Abstract To evaluate the antibiotic susceptibility patterns in URTIs reporting to tertiary hospitals of Lahore. A cross-sectional study employing 259 culture sensitivity reports obtained from tertiary care hospitals of Lahore. Using SPSS, descriptive statistics were used to estimate frequencies and percentages. In URTIs, S. aureus (5%) was the frequent gram-positive isolate followed by MRSA (1.5%) and MSSA (1.5%), while P. aeruginosa (15.8%) was the prevalent gram-negative isolate followed by Klebsiella (13.1%) and E. coli (6.9%). Against P. aeruginosa, ceftazidime (7.7%), cefuroxime/ceftriaxone (4.6%), amoxicillin (4.3%) and ciprofloxacin (4.2%), were tested resistant, while imipenem (11.2%), ciprofloxacin (9.2%), amikacin (9.2%), meropenem/ levofloxacin/gentamicin (8.1%) and piptaz (6.9%) were found sensitive. Against Klebsiella, carbepenems (7.3%), amikacin (6.5%), ciprofloxacin (5.4%) and gentamicin (5%) were tested sensitive, whereas, ceftazidime (8.5%), ceftriaxone (5.8%), cefaclor (5.5%), ampicillin (4.6%), co-amoxiclave (4.2%) and ciftazidime/ciprofloxacin (3.8%) were found resistant. Overall, imipenem (35%), meropenem (30.8%) and amikacin (31.9%) were the three most sensitive antibiotics, while ceftazidime (25.4%), ceftriaxone (19.2%) and ampicillin (18.5%) were the three most resistant antibiotics. Data suggested that P.aeruginosa and Klebsiella, were the most frequent bacterial isolates in URTIs of Lahore. These isolates were resistant to ampicillin, cefuroxime and ceftazidime, but were sensitive to carbapenem and aminoglycosides.

The study aimed to examine the psychometric properties of the Urdu version of Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0). We applied the forward-backward procedure to translate the PSPSQ 2.0 in the Urdu language. The test-retest reliability was assessed through Cronbach’s alpha reliability analysis. The validity of the translated PSPSQ 2.0 was constructed by using Confirmatory Factor Analysis (CFA) through principal axis factoring extraction and Oblique rotation with Kaiser Normalization onto 2 predetermined factors. The Quality of Care (QOC) construct exhibited Cronbach’s alpha values of 0.900 (Test) and α = 0.871 (Retest) at two-time points. The Interpersonal Relationship (IPR) Construct had alpha values of 0.845 (Test) and α = 0.819 (Retest). The Kaiser-Meyer-Olkin measure of sampling adequacy for the factor analysis was 0.899. Barlett’s Test of Sphericity was significant (Chi-square = 1192.72; p < 0.05) revealing relationships of the data and suitability of CFA. Two factors explaining the total variance of 40% were extracted whereby loading values were acceptable (> 0.50) for all items of the translated version of PSPSQ 2.0. Results of this study conclude that the translated version of PSPSQ 2.0 is a valid instrument in regions where Urdu is a prime language of communication

Abstract Objective: The current study was carried out to assess community pharmacists’ perceptions towards online health information, to examine the type of information seek from Internet and to identify the barriers when they retrieved online health information. Methods: The study was designed as a cross-sectional questionnaire-based survey whereby all (300) community pharmacists practicing in Federal Territory of Kuala Lumpur, Malaysia were targeted for data collection. A 35-itemed questionnaire was posted out along with a stamped addressed envelope, invitation letter and support letter. Responses were also accepted via online response. Both descriptive and inferential statistics were used for data analysis. All statistical analysis was performed using SPSS v. 20.0. Results: A total of 67 responses were received with a response rate of 22.3%. The top three frequently health information searched by respondents were medicine information, general healthcare information and disease-related information. High number of respondents agreed that Internet had too much health information to scan through. Gender (p=0.018) showed significant association with visiting established health websites. Meanwhile, statistical significant was observed between age and searching medicine information (p=0.037), undertaking online continuing professional development (p=0.023), as well as searching clinical guidelines (p=0.047). Respondents’ education level showed significant association with uncertainty about the reliability of online health information (p=0.023) and unsure about filtering the information (p=0.007). Conclusions: Majority of the respondents expressed positive perception with the use of Internet for health information. The findings of the current study showed the widely use of Internet for health information among community pharmacists. Hence, this study provides opportunity for future works to further examine community pharmacist’s retrieval and appraisal skills for online health information, as well as application of this information into their daily pharmacy practice.

