A Qualitative Study Exploring Community Pharmacists' Experiences and Views About Weight Management Interventions and Services in Klang Valley, Malaysia.

Objective: To qualitatively explore the perspectives of community pharmacists in Malaysia on their roles in weight management, and the barriers and facilitators in the expansion of these roles. Methods: A purposive sampling method was used to recruit community pharmacists in Klang Valley, Malaysia. Semi-structured individual interviews were conducted with community pharmacists, with an interview guide, from May 2018 to January 2019. The interviews were conducted in person (face-to-face). All interviews were audio-recorded with consent and transcribed verbatim. The interview transcripts were analyzed thematically, whereby emerging themes were coded and grouped into categories. Results: Twenty-four community pharmacists were recruited, with years of experience in pharmacy practice ranging from 2 to 40 years. Participants described their perceptions on the different weight management interventions where they emphasized the importance of a comprehensive lifestyle intervention and viewed that it should be the first-line intervention. Participants regarded their weight management service as easily accessible or approachable since community pharmacies are often the first point of call for patients seeking advice for their conditions before consulting doctors. Barriers identified by community pharmacists were mainly organizational in nature, which included lack of private consultation rooms, lack of time, and lack of qualified staff. Participants also described the need for training in weight management. Conclusion: Community pharmacists in Malaysia believed that they can positively contribute to the area of weight management. They cited multiple roles that they could play in weight management interventions and services. The roles cited include provision of education and advice, including on lifestyle modifications, drug therapy, weight loss products and supplements, and monitoring and providing referrals to other healthcare professionals. However, barriers would need to be addressed, including through pharmacist training, to strengthen and improve community pharmacists' roles and contributions in weight management service.

Impact of an Educational Training Program on the Knowledge, Attitude, and Perceived Barriers of Community Pharmacists Towards Obesity and Overweight Management in Malaysia.

Objective: To evaluate the impact of an educational training program on the knowledge, attitude and perceived barriers of community pharmacists (CPs) towards obesity and overweight management. Methods: This interventional study, which consisted of an educational training program, was conducted on a single cohort of Malaysian CPs. Thirty CPs attended the educational training program. The educational training program was delivered through didactic lectures, case studies and small group discussions, and consisted of various sessions covering different topics related to weight management. A validated questionnaire was used to assess the impact of the intervention on the CPs' knowledge, attitude, and perceived barriers. Results: The overall mean knowledge score increased both immediately after (14.93 ± 1.62) and 30 days following the intervention (17.04 ± 2.51), and the increment was statistically significant 30 days following the intervention (p = 0.001) compared to both pre-intervention and immediate-post intervention stages. After the intervention, the participants had a more positive attitude towards the provision of weight management service (WMS) in community pharmacies. They had significantly stronger perceptions about the importance of their role to manage overweight and obesity and their professional competence to treat obese patients. In addition, the barrier of not having space in pharmacy to perform proper counselling for weight management and the barrier of not having training sessions in the area of obesity management were perceived to be significantly less important post-intervention. Conclusion: This study showed the potential positive impact of an educational training program on CPs knowledge, attitudes and perceived barriers towards WMS.

A systematic review of pharmaceutical price mark-up practice and its implementation.

Pharmaceutical products, apart from being essential for medical treatment, are of high value and heavily regulated to ensure the prices are controlled. This systematic review was conducted to identify pharmaceutical pricing mark-up control measures, specifically in the wholesale and retail sectors. The search method comprised the following databases: PubMed, Science Direct, Springer Link, ProQuest, and EBSCOhost and Google Scholar. The results were filtered systematically from the inception of the aforementioned databases until 23 April 2021. Eligible studies were those focusing on the implementation of pharmaceutical pricing strategies that involve a) mark-ups of medicine, and b) pharmaceutical cost control measures. A total of 13 studies were included in this review: seven covered European countries, four covered Asian countries, one covered the USA and one covered Canada. The main points of discussion in the qualitative synthesis were the implementation of medicine mark-ups, price mark-up regulatory strategies and the outcomes of these regulatory strategies. Our findings suggest that Western countries have a lower mark-up margin, around 4% to 25% of the original purchased price, compared to Asian countries, up to 50%.

Factors Impacting Pharmaceutical Prices and Affordability: Narrative Review.

