIS). Their types of giving birth and NSAIDs
given at the point of discharge were recorded. RESULTS: From a sample of 300 patients, 186
patients experienced natural birth, 99 patients experienced C-section, and the remainder was
vacuum assisted birth. 98.9% of the natural birth patients were given mefenamic acid whilst 36% of
the C-section patients were given celecoxib. Only 2 patients with natural birth were prescribed
with celecoxib and 99.37% of NSAIDs were prescribed with appropriate indication. Celecoxib usage
is directly proportional to increasing number of C-section patients. CONCLUSION: Generally,
prescribers in Hospital Putrajaya adhered to the Malaysian guidelines for the usage of NSAIDs in
post-partum pain management. The increasing number of C-section cases justifies the increasing
trend of prescribing celecoxib for post-partum pain.
Keywords: NSAIDS, Post-Partum Pain
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P18:
RATE OF COMPLIANCE AMONG PATIENTS WITH DIABETES MELLITUS
(DM) TYPE 2 IN HOSPITAL TENGKU AMPUAN RAHIMAH KLANG
H.S. Nurul , M.Nasarudin, M.N. Norima, A. Norliah
Department Pharmacy, Hospital Tengku Ampuan Rahimah Klang
INTRODUCTION: Patient compliance or adherence is defined as the extent to which a person’s
behavior coincides with health-related advice. Medication compliance is often major problem in
the management of diabetes mellitus over the world .Compliance is important parameter to avoid
this problem and noncompliance increases morbidity OBJECTIVES: To investigate patient’s
compliance toward antidiabetic drugs by using Morisky scale in Diabetes Mellitus. METHOD: All
diabetes patients occupying odd bed number during the 3 months (Jun, July and August) period of
study and meet the inclusion criteria. Inclusion criteria: Diabetes mellitus patients, patients on
antidiabetic drugs, adults over 18 years old and able to interview were enrolled in the study. The
study was done in medical wards 7A, 7B, 8A and 8B. Standard questionnaires (i.e. CP1 government
form) with Morisky scale were used and data were collected via interviewing the study sample.
Data were then analyzed using Microsoft excel and SPSS 12.0 for window. RESULTS: Demographic
data: A total of 137 patients were enrolled in this study. 51.8% (n=71) of patients were male whilst
48% (n=66) are female. Majority of them were Indians (42%; n=58); followed by Malay (34%; n=47)
and Chinese (24%; n=32). The patients’ ages ranging from 18 to 50 years old with 45% (n=62) of
them fall between the age of 41 to 50 years old. Number of medication taken by patients: 34%
(n=47) of patients had to take four to six medications in a day while 9.4% (n=13) of them (p>0.05)
took more than 10 medication in a day. The rest of patient might either take three and/or lesser
medication or more than six but lesser than ten medications. Rate of compliance: Based on Morisky
scale score, results of patient’s rate of compliance are as follows: compliant, 18.2% (n=25);
satisfactory, 18.9% (n= 26); average, 39.4% (n= 54); poor, 16.8% (n= 23) and non-compliant, 6.7%
(n= 9). In general, there were no significant relation of gender, race, age and number of
medications towards assessing compliance in diabetic patients. CONCLUSION: From the study, we
found that most of patients are in the category of average or score indicator 2. However, this study
shall encourage pharmacist in HTAR to implement strategies in increasing compliance in DM
patients.
Keywords: rate of compliance, diabetes mellitus type 2
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P19:
STUDY OF RETURNED MEDICATIONS FROM WARDS AND DRUG
WASTAGE IN HOSPITAL RAJA PEREMPUAN ZAINAB (HRPZ) II
I. Hasnah, J.Y.H. Lee, D. Nur Aizati Athirah, C.S. Rasyidah , M. Nor Mardiana
Pharmacy Department, HRPZ II Kota Bharu
INTRODUCTION: In 2008, HRPZ II spent around RM16.8 million on medication for inpatients.
Medication wastage is considered to be a big problem to most hospitals. Unwanted medications are
regularly returned to the pharmacy department. Some of these medications can be reused whereas
others have to be destroyed. OBJECTIVES: This study aims to identifies percentage of returned
medication to the pharmacy, calculate the cost spent and drug wastage, as well as identifies which
medications are returned the most and the reasons of medication being returned. METHOD: The
data was collected prospectively from three wards which represents medical, surgical and intensive
care unit (ICU) for 6 weeks. The returned medications which met inclusion criteria were
categorized and quantified using data collection form. For each medication returned, the reason
for it being returned was investigated. RESULTS: Total number of medication returned is 2,473.
Total cost of this returned medication was RM 11,643. Cost of drug wastage is calculated to be RM
683. Meanwhile 57% of the sample is returned due to patient discharged, 11% because of
discontinuation and 5% due to patient transfer out. Most returned items were IV Tramadol from
surgical, tab Frusemide from medical and IV Bromhexine from ICU. CONCLUSION: Surgical and
medical returned 71% of medications supplied, while ICU 50%. Total cost of medication returned
was RM 11,643 and wastage calculated to be RM683. More than 50% medications were returned due
to patient discharged. The reduction in drug wastage is not a small issue. The implementation of
Unit Dose System hopefully will reduce the returned medications hence reducing drug wastage.
Keywords: returned medications, drug wastage, discharge medication.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P20:
A SURVEY ON THE EXPECTATIONS AND PERCEPTIONS OF DOCTORS
REGARDING SERVICES PROVIDED BY WARD-BASED CLINICAL
PHARMACISTS
C.M. Ong, S.C. Chai, E.C. Lee, C.M. Lee, S.Y. Kong, H.K. Chan
Pharmacy Department, Hospital Umum Sarawak
INTRODUCTION: The success of ward pharmacy service is highly dependent on the support of
doctors because clinical pharmacists are required to work closely with them. A better
understanding of the professional relationship between doctors and clinical pharmacists from the
doctors’ point of view is crucial in enhancing the communication between the two groups of
healthcare providers, and ultimately improving patient care. OBJECTIVES: To determine the
expectations and perceptions of doctors regarding ward-based clinical pharmacists. METHOD:
Questionnaires were distributed to 319 doctors working at the Sarawak General Hospital in April
2009. A 5-point Likert scale was used to measure the doctors’ level of agreement with statements
regarding their expectations and perceptions of the services provided by clinical pharmacists.
