Enhancing extemporaneous preparations in Thai Hospitals: exploring variation, common formulations, and challenges and needs related to extemporaneous preparations

Objective: This study aimed to assess the diversity of extemporaneous preparations, identify the prevalent formulations, and highlight the challenges and opportunities for standardization and improvement of extemporaneous preparation practices. Methods: A survey was conducted among 88 Thai hospitals representing the public and private sectors. The questionnaire gathered information on general hospital characteristics, detailed aspects of extemporaneous compounding, and the specific extemporaneous formulations used. Results: The survey revealed significant variations in extemporaneous preparations among Thai hospitals, with oral liquids, semisolids, and eye preparations commonly employed. The primary oral liquid formulations used were suspensions, syrups, and solutions. Specific medications frequently used in extemporaneous preparations were also identified. The challenges encompassed space, personnel, skills, raw materials, equipment, standardized formula information, preparation process information, funding, and other factors. Conclusion: A survey among Thai hospitals revealed significant variations in extemporaneous preparations in 88 participating hospitals. Common formulations used in extemporaneous compounding include oral liquid preparations, such as suspensions, syrups, solutions, semisolid preparations, and eye preparations. Stakeholder involvement, implementation of standardized operating procedures, resource allocation, comprehensive training programs, and collaboration among hospitals, pharmaceutical companies, and regulatory agencies are recommended to enhance extemporaneous compounding practices (AU)

Facilitators and barriers of the rational drug use hospital program in Thailand

The Thailand Ministry of Public Health has started a rational drug use (RDU) policy, which includes multifaceted strategies as well as the RDU hospital program to tackle irrational drug use. Objective: To investigate facilitators and barriers related to the CIPP model of the RDU hospital program in Thailand. Methods: This is a qualitative study. Data were collected through semi-structured interviews with regional policymakers who were members of the executive board for RDU management in the 10th health region. The interviews were conducted via telephone using a topic guide informed by the CIPP framework and reviewed for content validity by the research team. Data were transcribed, and thematically analyzed. Results: Fifteen pharmaceutical policymakers were interviewed. The main facilitators related to context, input, and process were the national policy on RDU, RDU awareness/practices among health professionals, particularly prescribers, and multidisciplinary teamwork under the organization’s leadership to use data feedback to improve the program. The main barriers related to context, input, and process were a lack of policy advocacy at the regional and provincial levels, doctor-related reasons such as medicolegal concerns, and a lack of multidisciplinary teamwork. For the product theme, participants were very satisfied and perceived positive impacts at both the individual and organizational levels, such as increased RDU awareness in patients and multidisciplinary teams, as well as RDU prescription. However, negative impacts, such as tensions surrounding professional responsibility and accountability, have been observed. (AU)

Analogous comparison of registered brand name drugs of tablets and capsules commercially available in Thailand: A retrospective study.

Drug name confusion or similar product packaging and labeling, also known as "look-alike, sound-alike" (LASA) medication error, is one of the most problematic causes of prescribing and dispensing errors. Therefore, this study aimed to compare the similarity of registered brand name drugs of tablets and capsules that are commercially available in Thailand to estimate the magnitude of LASA medication errors. Analogous comparisons of brand names using similarity in orthography (written forms with identical letters) were analyzed retrospectively. Tablets and capsules commercially available in Thailand and registered with the Bureau of Drug Administration, Food and Drug Administration (FDA) in 2012 as "dangerous drugs" and "specially controlled drugs" for humans and animals were included in this study. Descriptive statistics, including frequencies and percentages, were used in this study. The analogous comparison of brand name orthography was scrutinized, and the results revealed 1,668 brand names, which were categorized into three genres as follows: 1) Single brand names from a single manufacturer having the same active pharmaceutical ingredient (API) with numerous registration numbers (1,049 names, 62.89% of the total similarity results) 2) Single brand names from different manufacturers having the same API and possessing several registration numbers (615 names, 36.87% of the total similarity results) 3) Single brand names from different manufacturers with diverse APIs (four brand names, 0.24% of the total similarity results). Analogous results revealed that numerous identical brand names could be derived from the same manufacturers, APIs, dosage strengths, or otherwise. The results of this study recommend improvement on product registration to better ensure patient safety in the future.

