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1.
Children (Basel) ; 9(4)2022 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35455597

RESUMO

Lack of access to child-appropriate medicines results in off-label use. This study aimed to explore medicine management for paediatric patients and to highlight the challenges of the healthcare system under the universal health coverage of Thailand. Semi-structured interviews were conducted with 35 healthcare practitioners working in the public hospital network of Chiang Mai province from February to September 2020. Participants were asked about their experiences in managing the medicine supply for children. Findings revealed that paediatric patients had limited access to age-appropriate medicines. Children's medicines are rarely selected for inclusion into hospital formularies because of constraining regulations and limited budgets. Additionally, child-appropriate formulations are unavailable on the market. Pharmaceutical compounding is unavoidable. Prepared products are provided weekly or monthly because of product stability concerns. Often, tablets are dispensed, and caregivers are instructed to cut up a tablet and disperse it in syrup in order to obtain a smaller dose in a dosage form appropriate for children to use at home. Without systematic support, access to safe and quality medicines for children is limited.

2.
Children (Basel) ; 9(3)2022 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-35327673

RESUMO

The lack of appropriate medicines for children has a significant impact on health care practices in various countries around the world, including Thailand. The unavailability of pediatric medicines in hospital formularies causes issues regarding off-label use and extemporaneous preparation, resulting in safety and quality risks relating to the use of medicines among children. This research aimed to identify missing pediatric formulations based on the experience of healthcare professionals in a teaching hospital in northern Thailand. A cross-sectional survey was conducted to collect data on missing pediatric formulations, the reasons for their inaccessibility, their off-label uses, their reactions to the situation, and suggestions to improve access to these identified medications. The survey was distributed to all physicians, nurses, and pharmacists involved in prescribing, preparing, dispensing, and administering pediatric medicines. A total of 218 subjects responded to the survey. Omeprazole, sildenafil, and spironolactone suspension were most often identified as missing formulations for children by physicians and pharmacists. They are unavailable on the Thai market or in any hospital formulary. For nurses, sodium bicarbonate, potassium chloride, and chloral hydrate were the most problematic formulations in terms of preparation, acceptability, and administration. These medicines were difficult to swallow because of their taste or texture.

3.
Pharm Pract (Granada) ; 18(4): 2141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343773

RESUMO

BACKGROUND: In Thailand, pharmacists are responsible for all activities to ensure access to medicines throughout pharmaceutical supply chain. Competency framework (CF) is an important guidance for professional development and workforce planning. OBJECTIVE: This study aimed to explore needs for pharmacy services in pharmaceutical supply chain and competencies of pharmacists to serve those needs. It was the first step for developing evidence-based pharmacy CF within the context of Thailand in 2026. METHODS: A qualitative method using in-depth interviews to gain rich data from practitioners and leaders in all area of practices. 99 key informants from 56 workplaces in Thailand were interviewed during January and March 2016. Data was transcribed verbatim, and thematic analysis was used. Competencies were extracted, followed by several rounds of group discussion among team members to develop an initial framework. The competencies and CF were presented, and recommendations were gained from professional leaders for refining the findings. RESULTS: The key informants agreed that pharmacist's works and responsibilities have gradually been drifted to support changes in healthcare and pharmaceutical systems. The upcoming pharmaceutical services call for higher standards of practice, larger number of personnel, and skillful pharmacists who have strong foundation in pharmaceutical knowledge as well as an ability to integrate knowledge into practices. Two sets of CFs were established. The general CF comprises five core domains: product focus, patient focus, healthcare system focus, community focus, and personal focus for self-improvement. These general competencies allow practitioners to perform basic professional tasks, including providing information, dispensing, and compounding. The service-specific competency is the integration of general competencies tailored into specific area of practice. CONCLUSIONS: Regarding the professional goal to evolve pharmacists from generalists to specialists for providing higher quality of professional services, the pharmacists are required to demonstrate general competencies and service-specific competencies. The findings serve as the need-based evidence for developing a national CF for pharmacists in Thailand.

