Papers by Chua Siew Siang
Age
New prescriptions received by an outpatient pharmacy department of a teaching hospital were audit... more New prescriptions received by an outpatient pharmacy department of a teaching hospital were audited retrospectively for noncompliance with prescription writing requirements as well as to identify the types of prescribing errors. Of the 397 prescriptions screened in a single day, 96.7% had one or more of the legal or procedural requirements missing. These errors of omission, included prescriptions without the patient's age, date, clinic or department where the prescription was issued, route of administration, dose and frequency of the drug to be used, strength, dosage form and quantity of drug to be supplied. Additionally, there were errors of commission involving 8.4% of the prescribed drugs. A total of 39 drug -drug interactions were identified; 15 were classified as potentially hazardous but could be overcome with careful monitoring of the patients. The results of the present study show a low compliance rate to the legal and procedural requirements in prescription writing. This indicates a need for pharmacy and medical educators to further emphasize the importance of writing clear and complete prescriptions. It also calls for the implementation of educational and monitoring programmes to bring more awareness to all concerned so as to reduce the rate of noncompliance and hence minimize the occurrence of prescribing errors.
The International Pharmaceutical Federation (FIP) adopted a set of Good Pharmacy Practice (GPP) g... more The International Pharmaceutical Federation (FIP) adopted a set of Good Pharmacy Practice (GPP) guidelines in 1993 and recommended that the regulatory bodies of individual countries should adapt the guidelines in accordance with their resources. The Malaysian Pharmaceutical Society (MPS) introduced its benchmarking guidelines (BMG) in 2003 as a means to raise the professional standards of the community pharmacy practice in Malaysia. Therefore, this study aimed to determine the extent to which community pharmacies have adopted the BMG. A cross-sectional study was conducted using mail questionnaires, which were posted to all community pharmacies in Malaysia. A total of 371 questionnaires (29.2%) were returned. Only 51.0% of the respondents were aware of the BMG. The extent of compliance with the guidelines was 62.6+21.1% (mean + standard deviation), with a median of 65%. The type and ownership of the community pharmacies were significantly associated with compliance with certain aspects of the guidelines. The main problem in complying with the BMG was financial constraint, and this problem was more likely to occur with independent than with chain pharmacies. However, the respondents generally agreed that most aspects of the BMG could be achieved in less than five years. Since the level of awareness among community pharmacists regarding the BMG is low, the MPS should promote or publicise the BMG further. The BMG should be reviewed before being used as part of the criteria for the accreditation of community pharmacies, as proposed by the MPS to further improve the quality and standards of community pharmacies in Malaysia.
Contact lens solutions should only be used for four weeks after first opening but this practice i... more Contact lens solutions should only be used for four weeks after first opening but this practice is not always followed. Therefore, the present study was conducted to determine the duration that contact lens wearers could use their normal saline without microbial contamination. Two brands of normal saline, Opticare TM and Klean & Kare TM , were used by 30 contact lens wearers on alternate days. Samples were collected weekly for microbial evaluation. On an average, the duration of use without microbial contamination was four weeks. Half of the participants were able to use both bottles of their normal saline without microbial contamination for at least four weeks after first opening and this included nine participants who were able to use for at least eight weeks. The brands of normal saline, the frequency of use, the place where the normal saline was stored or used were not significantly related to the duration of contamination-free period. Of the 27 samples tested, 11 grew gram-positive bacteria and 16, gram-negative bacteria. The most common bacteria found were Staphylococcus aureus and Pseudomonas species. None of the samples had Acanthamoeba spp. and no eye infection or irritation was reported. It was concluded that on an average, a bottle of sterile normal saline can be used for at least four weeks after first opening. Some users may be able to extend this expiry date to eight weeks, depending on the way the solution was used.
