Provision of primary care pharmacy operated by hospital pharmacist.

A primary care pharmacy (PCP) is operated by hospital pharmacists in Thailand. This study aims to explore the level of PCP provisions operated by hospital pharmacists, to identify health service components that affect PCP operation and to collect opinions from pharmacists regarding factors influencing PCP operation. A postal survey was conducted in northeastern Thailand. A questionnaire included: (1) the PCP checklist (36 items), (2) questions investigating the health service components required for PCP operation (13 items), and (3) queries to pharmacists concerning factors influencing PCP operation (16 items). Questionnaires were mailed to 262 PCP pharmacists. The PCP provision score was calculated with a max score of 36, and reaching at least 28.8 points was deemed as having 'met expectation'. Multivariate logistic regression with a backward approach was used to determine health service components which affected PCP operation. Most respondents were female (72, 60.0%), aged 36.0 years (IQR 31.0-41.0) and PCP work experience of 4.0 years (IQR 2.0-10.0). Overall, the PCP provision score had met expectation (median = 29.00, Q1-Q3 = 26.50-32.00). Tasks that met expectation involved managing the medicine supply, a home visit with a multidisciplinary team and protecting consumer health. Improving medicine dispensary and promotion of self-care and herbal use were below expectation. PCP operation depended on doctor involvement (OR = 5.63 95% CI 1.07-29.49) and public health practitioner involvement (OR = 3.12 95% CI 1.27-7.69). The pharmacist's responsibility, i.e., a good relationship with the community, likely increased PCP provision. The PCP has been widely instituted in Northeast Thailand. Doctors and public health practitioners should get involved regularly. Further research is needed to monitor the outcomes and value of PCPs.

Economic evaluation of pharmacy services: a systematic review of the literature (2016-2020).

BACKGROUND: Economic evaluation is crucial for healthcare decision-makers to select effective interventions. An updated systematic review of the economic evaluation of pharmacy services is required in the current healthcare environment. AIM: To conduct a systematic review of literature on economic evaluation of pharmacy services. METHOD: Literature (2016-2020) was searched on PubMed, Web of Sciences, Scopus, ScienceDirect, and SpringerLink. An additional search was conducted in five health economic-related journals. The studies performed an economic analysis describing pharmacy services and settings. The reviewing checklist for economic evaluation was used for quality assessment. The incremental cost-effectiveness ratio and willingness-to-pay threshold were the main measures for cost-effective analysis (CEA) and cost-utility analysis (CUA), while cost-saving, cost-benefit-ratio (CBR), and net benefit were used for cost-minimization analysis (CMA) and cost-benefit analysis (CBA). RESULTS: Forty-three articles were reviewed. The major practice settings were in the USA (n = 6), the UK (n = 6), Canada (n = 6), and the Netherlands (n = 6). Twelve studies had good quality according to the reviewing checklist. CUA was used most frequently (n = 15), followed by CBA (n = 12). Some inconsistent findings (n = 14) existed among the included studies. Most agreed (n = 29) that pharmacy services economically impact the healthcare system: hospital-based (n = 13), community pharmacy (n = 13), and primary care (n = 3). Pharmacy services were found to be cost-effectiveness or cost-saving among both developed (n = 32) and in developing countries (n = 11). CONCLUSION: The increased use of economic evaluation of pharmacy services confirms the worth of pharmacy services in improving patients' health outcomes in all settings. Therefore, economic evaluation should be incorporated into developing innovative pharmacy services.

Efficacy of Varenicline in the Treatment of Alcohol Dependence: An Updated Meta-Analysis and Meta-Regression.