4.
Pharm. pract. (Granada, Internet) ; 18(4): 0-0, oct.-dic. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-202376

RESUMO

BACKGROUND: In Thailand, pharmacists are responsible for all activities to ensure access to medicines throughout pharmaceutical supply chain. Competency framework (CF) is an important guidance for professional development and workforce planning. OBJECTIVE: This study aimed to explore needs for pharmacy services in pharmaceutical supply chain and competencies of pharmacists to serve those needs. It was the first step for developing evidence-based pharmacy CF within the context of Thailand in 2026. METHODS: A qualitative method using in-depth interviews to gain rich data from practitioners and leaders in all area of practices. 99 key informants from 56 workplaces in Thailand were interviewed during January and March 2016. Data was transcribed verbatim, and thematic analysis was used. Competencies were extracted, followed by several rounds of group discussion among team members to develop an initial framework. The competencies and CF were presented, and recommendations were gained from professional leaders for refining the findings. RESULTS: The key informants agreed that pharmacist's works and responsibilities have gradually been drifted to support changes in healthcare and pharmaceutical systems. The upcoming pharmaceutical services call for higher standards of practice, larger number of personnel, and skillful pharmacists who have strong foundation in pharmaceutical knowledge as well as an ability to integrate knowledge into practices. Two sets of CFs were established. The general CF comprises five core domains: product focus, patient focus, healthcare system focus, community focus, and personal focus for self-improvement. These general competencies allow practitioners to perform basic professional tasks, including providing information, dispensing, and compounding. The service-specific competency is the integration of general competencies tailored into specific area of practice. CONCLUSIONS: Regarding the professional goal to evolve pharmacists from generalists to specialists for providing higher quality of professional services, the pharmacists are required to demonstrate general competencies and service-specific competencies. The findings serve as the need-based evidence for developing a national CF for pharmacists in Thailand


No disponible


Assuntos
Humanos , Prática Clínica Baseada em Evidências , Competência Profissional , Assistência Farmacêutica , Educação em Farmácia , Farmacêuticos , Pesquisa Qualitativa , Entrevistas como Assunto , Tailândia
5.
Pediatr Infect Dis J ; 39(1): 57-60, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31815839

RESUMO

BACKGROUND: Raltegravir granules for oral suspension, now recommended by World Health Organization for use in neonates with HIV infection, may be challenging for caregivers because of the multistep preparation required. METHODS: We evaluated the acceptability and feasibility of preparing granules for oral suspension in a low-to-middle-income country setting. Thirty-four caregivers and 10 health-care workers were enrolled from an HIV clinic in Durban, South Africa. Health-care workers were provided with pictorial instruction booklet, demonstration kit and guidance on preparation of granules for oral suspension. The health-care workers then trained caregivers on the preparation of granules for oral suspension. Caregivers were evaluated during the preparation process and instructed to practice at home with a sample kit and return to the clinic for repeat evaluation 5-7 days later. Caregivers and health-care workers were interviewed and participated in a focus group discussion regarding their experiences. RESULTS: The median age of the caregivers was 31 years (interquartile range: 9.7); 70% had received secondary-level education, 37% were employed. The median preparation time was 7.95 minutes (interquartile range: 5.08 minutes) and 7.48 minutes (3.55 minutes) at initial and repeated observation, respectively. Major errors were insufficient mixing time and incorrect suspension volume. The average number of errors between the 2 observation time points was significantly reduced at the repeat session (2.5 vs. 0.87, P = 0.023). Most participants found the preparation difficult at first but gained confidence over time. CONCLUSION: Despite the complexity involved in the preparation of the granules for oral suspension, with practice, this formulation was found to be acceptable and feasible to majority of participants in this low-resource setting. As a result, this formulation was included in the 2018 World Health Organization recommendations for first line in neonates living with HIV.


Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Inibidores de Integrase de HIV/administração & dosagem , Recursos em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Raltegravir Potássico/administração & dosagem , Cuidadores , Países em Desenvolvimento , Feminino , Infecções por HIV/virologia , Pessoal de Saúde , Humanos , Recém-Nascido , Masculino , Cooperação do Paciente , África do Sul/epidemiologia
7.
Adv Med Educ Pract ; 9: 713-722, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30310347

RESUMO

PURPOSE: To serve the higher demands of pharmaceutical services, pharmacy education in Thailand has shifted from 5-year BPharm program to 6-year PharmD program with two specialization tracks: pharmaceutical care (PC) and industrial pharmacy (IP). This study aimed to compare the perceptions regarding professional competencies, pharmacy profession, and planned workplace between graduates with 5-year BPharm and 6-year PharmD and between those with PC and IP specialty. METHODS: A cross-sectional national survey using a paper-pencil self-administered questionnaire was distributed to all new graduates attending the pharmacy licensure examination in March 2015. RESULTS: Of all 1,937 questionnaires distributed, 1,744 were returned and completed (90% response rate). Pharmacy graduates rated highest on their competencies in professional ethics, followed by PC services and system management. They rated low confidence in medication selection procurement and pharmaceutical industry competencies. The 6-year PharmD graduates showed higher confidence in ethics and professional pride than the 5-year BPharm graduates. Graduates with PC specialty rated higher perceived competency in PC, system management, primary care, and consumer protection domains, while the IP graduates were superior in IP and medication selection and procurement domains, and most graduates (PC and IP) intended to work mainly in a hospital or a community pharmacy. Hospital was preferred for the PC graduates, and the IP graduates were more likely to work in pharmaceutical industry, regulation and consumer protection, sales and marketing, and academia. CONCLUSION: With some gaps still to be filled, the transition from 5-year BPharm to 6-year PharmD program with specialty tracks gave extra confidence to graduates in their specialty competencies and professional pride, leading to differences in preferred workplace. The findings of this study reflect that Thai pharmacy education continues to adjust to the needs of the society and the changing health care environments. Longitudinal monitoring to observe this transition is needed for both curriculum adjustment and competency of the graduates.