Journal of Applied Pharmaceutical Science
The present study was conducted to determine the prevalence of nonadherence to antidiabetic medic... more The present study was conducted to determine the prevalence of nonadherence to antidiabetic medications in a Malaysian tertiary hospital and its association with patients' glycaemic outcomes. A cross-sectional study was conducted in the diabetes clinic of a tertiary hospital in Malaysia. Data was collected from patients' medical records and also via personal interviews of type 2 diabetic patients. Of the 405 respondents recruited, 41.7% (95% CI, 36.9-46.4%) did not adhere to their antidiabetic medications. Only employment status of the respondents and the types of diabetic treatment were significantly associated with medication nonadherence. All the respondents were on antidiabetic medications, including 49.9% on insulin but only 17.4% (95% CI, 13.7-21.1%) achieved HbA 1c of less than 6.5%. Those who were adherent to their antidiabetic medications were significantly more likely to achieve glycaemic control. Pharmacists should educate diabetic patients on the use of their med...
Medical toxicology and adverse drug experience
In recent years, considerable attention has been focused on the pressor effects of nonprescriptio... more In recent years, considerable attention has been focused on the pressor effects of nonprescription sympathomimetic agents. The impact and usage of these agents especially ephedrine, pseudoephedrine, phenylpropanolamine and phenylephrine, in hypertensive patients has been the topic of constant debates. The present review is an attempt to report and evaluate all the clinical trials and cases of pressor reactions associated with these 4 agents. The study protocols used in these clinical trials are examined and comments made on any diversion from the standard design. Many factors are found to cause the discrepancies in the data available. It is concluded that ephedrine and phenylpropanolamine are best avoided by hypertensive patients due to higher probability of causing pressor reactions. Data on pseudoephedrine and phenylephrine appear to indicate non-significant effects on blood pressure of normotensive subjects when used at the recommended oral dose as nasal decongestants. Phenylephr...
Patient Preference and Adherence, 2014
Background: Diabetes mellitus is a lifelong chronic condition that requires self-management. Life... more Background: Diabetes mellitus is a lifelong chronic condition that requires self-management. Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes. Purpose: To assess the effects of a pharmaceutical care (PC) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus. Patients and methods: A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at random to the control (n=121) or intervention (n=120) groups. Participants in the intervention group received PC from an experienced pharmacist, whereas those in the control group were provided the standard pharmacy service. Medication adherence was assessed using the Malaysian Medication Adherence Scale, and glycemic levels (glycated hemoglobin values and fasting blood glucose [FBG]) of participants were obtained at baseline and after 4, 8, and 12 months. Results: At baseline, there were no significant differences in demographic data, medication adherence, and glycemic levels between participants in the control and intervention groups. However, statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4, 8, and 12 after the provision of PC (median FBG, 9.0 versus 7.2 mmol/L [P0.001]; median glycated hemoglobin level, 9.1% versus 8.0% [P0.001] at 12 months). Medication adherence was also significantly associated with the provision of PC, with a higher proportion in the intervention group than in the control group achieving it (75.0% versus 58.7%; P=0.007). Conclusion: The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes. Therefore, the PC model used in this study should be duplicated in other health care settings for the benefit of more patients with type 2 diabetes.
Patient Preference and Adherence, 2014
Background: Self-monitoring of blood glucose (SMBG) helps to improve glycemic control and empower... more Background: Self-monitoring of blood glucose (SMBG) helps to improve glycemic control and empowerment of people with diabetes. It is particularly useful for people with diabetes who are using insulin as it facilitates insulin titration and detection of hypoglycemia. Despite this, the uptake of SMBG remains low in many countries, including Malaysia. Purpose: This study aimed to explore the barriers and facilitators to SMBG, in people with type 2 diabetes using insulin. Patients and methods: Qualitative methodology was employed to explore participants' experience with SMBG. Semistructured, individual in-depth interviews were conducted on people with type 2 diabetes using insulin who had practiced SMBG, in the primary care clinic of a teaching hospital in Malaysia. Participants were purposively sampled from different age groups, ethnicity, education level, and level of glycemic control (as reflected by the glycated hemoglobin [HbA 1c ]), to achieve maximum variation in sampling. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked, and analyzed using a thematic approach. Results: A total of 15 participants were interviewed, and thematic saturation was reached. The factors that influenced SMBG were mainly related to cost, participants' emotion, and the SMBG process. The barriers identified included: frustration related to high blood glucose reading; perception that SMBG was only for insulin titration; stigma; fear of needles and pain; cost of test strips and needles; inconvenience; unconducive workplace; and lack of motivation, knowledge, and self-efficacy. The facilitators were: experiencing hypoglycemic symptoms; desire to see the effects of dietary changes; desire to please the physician; and family motivation. Conclusion: Participants' perceptions of the purpose of SMBG, the emotions associated with SMBG, and the complexity, pain, and cost related to SMBG as well as personal and family motivation are the key factors that health care providers must consider when advising people with diabetes on SMBG.