Increasing prescription drug pricing often reflects additional work stress on medical professionals because they function as financial advisors for patients and help them manage out-of-pocket expenses. Providers or prescribers wish to help patients with prescription costs but often lack related information. Healthcare plan providers try to display prescription and drug cost information on their websites, but such data may not be linked to electronic prescription software. A mark-up is defined as the additional charges and costs that are applied to the price of a product for the purpose of covering overhead costs, distribution charges, and profit. Therefore, the policies implemented in the pharmaceutical distribution chain might include the regulation of wholesale and retails mark-ups and pharmaceutical remuneration. If mark-ups are regulated, countries are highly recommended to use regressive mark-ups rather than fixed percentage mark-ups. This narrative review provides insights into the framework of pharmaceutical mark-up systems by describing different factors impacting pharmaceutical prices and affordability. These include the interplay of medicine pricing and the supply chain, the impact of pertinent laws and regulation and out-of-pocket expenditure.

Attitudes, Practices, and Barriers of Malaysian Community Pharmacists Toward Provision of Weight Management Services.

In Malaysia, sharp increment in the prevalence of obesity over the last four decades has been documented. Community pharmacists (CPs) are strategically placed to tackle obesity by providing weight managements services (WMS) to general public. This study assessed the attitudes, practices and perceived barriers of Malaysian CPs to the provision of WMS. A cross-sectional, descriptive survey was conducted, and responses related to attitudes, practices and perceived barriers of CPs were collected using five-point Likert scale. A total of 550 pharmacists who worked across six states of Malaysia (Selangor, Federal Territory of Kuala Lumpur, Pulau Pinang, Johor, Sabah, and Melaka) participated in this study. Most of the CPs strongly agreed that over eating (n = 312, 56.7%) and sedentary lifestyles (n = 297, 54.0%) contribute to obesity and overweight. Most of them also strongly agreed that exercise training is an effective weight reduction strategy (n = 285, 51.9%), but they were generally not in favor of surgery (n = 231, 42% disagreed/strongly disagreed). CPs generally perceived barriers related to a lack of staff to provide WMS (n = 308, 56.0% agreed/strongly agreed) and ethical and legal issues associated with sales of products/drugs for obesity management (n = 285, 51.9% agreed/strongly agreed). Sociodemographic and practice characteristics such as age group, type of pharmacy, highest education qualification, and employment status of CPs influenced the attitudes, practices and perceived barriers associated with WMS. In terms of age, CPs who were aged less then 30 years expressed significantly stronger agreement that medication adherence is beneficial for weight loss compared to those CPs between 41-50 years. Additionally, CPs who were pharmacy owners provided significantly more frequent BMI measurement and patient information materials as part of their weight management practices compared to CPs who worked as a part timer/locum. This study could be taken as a baseline study on Malaysian CPs' perceptions on WMS.

Perceptions of the Malaysian general public on community pharmacy-based weight management services.

BACKGROUND: Obesity is now widely regarded as a main contributor to poor health. Involvement of community pharmacists can be a valuable tool in obesity management. However, there is still a lack of data in Malaysia on the potential involvement of and opportunities for community pharmacists in providing weight management services. Thus, it is essential to investigate the perceptions of the general public on weight management services in the community pharmacy setting. To evaluate the general public's perceptions on weight management services by community pharmacists in terms of perceived availability, utilization and factors influencing acceptability of services. METHODS: A descriptive, cross sectional-survey was conducted using a self-administered questionnaire comprising of sections that focused on public preferences and options on weight management approaches, perceived availability of extended services and resources provided by community pharmacists in relation to weight management, utilization of these services and resources, and factors influencing acceptability of weight management services provided by community pharmacists. The questionnaires were distributed to the general public aged 18 years and above in Klang Valley, Malaysia. RESULTS: A total of 730 respondents with a median age of 31 years participated in this study. Majority of respondents ranked dieticians as their preferred first line of consultation, with only about a quarter of respondents ranking community pharmacists as their preferred first or second line of consultation. Although more than half show of the study respondents perceived that community pharmacies they had visited offered services for measuring weight, height, blood pressure, blood glucose and blood cholesterol, fewer perceived that community pharmacies provided advice on physical activity and healthy eating to achieve weight loss. Additionally, majority of the respondents indicated that they had not utilized these services. However, most respondents perceived that community pharmacists should provide weight management services. The main factors influencing acceptability show of services included training of pharmacists, payment, waiting time and the issue of privacy. CONCLUSION: The findings of this study demonstrated that the majority of respondents were in support of weight management services in community pharmacy; however only a low percentage reported utilizing these services. Factors influencing acceptability of services included payment, waiting time and the issue of privacy. With adequate training among pharmacists and increased awareness of services among the public, community pharmacists could play a larger and important role in addressing the issue of obesity in Malaysia.

