Theses (Master Of Pharmacy Practice)

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for pain, fever, and inflammation. They are readily accessible over-the-counter (OTC) in community pharmacies without a prescription. Due to the ease with which NSAIDs can be acquired, selfmedication with NSAIDs is an increasing concern as it may result in inappropriate use, leading to drug-related problems and potentially serious adverse effects. Objective: The main purpose of this study was to assess the general public’s current level of knowledge, attitude, perception, and practice regarding the use of OTC NSAIDs, to explore their perspective regarding receiving information on NSAIDs, and also to determine the relationship between the knowledge, attitude, perception, and practice. Methods: A cross-sectional study was conducted among the general public in Selangor who had self-medicated with oral OTC NSAIDs. A structured, validated questionnaire was distributed electronically in community pharmacies and via social media platforms. In addition, a hard copy of the questionnaires was provided for non tech-savvy participants. Respondents were recruited through convenience sampling. Incomplete responses were excluded. Data was analysed using Statistical Package for Social Sciences (SPSS). Results: A total of 358 respondents completed the survey. Findings suggest that overall, the general public in Selangor demonstrated good knowledge (70.95%), positive attitude (PRR=67.88%), and good practice (PRR=58.75%) towards OTC NSAIDs use. However, perception of NSAID risks was poor (PRR=35.64%), especially related to risks of selfmedicating and sharing of NSAIDs among friends and family. Age, gender, and education levels were key determinants affecting knowledge levels. Most respondents (89.39%) showed a positive perspective towards receiving information on NSAIDs, with 94.14% agreeing that healthcare professionals (HCPs) should play a direct role in providing such information Statistically significant positive correlations were observed between knowledge-attitude (r=0.218, p<0.001), knowledge-perception (r=0.294, p<0.001), knowledge-practice (r=0.294, p<0.001), attitude-perception (r=0.270, p<0.001), attitude-practice (r=0.585, p<0.001) and perception-practice (r=0.385, p<0.001). Conclusion: There were potential gaps and misconceptions identified in certain areas, particularly regarding the safety aspects of NSAIDs. The study recommends targeted educational interventions to raise awareness and improve overall medication safety. Keywords: NSAIDs, painkillers, community pharmacy, health, wellbeing

Assessment of patient safety culture among healthcare providers in tertiary hospitals – a multicentre study Introduction: Patient safety culture is the combination of attitudes and behaviours toward patient safety that are addressed when a patient walks into a healthcare institution. The objectives of the present study were to identify the current level of patient safety culture and to evaluate and correlate the healthcare providers’ (HCPs) knowledge, attitude, and perception of patient safety culture in tertiary hospital settings. Methods: A cross-sectional study was carried out among the HCPs of private tertiary hospitals, which were Sunway Medical Centre (Sunway City) and Gleneagles Hospital Medini Johor. A structured validated questionnaire which includes Hospital Survey On Patient Safety Culture (HSOPSC) was used to analyse the level of patient safety culture. Results: A total of 550 HCPs were approached and only 158 of them responded to this online survey and the response rate was 28%. The overall patient safety grade was rated as very good or excellent by 110 (69%) respondents. The study revealed communication about the error (PRR=80), and organizational learning and continuous improvement (PRR=74) were good in the study settings, whereas staffing and work pace (PRR=28), and response to errors (PRR=40) require improvement in terms of patient safety culture. Conclusion: HCPs in the study settings had favourable attitudes towards the culture of patient safety in their organization. Inadequate staffing, work pace, and lack of response to mistakes were commonly seen that may increase the chances of errors, which pose health threats to the patients and needs to be addressed immediately. Every healthcare organization should address the issue of safety culture holistically. Keywords: Patient safety, hospital survey, error reporting, private hospital, healthcare.

Introduction: Zika, infection, which is a mosquito-borne virus of which unknown to many until this present day and now the focus of serious warnings from the World Health Organization (WHO) and the Center for Disease and Control and Prevention which declare the virus outbreak a Public Health Emergency of International Concern (PHEIC). Zika virus does not limit only through vector-borne transmission. It can also be through sexual and feto-maternal transmission. Currently, there is no antiviral treatment or vaccine available for Zika virus infection. Preventive strategies were an option. This study aimed to assess awareness, attitudes and perception of women towards Zika virus and their acceptance of Zika vaccine once it will be made available. Methods: A descriptive cross-sectional study was conducted with 516 women aged 18 to over 35 years old in Cebu City Philippines. A validated and pre-tested questionnaire was utilized in this study self-administered to the respondents. Data collected and SPSS was utilized for simple qualitative analysis. Results: Most respondents were 18-24 years old who never had pregnancy before. Awareness about Zika is low, have heard ofit, but don’t know much about Zika virus infection and only know a little about it. Subjects were not sure if they were living in or been travelling to places with Zika. However, knowledge about the transmission of Zika is quite high. Seventy six percent thought transmission through a bite of a mosquito. Attitudes of women were significantly associated with Zika virus and precautionary measures were thought out as well as preventive strategies considered as not at all hard. Respondents express that development of Zika vaccine is vital and substantially associated with the willingness to get vaccinated. Conclusion: Regardless of socioeconomic status, there were gaps on the level of awareness and knowledge towards Zika virus infection. Respondents had a low level of awareness how the Zika virus can be transmitted other than through mosquito bites. Consider preventive measures to prevent the infection and their willingness to accept Zika vaccine once a safe and effective be available. Keywords: Zika virus infection, Awareness, Attitudes, Perception, Vaccination

