Bruce Sunderland | Curtin University, Perth (original) (raw)

Papers by Bruce Sunderland

Research paper thumbnail of Knowing the gap: medication use, adherence and blood pressure control among patients with hypertension in Indonesian primary care settings

PeerJ, 2022

Background Hypertension is a major risk factor for global disease burden, however, little is know... more Background Hypertension is a major risk factor for global disease burden, however, little is known regarding the profiles of patients with hypertension in Indonesian primary care settings. Objective This study aimed to profile medication use, adherence to medications and lifestyle modifications as well as blood pressure control among patients with hypertension in Indonesian primary health centres (PHCs). Methods A cross-sectional study design used a structured data collection tool (questionnaire and checklist). Patients aged ≥18 years with a diagnosis of hypertension, and prescribed an antihypertensive medication, and attending follow-up visits in the five PHCs in Surabaya, Indonesia, during a two-week study period (May–October 2019) were included. Descriptive analyses summarised the data, while binary logistic regression provided any independent associations between adherence profiles and blood pressure control. Results Of 457 eligible patients, 276 patients consented: PHC A (n = 5...

Research paper thumbnail of Assessing readiness for research: a pilot study of Indonesian pharmacists

Journal of Pharmaceutical Health Services Research, 2021

Objectives Readiness is a key factor that influences pharmacists’ willingness to get involved in ... more Objectives Readiness is a key factor that influences pharmacists’ willingness to get involved in research, thus promoting evidence-based pharmacy practice. While the data are lacking, this study aimed to assess readiness for research, as well as the associated demographic and attitudinal characteristics of pharmacists in a range of healthcare settings in East Java Province, Indonesia. Methods A questionnaire was administered to all pharmacists in a public hospital in Malang (n = 55), pharmacists from primary health centre (PHCs) (n = 63) and community pharmacies (n = 100) in Surabaya in 2017. The questionnaire consisted of three sections: (1) demographic characteristics, (2) attitudinal aspects and (3) readiness for research. Descriptive analysis was used to summarise the data. Spearman correlation tests determined the correlations between ‘demographic characteristics’ or ‘attitudinal aspects’ versus ‘readiness’. Key findings A total of 142 pharmacists responded which comprised hosp...

Research paper thumbnail of Off-label and Unlicensed Medicines in a Paediatric Medical Ward in Indonesia

Research paper thumbnail of Counselling practices in an East Javan district, Indonesia: what information is commonly gathered by pharmacy staff?

Journal of Pharmaceutical Health Services Research, 2021

Counselling by pharmacy staff plays a key role in ensuring the quality use of medications in comm... more Counselling by pharmacy staff plays a key role in ensuring the quality use of medications in community settings. Information gathering is the first step and an essential part of counselling. Yet, data on information gathering during counselling in Indonesia is lacking. Objective To identify pharmacy staff’s practice of counselling and information gathered during counselling in an East Javan district, Indonesia. Methods A survey questionnaire was conducted in community-based health facilities in the district (i.e. 3 hospital outpatient clinics, 69 community pharmacies and 24 Community Health Centres [CHCs]); one health facility was represented by one pharmacy staff. Quantitative content analysis was used to summarise data regarding information gathering. Key findings Sixty-six pharmacy staff responded, giving a 69% response rate. Almost all staff reported providing counselling; those at CHCs and outpatient clinics mostly provided prescription medicine counselling (95.5% and 100.0%, r...

Research paper thumbnail of A training program incorporating a diabetes tool to facilitate delivery of quality diabetes care by community pharmacists in Malaysia and Australia

Pharmacy Practice, 2019

Objectives: To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM... more Objectives: To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM) incorporating a diabetes tool, the Simpler™ tool. Subsequently pharmacists' experience utilising the tool to deliver structured, consistent, evidence-based T2DM care was explored. Methods: Full-time non-credentialed diabetes pharmacists providing diabetes medication management services in community settings were purposively recruited. Participants had either face-to-face or online training on diabetes management using the tool which took about two hours and 20 minutes to complete. Their diabetes management knowledge was assessed pre-and post-training using quantitative methodology. They were then required to apply the tool in daily practice for one month. Feedback on both the training sessions and tool utilisation were obtained through semi-structured interviews and analysed using a qualitative approach. Results: Twelve pharmacists participated: Six from Australia and six from Malaysia. Before attending the training session, their median test score was 6.5/27, IQR 1.4 (1st marker) and 5.3/27, IQR 2.0 (2nd marker). After training, the scores doubled to 14.3/27, IQR 4.5 (1st marker) and 11.3/27, IQR 3.1 (2nd marker), showing significant improvements (p=0.002). Interview data identified perceived effectiveness factor through use of the tool. Participants found the content relevant, structured, concise and easy to understand; enabled comprehensive medication reviews; focused on achieving glycaemic improvement; facilitated documentation processes and pharmacists' role in T2DM management; and as a specific aid for diabetes management. Barriers included lack of accessibility to patients' laboratory data in Australia. Conclusions: The targeted training improved pharmacists' knowledge on diabetes management and supported the Simpler™ tool use in practice as a structured and beneficial method to deliver evidence-based T2DM care.