BACKGROUND: Although varenicline has been used for alcohol dependence (AD) treatment, its efficacy for this condition remains controversial. AIMS: This systematic review and meta-analysis of randomized controlled trials (RCTs) assesses the efficacy and safety of varenicline in patients with AD. METHODS: PubMed, Cochrane Library, ScienceDirect, Web of Science, and ThaiLis were systematically searched. RCTs investigating the efficacy and safety of varenicline in patients with AD were included. Study selection, data extraction, and quality assessment were independently performed by two authors. The Jadad score and Cochrane risk of bias were used to assess the quality of the included studies. Heterogeneity was assessed using I2 and chi-squared tests. RESULTS: Twenty-two high-quality RCTs on 1421 participants were included. Varenicline significantly reduced alcohol-related outcomes compared with placebo based on percentage of abstinent days (standardized mean difference [SMD] 4.20 days; 95% confidence interval [CI]: 0.21, 8.19; p = 0.04), drinks per day (SMD -0.23 drinks; 95% CI: -0.43, -0.04; p = 0.02), drinks per drinking day (SMD -0.24 drinks; 95% CI: -0.44, -0.05; p = 0.01), craving assessed using the Penn alcohol craving scale (SMD -0.35; 95% CI: -0.59, -0.12; p = 0.003), and craving assessed using the alcohol urge questionnaire (SMD -1.41; 95% CI: -2.12, -0.71; p < 0.0001). However, there were no significant effects on abstinence rate, percentage of drinking days, percentage of heavy drinking days, alcohol intoxication, or drug compliance. Serious side effects were not observed in the varenicline or placebo groups. CONCLUSION: Our results indicated that AD patients treated with varenicline showed improvement in percentage of very heavy drinking days, percentage of abstinent days, drinks per day, drinks per drinking day, and craving. However, well-designed RCTs with a large sample size and long duration on varenicline treatment in AD remain warranted to confirm our findings.

Overall Survival and Survival Time by Palliative Performance Scale: A Retrospective Cohort Study in Thailand.

Objectives: The palliative performance scale (PPS) is a useful tool for predicting the survival time of palliative patients and for multidisciplinary teams in designing an appropriate care plan for patients and their families. This study aimed to (1) assess the survival time of palliative patients, (2) examine the factors associated with survival time and (3) investigate the proportion of patients whose survival time matched the time proposed by existing literature, within the Thai population. Materials and Methods: A retrospective cohort study was conducted with data drawn from five hospitals in one of the north-east provinces in Thailand. The study population comprised patients with a palliative diagnosis (ICD10: Z51.5) who had registered in one of the five hospitals between 1 October 2015 and 30 September 2017. Kaplan-Meier survival analysis was used to assess overall survival time and an extended Cox regression model to identify predictors of survival. Results: Of the 2792 registered patients, 1163 were included in the analysis. Most patients were male (55.62%), with a mean age of 64.59 years (±15.38), and were covered by the universal coverage insurance (77.72%). Approximately half (56.23%) of the participants had cancer and about a quarter (27.13%) had an initial PPS result of 30. The overall median survival time was 14 days (mean = 64.08, 95% CI: 12-16). Three significant predictors for survival included sex, hospital and initial PPS score. Conclusion: The survival time of palliative patients was relatively short. Sex, hospital and initial PPS were significant predictors of survival. The median survival time by PPS was similar to the values reported by the previous study but proportion of correct prediction was low. Therefore, it might be necessary to investigate the survival time of palliative patients by country independently.

Applying action research in pharmacy practice.

Medication errors are closely associated with patient safety, as they affect quality of health care. Pharmacists play a key role in preventing such errors to ensure patient safety and enhance pharmacy service quality. Quality improvement has been suggested to be incorporated into daily practice, providing practitioners an opportunity to identify service delivery gaps and configure solutions fitting the context. This paradigm is similar to the concept of action research (AR); therefore, this research approach is deemed appropriate for improving the quality of pharmacy practice. AR is context-specific, dynamic, and systematic and is driven by a spiral process to identify problems, design solutions, and evaluate the impacts of the solution. Since AR uses multiple methods, including a spiral process, confusion may arise among practicing pharmacists and novice researchers interested in using it. This paper aims to describe key information regarding AR, including its brief history and definition, spiral process, and research methods used for data collection, key characteristics, and common limitations to help readers understand the AR protocol.

Community pharmacists' preparedness for substituting biologics and dispensing biosimilars - Lessons learned from a multinational survey.

Interchangeability between biological medicines and biosimilars, and subsequent substitution by pharmacists represent an important opportunity for costs savings for health care systems. Because biological medicines are complex products, the expert role of the pharmacist to inform patients and support physicians is indispensable. However, regulations on substitution of biosimilars differ around the globe, such that a substitution that is allowed in one country may be forbidden in another. Overall, pharmacists' knowledge of biosimilar medicines is incomplete and hesitancy to engage in substitutions is perceptible. As counter-balancing remedy, continued education about biosimilars is needed among practicing community pharmacists.