INTRODUCTION Adverse drug reaction, being one of the contributing causes of morbidity and mortality worldwide, continues to pose a threat to the general public as medications are being utilized for the treatment of various diseases. Spontaneous reporting systems (SRS) remains one of the most effective strategies for gathering post- marketing data on drug safety. However, as evident by numerous studies, spontaneous reporting systems are plagued with under-reporting by healthcare professionals. This study was conducted among hospital pharmacists in a tertiary healthcare setting to examine their knowledge, attitude and practice on pharmacovigilance and ADR reporting before and after an educational intervention. METHODS This was a pre- post interventional study. Participants were equally divided into two groups: a test group that received educational training intervention; and a control group that did not receive any training. The knowledge, attitudes and practice of pharmacovigilance and ADR reporting amongst the hospital pharmacists were assessed based on pretested questionnaire administered before and 1st, 3rd and 5th week after the intervention. The survey instrument was a modified version of similar studies conducted both locally and internationally done previously. RESULTS A total of 40 hospital pharmacists were involved in the study. At baseline, the difference of mean score between control and test group is considered to be infinitesimal (Control: 10.60 ± 1.39, Test: 11.65 ± 1.46). The mean ± SD of the total knowledge scores in the test group participants after the educational intervention significantly increased to 17.90 ± 0.91 (Week 1), 18.30 ± 0.87 (Week 2) and 18.60 ± 0.60 (Week 3) respectively compared to control group (Week 1: 12.40 ± 1.67, Week 3: 12.20 ± 2.07 and Week 5: 12.50 ± 1.82 . As for the ‘Attitude’ and ‘Practice’ aspects of the study material, both group of participants portrayed a positive attitude and practice when they are confronted with an adverse drug reaction, however, the test group participants have indeed showed a much significant positive response compared to control group following the educational intervention. CONCLUSION Educational intervention has an influential role in improving hospital pharmacists’ knowledge, attitude and practice on pharmacovigilance and ADR reporting. Hence, to improve the quantity and quality of ADR reporting, workshops and Continuous Pharmaceutical Development (CPD)programs need to be conducted in a timely manner. Keywords: Hospital pharmacist, adverse drug reaction reporting, educational intervention, knowledge, attitude and practices

Background: Falls have a detrimental influence on the quality of life of the elderly, as well as increase the health care cost in managing fall-related injuries. Fall incidences are expected to rise tremendously in the future as the world's elderly population expands, particularly in Southeast Asia. Since medications are one of the main factors that increase the risk of falling, much research has been conducted recently to examine the link between medications and falls. The frequency of falls among the elderly can be decreased by implementing intervention measures into practise. Objectives: The study aimed to assess the knowledge, attitude, and perception (KAP) of falls among the geriatric population in a primary care clinic setting, review the fall risk- increasing drugs (FRIDs), provide educational intervention to improve the awareness of falls and FRIDs, and lastly to analyse the effectiveness of the educational intervention. Methods: This interventional study was carried out in a primary care setting using a validated structured questionnaire to assess the KAP of falls. Elderly patients who were 65 years and above, seeking medical treatment in the primary care setting, and able to read, understand, and respond to the study questionnaire and educational interventional materials were included in the study. Results: In a total of 310 respondents, 74% of them obtained primary-level education, and 46% of them were living alone or with their partner/caregiver. The percentage of elderly patients who experienced falls in the past 12 months was 20%. Significant improvement (p<0.05) was observed in the respondents’ KAP in post-intervention. The findings revealed that the educational intervention provided is suitable to all respondents regardless of education level and prior knowledge of falls and fractures. Conclusion: The educational intervention provided to the elderly population has improved the respondents’ KAP to a certain extend. Future health policy must be crafted to address preventive measures to meet the requirements of the ageing population. Keywords: FRIDS, geriatrics, falls, educational intervention, knowledge, attitude, perspective.