RESULTS: The response rate was 60.2%. Respondents had high expectations of clinical pharmacists
to counsel patients (93.2%); to inform them if a patient encounters any drug-related problems
(88.4%); as knowledgeable drug experts (87.9%); and to provide drug information (87.8%). However,
they were not as keen on the role of clinical pharmacists in monitoring their patient’s response to
drug therapy (53.9%). There was no general association between the doctor’s position and medical
experience with their expectations and perceptions of clinical pharmacists. CONCLUSION:
Respondents appeared to value the services provided by clinical pharmacists, suggesting that the
acceptance of clinical pharmacists in the wards by doctors will not be a barrier to the extension of
clinical pharmacy services.
Keywords: Clinical pharmacist, Role, Doctors’ expectation, Doctors’ perception
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P21:
FACTORS
AFFECTING
COMPLIANCE
ON
THE
INHALER
CORTICOSTEROID THERAPY IN OUTPATIENT DEPARTMENT: A
SINGLE CENTRE EXPERIENCE.
S.H. Chuo, E.L. Ang, N. Mateni, X.V. Su
Pharmacy Department, Sarawak General Hospital
INTRODUCTION: Inhaled corticosteroid therapy (ICS) is still the mainstay controller therapy for
asthma patients. Despite effectiveness of the therapy, patient compliance is important to
determine level of asthma control. OBJECTIVES: This study was aimed to determine local
compliance pattern in the use of corticosteroid inhaler among adult patients in Sarawak General
Hospital, factors contributing to non compliance and to identify correlations between demographic
backgrounds with compliance rate. METHOD: The study was done in Outpatient Pharmacy, SGH
from 12th April to 31st May 2008. A self-developed, invalidated questionnaire was used to assess
subjects’ demographic background, compliance pattern, and assessment of inhaler technique via
convenient sampling method. RESULTS: Seventy nine respondents were recruited with thirty nine
(49.4%) male and forty (50.6%) female. Forty five (57.0%) patients were fully compliant to their
inhalers. Effectiveness of inhaler as controller was found to be the main motivation to compliance
(48.8%), followed by easy usage of the inhaler (26.7%). However, out of the 43% non compliance
respondents, forgetfulness is the leading factor (73.5%), followed by self-adjusting dosage (8.8%),
lack of understanding from previous counseling (5.9%) and reluctance to use ICS(5.9%). 50% of the
respondents had been counseled by pharmacists before and it had significantly benefited
respondents’ inhaler technique(p=0.022). Age, gender, race, educational level and occupational
background had not significantly affected compliance (p>0.05). Counseling on inhaler technique
was found to significantly benefit patients (p = 0.022).
Correlation between demographic
backgrounds with compliance was insignificant due to the relatively small sample size. Pharmacists
had taken the main role of counseling which had been shown to improve subjects’ inhaler
technique. However, counseling had not been shown to improve compliance rate. CONCLUSION:
This study showed despite patient demographic background, effective counseling should be
strengthened to improve patient compliance to ICS inhalers.
Keywords: Asthma, compliance, inhaled corticosteroid, Sarawak General Hospital
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P22:
A RETROSPECTIVE STUDY ON GERIATRIC PRESCRIBING IN MEDICAL
WARDS OF BINTULU HOSPITAL
E. Perit, C.M.C. Aaron
Pharmacy Department, Bintulu Hospital, Sarawak, Malaysia
INTRODUCTION: Elderly patients often receive multiple drugs for their multiple diseases. This
greatly increases the risk of drug interactions as well as adverse reactions, and may affect
compliance. To prevent these situations, the prescribing patterns should be reviewed.
OBJECTIVES: The objectives of the present study were to review the prescribing patterns and to
determine the prevalence of potentially inappropriate drug use among elderly medical inpatients in
Bintulu Hospital. METHOD: A retrospective study on prescribing patterns using validated data
collection form for 279 elderly patients admitted between June 2008 and December 2008 to the
medical wards of Bintulu Hospital. The prevalence of potentially inappropriate medication as
defined using modified Beers Criteria was measured together with the prevalence of inappropriate
co-prescribing was evaluated using a list of 8 potentially harmful drug combinations adapted from
previous study by Vlahovic et al (2003). RESULTS: We have studied 279 elderly medical inpatients
who were taking a total of 2,315 drugs, with an average drug exposure of 8.3 per patient. The
prevalence of polypharmacy (> 5 medicines in use) was 67.7% and excessive polypharmacy (≥ 10
medicines in use) was 29.4%. Antibiotics were given to over one quarter of the patients.
Amoxycilin/Clavulanic Acid was the most commonly prescribed antibiotic. Among 279 elderly
patients, the prevalence of potentially inappropriate choice of drugs was 39% and inappropriate coprescribing was 32.6%. The most common inappropriate drug was short-acting nifedipine. Mostly
used potentially harmful drug combinations were a calcium antagonist co-prescribed with beta
blocker and angiotensin converting enzyme inbibitor (ACEI) co-prescribed with potassium
supplement. CONCLUSION: This study provides strong evidence that inappropriate medication use
and potentially inappropriate co-prescribing were common among hospitalized elderly patients in
medical wards of Bintulu Hospital. In order to avoid possible harmful effects and to optimize
medications use among elderly patients, it is necessary to assess the medication regimen at regular
interval. There is considerable scope for improving geriatric prescribing practices in the medical
wards of Bintulu Hospital.