Objective: This study aimed to explore hypertensive patients’ perspectives on quality use of medication and issues related to hypertension management at the community level in Malaysia. Methods: Focus groups discussion was employed in this qualitative study. A total of 17 hypertensive patients were purposively recruited. Three focus group discussions with semi-structured interview were carried out at Flat Desa Wawasan, Penang. All the conversations were audio recorded, transcribed verbatim and thematically analysed. Results: Three major themes were developed, including medication adherence among hypertensive patients, self-management of hypertension and patients’ knowledge towards hypertension. Poor medication adherence was found and different strategies were taken to overcome the barriers towards adherence. Use of herbal and traditional therapies was perceived as alternative method in controlling blood pressure instead of taking antihypertensive medication. The participants were found to have poor knowledge on side effect and mechanism of action of hypertensive medication. Conclusions: The misconception about the side effect of antihypertensive medication has led to poor adherence among the participants. Lack of knowledge on targeted blood pressure level has led to poor blood pressure monitoring among the participants. Health awareness program and counselling from health care professional should be advocated among the hypertensive patients in addressing the above gaps.

ABSTRACT Background: Patients’ behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives. Objectives: This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication. Methods: A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island. Results: This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation. Conclusion: Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems.

Abstract Objective: The present study was aimed to evaluate the practices and attitudes of young Malaysian adults towards the use of antibiotics, and to determine the socioeconomic factors associated with the antibiotic use. Methods: A survey was carried in Cheras community by approaching a conveniently selected sample of 480 participants. A pre-tested questionnaire was used for data collection. Result: Of 480 participants approached, 400 agreed to participate in this study, giving a response rate of 83.3%. The study results showed that 42.75% of the participants exhibited poor attitudes towards antibiotic usage. Chinese race and high income were significantly associated with the positive attitudes towards antibiotic usage. It is shown that the practice of the participants towards antibiotics was relatively poor. The majority of participants agreed that they do not consult a doctor for minor illnesses (64%). The main reason for not consulting a doctor was the high fees of consultation (34.25%) and the inconvenience of visit (29.25%). However, a large proportion of respondents (77.5%) agreed that there is a need to enhance antibiotic education among public. Conclusion: The study results identified some crucial gaps in the attitudes and practices of Cheras community about the use of antibiotics. Thus, improving the public knowledge and changing their attitude towards antibiotic use along with proper interventions to regulate the ease of their availability would play a significant role for the effective use of antibiotics in the community.

Abstract Background: The provision of professional pharmacy services by community pharmacists continues to be limited, particularly in low and middle income countries. It was postulated that multiple management challenges faced by community pharmacists contribute to this situation. Objective: The primary aim of the research was to determine the challenges faced in the management of community pharmacies in Sarawak (the largest state in Malaysia), and practical strategies to cope and overcome the challenges. Methods: Semi-structured interviews were carried out with community pharmacists practising in Sarawak. Purposive and snowball sampling were employed to ensure a diverse group of informants. The interviews were audio-recorded and transcribed verbatim, with the resultant data analysed using thematic analysis. Data collection, coding, interpretation were carried out iteratively until theoretical saturation. Results: Twenty respondents from different demographic characteristics were recruited. Six major themes were identified. Management challenges faced by community pharmacists traverse five major domains: market competition, legislative issues, customers’ knowledge and expectations, macroeconomic impacts and operational challenges. Most of these challenges require government intervention to be resolved. In the meantime, improving customer service and expanding the range of professional services were seen as the most viable strategies to cope with existing challenges. The main concern is that current legislative and economic landscape may hinder these strategies. Enactment of dispensing separation and more protective measures against market competition were suggested to alleviate the challenges faced. Conclusion: Numerous management challenges faced by community pharmacists that distract them from delivering professional pharmacy services have been highlighted. Urgent affirmative actions by the government are warranted in supporting community pharmacists to realise and maximise their potentials.