8.
Nephrol Dial Transplant ; 24(4): 1298-305, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19131353

RESUMO

BACKGROUND: Despite the benefits of live donor kidney transplantation (LDKT) over deceased donor kidney transplantation, patients hesitate to pursue this option. METHODS: A total of 324 transplant-eligible haemodialysis patients attending 14 dialysis facilities in Maryland, Northern Virginia and Southern Pennsylvania were asked about their stages of readiness to pursue LDKT, attitudes towards LKDT and demographics. Logistic regressions were used to test the effect of patients' attitudes and demographics on their stages of readiness to pursue LDKT. RESULTS: Fewer than half of the patients who had heard about LDKT were considering this option. Among patients considering LDKT, 26% had not talked to their loved ones about LDKT and 54% had not asked anyone for a kidney. Concerns about the surgical procedure for the donor were associated with a lower likelihood of considering LDKT (adjusted OR = 0.38; CI 0.18-0.79), talking about LDKT (adjusted OR = 0.38; CI 0.18-0.78) and asking for a kidney (adjusted OR = 0.14; CI 0.06-0.36). Being satisfied with the information the patient received about LDKT was associated with a higher likelihood of talking with someone about LDKT and asking for a kidney (adjusted OR = 2.26; CI 1.33-3.83 and 3.89; CI 1.78-8.51). Women and younger patients were more likely to talk with family/friends about LDKT (respectively, adjusted OR = 1.76; CI 1.26-2.47 and 0.97; CI 0.95-0.99) and to ask for a kidney (respectively, adjusted OR = 4.36; CI 2.57-7.40 and 0.97; CI 0.94-0.99). CONCLUSION: Tailored educational programmes considering the patient's stage of readiness and related attitudinal and demographic factors might help patients move towards LDKT.


Assuntos
Falência Renal Crônica/psicologia , Falência Renal Crônica/cirurgia , Transplante de Rim/psicologia , Doadores Vivos , Adulto , Idoso , Atitude Frente a Saúde , Tomada de Decisões , Feminino , Humanos , Falência Renal Crônica/terapia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Diálise Renal
9.
Prog Transplant ; 18(4): 263-72, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19186579

RESUMO

CONTEXT: Given the shortage of kidneys available for transplantation, a community-based intervention trial was implemented to assess the impact of an educational program on patients' access to live donor kidney transplantation (LDKT). OBJECTIVE: To compare the short-term impact of a basic intervention and an enhanced intervention on patients' readiness to pursue LDKT. DEGISN: Baseline data and data from 1 week after interventions were analyzed. PARTICIPANTS: 214 transplant-eligible hemodialysis patients attending 14 dialysis facilities in Maryland, Virginia, and Pennsylvania. INTERVENTIONS: In the basic intervention, 107 patients watched a 10-minute videotape on the experience of recipients and live donors of a kidney. In the enhanced intervention, 107 patients watched the same videotape and had a discussion with a health educator on the risks and benefits of LDKT, who could be a donor, and how to address the barriers they were encountering when seeking a live kidney donor. MAIN OUTCOME MEASURE: Patient reported whether they were considering LDKT, had talked with family or friends about LDKT, and had asked someone for a kidney. RESULTS: Over half of transplant-eligible patients were not pursuing LDKT at baseline (64% in the basic intervention group, 61% in the enhanced intervention group). One week after the intervention, the odds of considering LDKT were higher among African Americans (odds ratio [OR], 2.28; confidence interval [CI], 1.22-4.25), younger patients (OR, 0.94; CI, 0.91-0.97), and patients who spent less time on dialysis (OR, 0.90; CI, 0.83-0.97). The odds of asking for a kidney were higher among African Americans (OR, 4.94; CI, 2.54-9.60) and patients who perceived they were in poor to fair health (OR, 3.30; CI, 1.12-9.67). CONCLUSIONS: Although both interventions helped patients consider LDKT and ask for a kidney, more time and expanded educational content might be needed to facilitate patients' discussion about LDKT with their loved ones.


Assuntos
Atitude Frente a Saúde , Transplante de Rim/psicologia , Doadores Vivos/provisão & distribuição , Educação de Pacientes como Assunto/organização & administração , Diálise Renal/psicologia , Obtenção de Tecidos e Órgãos/organização & administração , Fatores Etários , Currículo , Família , Feminino , Amigos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Intenção , Doadores Vivos/psicologia , Modelos Logísticos , Masculino , Maryland , Pessoa de Meia-Idade , Análise Multivariada , Pennsylvania , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo , Gravação de Videoteipe , Virginia
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