Theses (Master Of Pharmacy Practice)

Introduction Malaysia's diabetes prevalence of 12.1% exceeds global and regional averages. In 2017, management costs for diabetes exceeded RM 4 billion. Quality-adjusted Life Year (QALY) can be used to assess cost-effectiveness through Cost-Utility Analysis (CUA) using Health-related Quality of Life (HRQoL) indexes such as Quality ofWell­ Being Index Self-Administered (QWB-SA). Due to limited HRQoL studies in Malaysia, this research aims to determine the HRQoL value of the diabetic population in Kuala Langat. It will explore the associations between comorbidities, complications, and utility values, and investigate correlations between medication effects and HRQoL values in diabetes patients. This study offers an accessible method for obtaining utility values and aims to address knowledge gaps in Malaysian HRQoL research. Methods A total of 412 participants with diabetes were recruited from primary healthcare clinics in Kuala Langat. Each participant was given the Diabetic Survey Questionnaire (DSQ) to assess demographic characteristics, duration of diabetes, treatments, complications, and comorbidities. Additionally, the QWB-SA was used to calculate a health utility score. Statistical analysis was conducted using Wilcoxon's rank-sum test, Student's T­ test, and Pearson Chi-Square test to determine the significance of each factor on the health utility score obtained from QWB-SA. Results The study involved 412 participants, the majority being female (55.1%) and Malay (49.76%). The mean age of the participants was 62.3 years (95% CI: 61.2-63.3), the mean BMI was 27.7 (95% CI: 27.2-28.3), and the mean HbAlC was 8.11 (95% CI: 7.91-8.31). The mean utility score using QWB-SA was 0.770 (95% CI: 0.758- 0.782). Significant associations with QWB-SA were found for age, BMI, and HbAlC (p < 0.05). Categorical variables significantly associated included diabetes management type, total medications, cardiovascular disease, retinopathy, and nephropathy (all p < 0.01). These findings highlight key factors influencing health­ related quality of life in the studied population. Conclusion Diabetes complications, medications, treatment type, age, and BMI are significantly associated with the HRQoL of the diabetes population in Kuala Langat, whereas comorbidities, disease duration, gender, and ethnicity do not have any significant impact on their QoL. Further investigation 1s needed on the factors' impact on Malaysian utility values. Keywords: HRQoL, QWB-SA, utility values, diabetic survey questionnaire, DSQ.

Background: There is a growing trend in multimorbidity among the older adult population, which necessitates a complex treatment regimen as well as selfmanagement strategies and health literacy. Older adults who are burdened with their treatment and have poor health literacy may experience difficulty adhering to their medication plans. This study aimed to explore quantitatively how treatment burden and health literacy affect medication adherence in elderly living with multiple chronic conditions. Methods: Face-to-face structured interviews were conducted in 10 general practitioners (GP) clinics in Selangor among elderly aged >60 years to collect data comprising of (1) demographic details, (2) treatment burden assessed using the Burden of Treatment Questionnaire (TBQ-15), (3) health literacy of participants assessed using the Short Form Health Literacy Questionnaire (HLS-SF12) and (4) medication adherence level of participants assessed using the Malaysia Medication Adherence Assessment Tool (MyMAAT). Chi-square test and Pearson correlation coefficient test analyses were conducted to analyze the relationships among the study variables. Results: Hypertension (30.2%), hyperlipidemia (24.0%), and diabetes (18.0%) were the most reported chronic conditions among participants. The mean score of treatment burden was 53.4 out of 150 (SD = 28.2), indicating an acceptable burden of treatment. The mean score of health literacy was 16.4 out of 50 (SD = 12.6), indicating a limited health literacy level among participants meanwhile mean score of medication adherence was 32.6 out of 60 (SD =12.3), indicating medication non-adherence among participants. Medication adherence was significantly correlated with treatment burden (r = -0.22, p <0.0001), health literacy (r =0.36, p <0.0001), number of chronic conditions (r = -0.23, p <0.0001), and age (r = -0.11, p <0.05). Conclusion: The study findings indicate that multimorbid older adults with high treatment burden and low health literacy have poor medication adherence, underlining the importance for clinicians to recognize treatment burden and poor health to improve medication adherence among elderly with multiple chronic conditions. Keywords: Treatment burden; quality of life; medication; adherence, health; literacy, geriatrics.

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.

Introduction: Bleeding is a significant risk associated with oral anticoagulant (OAC) use, particularly in patients with non-valvular atrial fibrillation (NVAF). Existing bleeding risk scores have shown limited accuracy in predicting clinically relevant bleeding events, necessitating the development of a new predictive model. This study aims to create and validate a novel bleeding risk model that effectively predicts clinically relevant bleeding events. Methods: Using demographic, laboratory, and clinical data collected by Beshir SA et al., five bleeding risk models were developed through machine learning techniques, specifically utilizing recursive feature elimination (RFE) to identify pertinent variables. The dataset was divided into training and internal validation sets at 70:30 ratio. The model performance was assessed with accuracy, precision, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUROC). Upsampling and downsampling techniques were applied to original dataset with repetition in model building and evaluation. Results: Of 1,017 patients (median age: 67 years, male 52%), 77 patients (7.6%) faced clinically relevant bleeding within first year of observation period. The developed model comprised 10 variables, including renal failure, peripheral vascular disease, history of bleeding, age at diagnosis, hypertension, ischemic heart disease, sex, type II diabetes mellitus, smoking, and race. All five machine learning models had poor predictive performance, with AUROC between 0.49 to 0.50. The SVM-Radial model with upsampling dataset, demonstrated the highest predictive performance, with an AUROC 75.5%, a sensitivity of 86.88%, specificity of 64.18%, accuracy of 75.5.%, precision 70.81%, and F1 score of 78.03%. Conclusions: Feature selection using recursive feature selection – random forest picked 10 clinical predictors for CRB events despite data imbalance in original dataset. Downsampling provided realistic bleeding risk prediction which SVM-Linear performed best among five models. Upsampling improved bleeding risk prediction which SVM-Radial performed best among five models. New techniques to improve bleeding risk prediction are warranted. Keywords: non valvular atrial fibrillation, oral anticoagulants, bleeding, machine learning, bleeding risk score.

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.