Background: Pharmacy value added services (PVAS) was introduced as a matter of public health policy by Malaysia’s Ministry of Health to improve health outcomes through public healthcare services. For example, drive through pharmacy services is a major policy implementation of the Ministry. However, adoption rates are low and therefore hampering the achievement of national health policy goals. Objective: Our objective is to explore the key determinants and mediators of successful implementation of new public pharmaceutical services by investigating the cognitive perspectives of patients’ intentions to adopt with the Theory of Planned Behavior as the theoretical framework. Methods: A two phase mixed methodology involving first a qualitative exploration and the second a quantitative phase was conducted in public health facilities in Negeri Sembilan, Malaysia. Multiple regression and mediation analysis were performed. Results: Subjective norms, perceived behavioural control, knowledge and expectations are found to be significant predictors of intentions to adopt PVAS. Knowledge and expectations are found to exert significant indirect effects on intentions. Conclusion: Overall, we suggest that patient knowledge be enhanced through appropriate channels and expectations of service quality be met to increase intentions.

Background: Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used. Objective: To identify potential areas to improve the existing labels used for pediatric liquid medications. Methods: This study was qualitative in nature, whereby focus group Discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach. Results: Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While Discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions. Conclusion: This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications.

Objective: The objective of this study is to explore the pattern and practice of medicine use among the general public; and to explore the key factors influencing medicine use among medicine users. Methods: A qualitative approach using focus group Discussions was conducted to get in-depth information about medicines use pattern and practice from the general public. Adult people who reported using medicines at the time of study or in the previous month were approached. Two focus group Discussions were audio-recorded and transcribed verbatim. The obtained data were analysed using thematic content analysis. Results: This study found that there are some misunderstanding about the appropriate use of medicines. The majority of the participants reported that they were complying with their medication regimen. However, forgetting to take medicines was stated by 4 participants while 2 participants stopped taking medicines when they felt better. In addition, 10 participants reporting using medicines according to their own knowledge and past experience. Whereas 4 participants took medicines according to other informal resources such as family, friends or the media. Seven participants have experienced side effects with using medicines, 4 of them informed their doctor while 3 participants stopped taking medicines without informing their doctor. Conclusion: There was a misunderstanding about medicines use in terms of medication compliance, self-management of the illness and the resources of information about using medicines. Many efforts are still needed from health care professionals to provide sufficient information about medicines use in order to decrease the risk of inappropriate use of medicines and to achieve better therapeutic outcome.

Objective: (i) To develop the Pharmacy Value-Added Services Questionnaire (PVASQ) using emerging themes generated from interviews. (ii) To establish reliability and validity of questionnaire instrument. Methods: Using an extended Theory of Planned Behavior as the theoretical model, face-to-face interviews generated salient beliefs of pharmacy value-added services. The PVASQ was constructed initially in English incorporating important themes and later translated into the Malay language with forward and backward translation. Intention (INT) to adopt pharmacy value-added services is predicted by attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), knowledge and expectations. Using a 7-point Likert-type scale and a dichotomous scale, test-retest reliability (N=25) was assessed by administrating the questionnaire instrument twice at an interval of one week apart. Internal consistency was measured by Cronbach’s alpha and construct validity between two administrations was assessed using the kappa statistic and the intraclass correlation coefficient (ICC). Confirmatory Factor Analysis, CFA (N=410) was conducted to assess construct validity of the PVASQ. Results: The kappa coefficients indicate a moderate to almost perfect strength of agreement between test and retest. The ICC for all scales tested for intra-rater (test-retest) reliability was good. The overall Cronbach’ s alpha (N=25) is 0.912 and 0.908 for the two time points. The result of CFA (N=410) showed most items loaded strongly and correctly into corresponding factors. Only one item was eliminated. Conclusions: This study is the first to develop and establish the reliability and validity of the Pharmacy Value-Added Services Questionnaire instrument using the Theory of Planned Behavior as the theoretical model. The translated Malay language version of PVASQ is reliable and valid to predict Malaysian patients’ intention to adopt pharmacy value-added services to collect partial medicine supply.