2 0 1 4 referencing, and hence cannot be described as fair since the performance of an individual... more 2 0 1 4 referencing, and hence cannot be described as fair since the performance of an individual is dependent on the performance of the cohort. By computer-based modelling the Hofstee method using both normal and non-normal exam data, we have shown that the pass mark does not change significantly when fail rate and pass mark boundaries are varied.
Current Medical Research and Opinion, 2012
Generic medicines are often used in public hospitals. However, data on the quality of generic ale... more Generic medicines are often used in public hospitals. However, data on the quality of generic alendronate, its efficacy, side-effects and medication adherence in clinical practice is scarce. Therefore, this study aimed to compare the side-effects and medication adherence of generic (apo-alendronate*) and proprietary alendronate (Fosamax†). This prospective study involved two groups of patients: (1) postmenopausal osteoporotic women prescribed once-weekly Fosamax (proprietary group) but were switched to apo-alendronate after 2 years ('switched over' group); and (2) patients initiated with once-weekly apo-alendronate (generic group). Participants were recruited from the Osteoporosis Clinic of a tertiary hospital. Data were collected through interviews. Side-effects and medication adherence. A total of 131 participants were recruited: proprietary group = 64 and generic group = 67. An intergroup and a within-group comparison were made. Side-effects were reported by 6 (9.4%), 30 (44.8%) and 12 (18.8%) participants in the proprietary, generic and 'switched over' groups, respectively. Participants who were on generic alendronate were at a significantly higher risk of experiencing side-effects compared to those who were taking proprietary alendronate [odds ratio (OR):7.84 (95% CI: 2.98-20.65), p < 0.001]. However, no significant statistical difference was found between the 'switched over' and the proprietary group [OR: 2.23 (95% CI: 0.78-6.37), p = 0.127]. Four out of 12 (33.3%) patients who experienced side-effects immediately after switching to generic alendronate discontinued generic alendronate due to intolerable gastrointestinal side-effects. There was no difference in medication adherence to generic or proprietary alendronate. Medication adherence to both generic and proprietary alendronate appeared similar although patients who were taking generic alendronate* were significantly more likely to experience side-effects than those on proprietary alendronate. Therefore, the switch from proprietary alendronate to the generic forms should not only consider the cost of the products but must also ensure that the generic and proprietary alendronate are equivalent in all aspects of efficacy and safety.
Biopharmaceutics & Drug Disposition, 1989
The pharmacokinetics of non-prescription sympathomimetic agents are discussed with respect to abs... more The pharmacokinetics of non-prescription sympathomimetic agents are discussed with respect to absorption from the gastrointestinal tract, volumes of distribution, metabolism and renal excretion. Where specific data are not available, postulations are made with inference from the chemical structures of these agents, or from studies with other drugs. No studies on hypertensive patients have been found, but attempts are made to correlate any possible changes in the pharmacokinetics of these sympathomimetic agents to hypertensive patients as a high proportion of the elderly population is hypertensive. Sympathomimetic agents with lesser polar hydroxl groups, for example, are thought to be more lipophilic and are more readily absorbed from the gastrointestinal tract, have higher volumes of distribution, and are more extensively metabolized. Major metabolic pathways include oxidation, deamination, demethylation, and conjugation. Most of these agents are excreted primarily through the kidneys and due to their basic nature, the rate of excretion is dependent on urinary pHs. Any alteration in kidney functions such as in the aged is, therefore, expected to have some clinical significance on the pharmacokinetics of these agents.