Research paper thumbnail of The Pharmacists’ and pharmacy technicians’ scopes of practice in the management of minor ailments at community pharmacies in Indonesia: a cross-sectional study

Pharmacy Practice, 2021

Background: Managing minor ailments in community pharmacy is an evolving pharmacy service in deve... more Background: Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services. Objective: To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perceived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies. Methods: Cross-sectional surveys were conducted during January-February 2020 of pharmacists and pharmacy technicians attending seminars conducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses ide...

Research paper thumbnail of High prevalence of off-label and unlicensed paediatric prescribing in a hospital in Indonesia during the period Aug.—Oct. 2014

PLOS ONE, 2020

Background Data on off-label and unlicensed prescribing in children in Indonesia is limited. The ... more Background Data on off-label and unlicensed prescribing in children in Indonesia is limited. The aims of this study were to determine the prevalence of off-label and unlicensed prescribing for paediatric patients in a public hospital, Indonesia. Method A retrospective cross-sectional study of 200 randomly selected paediatric patients admitted to hospital between August and October 2014, collected patient details and all drugs prescribed. Licensed drugs were classified as off-label if there was a non-compliance with the Product Information for age, weight, indication, dose, frequency and route of administration, if there was a contraindication, special precautions or not recommended for children. Unlicensed drugs were those not approved for use in Indonesia. The main outcome was the prevalence of off-label or unlicensed prescribing to infants, children and adolescents and the impact of age group on off-label prescribing. Results A total of 200 patients received 1961 medicines of which 1807/1961 (92.1%) were licensed and 154/1961 (7.9%) were unlicensed. There were 1403/1961 (71.5%) drugs prescribed off-label. More than half of the total drugs (n = 1066; 54.4%) were administered parenterally. Every patient was prescribed at least one off-label drug. Indication (n = 810; 34.6%) was the most common reason for off-label prescribing. Ranitidine was the most frequent drug prescribed off label. Darplex ® (dihydroartemisinin and piperaquine), although manufactured in Indonesia, was unlicensed. There was a significant difference between age group and offlabel prescribing in that children were prescribed significantly less off-label drugs (p<0.0003).

Research paper thumbnail of Antibiotic Utilization Trends in Two State Hospitals of Mongolia from 2013 to 2017

BioMed Research International, 2019

Background. The study aimed to evaluate inpatient antibiotic use in both the State Second Hospita... more Background. The study aimed to evaluate inpatient antibiotic use in both the State Second Hospital and State Third Hospital in Mongolia, using the WHO developed and standardized ATC/DDD methodology. Methods. Data were collected from the State Second Hospital and State Third Hospital which are major public hospitals that provide health care for approximately one fifth of the Mongolian population. Antibiotic utilization was monitored retrospectively for five years (2013–2017) using the ATC/DDD methodology and data were presented in DDD/ admission and DDD/100 bed days. Statistical analysis was performed using a Student’s t-test for parametric data. A P value of ≤0.05 was considered to be statistically significant. Results. The annual consumption rates in the State Second Hospital were stable over time while in the State Third Hospital consumption rates varied considerately between years. Overall, the total antibiotic consumption rate was very high, but has decreased in both hospitals. ...

Research paper thumbnail of The use of initial dosing of gentamicin in the management of pyelonephritis/urosepsis: A retrospective study

PLOS ONE, 2019

The primary objective was to determine if initial empirical intravenous dosing of gentamicin impr... more The primary objective was to determine if initial empirical intravenous dosing of gentamicin improved patient's outcomes in pyelonephritis/urosepsis compared with alternative IV antibiotic management. Design Retrospective cross-sectional descriptive study. Setting Public TertiaryTeaching Hospital serving adults in an urban centre. Participants All adult patient records with a recorded diagnosis of any of pyelonephritis/urosepsis, urinary tract infection, UTI, complicated urinary tract infection, bacteriuria, symptomatic bacteriuria and asymptomatic bacteriuria from 2 nd February 2012 to 10 th May 2014 were reviewed. Only patients treated with an empirical regimen of one or more IV antibiotics were included in the study. Main outcomes The primary outcomes were: duration of IV antibiotic treatment, time to resolution of symptoms and length of hospital stay (LOS). Secondary end points were: compliance with Therapeutic Guidelines: Antibiotic (electronic version) (eTG) for severe pyelonephritis/urosepsis and appropriateness of gentamicin use.

