Expert consensus guidelines for community pharmacists in the management of diabetic peripheral neuropathy with a combination of neurotropic B vitamins.

This consensus guidance is for community pharmacists in diabetic peripheral neuropathy (DPN) management with a combination of neurotropic B vitamins. A multidisciplinary team including endocrinology, neurology, and pharmacy from Thailand discussed and aligned the practical scheme of DPN management in the community pharmacy setting, using the literature review and having face-to-face meeting. Five major statements have been endorsed as consensus recommendations for DPN care with strong acknowledgment. The aims of DPN management included reducing symptoms and the risk of complications, minimising adverse reactions from treatment regimens, and improving patients' knowledge and adherence to the treatment strategies. An initial screening process using a 7 items interview of Douleur Neuropathique 4 (DN4) questionnaire should be implemented to identify patients at risk of developing DPN. Subsequently, pharmacologic, and non-pharmacologic treatment should be employed based on patient-centered care. An interesting approach is combination of neurotropic B vitamins, which may be used as monotherapy or combination therapy to control DPN symptoms. The combined therapy potentially exhibits a synergistic effect and improves patient adherence. The consensus would be further considered in context of harmonisation of routine practice and country requirements.

Earlier diagnosis of peripheral neuropathy in primary care: A call to action.

Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.

A multidisciplinary approach to verify and de-label of drug allergic histories in a university hospital in Thailand: a retrospective descriptive study.

BACKGROUND: Mislabeling of drug allergic histories causes avoidable negative impacts on patients and healthcare system. Although multidisciplinary adverse drug reaction (ADR) services to verify and de-label drug allergic histories have been operated in particular hospitals in Thailand, their performances have not been reported. This research aimed to examine the effectiveness of verification of drug allergic history and de-labeling (VD) services of the physician-led multidisciplinary ADR clinic. METHODS: This research was a retrospective descriptive study. Medical charts of patients with at least one drug allergic history who received VD services at the multidisciplinary clinic between January 2017 to December 2018, were reviewed. Data on the history of drug allergy, VD services, and results were analyzed and presented using descriptive statistics. RESULTS: Seventy patients' charts were reviewed, and 171 unconfirmed drug allergic histories were identified. 79.53% of the reported reactions involved skin and soft tissues. The most found adverse skin reactions were maculopapular rash, pruritic and erythematous rash, and angioedema. The remaining 20.47% were systemic reactions which included drug reaction with eosinophilia and systemic symptoms (DRESS), anaphylaxis, and nausea/vomiting was the most prevalent. Antituberculosis, beta-lactam antibiotics, and nonsteroidal anti-inflammatory drugs (NSAIDs) were the most reported suspected drugs. Drug allergic history reviewing by physicians or pharmacists could confirm and de-label for 3 and 20 reactions, respectively. Seven and one reactions were confirmed by enzyme-linked immunospot assay and patch test, respectively. The provocation tests with the suspected or alternative drug were conducted in 64 reactions. Twelve reactions were confirmed, and 45 reactions were de-labeled. Totally, 65/171 (38.01%) allergic histories were successfully de-labeled, 23/171 (13.45%) were confirmed, and 83/171 (48.53%) were inconclusive. CONCLUSIONS: More than half of drug allergic histories were successfully confirmed or de-labeled by the multidisciplinary ADR team. The collaborative activities of various healthcare professionals, consisting of physicians, nurse, and pharmacists as presented in the study were effective in VD services and should be implemented in other healthcare settings.

Parental COVID-19 vaccination hesitancy among parents of children aged 5-18 years in Thailand: a cross-sectional survey study.

