Pharmacy students' preparation to provide pharmaceutical care for patients with non-communicable diseases in six ASEAN countries: A qualitative study.

INTRODUCTION: Pharmacy education programs prepare graduates to promote health for patients with noncommunicable disease (NCDs), but there is limited information concerning Association of South East Asia Nations (ASEAN) countries. The study aim was to synthesize academic staff's, alumni's, and alumni supervisors' perspectives on preparation for students to provide pharmaceutical care in NCDs. METHODS: A qualitative research design was used. In-depth interviews with structured questions following the Context, Input, Process, and Product/Outcomes model framework were conducted with four academic staff, three alumni, and three alumni supervisors from six study sites in six countries. Interview questions were constructed in Thai and translated to English by using forward and backward translation. Verbatim transcriptions were used to perform thematic analysis with investigator triangulation. RESULTS: Sixty participants were included. The context showed three main themes related to Burden of NCDs, Pharmacist Roles in NCDs, and Goals. The input showed three main themes of Teaching Methods, Development Plans for Academic Staff, and Budgets and Infrastructure. The process showed one main theme of Struggles in Teaching Methods. The outcomes/outputs showed three main themes of Individual, Organizational, and Professional Levels. Schools need curricula that focus on NCDs, pharmacist competency and skills, and academic preparation of students for practice. Gaps limiting achievement of goals included lack of well-trained academic staff, limited learning facilities, self-learning opportunities, acceptance from other health professionals, and career ladders. CONCLUSIONS: The preparation of pharmacy students varied in six ASEAN countries. Pharmacy education programs must address existing gaps that limit achievement of goals related to NCDs.

A community pharmacist-led smoking cessation intervention using a smartphone app (PharmQuit): A randomized controlled trial.

WHO supports the harnessing of mobile technologies to improve access to smoking cessation services. As such, this study evaluated the effectiveness of smoking cessation services provided by community pharmacists using PharmQuit compared with standard care. The study was a prospective, multicenter, randomized controlled trial that included 156 participants who were 18 years or older and smoked at least one cigarette daily for a month, were ready to quit, willing to participate, and had a smartphone. The study was performed at seven community pharmacies in three provinces in Thailand. Participants were allocated to the intervention (n = 78) and control groups (n = 78). Both groups received the usual smoking cessation services with pharmacotherapy and counseling from community pharmacists for 6 months. The intervention group received PharmQuit as an additional service. Both groups were scheduled for follow-up visits on days 7, 14, 30, 60, 120, and 180. The primary outcome was continuous abstinence rate on day 180. The secondary outcomes included 7-day point abstinence rate, number of cigarettes smoked per day, exhaled carbon monoxide levels, adherence rate to the program, and satisfaction with PharmQuit. An analysis using the intent-to-treat principle was performed. Smoking cessation rates and the number of cigarettes smoked per day were significantly higher during the follow-up visits in both groups (p < 0.05). However, there were no statistically significant differences between the two groups. The adherence rate to the smoking cessation program was higher in the intervention group than in the control group (74 days vs. 60 days, p > 0.05). The results showed the benefits of the contribution of community pharmacists. Although the inclusion of PharmQuit did not yield better results than pharmacists' counselling alone, it may help obtain better adherence to smoking cessation programs. Trial registration: Thai Clinical Trials Registry: TCTR20200925004 on September 25, 2020 -retrospectively registered, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=6841.

Efficacy and Safety of Eucalyptus for Relieving Cough: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: To assess the efficacy and safety of Eucalyptus globulus Labill (Eucalyptus) on cough. Background: Cough is a common symptom of upper respiratory tract infections (URTIs) and bronchitis. Eucalyptus products are frequently used as over-the-counter cough medications but their efficacy and safety are uncertain. Methods: Randomized controlled trials (RCTs) investigating efficacy and safety of Eucalyptus for cough were systematically searched in electronic databases till February 2021. Two reviewers independently performed study selection, data extraction, and quality assessment. Clinical outcomes including improvement or resolution of overall cough symptoms, cough frequency (CF), and adverse events (AEs) of Eucalyptus were evaluated and analyzed using a random-effects model. Heterogeneity was evaluated using I2 and chi-squared test. Results: Six RCTs with 1,857 participants with cough were included in this study. Most of the included studies used Eucalyptus in combination formula (four of six studies). Based on Cochrane's risk of bias criteria, three of six studies (50%) were rated low risk of bias, whereas the remaining were judged as high risk of bias. This study found that Eucalyptus products are more effective than placebo in terms of improvement or resolution of overall cough symptoms with relative risk 1.45 (95% confidence interval (95% CI) 1.26-1.67). Whereas all Eucalyptus formulae reduced CF with weighted mean difference 0.44 (95% CI 0.28-0.60), when compared with placebo. There are no serious AEs associated with Eucalyptus during treatment periods. Mild-to-moderate gastrointestinal symptoms were common AEs reported in a comparable study between Eucalyptus and control groups. Conclusion: The findings indicate that Eucalyptus products are safe for use in cough related to respiratory diseases such as URTIs and bronchitis. However, their efficacy is minimal and of uncertain clinical importance. Further high-quality studies are still necessary to confirm this finding.