Drug Safety, 2012
Background: A previous meta-analysis reported that 9.5% of hospitalized children suffered from an... more Background: A previous meta-analysis reported that 9.5% of hospitalized children suffered from an adverse drug reaction (ADR); however, reported incidences among studies varied. Objective: To enhance the knowledge of ADRs in paediatric hospitalized patients at a global level we investigated the incidence and characteristics of ADRs in hospitalized children in European and non-European countries. Methods: A prospective observational cohort study was conducted in academic and non-academic hospitals in five countries: Australia, Germany, Hong Kong, Malaysia and the UK. Children aged 0-18 years admitted during a 3month period (between 1 October 2008 and 31 December 2009) were recruited. The main outcome measures were incidence, causality and outcome of ADRs. Results: A total of 1278 patients (1340 admissions) were included [Australia n = 146 (149 admissions), Germany n = 376 (407), Hong Kong n = 143 (149), Malaysia n = 300 (314) and the UK n = 313 (321)]. The median age was 2 years (interquartile range [IQR] 0-7). Patients received a total of 5367 drugs (median 3; IQR 2-5) and median length of hospital stay was 4 days (IQR 3-7). A total of 380 ADRs were identified in 211 patients. The resultant ADR incidence of 16.5% (95% CI 14.5, 18.7) varied significantly between countries (p < 0.001). The highest incidences were observed in Malaysia and the UK. 65.3% (n = 248) of ADRs were found to be probable, and 24% of the ADRs were serious, with one being fatal.
Asia-pacific Journal of Public Health, 2005
Evidence-based Medicine, 2010
ABSTRACT Commentary on: GhalebMABarberNFranklinBD. The incidence and nature of prescribing and me... more ABSTRACT Commentary on: GhalebMABarberNFranklinBD. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child2010;95:113–18.
International Journal of Pharmacy Practice, 2006
Objective To assess the response of community pharmacists to the presentation of back pain.Method... more Objective To assess the response of community pharmacists to the presentation of back pain.Method The researcher posed as a customer to obtain medication for back pain for her grandfather, and the consultations were recorded in a pretested data collection form.Setting The study was conducted in 100 randomly selected community pharmacies located within the Klang Valley in Malaysia. This includes Kuala Lumpur, the capital city of Malaysia and its surrounding suburban areas.Key findings In 85% of the consultations, pharmacists asked at least one question before recommending a treatment. The patient's medical history was the most frequently asked question by the pharmacists (60%). In general, a median of only five counselling elements were addressed by the pharmacists out of 13 recommended. The most common element of counselling addressed was the route of administration (98%), followed by the frequency and dose to be taken (92% and 88%, respectively). None of the pharmacists asked the ‘customer’ whether she required any further information. The number of counselling elements addressed was significantly associated with the age of the pharmacist, duration of consultation and the types of medication recommended (P < 0.05). Most of the pharmacists (88%) recommended at least an oral non-steroidal anti-inflammatory drug or a selective cyclooxygenase-2 inhibitor for the treatment of acute back pain. Diclofenac was the most commonly recommended medication for back pain (55% of consultations), followed by meloxicam (15%). The cost of treatment for back pain ranged from RM2.00 to RM38.00 with a median of RM10.00.Conclusion This study demonstrates that the extent of information gathering and counselling varied among community pharmacists in Malaysia and that in general, this appeared to be suboptimal. Professional bodies such as the Malaysian Pharmaceutical Society should create awareness among pharmacists regarding their responsibility to counsel patients or their caregivers.
Asia-pacific Journal of Public Health, 2002
The practice of losing weight is gaining popularity globally with an increase in health conscious... more The practice of losing weight is gaining popularity globally with an increase in health consciousness among the general public. A survey was conducted in seven shopping centres in Kuala Lumpur and its neighbouring towns to assess the weight-loss practices of the general public. Out of the 1032 people approached by the researcher, 389 (37.7%) admitted that they had tried to lose weight before. Of these respondents, 50.4% had the wrong perceptions about their weight with 39.1% of the respondents having BMI lower than what they had perceived. The most common weight-loss method used was dieting (89.5%), followed by exercise (81%) and the use of slimming teas (24.9%). Exercise (79.0%) was perceived as the most effective method for losing weight, followed by dieting (71.6%). Most respondents (60.6%) obtained their weight-loss products from the pharmacies but only 34.9% of these respondents had consulted the pharmacists on these products. Therefore, pharmacists should play a more active role in assisting the general public to lose weight successfully and safely.