Research paper thumbnail of Multimetal organic frameworks as drug carriers: aceclofenac as a drug candidate

Drug Design, Development and Therapy, 2018

Background: Multimetal organic frameworks (M-MOFs) were synthesized by including a second metal i... more Background: Multimetal organic frameworks (M-MOFs) were synthesized by including a second metal ion with the main base metal in the synthesis process to enhance their applications for drug delivery. Aceclofenac (ACF), a nonsteroidal anti-inflammatory analgesic drug of low aqueous solubility, was selected as a candidate for the drug delivery system Purpose: This study aimed to evaluate the loading capacity (LC) and entrapment efficiency (EE) percentages of multi-Material of Institute Lavoisier (MIL)-100(Fe) (M-MIL-100(Fe)) for ACF. Materials and methods: Hydrothermal synthesis procedure was used to prepare multi-MIL-100(Fe) samples (Zn I-MIL-100(Fe), Zn II-MIL-100(Fe), Ca I-MIL-100(Fe), Ca II-MIL-100-(Fe), Mg I-MIL-100(Fe), Mg II-MIL-100(Fe), Mn I-MIL-100(Fe), and Mn II-MIL-100(Fe)). The characterization of M-MIL-100(Fe) samples was evaluated by X-ray powder diffraction (XRD), Fourier transform infrared spectra, scanning electron microscope (SEM), TGA, and N 2 adsorption isotherms. The LC of M-MIL-100(Fe) and EE of ACF were determined. Nuclear magnetic resonance (NMR) and zeta-potential analyses were employed to confirm qualitatively the drug loading within M-MIL-100(Fe). Results: The ACF LC of MIL-100(Fe) was 27%, whereas the LC of M-MIL-100(Fe) was significantly increased and ranged from 37% in Ca I-MIL-100(Fe) to about 57% and 59% in Mn II-MIL-100(Fe) and Zn II-MIL-100(Fe), respectively. The ACF@M-MOFs release profiles showed slow release rates in phosphate buffer solutions at pH 6.8 and 7.4 as compared to the ACF@MIL-100(Fe). Conclusion: Therefore, M-MOFs showed a significant potential as a carrier for drug delivery systems.

Research paper thumbnail of Stability studies of lincomycin hydrochloride in aqueous solution and intravenous infusion fluids

Drug design, development and therapy, 2016

The purpose of this study was to evaluate the chemical stability of Lincocin(®) (lincomycin hydro... more The purpose of this study was to evaluate the chemical stability of Lincocin(®) (lincomycin hydrochloride) in commonly used intravenous fluids at room temperature (25°C), at accelerated-degradation temperatures and in selected buffer solutions. The stability of Lincocin(®) injection (containing lincomycin 600 mg/2 mL as the hydrochloride) stored at 25°C±0.1°C in sodium lactate (Hartmann's), 0.9% sodium chloride, 5% glucose, and 10% glucose solutions was investigated over 31 days. Forced degradation of Lincocin(®) in hydrochloric acid, sodium hydroxide, and hydrogen peroxide was performed at 60°C. The effect of pH on the degradation rate of lincomycin hydrochloride stored at 80°C was determined. Lincomycin hydrochloride w as found to maintain its shelf life at 25°C in sodium lactate (Hartmann's) solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution, with less than 5% lincomycin degradation occurring in all intravenous solutions over a 31-day p...

Research paper thumbnail of A questionnaire study of injections prescribed and dispensed for patients diagnosed with mild/moderate community-acquired pneumonia in Mongolia

PeerJ, 2015

Purpose.The study aimed to determine the extent of and factors influencing the prescribing of inj... more Purpose.The study aimed to determine the extent of and factors influencing the prescribing of injections for the treatment of mild/moderate community acquired pneumonia (CAP) in Mongolia.Methods.Questionnaires were developed and administered to medication providers (34 Pharmacists, 27 pharmacy technicians) and prescribers (22 general doctors and 49 medical specialists) working in Mongolia.Results.Cefalosporins were prescribed for patients with mild pneumonia and doctors tended to prescribe injectable cefalosporins (cefazolin) rather than oral dosage forms. This was supported by the questionnaire study with pharmacists and pharmacy technicians. Additionally, 23 pharmacists and pharmacy technicians indicated that OTC injectable cefalosporins (37.7%) and injectable aminopenicillins (33,9%) were frequently sold by pharmacies for the treatment of mild/moderate CAP. Doctors and particularly pharmacists in the questionnaire studies indicated choosing an injection was to avoid non-complianc...