BACKGROUND: To promote an acceptance rate of COVID-19 immunization among Thai children, concerns about parental vaccination hesitancy should be urgently studied. This study aimed to examine the parental COVID-19 vaccination hesitancy (PVh) level and influencing factors among Thai parents of children 5-18 years of age. METHODS: This cross-sectional survey was conducted in Thailand during May and June of 2022. The Google forms for data collection were distributed to parents (a father, a mother, or one who nurtures and raises a child) via various online social media. Data regarding PVh level, relevant attitudes, experiences of COVID-19 and COVID-19 vaccination (EC&V), and family contexts (FC) were collected and analyzed using descriptive statistics. Mann-Whitney U test was used to compare the differences among groups of parents based on EC&V and FC. The factors influencing PVh were assessed by multiple regression analysis. RESULTS: Four hundred and eighty-eight parents completed the online questionnaire. Their median (IQR) age was 41 (35-47) years. They lived in different provinces from all regions across Thailand. Ninety percent of them were authorized persons to make decision about children vaccination. Fifty-eight percent of the respondents had vaccine hesitancy, defined as PVh level at moderate or above. Parents who had ever refused COVID-19 vaccination for themselves or refused to vaccinate their children against any other diseases had statistically significant higher levels of PVh (p value < 0.001). Conversely, the parents who had finished the initial COVID-19 vaccine had lower PVh levels with statistical significance (p value = 0.001). Attitude towards COVID-19 (AC), attitude towards COVID-19 vaccine (AV), and perceived behavioral control (PC) of the parents negatively influenced PVh with statistical significance, according to the results of the multiple regression analysis (Betas = - 0.307, - 0.123, and - 0.232, respectively). CONCLUSIONS: COVID-19 vaccination hesitancy was commonly found among Thai parents. The factors of the hesitancy were multifaceted. Different experiences regarding COVID-19 vaccination for themselves and any vaccinations for their children were associated with different PVhs. The attitudes especially AC, AV, and PC statistically influenced PVh. These findings should be exploited for national and local policy planning as well as public campaigns.

Customers' satisfaction toward drugstore facilities and services based on the good pharmacy practice standard in Thailand.

Introduction: The Good Pharmacy Practice (GPP) standards in Thailand have been legally implemented for all drugstores since 2014. However, customer satisfaction has not been studied. This research aimed to explore the satisfaction of the customers with the facilities and services received from drugstores under the GPP standards and examine the impact of satisfaction toward each GPP domain on overall satisfaction (OS) and the intention to receive the pharmacy services as the first choice in the case of common and non-serious illnesses (IntR). Methods: This research was a cross-sectional survey study. The Google Forms for data collection was distributed via the online social media between June and August 2021. The satisfaction toward OS, IntR, and the GPP domains; places and equipment (PE), personnel (P), quality control (QC), and pharmacy services (PS) were collected using 5-Likert scales. Descriptive statistics, intra-class correlation, and multiple regression were used in data analysis with statistical significance at p-value<0.05. Results: Three hundred and eighty-eight drugstore's customers responded to the questionnaires. Most customers rated the OS and the IntR at the highest level. The mean of the OS was 4.4±0.7 and the IntR was 4.6±0.7 points out of five. The OS and the IntR were highly correlated with the ICC of 0.719 (p-value<0.001). The satisfactions toward each GPP criteria were ranged between 3.9±0.9 to 4.6±0.7 indicating high levels of satisfaction. All 4 domains of the GPP standards explained the OS and the IntR with R square at 0.541 and 0.363, respectively. However, only PS and PE impacted the OS and only QC and PS impacted the IntR with statistical significance. Conclusion: Thai customers had high levels of the OS and the IntR toward drugstore facilities and services based on the GPP standards. The PS was the domain that statistically influenced both the OS and the IntR, whereas the PE and the QC also statistically influenced the OS and the IntR, respectively. Since PE was the most weighted domain for current inspection, PS and QC should be more emphasized in future revision of the GPP inspection.

Customers’ Satisfaction toward Drugstore Facilities and Services based on the Good Pharmacy Practice Standard in Thailand

Introduction: The Good Pharmacy Practice (GPP) standards in Thailand have been legally implemented for all drugstores since 2014. However, customer satisfaction has not been studied. This research aimed to explore the satisfaction of the customers with the facilities and services received from drugstores under the GPP standards and examine the impact of satisfaction toward each GPP domain on overall satisfaction (OS) and the intention to receive the pharmacy services as the first choice in the case of common and non-serious illnesses (IntR). Methods: This research was a cross-sectional survey study. The Google Forms for data collection was distributed via the online social media between June and August 2021. The satisfaction toward OS, IntR, and the GPP domains; places and equipment (PE), personnel (P), quality control (QC), and pharmacy services (PS) were collected using 5-Likert scales. Descriptive statistics, intra-class correlation, and multiple regression were used in data analysis with statistical significance at p-value<0.05. Results: Three hundred and eighty-eight drugstore’s customers responded to the questionnaires. Most customers rated the OS and the IntR at the highest level. The mean of the OS was 4.4±0.7 and the IntR was 4.6±0.7 points out of five. The OS and the IntR were highly correlated with the ICC of 0.719 (p-value<0.001). The satisfactions toward each GPP criteria were ranged between 3.9±0.9 to 4.6±0.7 indicating high levels of satisfaction. All 4 domains of the GPP standards explained the OS and the IntR with R square at 0.541 and 0.363, respectively. However, only PS and PE impacted the OS and only QC and PS impacted the IntR with statistical significance. (AU)