Provision of travel medicine advice through community pharmacies: assessment of knowledge, attitudes and practices of pharmacists in Malaysia.

OBJECTIVES: The risk for travel-related illnesses has increased with significant growth in international travel, but very few travellers seek travel advice. Community pharmacists can play a vital role in the provision of travel medicine advice due to their accessibility. This study aimed to assess travel medicine knowledge, attitudes and practices (KAP) among community pharmacists in Kuala Lumpur, Malaysia. METHODS: A self-administered KAP questionnaire was distributed to a convenience sample of pharmacists in Kuala Lumpur identified from the list of licensed community pharmacists in Malaysia year 2014. KEY FINDINGS: Questionnaires were returned by 111 pharmacists of 143 distributed (response rate, 78%). Most of the respondents (82%) were not trained in travel medicine. Overall, mean knowledge score was 4.4 ( ± 1.7), indicating a moderate level of knowledge on a variety of travel-related health issues. Community pharmacists who graduated from foreign universities possessed significantly higher knowledge scores than did those who graduated locally (P < 0.05). The majority had a positive attitude towards travel medicine. A vast majority provided travel medicine advice mainly to adults who travel as tourists, and the primary travel advice given was on traveller's diarrhoea. CONCLUSION: There are gaps in the knowledge and practice of travel medicine among Malaysian pharmacists. Positive attitudes of pharmacists towards travel medicine and appropriate interventions, such as incorporation of travel medicine in local pharmacy curricula, continuous pharmacy education or certified training may improve the quality of travel advice given and allow pharmacists to be recognised as a credible source of information on travel medicine.

Suitability of a Group Behavioural Therapy Module for Workplace Smoking Cessation Programs in Malaysia: a Pilot Study.

In Malaysia, data on components suitability the established smoking cessation module is limited. This exploratory study aimed to evaluate the suitability of the components developed in the module for group behavioural therapy in workplace smoking cessation programs. Twenty staff were identified but only eight individuals were selected according to the study criteria during the recruitment period in May 2014. Focus group discussion was conducted to identify themes relevant to the behavioural issues among smokers. Thematic analysis yielded seven major themes which were reasons for regular smoking, reasons for quitting, comprehending smoking characteristics, quit attempt experiences, support and encouragement, learning new skills and behaviour, and preparing for lapse/relapse or difficult situations. As a result, the developed module was found to be relevant and suitable for use based on these themes.

Validation of the Schizophrenia Quality of Life Scale Revision 4 among Chronic Schizophrenia Patients in Malaysia.

OBJECTIVES: To explore the validity and reliability of a disease-specific health-related quality-of-life questionnaire-the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4)-in patients with schizophrenia in Malaysia. METHODS: A total of 222 outpatients with schizophrenia receiving treatment at the Universiti Kebangsaan Malaysia Medical Centre completed the SQLS-R4 in either the Malay or the English language. A generic self-report health-related quality-of-life measure-the EuroQoL group EuroQol five-dimensional questionnaire-and a measure of symptom severity-the Clinical Global Impression-Schizophrenia scale-were also administered to assess validity. RESULTS: Good internal consistency reliability was found for both the psychosocial and vitality domains (Cronbach's α = 0.95 and 0.85, respectively). Most items were also significantly correlated with their own scale score (rs ranging from 0.29 to 0.74). There was a moderate correlation between the SQLS-R4 "vitality" domain and the EuroQol five-dimensional questionnaire "usual activities" domain (rs = 0.44) and a large correlation between the SQLS-R4 "psychosocial" domain and the EuroQol five-dimensional questionnaire "anxiety/depression" domain (rs = 0.44-0.57). Most of the symptom dimensions of the Clinical Global Impression-Schizophrenia scale were also moderately correlated with the SQLS-R4 subscale scores. CONCLUSIONS: The SQLS-R4 is a valid and reliable health-related quality-of-life instrument for use in minimally ill patients with schizophrenia in Malaysia, but some of the items may be redundant and irrelevant. Validation of SQLS-R4 in different types of patients and various levels of illness severity is required to further verify its application.