Research paper thumbnail of A comparative evaluation of pharmacy services in single and no pharmacy towns

Australia and New Zealand health policy, Jan 26, 2006

Recent attention has focused on access of communities to pharmacy services in rural areas. To inc... more Recent attention has focused on access of communities to pharmacy services in rural areas. To increase access to pharmacy services in rural Western Australia some doctors have been granted a licence to dispense medication on the rationale that a pharmacy would not be economically viable in that community. However, there have been no studies conducted on whether a doctor dispensing service adequately provides a pharmacy service with respect to access and quality. Residents of seven single pharmacy towns and seven non-pharmacy rural towns were surveyed to evaluate pharmacy services delivered by a pharmacist and doctor. The towns were chosen to match closely on key demographic features, with an average population of 1,246 and 1,263 respectively. A random sample of 150 households from each town was sent the questionnaire on pharmacy services (1050 in each group). Data was also collected from the Health Insurance Commission (HIC) on dispensing locations for the residents of the two group...

Research paper thumbnail of Clinical setting influences off-label and unlicensed prescribing in a paediatric teaching hospital

PloS one, 2015

To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediat... more To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediatric teaching hospital in Western Australia. A 12-month retrospective study was conducted at Princess Margaret Hospital using medication chart records randomly selected from 145,550 patient encounters from the Emergency Department, Inpatient Wards and Outpatient Clinics. Patient and prescribing data were collected. Drugs were classified as off-label or unlicensed based on Australian registration data. A hierarchical system of age, indication, route of administration and dosage was used. Drugs were classified according to the Anatomical Therapeutic Chemical Code. A total of 1,037 paediatric patients were selected where 2,654 prescriptions for 330 different drugs were prescribed to 699 patients (67.4%). Most off-label drugs (n = 295; 43.3%) were from the nervous system; a majority of unlicensed drugs were systemic hormonal preparations excluding sex hormones (n = 22, 32.4%). Inpatients were...

Research paper thumbnail of Enhanced pharmacy services, barriers and facilitators in Australia's community pharmacies: Australia's National Pharmacy Database Project

Objective To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's ... more Objective To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's community pharmacies and to analyse barriers and facilitators for providing priority services. Setting A large representative sample of community pharmacies in Australia in 2002. Method Questionnaires were mailed to owners or managers of a stratified, representative sample of Australia's community pharmacies; 1131of 1391 consenting pharmacies responded (81.3%). Specifically trained staff, fees charged, structural and other components and plan to introduce EPS were analysed. The barriers and facilitators for all EPS were rated by a Likert scale. Logistic regression models tested for predictors for providing one or more EPS and those related to Australia's National Health Priorities. Key findings Eighty-eight per cent of Australia's community pharmacies offered ≥1 EPS. More than 40% offered EPS for asthma, diabetes, methadone, herbal medicines, hypertension and wound care. Pharmacies with higher turnover (odds ratio (OR), 1.90; 99% confidence interval (CI) = 1.05-3.42) and younger owners (OR for age, 0.69; 99% CI = 0.48-0.99) were predictors for providing ≥1 EPS. Higher turnover was a predictor for diabetes care. Enclosed counselling area was a predictor for hypertension care. Owners and managers committed to continuing education was a predictor for diabetes and hyperlipidaemia services. Significant barriers perceived were lack of confidence for diabetes care and not being regarded as 'part of the job' for asthma, diabetes, hypertension and weight-management services. Conclusion The percentages of pharmacies in Australia that provided equivalent EPS were similar or higher than the UK, New Zealand and USA. The frequency of existing and planned EPS appeared disproportionately low to satisfy national health priorities. Significant barriers and facilitators and pharmacy characteristics for providing EPS were identified. The results assist national bodies to increase the uptake of EPS by pharmacies. Community pharmacies in developed countries have evolved into diversified practices with a range of specialised, extended or enhanced pharmacy services (EPS). 1,2 EPS refer to the health-related services provided in pharmacies other than the routine provision of prescribed and non-prescribed therapeutic agents. EPS have become important for many reasons. These include the national maldistribution of primary care workers, international dissatisfaction with existing primary care provision, the use of costly higher levels of healthcare especially of hospitals where equivalent services exist in primary care, and the acceptance of non-medical primary care workers. 3-6 Additionally, pharmacists are seeking new forms of revenue to compensate them for the rising costs and declining fees for dispensing prescribed medicines. 7 This study reports the frequency and nature of EPS provision by community pharmacies in Australia and quantifies the facilitators and barriers to improving EPS provision. Community pharmacies have a long history of providing a range of health-related services. 8 The growth in knowledge and health technologies have led to higher expectations of pharmacies providing more primary care services. Health and pharmacy bodies have

Research paper thumbnail of Comparative Effects of Sandalwood Seed Oil on Fatty Acid Profiles and Inflammatory Factors in Rats