Promoting rational herb-drug use through pharmacy-led advice and home visits in NCD patients.

Introduction: There has been a considerable increase in the concurrent use of prescribed medicines and herbal products, but most users do not have any information about drug-herb interactions. Objective: Therefore, this study aimed to investigate the effects of pharmacological advice by community pharmacists on promoting the rational use of prescribed medicines together with herbal products. Methods: The study was one group pretest-posttest experimental design, performed on a sample of 32 people who met the following criteria: aged ≥18 years, lived in an urbanized area, have NCDs such as diabetes, hypertension, dyslipidemia, or cardiovascular disease, and have used prescribed medicines and herbal products concurrently. The participants were informed and practically advised on the rational use of herbal products simultaneously with prescribed medicines, the possibility of drug-herb interactions, and self-monitoring of possible adverse effects. Results: After implementing pharmacological advice, the participants showed a significant increase in knowledge of rational drug-herb use: from 5.8±1.8 to 8.4±1.6 out of a total of 10 (p<0.001), and their score in terms of appropriate behavior rose from 21.7±2.9 to 24.4±3.1 out of a total of 30 (p<0.001). Additionally, the number of patients with herb-drug interaction risk decreased statistically significantly (37.5% and 25.0%, p=0.031). Conclusion: Pharmacy-led advice on rational use of herbal products with prescribed NCD medicines is effective in terms of promoting increases in knowledge and appropriate behavior in these matters. This is a strategy for risk management of herb-drug interactions in NCD patients.

A meta-analysis of effects of CYP2C9 and CYP2C19 polymorphisms on phenytoin pharmacokinetic parameters.

Aim: Phenytoin is metabolized through CYP2C9 and CYP2C19. Polymorphisms of CYP2C9 and CYP2C19 may increase plasma concentration and side effects. Materials & methods: Systematic review and meta-analysis were performed to evaluate the effects of CYP2C9 and CYP2C19 polymorphism on pharmacokinetic parameters. PubMed, Science Direct, Cochrane library, and Thai databases were systematically searched. Results: Eight observational studies, comprising a total of 633 patients were included. Michaelis-Menten constant was significantly higher in the polymorphism of CYP2C9IM/CYP2C19EM and CYP2C9IM/CYP2C19IM groups as compared with the control groups (CYP2C9EM/CYP2C19EM) at 2.16 and 1.55 mg/l (p < 0.00001, p < 0.0001). The maximum rate of action was significantly lower in the control groups as compared with the polymorphism of CYP2C9IM/CYP2C19EM and CYP2C9IM/CYP2C19IM groups at 3.10 and 3.53 mg/kg/day (p = 0.00001, <0.0001). Conclusion: The dosage regimen for patients in the CYP2C9IM group to achieve phenytoin therapeutic levels was 2.1-3.4 mg/kg/day.

Health promotion integrated into a Thai PharmD curriculum to improve pharmacy practice skills.

OBJECTIVE: To implement and evaluate 5 integrated teaching modules in the fifth-year doctor of pharmacy (PharmD) curriculum to increase students' ability to promote patients' health as part of their pharmacy practice. DESIGN: Activity-based learning was added to each module: (1) a practice experience in which students provided health information and counseling to the public; (2) academic debates on current issues in pharmacy (3) journal clubs on articles from the pharmacy literature; and (4) research projects relating to ongoing faculty research on diabetes. Students on 12-week practice experiences had visits to patients in inpatient wards, outpatient clinics, and either primary care units or community pharmacies. ASSESSMENT: Practice examinations at the end of the first semester, the average student score was above 80% as determined by preceptors in experience sites and from faculty members. Group interviews found that students were positive about the benefits of integrated teaching. CONCLUSION: The integration of the teaching between modules in the same semester is possible and greatly benefits student learning.