Process, quality and challenges of diabetes care in primary care: a study of district health network in Thailand.

This study aimed to describe the process of care, assess the quality of care based on defined indicators, and identify challenges associated with providing diabetes care via sub-district health promotion hospital (SHPH) facilities in Thailand. Primary care policy has directed that diabetes care be delivered via SHPH in order to reduce hospital congestion and minimize travel costs for patients. Limited data is available regarding the structure for providing care. Likewise, barriers to delivery of optimal care have not been well defined, especially from the perspective of health care providers. This study employed mixed-methods research, which included semi-structured interviews to gain insights into the current diabetes care process, a descriptive study to evaluate quality of care, and use of a focus group to identify challenges associated with delivery of diabetic care via SHPH. Diabetes care processes in primary care included multiple steps and involved collaboration between various health care providers at both the hospital and SHPH. Four process indicators and one outcome had been achieved but performance of other indicators was apparently low. Three factors were found to pose challenges to providing this service: the resources of the health service, the delivery of services, and patient factors. SHPH require additional support, particularly in the areas of primary care workforce, finance, medical device procurement, and patient information systems. While delivery of diabetes care via primary care centers has been well established in Thailand, regional differences in the quality of care persist. Additional support is required to strengthen the primary care system nationwide.

Outcomes, costs and stakeholders' perspectives associated with the incorporation of community pharmacy services into the National Health Insurance System in Thailand: a systematic review.

OBJECTIVES: Identify costs, outcomes and stakeholders' perspectives associated with incorporation of community pharmacy services into the Thai National Health Insurance System and their values to all stakeholders. METHODS: Using a combination of search terms, a comprehensive literature search was performed using the Thai Journal Citation Index Centre, Health System Research Institute database, PubMed and references from recent reviews. Identified studies were published between January 2000 and December 2014. The review included publications in English and Thai on primary research undertaken in community pharmacies associated with the National Health Insurance System. Two independent authors performed study selection, data extraction and quality assessment. KEY FINDINGS: The literature search yielded 251 titles, with 18 satisfying the inclusion criteria. Clinical outcomes of community pharmacy services included control and reduction in blood pressure and blood sugar, improved adherence to medications, an increase in acceptance of interventions, and an increase in healthy behaviours. Thirty-three percentage of those at risk of diabetes and hypertension achieved normal blood sugar and blood pressure levels after being followed for 2-6 months by a community pharmacist. The cost of collaborative screening by community pharmacies and primary care units was US$ 4.5. Diabetes management costs were US$ 5.1-30.7. Community pharmacists reported high satisfaction rates. Stakeholders' perspectives revealed support for the community pharmacists' roles and the inclusion of community pharmacies as partners with the National Health Insurance System. CONCLUSIONS: Community pharmacy services improved outcomes for diabetic and hypertensive patients. This review supports the feasibility of incorporating community pharmacies into the Thai National Health System.

Unit cost of common illness management: a comparison between a primary care unit and a community pharmacy in Thailand.

Aim This study was to perform unit cost analysis of managing common illnesses comparing between a primary care unit (PCU) and a community pharmacy. BACKGROUND: PCU is a key point of access for primary care in Thailand. Although a community pharmacy is an ideal setting, it has not been successfully incorporated in Thailand's health service. Common illnesses are encountered everyday by community pharmacists, an appropriate compensation for this service has not been established. METHODS: A primary care service of one educational institution was a study site. Eight common illnesses were emphasised. Patient visits were observed, prospectively at community pharmacy and retrospectively at PCU, during August to October 2013. Labour and material costs related to management of common illnesses were recorded. Total cost divided by total patient visits determined the unit cost. For the community pharmacy, patients were followed up after 3-14 days of visit to evaluate the effectiveness. Sensitivity analysis was performed by varying direct medical cost at ±10-30%. Findings At the community pharmacy, community pharmacists performed multiple tasks including interviewing and assessing patients, choosing an appropriate treatment and dispensing. Of 9141 visits, 775 (8.5%) with common illnesses were included. Upper respiratory disorder was found the highest 41.9% (325/755). Unit cost of treatment ranged from 54.16 baht (£1.18) for pain to 82.71 baht (£1.80) for skin disorder. Two-thirds of pharmacy visits (77.9%, 539/692) reported complete recovery. Managing common illnesses at the PCU was performed by nurse assistants, nurses, doctors and pharmacists. Of 6701 patient visits to the PCU, 1545 (23.1%) visits were at least one of the eight illnesses. Upper respiratory disorder was the majority, 53.0% (771/1454). Unit cost of treatment ranged from 85.39 baht (£1.86) for eye/ear to 245.93 baht (£5.36) for sexual health. Managing common illness at a community pharmacy shows satisfactory effectiveness with lower unit cost.