Lipids, 2012

The aim of the present study was to investigate the effect of sandalwood seed oil on fatty acid (... more The aim of the present study was to investigate the effect of sandalwood seed oil on fatty acid (FA) profiles and inflammatory factors in rats. Fifty male Sprague-Dawley rats were randomly divided into five different dietary groups: 10 % soybean oil (SO), 10 % olive oil (OO), 10 % safflower oil (SFO), 10 % linseed oil (LSO) and 8 % sandalwood seed oil blended with 2 % SO (SWSO) for 8 weeks. The SWSO group had a higher total n-3 polyunsaturated fatty acids (PUFA) levels but lower n-6:n-3 PUFA ratios in both adipose tissue and liver than those in the SO, OO and SFO groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Although the SWSO group had a much lower 18:3n-3 level (4.51 %) in their dietary lipids than the LSO group (58.88 %), the levels of docosahexaenoic acid (DHA: 22:6n-3) in liver lipids and phospholipids of the SWSO group (7.52 and 11.77 %) were comparable to those of the LSO group (7.07 and 13.16 %). Ximenynic acid, a predominant acetylenic FA in sandalwood seed oil, was found to be highly incorporated into adipose tissue (13.73 %), but relatively lower in liver (0.51 %) in the SWSO group. The levels of prostaglandin F(2α), prostaglandin E₂, thromboxane B₂, leukotriene B₄, tumor necrosis factor-α and interleukin-1β in both liver and plasma were positively correlated with the n-6:n-3 ratios, suggesting that increased n-6 PUFA appear to increase the formation of pro-inflammatory cytokines, whereas n-3 PUFA exhibit anti-inflammatory activity. The present results suggest that sandalwood seed oil could increase tissue levels of n-3 PUFA, DHA and reduce the n-6:n-3 ratio, and may increase the anti-inflammatory activity in rats.

Research paper thumbnail of Stability of apomorphine in solutions containing ascorbic acid and bisulfite and effects of antioxidants on apomorphine-induced cage climbing and hypothermia in mice

Journal of Pharmaceutical Sciences, 1980

Page 1. in the experiment by Levy and Guciniki (9) the fish exposed to seco-harhital apparently d... more Page 1. in the experiment by Levy and Guciniki (9) the fish exposed to seco-harhital apparently did fit the model, which led these investigators to conclude that secoharhital was ahsorhed in both the unionized and ion-ized forms. ...

Research paper thumbnail of Appropriateness of prescribing in selected healthcare facilities in Papua New Guinea

Health Policy and Planning, 2013

The objective of this study was to evaluate the level of appropriateness of prescribing to outpat... more The objective of this study was to evaluate the level of appropriateness of prescribing to outpatients in selected healthcare facilities in Papua New Guinea (PNG), using health department guidelines as the benchmark. Methods A prospective study was carried out at Losuia Health Centre (LHC), Alotau Provincial Hospital (APH) and Port Moresby General Hospital (PMGH) in PNG. At each setting >300 consecutive prescriptions were evaluated in 2010. Diagnosis and prescribing data were collected from written prescription orders, patient health books and by patient interview. The appropriateness of prescribing was evaluated with respect to the relevant PNG Health Department guidelines. Differences in prescribing indices were evaluated using chi-squared tests as appropriate. Results There were 1090 patients (748 adults; 341 children) enrolled in the study with 356 at LHC, 318 at APH and 416 at PMGH. A total of 2495 medicines were prescribed. The most common were amoxicillins (355), paracetamol (344), artemether/artesunate (186) and chloroquine (162). The average number of drugs prescribed per patient was 2.3 (range: 1-7). The most common diseases treated were malaria (23.2%), acute soft tissue injuries (10.4%), anaemia (8.9%), respiratory problems (8.7%) and cough (5.9%). Overall, inappropriate prescribing was 33.4% in adults and 39.9% in children, the difference mainly arising from inappropriate drug dosage. There were statistically significant differences observed for the level of inappropriate prescribing by prescriber category on drug selection (P < 0.0001), drug dosage (P < 0.0001) and drug duration (P < 0.0001). Conclusion The level of inappropriate prescribing was as high as 53.8% in the selected locations in PNG, which is of great concern with respect to the quality of PNG healthcare delivery. Appropriate interventions such as review/upgrade of the guidelines, supervision/oversight of compliance to guidelines and/or publication of ongoing supervision/audit oversight reports need to occur to address the underlying causes.