An Overview of Pharmaceutical Production in Thai Hospitals.

Purpose: The purpose of this research was to provide an overview of pharmaceutical production in Thai hospitals. Methods: A cross-sectional survey was developed to study pharmaceutical production in the 1347 Thai hospitals. A representative sample was chosen using multistep selection arriving at a final total of 750 hospitals. Five experts in hospital pharmacy production were recruited to evaluate the content validity. The questionnaire consisted of 2 parts: (1) general details of the hospitals and (2) the type of pharmaceutical products. The latter classification were further divided into 6 types: (1) nonsterile products, (2) extemporaneous preparations, (3) total parenteral nutrition, (4) intravenous admixtures, (5) cytotoxic preparations, and (6) herbal medicine products. All data were analyzed via descriptive statistics. Results: From the 750 questionnaires sent out, 395 hospitals (52.67%) responded to the questionnaires. Regarding the 395 respondent sample group, approximately 60% of the hospitals were involved in pharmaceutical production. The top 3 pharmaceutical products were as follows: (1) cytotoxic preparations (315 items); (2) liquid nonsterile preparations (60 items), and (3) liquid extemporaneous preparations (52 items). The most frequently mentioned reasons for the production of each dosage form were as follows: (1) no commercially available product in appropriate dosage form or strength needed and (2) product was prepared following the hospital's policy. The support needs in hospital pharmacy production were revealed as follows: (1) master formula, (2) quality assurance and quality control processes, (3) equipment, (4) standard references, (5) buildings, (6) personnel, (7) budget, (8) raw material suppliers, and (9) the coordination between the faculties of pharmaceutical sciences and hospitals. Conclusions: Approximately 60% of the respondents had pharmaceutical production in their hospitals. The greatest need for support was for a master formula to inform hospital-based pharmaceutical production. These findings provide essential information, especially for stakeholders, to understand the professional challenges and likely pharmaceutically related health service changes in the future.

Usage of and cost of complementary/alternative medicine in diabetic patients.

The purposes of the present survey research in diabetic patients were 1) to determine characteristics of complementary/alternative medicine (CAM) use, 2) to identify factors related to CAM use such as sociodemographic, adverse effects, and quality of life, and 3) to determine differences between patients who used and did not use CAM. The data was collected through developed questionnaires and SF-36 scale Thai version. Samples were 159 diabetes patients over 18 years of age or older who came for treatment at Suppasitthiprasong Hospital, Ubon Ratchathani Province, Thailand. The results indicated that the prevalence of CAM use was rather high (47.8%). The most common types of CAM used were yoga/exercise (32.8%), unchanged form of herbal medicine (29.9%), and changed form herbal medicine (17.8%). The average expense of CAM use was dollar 8.58 per person per month. Thus, if the percentage of CAM use and the cost were true for other Thai diabetic patients throughout Thailand, CAM use expenditure for the whole country would be about dollar 915,250-1,545,750 per month, which is quite high for a small country like Thailand. Most patients (64.4%) who used CAM did not inform their doctors about their CAM use. Results also indicated that government official patients were more likely to use CAM than those of farmer patients significantly (p-value = 0.03, odds ratio = 12.11). In addition, the present study found that patients who had a higher income were more likely to use CAM than those of lower income patients significantly (p - value = 0.04, odds ratio = 1.01). However, other factors such as age, sex, marital status, level of education, health insurance coverage status, duration of time to treat, occurrence of adverse effects, and quality of life were not different between the patients who used CAM and who did not use CAM. Physicians should pay more attention to the CAM use of patients since they used CAM without informing physicians and some herbal medicines may cause hypoglycemia. However, the study results had some limitations to apply to other Thai populations since the sample were Suppasitthiprasong patients who may be different from other Thai populations in many ways such as their local culture, belief, and CAM use types and cost.