Objetivo: (i) Desarrollar el Pharmacy Value-Added Services Questionnaire (PVASQ) utilizando temas salidos de entrevistas, (ii) establecer la fiabilidad y validez del cuestionario. Métodos: Utilizando la Teoría del Comportamiento Planeado aumentada como modelo teórico, unas entrevistas presenciales extrajeron los creencias sobre los servicios farmacéuticos de valor añadido. Se construyó el PVASQ inicialmente en Ingles incorporando temas importantes y más tarde se tradujo al malayo, con traducción y retro-traducción. La Intención (INT) de adoptar servicio farmacéuticos de valor añadido se predice por las Actitudes (ATT), Normal Subjetiva (SN), Control Comportamental Percibido (PBC), Conocimiento y Expectativas. Usando una escala de Likert de 7 puntos y una escala dicotómica se evaluó la fiabilidad test-retest (N=25) administrando el cuestionario dos veces en el intervalo de una semana. La consistencia interna se midió con el alfa de Cronbach y la validez de constructo entre dos administradores se evaluó con el estadístico kappa y el coeficiente intra-clase (ICC). Se realizó un análisis factorial confirmatorio (CFA) (N=410) para evaluar la validad de constructo del PVASQ. Resultados: Los coeficientes kappa indicaron una fuerza de acuerdo moderada a casi perfecta en el test-retest. Los ICC para todas las escalas probaron que la fiabilidad intra-evaluador (test-retest) era buena. El alfa de Cronbach global (N=25) es de 0,912 y 0,908 para cada tiempo medido. Los resultados del CFA (N=410) mostraron que la mayoría de los ítems cargaban fuerte y correctamente en sus correspondientes factores. Sólo se eliminó un ítem. Conclusiones: Este estudio es el primero para desarrollar y establecer la fiabilidad y validez del Pharmacy Value Added Services Questionnaire utilizando la Teoría del Comportamiento Plneado como modelo teórico. La versión traducida al malayo del PVASQ es fiable y válida para predecir las intenciones de los pacientes para adoptar servicios farmacéuticos de valor añadido al recoger su provisión de medicamentos.

Background: Acceptance of generic medicines by patients is an essential factor given that they are the end users of these medicines. In fact, adequate knowledge and positive perceptions are prerequisite to patients´ acceptance and use of generic medicines. Objective: To assess the current belief and views of patients about generic medicines in Malaysia. Method: This was a self-administered questionnaire-based study. The study was conducted with patients visiting outpatient pharmacy department at a tertiary care hospital in Malaysia. The Malaysian version of Generic Medicines Scale (GMS) was used. The GMS consists of two subscales: efficacy and similarity of generic medicines to original brand medicines. The efficacy subscale consists of 10 items while the similarity subscale consists of 6 items. The responses to the items were framed as a five-point Likert scale (1=strongly disagree to 5=strongly agree). Results: A total of 202 out of 300 patients participated in the study, giving a response rate of 67.3%. In this study, only 49% of them (n=99) knew the term "generic medicine". Moreover, only 53.5% of the respondents (n=108) believed that the efficacy of generic medicines was the same as original brand medicines. In terms of quality, only 44% of the respondents (n=89) disagreed that generic medicines were of a lower quality. About one third (n=65, 32.2%) believed that generic medicines were cheaper because they were less efficacious. In terms of side effects, 44.5% of the respondents (n=90) believed that generic medicines had the same side effect profile as original brand medicines. Conclusions: The study finding showed that almost half of the respondents had negative belief in generic medicines. Similarly, many patients were not aware of the similarities and differences between generic and original brand medicines. Therefore, there is a need to provide patients with adequate information about generic medicines.

