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.

Single Nucleotide Polymorphism in the 3' Untranslated Region of PRKAA2 on Cardiometabolic Parameters in Type 2 Diabetes Mellitus Patients Who Received Metformin.

Purpose: This study aimed to explore the association of rs857148 A>C as 3'UTR variants with blood pressure, HbA1c profile, and lipid profiles as cardiometabolic parameters among patients with T2DM receiving metformin. Patients and Methods: This cross-sectional analytic research was conducted with 114 consecutively selected patients with T2DM. Polymerase chain reaction-restriction fragment length polymorphism was conducted to determine rs857148. A total of 108 patients fulfilled inclusion and exclusion criteria. Results: Genotype distribution agreed with the Hardy Weinberg Equation for Equilibrium (p>0.05) but wildtype allele was found as the minor allele. Subjects with CC genotype and C allele had enhanced HbA1c levels (OR=7.12; 95% CI=1.05-48.26; p=0.04; OR=1.66; 95% CI=1.06-2.60; p=0.03, respectively). It was confirmed by dominant model whereas subjects with AA tended to have reduced HbA1c compared to AC+CC genotype (OR=0.15; 95% CI=0.02-0.97; p=0.047). AC genotype had significant correlation to total cholesterol (OR=1.05; 95% CI=1.01-1.10; p=0.03) compared to AA genotype. Conclusion: We conclude that polymorphism of rs87148, specifically CC genotype and C allele, has a significant association with HbA1c and total cholesterol after considering oral hypoglycemia agent dose, age, gender, and combination therapy, compared to AA genotype. Future studies that involve a larger sample population and more rigorous selection criteria are required.

The Effect of Health Education by Pharmacists on 10-Year Atherosclerotic Cardiovascular Disease Risk: A Cluster-Randomized Control Study in a Low Socioeconomic Status Javanese Population.

BACKGROUND: Evidence from previous studies demonstrates that lifestyle modification reduces the incidence and complications of atherosclerotic cardiovascular disease. The study aimed to investigate the effect of a lifestyle intervention provided by pharmacists on the 10-year atherosclerotic cardiovascular disease (ASCVD) risk and quality of life (QoL) in a low socioeconomic status Javanese population. METHODS: This research was a cluster-randomized controlled study of 1-year duration, conducted in a lower social economic community in the Sleman District of Yogyakarta, Indonesia. The eligible subjects were dichotomized into 2 groups: 40 to 55 years (n = 61 vs 65) and 56 to 70 years (n = 21 vs 43) for intervention and control subjects, respectively. The ASCVD score and risk factors within the age-based groups were analyzed using T test/Mann-Whitney test for continuous data or chi-square test for categorical data. RESULTS: The intervention and control subjects had similar baseline characteristics ( P > .05), including the ASCVD risk with the low- and high-risk classification for younger and elder subjects, respectively. At final follow-up, the younger intervention subjects had lower 10-year ASCVD risk ( P = .001), higher high-density lipoprotein cholesterol ( P = .02), smoking status ( P = .001), persistence rate ( P = .03), and QoL value for the physical and social function domains ( P < .05) than the control subjects, whereas the elder intervention subjects only had better ASCVD risk score than controls ( P = .03). Smoking interacting with intervention was the most influential variable on ASCVD risk in logistic regression analysis. CONCLUSION: The study demonstrates that the health education by the pharmacists produce significant outcomes of the ASCVD risk, smoking status, and QoL of physical and social function particularly in the younger group.

Pharmacists' views on the development of asthma pharmaceutical care model in Indonesia: A needs analysis study.

BACKGROUND: Over recent years the pharmacy profession in Indonesia has adopted a stance of pharmaceutical care to expand their scope of practice. Asthma management presents a key opportunity for pharmacists to test expanded roles in health service provision. There is however no exploratory work on the willingness, experience or future practice needs of Indonesian pharmacists in the realm of specialised asthma service provision. OBJECTIVES: The objectives of this study were to explore Indonesian pharmacists' experiences, perspectives, and needs regarding the provision of pharmaceutical care for asthma patients in Indonesia. METHODS: The study utilised conventional qualitative content analyses with two stages, i.e.: deductive analyses and inductive concept development. Data were collected using Focus Group Discussion (FGD) Method. FGDs were conducted using a topic guide and by facilitators trained in FGD conduct. FGDs were audio-recorded and transcribed verbatim prior to analysis. A maximum variation sampling methods targeted pharmacist across various settings of practice within Yogyakarta Indonesia. RESULTS: Nine focus groups with 103 pharmacist participants were conducted, with an average of 11 participants in each group. Inductively derived concepts that emerged included: willingness to adopt asthma service provision roles, pragmatism in recognising essential barriers/facilitators in adopting such roles, reflections regarding practice gaps and barriers to interprofessional collaboration mainly in relation to doctors. Inductive data analysis indicated clear differences in responses between hospital and non-hospital pharmacists. Key barriers to service provision included lack of training, lack of supportive professional frameworks, time and lack of reimbursement channels for services. Participants urged for a visionary leadership to facilitate pharmacists' role expansion into health services provision in Indonesia. CONCLUSIONS: Indonesian pharmacists were willing to adopt change and reported universally recognised barriers and facilitators to changing roles, especially in the provision of asthma care. Given this universality of pharmacists expressions, it may be suggested that the experience of researchers and academics who have expended time and effort in developing and implementing asthma care models in other countries should be, to some extent, transplanted to regions where pharmacy organisations are now considering adopting roles additional to medicines supply.