Keywords: Elderly patients, Inappropriate drug use, Prescribing patterns, Polypharmacy, Beers criteria,
Sarawak.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P23:
STABILITY STUDY OF EXTEMPORANEOUS PREPARATIONS AT
PHARMACY DEPARTMENT OF HOSPITAL TENGKU AMPUAN
RAHIMAH KLANG
R.A. Nur Ain, S.I. S. Mahanim, A. Asmawarni, F. Nurfadilla, N.A. Abdullah, A. Norliah
Pharmacy Department, Hospital Tengku Ampuan Rahimah Klang
INTRODUCTION: The formulation of syrup from tablets or powdered drug for pediatric use requires
careful consideration of many factors to ensure its optimum quality and efficacy, as they are
susceptible to chemical reactions such as hydrolysis, oxidation and reduction, leading to
degradation. The reaction rate is usually influenced by pH or exposure to light, temperature and
humidity. OBJECTIVES: To investigate the stability of drug concentration and pH of
extemporaneous preparations done at inpatient pharmacy. METHOD: This study is conducted for a
period of three months. Five selected drugs were made into extemporaneous syrup. Initially, five
batches of samples for each drug were stored at ward room temperature (27 ◦C) and refrigerated at
2-8◦C. Two samples from each batch were sent to Laboratory of University of Institute Technology
Mara for testing on the pH and drug contents on day 1, 7 and 14. The remaining of samples was
observed at the respective storage area for any physical changes, including color, resuspendibility
and form of sedimentation. RESULTS: All samples have shown deterioration over time with those
stored in the ward showing more loss in concentration than those stored in the refrigerator. Three
out of five samples showed less than 50% reduction in the concentration measured at day 14. pH of
the samples were found to range between 7.0 to 7.5 which was similar to the syrup simplex used as
diluents in the preparations and it decreased from day 1 to day 7 to day 14. No color change was
visualized during the period of study. Four of the samples had formed sedimentation regardless of
their storage conditions. Two of those which were stored in the refrigerator needed to be shaken
well and took longer time to re-disperse compared to the others. CONCLUSION: When the formulae
of preparations and stability information referred are strictly followed when preparing drug
extemporaneously, there should be other factors which may contribute to the instability of these
preparations. Those factors may need to be further identified in the near future.
Keywords: extemporaneous preparation, stability, resuspendibility, sedimentation
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P24:
PATIENTS’ UNDERSTANDING ON PRESCRIBED MEDICATIONS IN
CARDIAC REHABILITATION PROGRAM IN CCU AND CRW WARD,
HOSPITAL SULTANAH BAHIYAH.
S. Noraida1, M.R. Rabiatul2, S.S. Ooi3, K.T. Leong4,
1Pharmacy Department, Hospital Kulim. 2Pharmacy Department, Hospital Sik.
Hospital Kuala Lumpur. 4Kedah State Enforcement Branch.
3Pharmacy
Department,
INTRODUCTION: Cardiac rehabilitation is a lifelong process that starts at the onset of coronary
heart disease (CHD) and continues throughout life. Cardiac rehabilitation can be an effective
means of secondary prevention of CHD. OBJECTIVES: In this prospective, randomized study, we
investigated the effectiveness of CRP by comparing the understanding level of pre and post
intervention on population selected. METHOD: Subjects included 55 patients (7 women, 48 men;
mean age, 60, range 48 – 73 years) who had been referred by doctor for CRP. Patients were
randomized to either control or CRP. They were accessed their understanding on cardiac
medication by using a standard questionnaire created. Both groups were accessed at the first time
and being followed up after one month period of time to reassess their understanding on cardiac
therapy. RESULTS: Of the 55 patients, 30 (54.5%) were control group, and 25 (45.5%) were subject
group. Baseline characteristic of patients did not differ between groups. Before follow-up, patients
from control group showed 29.2 mean score and patient from subject group showed 26.3 mean
score. However, after follow-up, patients from control group showed 32.2 mean score and patient
from subject group showed 64.6 mean score. CONCLUSION: These result show that subject group
(patient undergone CRP) have superior understanding on prescribed medication to control group.
Keywords: cardiac rehabilitation, coronary heart disease, cardiac medication
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P25:
ADHERENCE TO NATIONAL ANTIBIOTIC GUIDELINE 2008 FOR
SURGICAL ANTIBIOTIC PROPHYLAXIS: AN AUDIT IN SURGICAL
WARDS, HRPZII
M.G. Nurul Syalwa, Z. Zaimawati, L.K. Ho, S.H. Choe
Pharmacy Department, Hospital Raja Perempuan Zainab, Kelantan.
INTRODUCTION: Administration of appropriate prophylactic antibiotics can prevent the surgical
site infections. However, inappropriate use of antibiotic for surgical prophylaxis can increase the
cost to the patient, healthcare system and community.
Recent studies assessing the current
practice of prophylaxis throughout the world have shown inappropriate dose and timing remain a
problem in surgical prophylaxis. OBJECTIVES: To study the adherence to National Antibiotic
Guideline 2008 for antimicrobial prophylaxis in surgery and to determine the most frequently
prescribed antibiotic prophylaxis in surgical ward. METHOD: A prospective and cross-sectional
audit, was carried out between January 2009 until May 2009 in 3 surgical wards (28,29,30). By
reviewing medical, anesthetic and nursing records and also medication charts, the prescription of
antibiotics was compared with the national antibiotic guideline on antibiotic choice, duration of
prophylaxis, dosage, dosing interval and timing of the first dose. RESULTS: A total of 124 surgical
operations were studied during the 5-month period. Overall 11% (14/124) of patients received the
correct antimicrobial agent and dose as recommended in the guideline. Of the 124 surgery
operations assessed, 50 (45%) patients received the antibiotic different from guideline, 0.9% of
patients received additional antibiotic as compared with guideline, 29% of patients received dose
different from guideline and 25% of patients did not receive antibiotic although it is indicated in
guideline. The highest usage for antibiotic prophylaxis was metronidazole (37.5%) followed by
cefoperazone (25%)and ampicillin (11.96%). CONCLUSION: The results have highlighted overall poor
adherence to national antibiotic guideline. Adherence to guideline on the choice and dose of
antibiotic prophylaxis needs improvement. Interventions have to be made about the development,
distribution and adoption of adequate guidelines in collaboration with surgeons.
Keywords: antibiotic prophylaxis, adherence
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P26:
TRADITIONAL AND COMPLIMENTARY MEDICINE (TCM) USE AMONG
INPATIENTS WITH DIABETES MELLITUS AT MEDICAL WARDS IN
HOSPITAL TENGKU AMPUAN RAHIMAH KLANG
W.I. Looi, C.F. Choo, Y.N. Tan, A. Nor Aziah, A. Norliah
Pharmacy Department, Hospital Tengku Ampuan Rahimah Klang
INTRODUCTION: Traditional medicine is known as “alternative medicine” in the early 70’s and 80’s
and more familiar as “complimentary medicine” in recent years. There is little known about the
pattern of TCM use among diabetics in Malaysia. However, on the prevalence and comparison of
TCM use in individuals with diabetes and individuals with chronic medical conditions showed that
individuals with diabetes were 1.6 times more likely to use TCM than individual without diabetes.