Antecedentes: La aceptación de los genéricos por los pacientes es un factor esencial dado que son los utilizadores finales de estos medicamentos. De hecho, el conocimiento adecuado y las percepciones positivas son requisitos para la aceptación y el uso de genéricos por los pacientes. Objetivo: Evaluar las creencias y la visión actuales de los pacientes sobre medicamentos genéricos en Malasia. Método: Este fue un estudio basado en un cuestionario auto-administrado. El estudio se realizó con pacientes que visitaron un departamento de farmacia ambulatoria de un hospital terciario en Malasia. Se usó la versión malaya del Generic Medicines Scale (GMS). El GMS consiste en dos escalas: eficacia y semejanza del genérico con el original de marca. La sub-escala de eficacia consiste en 10 ítems, mientras que la de semejanza consiste en 6 ítems. Las respuestas de los ítems se estipularon en una escala de Likert de 5 puntos: (1=desacuerdo fuerte a 5=acuerdo fuerte). Resultados: Un total de 202 de los 300 pacientes participaron en el estudio, lo que da una tasa de respuesta del 67,3%. En este estudio, solo el 49% de ellos (n=99) conocían el término "medicamento genérico". Sólo el 53,5% de los respondentes (n=108) creían que la eficacia de los genéricos era la misma que la de los originales de marca. En términos de calidad, solo el 44% de los respondentes (n=89) estaba en desacuerdo que los genéricos eran de menor calidad. Cerca de un tercio (n=65, 32,2%) creía que los genéricos eran más baratos porque eran menos eficaces. En términos de efectos adversos, el 44,5% de los respondentes (n=90) creía que los genéricos tenían el mismo perfil de efectos adversos que los medicamentos de marca. Conclusiones: Los hallazgos del estudio demostraron que casi la mitad de los respondentes tenían creencias negativas sobre los genéricos. Del mismo modo, muchos pacientes no conocían las semejanzas y similitudes de los genéricos y los de marca. Por tanto, se necesita proporcionar a los pacientes información adecuada sobre medicamentos genéricos.

Objective: To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). Method: A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy´s management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities. Results: The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities. Conclusion: The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel´s at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.

Objetivo: Documentar el manejo de casos de malaria no complicada en farmacias comunitarias situadas en las dos principales ciudades de Pakistán: Islamabad (la capital) y Rawalpindi (ciudad gemela). Método: Se diseñó un estudio comparativo transversal para documentar el manejo de la malaria no complicada en las farmacias comunitarias de las ciudades gemelas de Pakistán mediante visitas de pacientes simulados. Se realizaron visitas a 238 farmacias aleatoriamente seleccionadas para pedir consejo en un caso de un paciente simulado con malaria. El manejo de la farmacia se puntuó en un listado que incluía la recogida del historial y la provisión de asesoramiento e información. Se utilizaron los tests de Kruskal-Wallis y de Mann-Whitney U para comparar el manejo de los casos de malaria no complicada por los dispensadores trabajando en farmacias comunitarias gestionadas por diferentes proveedores y en diferentes localizaciones de las ciudades gemelas. Resultados: Los pacientes simulados fueron atendidos por vendedores (74,8%, n=178), farmacéuticos (5,4%, n= 13), y diplomados (19,8%, n=47). Se dispensó medicación en el 83,1% (n=198) de las visitas, pero pocos de los casos tratados estaban de acuerdo con las recomendaciones para el tratamiento de la malaria. Sin embargo, en el 14,8% de los casos (n=53) los pacientes simulados fueron remitidos directamente al médico. Hubo diferencia significativa en el proceso de recogida del historial entre los diferentes dispensadores (p.e. farmacéuticos, auxiliares de farmacia, diplomados en farmacia, y vendedores), mientras que no hubo diferencias significativas en la provisión de asesoramiento entre los diferentes dispensadores. Los farmacéuticos, si estaban disponibles en la farmacia, estaban más involucrados en el proceso de recogida del historial. Por otro lado, no se apreciaron diferencias significativas en el manejo del caso (recogida del historial y provisión de asesoramiento) para el tratamiento de la malaria entre las farmacias comunitarias de diferentes localizaciones de las ciudades gemelas (p.e. cerca de un hospital/supermercado/mercadillo). Conclusión: Los resultados del estudio revelaron que el proceso general de manejo de la malaria no complicada en farmacias comunitarias no estaba de acuerdo con las recomendaciones nacionales de tratamiento de malaria. Los pacientes fueron atendidos por personal de las farmacias sin entrenamiento en las farmacias sin ninguna idea de remisión al médico. Sin embargo, los farmacéuticos estaban más involucrados en la recogida del historial, aunque su disponibilidad en las farmacias comunitarias era baja.