Research paper thumbnail of An evaluation of prescribing practices for community-acquired pneumonia (CAP) in Mongolia

BMC Health Services Research, 2013

Background: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality ... more Background: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality in all age groups worldwide. It may be classified as mild/moderate or severe, the latter usually requiring hospitalisation. Although, there are many studies reported in relation to CAP, there is relatively little known about the treatment of CAP and its antibiotic use in Mongolia. The study aim was to evaluate prescribing practices for the treatment of mild/moderate CAP in Mongolia with respect to national prescribing guidelines. Methods: Written prescriptions with a written diagnosis of CAP included were collected prospectively and sequentially for ten weeks from a purposefully selected sample of community pharmacies in rural and urban areas of Mongolia. The data collected included the patient's age, gender, medication details, frequency and number of doses prescribed. Evaluation was with respect to the Mongolian Standard Treatment Guidelines (2005, 2008). Statistical differences between groups were tested using the Chi-squared and Fisher's exact tests. Results: Prescriptions were collected from 22 pharmacies and represented the prescribing practices of 118 doctors. The study enrolled 394 (193 adults and 201 children) patients, with a median age for children of 2.0 years (range: 0.03-12) and adults of 33.0 years (range: 13-92). The most commonly prescribed drugs were aminopenicillins, vitamins, and mucolytics, with the median number of drugs being three per prescription. Inappropriate drug selection was similar for adults (57.7%) and children (56.6%), and the major reason for an overall frequency of inappropriate prescribing for adults was 89.0% and for children 78.0%. Doctors in urban areas prescribed more inappropriate drugs than those in rural areas for both children and adults, p = .0014. The proportion of prescribed injections was 28.4% for adults and 9.0% for children, and for adults was significantly higher in urban areas. The prescribing standard for non-hospitalized patients in Mongolia states that injections should not be prescribed. Conclusions: The high level of inappropriate prescribing for mild/moderate CAP highlights the need to develop comprehensive and reliable procedures nationwide to improve prescribing practices in Mongolia.

Research paper thumbnail of Medication supply to residential aged care facilities in Western Australia using a centralized medication chart to replace prescriptions

BMC Geriatrics, 2012

Background: Current model of medication supply to Residential Aged Care Facilities (RACFs) in Aus... more Background: Current model of medication supply to Residential Aged Care Facilities (RACFs) in Australia is dependent on paper-based prescriptions. This study is aimed at assessing the use of a centralized medication chart as a prescription-less model for supplying medications to RACFs. Methods: Two separate focus groups were conducted with general practitioners (GPs) and pharmacists, and another three with registered nurses (RNs) and carers combined. All focus group participants were working with RACFs. Audio-recorded data were compared with field notes, transcribed and imported into NVivo W where it was thematically analyzed. Results: A prescription-less medication chart model was supported and it appeared to potentially improve medication supply to RACF residents. Centralization of medication supply, clarification of medication orders and responding in real-time to therapy changes made by GPs were reasons for supporting the medication chart model. Pharmacists preferred an electronic version of this model. All health professionals cautioned against the need for GPs regularly reviewing the medication chart and proposed a time interval of four to six months for this review to occur. Therapy changes during weekends appeared a potential difficulty for RNs and carers whereas pharmacists cautioned about legible writing and claiming of medications dispensed according to a paper-based model. GPs cautioned on the need to monitor the amount of medications dispensed by the pharmacy. Conclusion: The current use of paper prescriptions in nursing homes was identified as burdensome. A prescription-less medication chart model was suggested to potentially improve medication supply to RACF residents. An electronic version of this model could address main potential difficulties raised.

Research paper thumbnail of Knowing the gap: medication use, adherence and blood pressure control among patients with hypertension in Indonesian primary care settings

PeerJ, 2022

Background Hypertension is a major risk factor for global disease burden, however, little is know... more Background Hypertension is a major risk factor for global disease burden, however, little is known regarding the profiles of patients with hypertension in Indonesian primary care settings. Objective This study aimed to profile medication use, adherence to medications and lifestyle modifications as well as blood pressure control among patients with hypertension in Indonesian primary health centres (PHCs). Methods A cross-sectional study design used a structured data collection tool (questionnaire and checklist). Patients aged ≥18 years with a diagnosis of hypertension, and prescribed an antihypertensive medication, and attending follow-up visits in the five PHCs in Surabaya, Indonesia, during a two-week study period (May–October 2019) were included. Descriptive analyses summarised the data, while binary logistic regression provided any independent associations between adherence profiles and blood pressure control. Results Of 457 eligible patients, 276 patients consented: PHC A (n = 5...

Research paper thumbnail of Assessing readiness for research: a pilot study of Indonesian pharmacists

Journal of Pharmaceutical Health Services Research, 2021

Objectives Readiness is a key factor that influences pharmacists’ willingness to get involved in ... more Objectives Readiness is a key factor that influences pharmacists’ willingness to get involved in research, thus promoting evidence-based pharmacy practice. While the data are lacking, this study aimed to assess readiness for research, as well as the associated demographic and attitudinal characteristics of pharmacists in a range of healthcare settings in East Java Province, Indonesia. Methods A questionnaire was administered to all pharmacists in a public hospital in Malang (n = 55), pharmacists from primary health centre (PHCs) (n = 63) and community pharmacies (n = 100) in Surabaya in 2017. The questionnaire consisted of three sections: (1) demographic characteristics, (2) attitudinal aspects and (3) readiness for research. Descriptive analysis was used to summarise the data. Spearman correlation tests determined the correlations between ‘demographic characteristics’ or ‘attitudinal aspects’ versus ‘readiness’. Key findings A total of 142 pharmacists responded which comprised hosp...