OBJECTIVES: The purpose of conducting this study is to evaluate the extend of TCM use in patients
with diabetes mellitus and to identify which demographic and socio-economic characteristics that
potentially associated with TCM use. METHOD: This convenient sampling study was carried out by
interviewing eligible diabetic patients from medical wards to gather necessary information about
TCM use. Other relevant information of the patient was gathered from the medical records.
RESULTS: Fifty-six patients (n=56) with diabetes mellitus were enrolled in the study (male= 34
(60.7%), female = 22 (39.3%); malay = 18 (32.1%), Chinese = 9 (16.1%), Indians = 29 (51.8%)). In
term of age, the patients were group into five age groups; 30-40 = 1 (1.7%), 40-50 = 7 (12.5%), 5060 = 21 (37.5%), 60-70 = 20 (35.7%) and 70-80 = 7 (12.5%). From the study, only 35.7% (n=20) of
patients use TCM with the highest users were as follows: 60% (n=12) (p>0.05) were male, 40% (n=
8) (p>0.05) were from the age between 50-60 years old and 50% (n=10) (p>0.05) were Indians. The
education level of the fifty-six patients studied were rank as the followings; 16.1% (n=9) of patients
had no formal education, 44.6% (n=25) of patients had primary school education and 39.3% (n=22)
of patients had secondary school education. None of the patients were graduates. Only 25% (n=14)
of those patients are employed whilst the rest are unemployed. From the two variables, out of
twenty TCM users, 60% (n=12) (p<0.05) of them had studied up to secondary school and 60% (n=12)
(p<0.05) them are jobless. CONCLUSION: There is low prevalence of TCM use among diabetes
mellitus patients in this hospital. Socio-economic factors, such as education level and employment
status were found significantly associated and related with TCM use.
Keywords: Traditional and complementary medicine, diabetes mellitus
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P27:
COMPLIANCE ASSESSMENT IN PATIENTS ADMITTED TO MEDICAL
WARD
P.P. Lim, Y. Nurazrina, H.K. Siu, C.S. Ooi
Pharmacy Department, Hospital Seberang Jaya , Pulau Pinang
INTRODUCTION: Medication non-compliance is a serious health care concern. Poor compliance on
prescribed medicine can adversely affect the treatment outcome. Understanding patient’s
compliance behavior is a key link to resolve non-compliance problem. OBJECTIVES: The objectives
were i) to assess the compliance of patients admitted to medical ward of Hospital Seberang Jaya,
ii) to identify the factors contributing to non-compliance, iii) to investigate the possible association
or correlation between compliance and various descriptive variables and iv) to suggest appropriate
intervention to improve medication compliance based on the factors identified in this study.
METHOD: A prospective, descriptive, analytical study was executed from 13 th April 2008 until 17th
June 2008 (10 weeks) in medical ward of Hospital Seberang Jaya. A total of 130 subjects were
interviewed using a structured questionnaire. Compliance was assessed using Morisky Scale, with
scores ranging from 0 (compliance) to 4 (non-compliance). T- Test and ANOVA analysis were used
to assess the significance of differences within each descriptive variable and Pearson correlationRegression analysis were used to assess bivariate associations between Morisky score and various
descriptive variables. RESULTS: More than half of the subjects (56.2%) were not compliant to
medications (Morisky score > 2). Forgetfulness (51.9%) was the main reason of non-compliance.
Variables such as age, gender, frequency of administration and understanding the reason of taking
medication did not significantly affect Morisky score. Subjects fully assisted by family members or
friends have lower Morisky score significantly compared to subjects received partial or no
assistance (p<0.05). Subjects who did not worry on side effects of medication also have lower
Morisky score significantly (p<0.01). CONCLUSION: Non-compliance rate in our study is higher than
other studies. Increased supervision by family members, pill box and setting alarm were methods
can be suggested to overcome forgetfulness. Individualized counseling involving family members
and targeting the specific reason of non-compliance will be the best tool to enhance compliance.
Keywords: medication compliance, Morisky score, descriptive variable
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
P28:
CENTRALISED INTRAVENOUS ADMIXTURE SERVICE (C.I.V.A.S.) COSTEFFECTIVENESS STUDY
Y.Y. Hor, C.P. Tan, F.A. Rahman, S.N. Said.
Pharmacy Department, Hospital Sultan Ismail, Johor Bahru.
INTRODUCTION: Centralised Intravenous Admixture Service or CIVAS offers ready-to-use (RTU)
antibiotic injections aimed to improve accuracy, patient safety and cost-saving. OBJECTIVES: To
evaluate the cost of RTU antibiotic injections supplied by CIVAS compared with conventional supply
by the pharmacy. This study was also to determine the most commonly used antimicrobial drug,
RTU injection wastage cost and to access CIVAS acceptability in the ward. METHOD: All data for
antibiotic orders on 17 antimicrobial drugs for a paediatric ward were collected retrospectively
from January 2009 to March 2009. Total daily usages per milligram and per vial were recorded on a
daily basis. The unit price of each antimicrobial drug was obtained from store pharmacy. All
returned RTU injections during the study period were recorded. User satisfaction survey form was
distributed to the ward nurses to determine their acceptability of CIVAS. RESULTS: Total drug cost
was reduced by 49.7% (RM 6724) in the RTU compared to the conventional supply (RM 13,372).
Average cost per month was RM 2242 compared to RM 4458 for RTU and conventional supply
respectively. Benzylpenicillin (34%) and cefuroxime (27%) was the most used antibiotics. The cost
of the unused RTU injections was found to be almost 10% (RM672) of the total CIVAS supplied. The
user satisfaction survey showed that the ward staffs were satisfied with the RTU injection methods.
CONCLUSION: Ready-to-use antibiotic injections preparation can help to reduce the drug cost
compared to the conventional supply in a paediatric ward. It is also very convenient for the nursing
staff in terms of antibiotic preparation and administration.