A meta-analysis of efficacy of Morus alba Linn. to improve blood glucose and lipid profile.

PURPOSE: The previous studies have reported the Morus alba may improve blood glucose and lipid profile. The evidence from these studies is not consistent. This meta-analysis was to evaluate efficacy of products derived from M. alba on blood glucose and lipid levels. METHODS: Literature was reviewed via international database (PubMed, PubMed Central, ScienceDirect, and SciSearch) and Thai databases. Thirteen RCTs with high quality, assessed by Jadad score, were included. RESULTS: M. alba expressed a significant reduction in postprandial glucose (PPG) at 30 min (MD -1.04, 95 % CI -1.36, -0.73), 60 min (MD -0.87, 95 % CI -1.27, -0.48) and 90 min (MD -0.55, 95 % CI -0.87, -0.22). The difference was not found in the levels of other glycaemic (FBS, HbA1C, or HOMA-IR) and lipidaemic (TC, TG, LDL, or HDL) markers. Serious adverse effects were found neither in the control nor in the group received M. alba. CONCLUSION: Products derived from M. alba can effectively contribute to the reduction in PPG levels, but large-scale RCTs would be informative.

Depression screening and advisory service provided by community pharmacist for depressive students in university.

BACKGROUND: Depressive symptom among adolescent is prevalent but advisory service for this symptom is limited, particularly in university. OBJECTIVES: (1) To identify depressive students in health science faculties, (2) To evaluate the consequence of depression advisory service by community pharmacist, compared between a group counseling and an individual one. METHODS: A two-phase study was designed-a cross-sectional study followed by an experimental study. Health science students were screened by CES-D questionnaire. The prevalence and predictors of depressed mood were determined. Depressive students were then invited to the experimental study. Participants were assigned into 2 groups, by stratified random sampling, and followed up for 16 weeks. Group 1 received a group counselling, group 2 received an individual counselling from a trained pharmacist. Outcomes measured were the CES-D score and quality of life. RESULTS: The prevalence of depressed mood students was 13.7 % (195/1421). Students in year 2nd and year 3rd, nursing and medicine students, and GPA were strongly associated with the CES-D score (P < 0.05). Sixty-eight depressive students were assigned into the experiment. The CES-D scores of both groups were significantly reduced from the baseline (P < 0.001). The post-test score of group 2 was lower than group 1 (17.7 ± 4.5 vs 20.1 ± 4.6, P = 0.038). At week 16, both counselling types significantly increased mean score of physical health (P < 0.001) whereas score of mental health was increased significantly only by the individual counselling, from 37.9 ± 9.9 to 43.1 ± 8.4 (P = 0.036). CONCLUSIONS: Depressive symptom among health science students is considerably high. Year of study, faculty and GPA are significant predictors of this disorder. Trained community pharmacists can effectively screen and provide advisory service. Individual counseling is more effective than using group advice.

How to enhance public health service utilization in community pharmacy?: general public and health providers' perspectives.