Int J Pharm Pract, Feb 2013
OBJECTIVES: The study was conducted to assess how the general public in the Klang Valley, Malaysi... more OBJECTIVES: The study was conducted to assess how the general public in the Klang Valley, Malaysia, utilised community pharmacists. METHODS: This was a prospective observational study which documented interactions between community pharmacists and their customers. A researcher was stationed in 10 participating community pharmacies around the Klang Valley to observe and record all the interactions, using a structured data-collection form. KEYS FINDINGS: Interactions between 1914 customers and the pharmacists of the 10 community pharmacies were recorded. A total of 2199 requests were made by these customers. The main types of request were for medications by brand name (32.2%), advice on minor health problems (25.9%) and for health supplements (11.7%). Only 65 prescriptions were received by the community pharmacies; that is, fewer than two prescriptions per pharmacy per day. The pharmacists provided counselling for only 54.4% of the requests where a medication or health supplement was dispensed. Counselling by pharmacist was significantly associated with the type of request (P < 0.001). CONCLUSIONS: The main reason for the general public to visit a community pharmacy in Malaysia was to purchase a particular medication. Few prescriptions were filled at community pharmacies in Malaysia, indicating the under-utilisation of community pharmacists as a safety net for prescribed medications in primary care.
Int J Clin Pharm, Aug 2013
BACKGROUND: This study describes the analysis of secondary outcomes from a previously published r... more BACKGROUND: This study describes the analysis of secondary outcomes from a previously published randomised controlled trial, which assessed the effects of pharmaceutical care on medication adherence, persistence and bone turnover markers. The main focus of this manuscript is the effect of the provision of pharmaceutical care on these secondary outcomes, and details on the design of the intervention provided, the osteoporosis care plan and materials used to deliver the intervention. OBJECTIVES: To evaluate the effects of pharmaceutical care on knowledge, quality of life (QOL) and satisfaction of postmenopausal osteoporotic women prescribed bisphosphonates, and their associating factors. SETTING: Randomised controlled trial, performed at an osteoporosis clinic of a tertiary hospital in Malaysia. METHODS: Postmenopausal women diagnosed with osteoporosis (T-score </=-2.5/lowtrauma fracture), just been prescribed weekly alendronate/risedronate were randomly allocated to receive intervention or standard care (controls). Intervention participants received a medication review, education on osteoporosis, risk factors, lifestyle modifications, goals of therapy, side effects and the importance of medication adherence at months 0, 3, 6 and 12. MAIN OUTCOMES MEASURE: Knowledge, QOL and satisfaction. RESULTS: A total of 198 postmenopausal osteoporotic women were recruited: intervention = 100 and control = 98. Intervention participants reported significantly higher knowledge scores at months 3 (72.50 vs. 62.50 %), 6 (75.00 vs. 65.00 %) and 12 (78.75 vs. 68.75 %) compared to control participants. QOL scores were also lower (which indicates better QOL) at months 3 (29.33 vs. 38.41), 6 (27.50 vs. 36.56) and 12 (27.53 vs. 37.56) compared to control participants. Similarly, satisfaction score was higher in intervention participants (93.67 vs. 84.83 %). More educated women, with back pain, who were provided pharmaceutical care had better knowledge levels. Similarly, older, more educated women, with previous falls and back pain tend to have poorer QOL, whilst women who exercised more frequently and were provided pharmaceutical care had better QOL. Satisfaction also increased as QOL increases and when provided pharmaceutical care. CONCLUSION: The provision of pharmaceutical care improved knowledge, QOL and satisfaction in Malaysian postmenopausal osteoporotic women, showing that pharmacists have the potential to improve patients' overall bone health. Policymakers should consider placing a clinical pharmacist in the osteoporosis clinic to provide counselling to improve these outcomes.
Med J Malaysia, Apr 2013
BACKGROUND: Hypertension is the number one cardiovascular risk factor in Malaysia. This study aim... more BACKGROUND: Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care. METHODS: This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline. RESULTS: The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001. CONCLUSIONS: Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
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Papers by Chua Siew Siang