Keyword: CIVAS, antibiotic, ready-to-use, cost-effectiveness
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NON-COMPETING
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC1:
A RANDOMIZED CONTROLLED TRIAL TO EVALUATE THE EFFICACY
OF COMMUNITY-BASED CARDIOVASCULAR RISK FACTORS
INTERVENTION STRATEGIES (CORFIS) IN MANAGING DM IN THE
PRIMARY CARE SETTING.
W.H.H. Low1, S.P. Dan1, H. Jamaiyah1, W. Seet 1, C.L. Teng2, V.K.M. Lee2, S.F. Tong3, A.S. Ramli4, I. Mastura,
S.S. Chua6, M.Y. Faridah Aryani1, K.H. Sim7, G.R.R. Letchuman8, Y.Y. Ngau9, H. Zanariah3, A.M. Kauthaman11,
L.M. Ong12, T. Karupaiah3, W.S.S. Chee2, P.P. Goh1, M.M.Z. Zaki2, T.O. Lim1
Clinical Research Centre, 1HKL, 12Penang Hospital, 7Sarawak General Hospital. 2 International Medical
University Malaysia, 3 UKM , 4 UiTM , 5 Kuala Pilah Primary Healthcare Clinic , 6 UM , Department of Medicine,
8 Taiping Hospital, 9 HKL, 10 Putrajaya Hospital, 11Melaka Hospital.
INTRODUCTION: Hypertension, diabetes mellitus and hyperlipidaemia are emerging as global
health problems and also are poorly managed and controlled. Control of hypertension, diabetes
mellitus and hyperlipidaemia can reduce the risk of developing cardiovascular and renal
complications. OBJECTIVES: The aim of our study was to assess the efficacy of a chronic disease
management strategy (Community Based Cardiovascular Risk Factor Intervention Strategies CORFIS) in the management of diabetes mellitus. METHOD: We conducted a prospective,
randomized, open label community trial at 75 general practice (GP) clinics in Klang Valley,
Malaysia. They were randomly selected to provide either CORFIS or conventional care for 6 months.
Seven hundred and eighty four patients who were diagnosed with hypertension, diabetes mellitus
and hyperlipidaemia and currently treated for one or more of these conditions were enrolled into
the study; n=527 in intervention versus n=257 in control groups. All patients with diabetes were
analysed (intention-to-treat) as a subgroup with the primary outcomes of achieving target HbA 1C of
≤7% and fasting blood glucose of 4.4-6.1mmol/l. RESULTS: Baseline clinical and laboratory
measures were similar in both the groups. Significantly higher reduction was noted in the
intervention arm than in the control arm for HbA 1C (median of -0.7% versus -0.2%) and fasting blood
glucose (median of -0.4mmol/l versus 0.1mmol/l) after 6 months of CORFIS intervention. More
diabetic patients in the intervention arm than control arm (58% versus 42%; p<0.01) achieved
glycaemic target (HbA1C≤ 7%) and significantly higher number of diabetic patients with uncontrolled
HbA1C at baseline achieved target control in the intervention arm than control arm (43% versus 23%;
p<0.01). After 6 months of intervention, 6% of intervention patients showed increased compliance
to their medications but 18% of control arm reported decreased compliance. CONCLUSION: The
CORFIS programme has shown to be more superior compared to conventional care in achieving
glycaemic control among diabetic patients in primary care.
Keywords: Chronic Disease Management, Diabetes, Hypertension, Hyperlipidaemia, multidisciplinary care
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC2: EVALUATION ON WARFARINISED PATIENT’S OUTCOME ON TARGET
INR ACHIEVED, KNOWLEDGE AND COMPLIANCE IN MOH HOSPITAL
S. Siti Rosnah1, M.A. Kamarun2, N. Basariah3, S.A.R. Sameerah4, J. Nirmala5, B. Nurul Zaidah2,J.L. Quah6
1Pharmacy Department, Sultanah Aminah Hospital, 2 Pharmacy Department, Serdang Hospital, 3Pharmacy
Department, Kuala Lumpur Hospital 4Pharmacy Services Division, Ministry of Health, 5 Pharmacy Department,
Kuala Lumpur Hospital, 6 Pharmacy Department, Duchess of Kent Hospital
INTRODUCTION:
Warfarin, a narrow therapeutic drug is the most commonly used oral
anticoagulant in Malaysia. It requires individualized dosing and intensive laboratory monitoring.
Over the years efforts have been taken to educate patient on warfarin therapy in an attempt to
improve their compliance and help them to achieve their INR target. OBJECTIVES: To study the
percentage of warfarinised patients who achieved the targeted INR values. In addition, their
knowledge and compliance were evaluated. METHOD: An observation, cross sectional study was
conducted at 6 hospitals throughout Malaysia. Patients’ INR records were reviewed and the four
latest INR values were recorded. Patients were also interviewed on their knowledge on warfarin
therapy and their level of compliance. RESULTS: A total of 259 patients from 6 hospitals were
recruited (87.6% MTAC). 54.6% were male with mean age of 58.07 + 13.88. Ethnic distribution as
follows: 38.6% Malay, 37.1% Chinese, 12.4% non-Malay Bumi and 10% Indian. 70.2% of them were
diagnosed of AF. The percentage of patients who achieved their target INR range were 49.3% MTAC
patients and 45.3% for non-MTAC patients respectively (p<0.001). Based on the expanded target
INR range 70.2% of the MTAC patients fall within the range compared to only 45.3% for non-MTAC
patients (p<0.0001). Generally more than 70% of the patients were able to answer all the questions
on warfarin therapy except for INR and side effects. Overall 81.8% patients were compliant based
on Morisky Score. CONCLUSION: Patient under MTAC tends to fall within range more than nonMTAC patients. Patient education on INR target, side effects and compliance should be emphasizing
at the point of counseling.
Keywords: Warfarin, narrow therapeutic drug, INR
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC3:
THE NATIONAL MEDICINES USE SURVEY – IDENTIFYING RESEARCH
PRIORITIES FOR BETTER DRUG UTILISATION IN DISEASE
MANAGEMENT
L.M. Lian1, H. Hazimah1, A.M.Y. Faridah2
1Clinical Research Centre, Kuala Lumpur, 2Pharmaceutical Services Division MOH
INTRODUCTION: The National Medicines Survey (NMUS) is conducted jointly by the Pharmaceutical
Services Division and Clinical Research Centre, Ministry of Health Malaysia. OBJECTIVES: to collect
medicines utilization data in Malaysia, and to provide reference data/statistics for other purposes
such evidence-based decision making, medicines policies, clinical practice guidelines and research.