BACKGROUND: Community pharmacists (PHs) in England are increasingly providing a range of public health services. However, the general public view pharmacists as drug experts and not experts in health, and therefore, services may be underutilized. OBJECTIVES: To explore experiences and views of 4 groups of participants, the general public, PHs, general practitioners (GPs), and other stakeholders (STs) on pharmacy-based public health services, and identify potential factors affecting service use. METHODS: The study was undertaken in a locality of North West England. Three focus groups were conducted with the general public (n=16), grouped by socioeconomic status. Fourteen semistructured interviews were undertaken with PHs (n=9), GPs (n=2), and STs (n=3). Discussions/interviews were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: All 4 groups of participants agreed that community pharmacies are a good source of advice on medicines and minor ailments but were less supportive of public health services. Six factors were identified affecting utilization of pharmacy services: community pharmacy environment, pharmacist and support staff, service publicity, general public, GP services, and health care system and policies. Crucial obstacles that could inhibit service utilization are perceptions of both the general public and other health providers toward pharmacists' competencies, privacy and confidentiality in pharmacies, high dispensing workload, and inadequate financial support. Networking between local health professionals could enhance confidence in service delivery, general awareness, and thus utilization. CONCLUSIONS: Community pharmacy has the potential to deliver public health services, although the impact on public health may be limited. Addressing the factors identified could help to increase utilization and impact of pharmacy public health services.

Thai community pharmacist involvement in weight management in primary care to improve patient's outcomes.

BACKGROUND: The community pharmacist has significant potential to assist in providing health advice aimed at the improvement outcomes pertaining to weight management, however, up to now, evidence regarding its effectiveness has been inconclusive. In Thailand, community pharmacy involvement in weight management is a novel idea and therefore needs an evaluation of its effectiveness. OBJECTIVE: To examine essential outcomes, comparing the pharmacist's interventions with a routine weight management service provided at a primary care unit (PCU). SETTING: Maha Sarakham province, Thailand. METHODS: A randomized controlled trial was designed involving sixty-six obese patients randomly assigned to either the control group or the experimental group. Participants in the control group received group counselling from the PCU staff as usual, while those participants in the experimental group received one-on-one advice from a community pharmacist along with the weight loss handbook for self-study. Both groups were followed up and clinical outcomes were monitored four times at weeks 0, 4, 8, and 16. Eating behaviours and knowledge about overweight and obesity were measured twice, at weeks 0 and 16. MAIN OUTCOME MEASURE: Clinical outcomes included weight, waist circumference, body mass index, measured by standard medical devices. Eating behaviours were measured by the theory of planned behaviour (TPB) questionnaire. Knowledge was measured by a questionnaire focusing on the subjects' level of understanding regarding overweight and obesity issues. RESULTS: Neither group showed improvement in clinical outcomes. The TPB average sum score significantly increased from baseline in the experimental group in terms of intention to perform healthy dieting behaviour, subjective norm, behavioural beliefs, normative beliefs, and control beliefs. (P < 0.05) In the control group, scores increased significantly from the baseline only for behavioural beliefs. (P < 0.05) Moreover, the knowledge score in experimental group increased significantly from 6.42 ± 1.94 to 8.75 ± 0.68 (P < 0.05). CONCLUSION: Thai community pharmacists can help to improve both eating behaviour and knowledge about weight and obesity among obese patients. However, since the effect on clinical outcomes is unclear, a long-term study is still needed.

Economic analysis of the diabetes and hypertension screening collaboration between community pharmacies and a Thai government primary care unit.

AIMS: To evaluate models for collaboration between community pharmacies and a government primary care unit (PCU) in carrying out a screening program for diabetes and hypertension. METHODS: An action research was undertaken and a screening and referring protocol developed. Study sites were two community pharmacies (Model 1) and footpaths/streets and seven communities (Model 2) under supervision of PCU in the city of Maha Sarakham Province, Thailand. The Combined Model consisted of Models 1 and 2. Those eligible were aged 40 years and over, not known to have diabetes or hypertension. Activity based costing of three models was analyzed from the provider perspective. RESULTS: The study involved 456 people during July-September 2007; 11 out of 51 attending pharmacies (21.6%) and 27 out of 405 attending the communities (6.6%) met criteria for referral to PCU for confirmatory diagnosis. Only six attended the PCU. Two of 456 (0.4%) were confirmed the diagnosis having hypertension, one was referred from a pharmacy (2%, 1/51) the other from a community (0.2%, 1/405). Model unit costs were US$ 11.2, 4.3 and 5.1 per screened person, respectively. CONCLUSIONS: The results indicate a working model can identify people in the community requiring treatment of hypertension or diabetes. Pharmacy-based screening was more costly, but the success rate for referral was higher compared with a community-based service. More effort is needed to ensure referred patients attend the PCU.