Research paper thumbnail of Off-label and Unlicensed Medicines in a Paediatric Medical Ward in Indonesia

Research paper thumbnail of Counselling practices in an East Javan district, Indonesia: what information is commonly gathered by pharmacy staff?

Journal of Pharmaceutical Health Services Research, 2021

Counselling by pharmacy staff plays a key role in ensuring the quality use of medications in comm... more Counselling by pharmacy staff plays a key role in ensuring the quality use of medications in community settings. Information gathering is the first step and an essential part of counselling. Yet, data on information gathering during counselling in Indonesia is lacking. Objective To identify pharmacy staff’s practice of counselling and information gathered during counselling in an East Javan district, Indonesia. Methods A survey questionnaire was conducted in community-based health facilities in the district (i.e. 3 hospital outpatient clinics, 69 community pharmacies and 24 Community Health Centres [CHCs]); one health facility was represented by one pharmacy staff. Quantitative content analysis was used to summarise data regarding information gathering. Key findings Sixty-six pharmacy staff responded, giving a 69% response rate. Almost all staff reported providing counselling; those at CHCs and outpatient clinics mostly provided prescription medicine counselling (95.5% and 100.0%, r...

Research paper thumbnail of A training program incorporating a diabetes tool to facilitate delivery of quality diabetes care by community pharmacists in Malaysia and Australia

Pharmacy Practice, 2019

Objectives: To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM... more Objectives: To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM) incorporating a diabetes tool, the Simpler™ tool. Subsequently pharmacists' experience utilising the tool to deliver structured, consistent, evidence-based T2DM care was explored. Methods: Full-time non-credentialed diabetes pharmacists providing diabetes medication management services in community settings were purposively recruited. Participants had either face-to-face or online training on diabetes management using the tool which took about two hours and 20 minutes to complete. Their diabetes management knowledge was assessed pre-and post-training using quantitative methodology. They were then required to apply the tool in daily practice for one month. Feedback on both the training sessions and tool utilisation were obtained through semi-structured interviews and analysed using a qualitative approach. Results: Twelve pharmacists participated: Six from Australia and six from Malaysia. Before attending the training session, their median test score was 6.5/27, IQR 1.4 (1st marker) and 5.3/27, IQR 2.0 (2nd marker). After training, the scores doubled to 14.3/27, IQR 4.5 (1st marker) and 11.3/27, IQR 3.1 (2nd marker), showing significant improvements (p=0.002). Interview data identified perceived effectiveness factor through use of the tool. Participants found the content relevant, structured, concise and easy to understand; enabled comprehensive medication reviews; focused on achieving glycaemic improvement; facilitated documentation processes and pharmacists' role in T2DM management; and as a specific aid for diabetes management. Barriers included lack of accessibility to patients' laboratory data in Australia. Conclusions: The targeted training improved pharmacists' knowledge on diabetes management and supported the Simpler™ tool use in practice as a structured and beneficial method to deliver evidence-based T2DM care.

Research paper thumbnail of The Pharmacists’ and pharmacy technicians’ scopes of practice in the management of minor ailments at community pharmacies in Indonesia: a cross-sectional study

Pharmacy Practice, 2021

Background: Managing minor ailments in community pharmacy is an evolving pharmacy service in deve... more Background: Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services. Objective: To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perceived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies. Methods: Cross-sectional surveys were conducted during January-February 2020 of pharmacists and pharmacy technicians attending seminars conducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses ide...

Research paper thumbnail of High prevalence of off-label and unlicensed paediatric prescribing in a hospital in Indonesia during the period Aug.—Oct. 2014

PLOS ONE, 2020

Background Data on off-label and unlicensed prescribing in children in Indonesia is limited. The ... more Background Data on off-label and unlicensed prescribing in children in Indonesia is limited. The aims of this study were to determine the prevalence of off-label and unlicensed prescribing for paediatric patients in a public hospital, Indonesia. Method A retrospective cross-sectional study of 200 randomly selected paediatric patients admitted to hospital between August and October 2014, collected patient details and all drugs prescribed. Licensed drugs were classified as off-label if there was a non-compliance with the Product Information for age, weight, indication, dose, frequency and route of administration, if there was a contraindication, special precautions or not recommended for children. Unlicensed drugs were those not approved for use in Indonesia. The main outcome was the prevalence of off-label or unlicensed prescribing to infants, children and adolescents and the impact of age group on off-label prescribing. Results A total of 200 patients received 1961 medicines of which 1807/1961 (92.1%) were licensed and 154/1961 (7.9%) were unlicensed. There were 1403/1961 (71.5%) drugs prescribed off-label. More than half of the total drugs (n = 1066; 54.4%) were administered parenterally. Every patient was prescribed at least one off-label drug. Indication (n = 810; 34.6%) was the most common reason for off-label prescribing. Ranitidine was the most frequent drug prescribed off label. Darplex ® (dihydroartemisinin and piperaquine), although manufactured in Indonesia, was unlicensed. There was a significant difference between age group and offlabel prescribing in that children were prescribed significantly less off-label drugs (p<0.0003).