METHOD: A cross-sectional survey was conducted using secondary data from public and private
hospitals (medicines procurement), private clinics (prescriptions) and private pharmacies
(dispensing). Analysis on overall drug utilization based on data collected was reported in the
‘Malaysian Statistics on Medicines (MSOM)’. The MSOM 2006 was reviewed and key areas of concern
in medicines utilisation were selected for research priorities. RESULTS: For 2006, anti-diabetic
drugs ranked highest in utilization by therapeutic groups, followed by cardiovascular drugs, lipid
modifying agents and drugs for obstructive airway diseases. Glibenclamide was the highest utilised
drug and cardiovascular drugs accounted for 18 of the top 40 drugs utilised. Several areas of
concern were discussed in the report. The key research priorities which are identified from the
areas of concern include 1) low utilisation of insulin and high utilisation of sulphonylureas in
diabetes management, 2)low overall utilisation of anti-epileptic drugs and high usage of phenytoin
amongst the anticonvulsants, 3) review of use drugs in management of obstetrical and
gynaecological disorders in Malaysia, 4) appropriateness of topical steroids and topical antibiotics
use in private healthcare practice, 5) adequacy and appropriateness of use of glucocorticoids
versus beta agonists, oral medications versus inhaled preparations, cost benefits and affordability
of inhaled preparations in treatment and management of asthma. CONCLUSION: The NMUS survey
in 2006 provides statistics on the utilization of medicines in the country. In addition it helps
identify research priorities based on the pattern of use and areas of concern raised.
Keywords: medicines utilization, medicines statistics, research priority
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC4: DRUG RELATED PROBLEM IN HOSPITALIZED PATIENTS AT NORTHERN
REGION HOSPITALS OF MALAYSIA: A RETROSPECTIVE REVIEW ON
WARD PHARMACY DOCUMENTATION
M.Y. Abdul Haniff1, H. Atia2, K. Akmalyatun3, G. Nor Sharliza4, M.C. Oiyammal5, H. Norhayati6
1Pharmacy Department ,1Hospital Teluk Intan, Perak; 2,4Hospital Sultanah Bahiyah, Alor Star, Kedah; 3Hospital
Ipoh, Perak; 5Hospital Pulau Pinang; 6Hospital Sultan Abdul Halim, Sg. Petani, Kedah
INTRODUCTION: In Malaysia, ward pharmacists who identify pharmaceutical care issues will make
appropriate interventions to ensure optimal care of the patients. The interventions made will be
documented accordingly. Currently, published local data regarding drug related problems of
hospitalized patients is lacking. It is hoped that by identifying the drug related problems, will help
in designing and developing pharmaceutical model of care within the health care team.
OBJECTIVES: To determine the drug related problems in hospitalized patients which had been
identified and intervened by ward pharmacists, to describe the type and rate of interventions
made by the pharmacists, to determine the acceptance level of the interventions and to identify
the factors that correlate with the number of pharmaceutical care issues, with the intervention
rate and with the acceptance level of the interventions. METHOD: This was a multi-centre,
retrospective study on documentation within January 2007 to December 2007 by the ward
pharmacists on the identified drug related problems in hospitalized patients in the northern region
hospitals with full time ward pharmacists. Pharmaceutical care issues documented in the standard
Pharmacotherapy Review forms were reviewed by selected ward pharmacists. Data analysis was
conducted using SPSS for Windows version 12. Continuous variables were represented as the mean
± standard deviation. The type and rate of intervention were represented descriptively. The
correlation between factors associated with pharmaceutical care issues were tested using test of
correlation. A p value of < 0.05 is considered significant for applicable statistic. RESULTS: There
were 892 patient records with a total of 3257 drug related problems involving 1876 medications.
Age, number of medications prescribed, number of co-morbidities, number of predisposing factors
and number of medications involved were found significantly correlated with number of identified
drug related problems. The intervention of drug related problems was made at prescriber level
(59.13%), patients/caretakers levels (24.16%), and at drug level (11.67%). CONCLUSION: Current
ward pharmacist documentation had shown that there were a lot of drug related problems in the
hospitalized patients. Hence more pharmacist’s participation are required and allocation of more
ward pharmacists are needed in order to prevent drug related harm to hospitalized patients.
Keywords: drug related problem, ward pharmacy, intervention, pharmaceutical care
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC5:
DEVELOPMENT AND APPLICATION OF A TOOL FOR MEASURING
NICOTINE WITHDRAWAL SYMPTOMS IN SMOKING CESSATION
CLINICS IN MALAYSIA
A. Awaisu1, O. Che Gayah1, L. Razak2, S. Sulastri2, A. Nur Afni2, H. Mohd Ikhwan3, N.M. Mohamad Haniki4, S.
Asrul Akmal5, H. Mohamed Azmi5
1Discpline of Clinical Pharmacy, School of Pharmaceutical Sciences, USM. 2National Poison Centre, USM.
3Advanced Medical and Dental Institute, USM.4Department of Pharmacy Practice, Kulliyyah of Pharmacy,
International Islamic University Malaysia. 5Discipline of Social and Administrative Pharmacy, School of
Pharmaceutical Sciences, USM
INTRODUCTION: Tobacco cessation interventions using counselling and pharmacological agents,
provided by healthcare professionals, have been proven to be effective in increasing quit rates.
However tobacco withdrawal syndrome is a major impediment to successful quitting and may lead
to smoking relapse. The Wisconsin Smoking Withdrawal Scale (WSWS) is one of the instruments use
to measure the symptoms in an effort to determine the success of quitting smoking and the
effectiveness of the smoking cessation clinics. Unfortunately, smoking cessation clinics in the
country do not assess this important parameter due to unavailability of WSWS Malay translated
version. OBJECTIVES: The purpose of the study was to produce a Malay version of Wisconsin Smoking
Withdrawal Scale (an instrument for measuring nicotine withdrawal symptoms) that was “conceptually
equivalent” to the original U.S. English version and to highlight its application in clinical practice.