Introduction: The consequences of unused and expired medications encompass environmental contamination, increased global warming risks, wastage of public resources, as well as unintentional poisoning resulting from accidental ingestion. To facilitate the return of unused or excess medications by patients, the MoH in Malaysia has implemented the “Return YourMedicines Program”. The goal of this study was to assess the effectiveness of a pharmacist-led educational intervention in educating the public and enhancing the appropriate disposal of unused and expired medications. Methods: An interventional research study had been carried out for a duration of eleven months from October 2022 to August 2023. The respondents participated in this study via invitation from email, WhatsApp messages, and other social media platforms. All respondents had answered a pre-intervention questionnaire prior to the educational intervention, followed by seven days of educational intervention, as well as a final data collection on the seventh day. Results: The study successfully obtained 397 responses in pre-intervention, and 353 responses in post-intervention, thereby achieving a response rate of 89%. The knowledge score of the respondents had enhanced to a sufficient level from 44.4% to 91.2% upon completion of the educational intervention. Vitamins (Npre=194, 48.9%; Npost=222, 62.9%), and cough preparation (Npre=193, 48.6%; Npost=219, 62.0%) were the two most widely existing unused and/or expired medications before and after educational intervention. An excessive number of medications (Npre=230, 57.9%; Npost=215, 60.9%), and improvement in the illness condition (Npre=158, 39.8%; Npost=261, 73.9%) were known as the two most common reasons for having unused and/or expired medications before and after educational intervention. Approximately 90% of the respondents (n=317) would participate in the “Return Your Medicines Program” in managing unused and/or expired medications after receiving the educational intervention. Conclusion: The educational intervention demonstrated a positive impact in enhancing the knowledge, attitude, and practice regarding the safe disposal of unused and expired medications. Keywords: unused, expired, medications, effectiveness, intervention

Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that contributes to cardiovascular diseases (CVD), type 2 diabetes mellitus (T2DM), cerebrovascular complications, as well as bone and gastrointestinal disorders, thus regarded as a major global health concern. Abdominal obesity, high blood pressure, high serum glucose, and dyslipidemia are four important components of MetS. These metabolic disorders are modifiable with relevant pharmacotherapy and lifestyle modifications. Patients’ education can be a key element in reducing the poor and inappropriate management of MetS. Objective: The study aimed to assess the knowledge, attitudes, and perceptions (KAP) of MetS among patients with MetS. The study also aimed to determine the cardiovascular risk scores among the patients with MetS, and provide online educational interventions on MetS among these patients. It is also intended to evaluate the effectiveness of pharmacist-led online educational interventions in improving the KAP of patients with MetS. Lastly, to assess the medication adherence behaviors among these patients with MetS. Methods: An online interventional study was conducted among the general population in Klang Valley who have been diagnosed with MetS. The participants were recruited by convenience sampling method. A structured, validated study questionnaire was distributed via social media platforms, as well as study posters embedded with the “Quick Response” code were displayed in prominent areas to recruit eligible participants. Incomplete responses were excluded. The eligible study participants were divided into intervention and control groups, where the intervention group received online educational interventions led by the pharmacist for 15 days. The data was analysed using Statistical Package for Social Sciences (SPSS). Results: A total of 50 participants in the control group and 47 participants in the intervention have completed the survey. Female participants were predominantly involved in both the control (n=32, 64%) and intervention (n=27, 57.4%) groups. Overall, the current study suggests that the majority of the patients with MetS have limited knowledge (n=81, 83.5%), negative attitudes (PRR=40.72%), and positive perceptions (PRR=76.12%) towards MetS. Post-intervention, the KAP towards MetS significantly improved among the participants in the intervention group as compared to the pre-intervention (p<0.01), which was not observed in the control group. The findings also suggested that most of the participants in the current study in both groups have poor to moderate medication adherence (n=71, 73.2%). The online educational interventions elicited a statistically significant change in medication adherence among the patients with MetS in the intervention group (p<0.01). Conclusion: The incorporation of online-based patient education in addition to the therapeutic management of MetS is warranted, which will effectively improve the KAP towards MetS and medication adherence among patients with MetS. Keywords: Metabolic syndrome, hypertension, diabetes, dyslipidemia, obesity, knowledge, attitude, perception.