METHOD: The production of the translated version was accomplished in accordance with
internationally accepted validation procedures. These include review by clinicians and cognitive
debriefing in a sample of smokers at different stages of quitting smoking. RESULTS: Linguistic and
conceptual issues arose during the process of validating the instrument. These were resolved
following communications with the original developers. In addition, the researchers had to find
culturally acceptable equivalents for some terms and idiomatic phrases.
During the clinicians’
review and cognitive debriefing process, respondents did not encounter problems with
understanding the contents of the validated instrument. It was found to be easily comprehensible,
clear, and appropriate for the smoking withdrawal symptoms intended to be measured.
CONCLUSION: We applied a rigorous translation method to ensure conceptual equivalence and
acceptability of WSWS in Malay prior to its utilization in clinical practice. The current processes
undertaken suggest that the Malay version of WSWS has a great potential to be utilized in smoking
cessation clinics in Malaysia for the management of withdrawal symptoms and prevention of
smoking relapse.
Keywords: Withdrawal symptoms, smoking cessation clinics, Wisconsin Smoking Withdrawal Scale, WSWS,
linguistic validation
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC6:
THE VALIDATION OF THE EQ-5D IN MALAYSIAN DIALYSIS PATIENTS
A. Faridah1, H. Jamaiyah2, A.Goh3, A.Soraya3
1 Pharmacy Services Division, 2 Clinical Research Centre HKL, 3 Azmi Burhani Consulting
INTRODUCTION: The EQ-5D is a quality of life instrument that measures five dimension of health.
For the use instrument to be used, the validation of the questionnaires is warranted. OBJECTIVES:
This study set out to investigate the reliability and validity of a well-established quality of life
instrument, the EQ-5D, in the Malaysian dialysis population. METHOD:
Patients on dialysis in
selected Malaysian Ministry of Health hospitals completed the EQ-5D questionnaire in one of three
languages spoken locally: Malay, English or Chinese. Test-retest reliability, convergent and
discriminant validity were assessed. Data from two concurrent surveys collected between
December 2004 and April 2005 was used. RESULTS: 686 patients completed the first survey, while
153 patients completed the second survey.
86 subjects completed both surveys. Test-retest
reliability using Cohen’s kappa was found to be acceptable in 4 out of 5 dimensions (Mobility,
κ=0.30,
p<0.05;
Usual
activities,
κ=0.18,
p<0.05;
Pain/discomfort,
κ=0.43,
p<0.05;
Anxiety/depression, κ=0.38, p<0.05) the only exception was the dimension of self-care (κ=-0.02,
p=0.59). Convergent validity comparing the EQ-VAS to the York utility tariff was found to be
present, Spearman’s correlation coefficient, 0.45 (p<0.05). However, discriminant validity was
found in only 2 out of 6 hypotheses tested which revealed statistically significant differences
between age group vs. mobility and modality vs. usual activity. CONCLUSION: The study shows that
the EQ-5D has potential to be used in the Malaysian dialysis population. However, further study is
required to definitively establish its validity.
Keywords: Validation, Quality of Life, EQ-5D, Haemodialysis, Continuous Ambulatory Peritoneal Dialysis.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC7:
EFFLUX INHIBITORY ACTIVITY OF SELECTED PLANT-BASED
ALKALOIDS AGAINST METHICILLIN-RESISTANT STAPHYLOCOCCUS
AUREUS (MRSA)
J. Saiful Azmi1, M. Mastura2, L. Abdul Rashid2
1Antimicrobial Laboratory, Anti-infective Branch, Bioactivity Programme and 2Phytochemical Analysis Branch,
Phytochemistry Programme, Medicinal Plants Division, Forest Research Institute Malaysia, Kepong, Selangor.
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is regarded as one of the most
problematic and economically relevant nosocomial-associated pathogen in the world today. Current
studies have shown that efflux-mediated resistance is an important contributor of antibiotic
resistance in bacteria, especially in MRSA isolates. Reserpine, a universally used plant-based efflux
pump inhibitor (EPI) is toxic to humans even at low concentrations limit its usage thereby
warranting the quest for alternative alkaloid-based EPIs. OBJECTIVES: To evaluate selected
alkaloid compounds as potential inhibitory agents and/or potential efflux pump inhibitors (EPIs)
against a panel of MRSA isolates. METHOD: Six plant-based commercially available alkaloids were
evaluated for its anti-infective activity using minimum inhibitory concentration (MIC) value
determination assay and resistance-modifying potentials via efflux assay against three MRSA clinical
isolates and a methicillin-susceptible S. aureus (MSSA). RESULTS: None of the alkaloids showed
inhibitory activity, even at 250 μg/ml. However, notable efflux inhibitory activity (ranging from
two to eight fold Ethidium Bromide MIC reduction) was detected from quinine, piperine and
harmaline using reserpine as the positive control. Both harmaline and piperine recorded the highest
EPI potential with eight fold EtBr MIC reduction against isolate N441, in addition to a four-fold EtBr
MIC reduction against U949 and ATCC 25923 respectively. On the other hand, Quinine exhibited a
four-fold MIC reduction in isolate N441 (15.6 μg/ml to 3.9 μg/ml) and a two-fold (250 μg/ml to 125
μg/ml) MIC reduction in isolate U949 but no changes in isolate ATCC 25923. CONCLUSION: Findings
from this study support the opinion that a vast number of potential phytocompounds with
pharmacological potential await discovery. Therapeutic application of these compounds however
warrants further investigation to ascertain their pharmacodynamics and safety aspects.
Keywords: methicillin-resistant Staphylococcus aureus (MRSA); plant-based alkaloids; minimum inhibitory
concentration (MIC) assay; efflux assay; efflux pump inhibitors (EPIs)
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC8:
AWARENESS AND PERCEPTION AMONG PUBLIC AND COMMUNITY
PHARMACISTS TOWARDS THE USE OF HOLOGRAM MEDITAG™ IN
COMBATING THE COUNTERFEIT MEDICINAL PRODUCTS IN
MALAYSIA.
I. Mazlan, I. Dali, M.D. Hariah, A. Noraniza, I. Nurul Ain, A.M. Rahayu, A.L. Nurhairani, S. Siti, N.I. Azan, O.
Fadli, A.S. Astrina, S.Y. How,
Pharmacy Enforcement Division, Ministry of Health Malaysia.
INTRODUCTION: Hologram Meditag™ is a security device used to authenticate and verify that
products sold have been duly registered with the Drug Control Authority (DCA). It has been a
requirement to affix this hologram onto each registered product since May 2005 in combating
counterfeit medicinal products in Malaysia. OBJECTIVES: A multi-centered survey has been carried
out by the Pharmacy Enforcement Officers through out Malaysia to determine the awareness and
perception among public and community pharmacists towards the use of Hologram Meditag™.
METHOD: A descriptive cross-sectional survey was conducted using structured questionnaire from
May to June 2008 involving 538 community pharmacists and 3,000 public respondents. Data was
analyzed using SPSS version 15. RESULTS: The result showed, 76.6% of the community pharmacists
and 36.7% public were aware of the use of Hologram Meditag™. Only 23% of public respondent has
used Meditag™ decoder to authenticate their medicinal products. Both group of respondent agreed
that the use of Hologram Meditag™ has increased the security features of medicinal products to
prevent counterfeiting with 80.1% and 61.1% from community pharmacists and public respondent
respectively. 76.9% community pharmacists and 69.6% public respondent agreed that the public
safety cannot be compromised despite of the usage of hologram may increase the cost of products.
Pharmacy Enforcement Officers was the main source of information on Hologram Meditag™ with
38.6% from the public respondent. CONCLUSION: In conclusion, the public awareness needs to be
increased and the community pharmacists should play a bigger role in providing information and
assistance with regards to Hologram Meditag™.
Keywords: Hologram Meditag™, counterfeit, decoder, Pharmacy Enforcement Officers.
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC9:
MEDICINE PRICE MONITORING SURVEY- AN ANALYSIS OF PRICE
VARIATION, TREND AND MARK-UPS IN THE PUBLIC AND PRIVATE
SECTORS
M.N. Saimah, M. Hasniza, S.W. Lee
Pharmaceutical Services Division
INTRODUCTION: Medicine prices have in recent years become a contentious issue in the country
with increasing public awareness and concerns on price of medicines and the cost of medical care
in Malaysia. OBJECTIVES: To describe the medicines price variation, trend and mark-ups in public
and private sectors, as an effort to obtain information on medicines price trend in the market and
to identify the components of medicine pricing in Malaysia. METHOD: An observational, repetitive
cross-sectional prospective survey was designed in public and private premises.
Each main
government state hospitals were selected and the tertiary or secondary hospitals were selected
proportionately. Retail pharmacies randomly selected within 5 km radius (West Malaysia) or 10 km
radius (East Malaysia) of each selected government hospitals. About 100 types of medicines were
surveyed such as commonly used medicines for the treatment of prevalent conditions with highest
usage, newly registered patented medicines and specialized single source products. The data were
collected in June and December every year by about 100 pharmacists who had been trained as Data
Collectors, and analysed using Microsoft Access and Stata. RESULTS: The study was conducted in
44 public premises, 47 private premises and 3 university hospitals. Price variation is greater in the
private sector (wholesale median of 3.0 times) and greater for generics (3.46 times). First half to
second half of 2007, showing median increase of originators price, 1.9% and 2.4% respectively in
private wholesale and retail, and 14% for generics in private wholesale. The median mark-up of
medicines from private wholesale to private retail was 39% and higher mark-ups were observed for
generics (median 67%) compared to originators (median 33%). CONCLUSION: Price variation for
medicine is greater in the private sector as compared to public sector and greater for generics as
compared to originators. Prices were not increasing through 2007. Some mark-up was observed
from wholesale to retail sector with higher mark-ups were observed for generics.
Keywords: price variation, price trend, price mark-ups
6th NATIONAL PHARMACY R&D CONFERENCE - 2010
NC10:
A NATIONAL SURVEY ON THE USE OF MEDICINES BY MALAYSIAN
CONSUMERS
B. Salmah1, O. Nour Hanah1, A. H. Mohd Azmi2, S. Asrul Akmal2, M.I.M2. Ibrahim
1Pharmaceutical Services Division, Ministry of Health Malaysia, 2Discipline of Social & Administrative
Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia
INTRODUCTION: The National Medicines Policy of Malaysia stresses the importance of quality use
of medicines among consumers. Hence, this first comprehensive nationwide study was done to
document the extent of medicines use by consumers in Malaysia. The information is crucial to plan
and evaluate strategies to enhance the quality use of medicines by consumers in Malaysia.
OBJECTIVES:
To identify prescription and non prescription medicine use pattern among
consumers, to explore the current knowledge of consumers on drug usage and to determine the
sources of drug information that are widely used by consumers in Malaysia. METHOD: A cross
sectional household survey using a face to face interview structured questionnaire was done from
the 15th November 2007 to 15th January 2008. One stage random cluster sampling technique was
employed to determine two clusters of public health clinics that served the most rural and urban
population in each state. Respondents who were above 18 years old, non-hospitalised, able to read
and write or listen and living within 30 kilometers of the chosen cluster were randomly selected
from the 14 states. Appropriate descriptive and inferential statistical tests were performed on data
gathered with significance level at p<0.05. RESULTS: Out of the 2,979 respondents interviewed,
32% consumers were using prescribed medicines to treat chronic diseases while 43%, 26% and 24%
consumers took health supplements, traditional medicines and modern and traditional medicines
together respectively. As for knowledge on drug usage, 55.6% consumers did not understand proper
use of medicines, 51% and 66% consumers were unable to recognise medicines’ trade and generic
names respectively while 56% consumers were unaware that medicines have side effects. Although
48% and 26% consumers regarded doctors and pharmacists respectively as their first reference for
drug information, 34% and 26% consumers found it difficult to get this information from those in
the private sector. Meanwhile, 74% consumers preferred written medicine information from health
care providers and 73% of them agreed that counselling sessions are necessary to help them in
taking their medication. CONCLUSION: Knowledge on the appropriate use of medicines among
Malaysians is inadequate and there is a dire need for an effective educational intervention
targeting consumers in order to empower them with pertinent information on medicines use.
Keywords: Medicines; Consumers; Use; Pattern; Knowledge