Unwanted teen pregnancy is a serious social problem in Malaysia. Community pharmacists may play a vital role in advising teenagers on contraception. The aim of this study was to assess the knowledge, attitude, and practice of emergency contraception (EC) among teenagers among Malaysian community pharmacists. Methods A 33-item survey was conducted using Google form on fully or provisionally registered community pharmacists throughout Malaysia. The demographic, educational and professional characteristics of these pharmacist were recorded, and the scores of the various study components of the questionnaire between different groups were compared. Results A total of 311 community pharmacists completed the survey, and the response rate was 61% (311/510). In our survey, 90% of participants rated themselves to have good EC knowledge, however, only 66% of respondents showed having adequate EC knowledge in answering the knowledge questions. The two main barriers for EC supply are the concerns about safety or efficacy of EC and the possibility of discouraging regular oral contraceptives. Those aged above 30 years, male sex, owners of a community pharmacy, longer working experience, and members of a pharmacy professional organization have a significantly higher knowledge score than those who were not. There was no significant differences in knowledge scores and attitude scores between fully registered pharmacists and provisionally registered pharmacists. But statistically significant difference in the perceived barriers was noted between these two groups. Conclusion The present study shows that community pharmacists in Malaysia generally lack in knowledge of EC. Efforts should be directed at promoting knowledge in EC among community pharmacists through ongoing professional development or training courses and ongoing education programmes so that they are more prepared to advice customers especially teenagers on EC. Keywords: emergency contraceptive, teenagers, knowledge, attitude, barriers, unwanted teenage pregnancy, morning after pills

Background: World Health Organization defines Adverse Drug Reaction as “any noxious, unintended, and undesired effect of a drug, which occurs to normal doses used in humans for prophylaxis, diagnosis, or therapy”. ADRs are the most common cause of morbidity, mortality, and poor therapeutic outcomes. Therefore, pharmacovigilance is very important to monitor the risk and benefits of pharmaceutical products after they have been launched into the market. Objective: The objective of this study was to evaluate the knowledge, attitude, and practices of medical practitioners on pharmacovigilance and ADR reporting system in Malaysia and also to elucidate the factors leading to underreporting of ADRs. Methods: A cross-sectional survey study was conducted among 600 private and public medical practitioners of Kuala Lumpur and Selangor, using a structured and validated questionnaire to collect the respondent’s demographic details and KAP on ADR reporting. A convenience sampling technique was used to recruit the sample size. Results: In this study, a total of 600, that is 300 practitioners each from the private and public medical facilities completed the questionnaire. The knowledge assessment showed that 94.83% (Private medical practitioners- n=281, 93.67%; public medical practitioners- n=288, 96%) of respondents believe ADR reporting helps to identify safe drugs and 91.33% (Private medical practitioners- n=276, 92%; public medical practitioners- n=272, 90.67%) said it helps to measure ADR incidence. Regarding practice, 94% (Private medical practitioners- n=287, 95.67%; public medical practitioners- n=277, 92.33%) of respondents were willing to report an incident only if they were confident that the reaction is an ADR. Around 251 (83.67%) private and 266 (88.67%) public medical practitioners suspected an ADR, but they did not report it. Conclusion: The study concluded that around half of the participants were having an average to moderate level of knowledge, attitude, belief, and practice toward ADR reporting. Underreporting of ADR was observed at all levels of practice; hence, an extensive intervention is needed to rule out the root cause of underreporting and to improve the rate of ADR reporting. Keywords: Pharmacovigilance, adverse reactions, side effects, spontaneous reporting, practitioners.

Introduction Telehealth services have grown in popularity since the outbreak of COVID-19 due to the need for physical distancing and are expected to continue expanding even after the pandemic has subsided. Studies in other countries have indicated that the views and awareness towards telehealth have shifted since the pre-pandemic era. It is vital to understand the current levels of knowledge, attitude, and perception of the public on the readiness for telehealth services in Malaysia to ensure that the country’s healthcare system adapts to the changing environment effectively. Methods A cross-sectional study was conducted among public members of Malaysia from September 2022 to February 2023. The survey form was distributed online via social media applications such as WhatsApp, Facebook, and Instagram. In addition, physical survey forms were also distributed in public areas such as shopping malls and business centers. Participants were selected using convenience sampling technique. Data obtained was analyzed using descriptively and analytically using SPSS software. Results A total of 384 (100%) complete responses were collected. Findings suggest that the public has good knowledge and a positive attitude towards telehealth services in Malaysia. The public also had a positive perception on readiness for telehealth services. Among the respondents, 52.6% of them agreed and 17.2% strongly agreed that they were ready to undertake a telehealth consultation. Factors that may significantly influence the perception on readiness for telehealth (p < 0.05) were the level of highest education with 95% CI [1.021, 1.904], individuals who own a computer or laptop [0.156, 0.827], and levels of knowledge [1.074, 1.314] and attitude [1.125, 1.254]. There were significant positive correlations between knowledge and attitude (r=0.260, p <0.001), knowledge and perception on readiness for telehealth services (r=0.308, p <0.001), and attitude and perception on readiness for telehealth services (r=0.511, p <0.001). Conclusion There is great potential for telehealth services in Malaysia, in view of good levels of knowledge and the positive attitude of the public towards it. There is a wider acceptability of telehealth services among the general public and hence, telehealth services need to be strengthened across the country. Keywords: Consultation, healthcare, patient services, awareness, health.