Research paper thumbnail of Antibiotic Utilization Trends in Two State Hospitals of Mongolia from 2013 to 2017

BioMed Research International, 2019

Background. The study aimed to evaluate inpatient antibiotic use in both the State Second Hospita... more Background. The study aimed to evaluate inpatient antibiotic use in both the State Second Hospital and State Third Hospital in Mongolia, using the WHO developed and standardized ATC/DDD methodology. Methods. Data were collected from the State Second Hospital and State Third Hospital which are major public hospitals that provide health care for approximately one fifth of the Mongolian population. Antibiotic utilization was monitored retrospectively for five years (2013–2017) using the ATC/DDD methodology and data were presented in DDD/ admission and DDD/100 bed days. Statistical analysis was performed using a Student’s t-test for parametric data. A P value of ≤0.05 was considered to be statistically significant. Results. The annual consumption rates in the State Second Hospital were stable over time while in the State Third Hospital consumption rates varied considerately between years. Overall, the total antibiotic consumption rate was very high, but has decreased in both hospitals. ...

Research paper thumbnail of The use of initial dosing of gentamicin in the management of pyelonephritis/urosepsis: A retrospective study

PLOS ONE, 2019

The primary objective was to determine if initial empirical intravenous dosing of gentamicin impr... more The primary objective was to determine if initial empirical intravenous dosing of gentamicin improved patient's outcomes in pyelonephritis/urosepsis compared with alternative IV antibiotic management. Design Retrospective cross-sectional descriptive study. Setting Public TertiaryTeaching Hospital serving adults in an urban centre. Participants All adult patient records with a recorded diagnosis of any of pyelonephritis/urosepsis, urinary tract infection, UTI, complicated urinary tract infection, bacteriuria, symptomatic bacteriuria and asymptomatic bacteriuria from 2 nd February 2012 to 10 th May 2014 were reviewed. Only patients treated with an empirical regimen of one or more IV antibiotics were included in the study. Main outcomes The primary outcomes were: duration of IV antibiotic treatment, time to resolution of symptoms and length of hospital stay (LOS). Secondary end points were: compliance with Therapeutic Guidelines: Antibiotic (electronic version) (eTG) for severe pyelonephritis/urosepsis and appropriateness of gentamicin use.

Research paper thumbnail of Multimetal organic frameworks as drug carriers: aceclofenac as a drug candidate

Drug Design, Development and Therapy, 2018

Background: Multimetal organic frameworks (M-MOFs) were synthesized by including a second metal i... more Background: Multimetal organic frameworks (M-MOFs) were synthesized by including a second metal ion with the main base metal in the synthesis process to enhance their applications for drug delivery. Aceclofenac (ACF), a nonsteroidal anti-inflammatory analgesic drug of low aqueous solubility, was selected as a candidate for the drug delivery system Purpose: This study aimed to evaluate the loading capacity (LC) and entrapment efficiency (EE) percentages of multi-Material of Institute Lavoisier (MIL)-100(Fe) (M-MIL-100(Fe)) for ACF. Materials and methods: Hydrothermal synthesis procedure was used to prepare multi-MIL-100(Fe) samples (Zn I-MIL-100(Fe), Zn II-MIL-100(Fe), Ca I-MIL-100(Fe), Ca II-MIL-100-(Fe), Mg I-MIL-100(Fe), Mg II-MIL-100(Fe), Mn I-MIL-100(Fe), and Mn II-MIL-100(Fe)). The characterization of M-MIL-100(Fe) samples was evaluated by X-ray powder diffraction (XRD), Fourier transform infrared spectra, scanning electron microscope (SEM), TGA, and N 2 adsorption isotherms. The LC of M-MIL-100(Fe) and EE of ACF were determined. Nuclear magnetic resonance (NMR) and zeta-potential analyses were employed to confirm qualitatively the drug loading within M-MIL-100(Fe). Results: The ACF LC of MIL-100(Fe) was 27%, whereas the LC of M-MIL-100(Fe) was significantly increased and ranged from 37% in Ca I-MIL-100(Fe) to about 57% and 59% in Mn II-MIL-100(Fe) and Zn II-MIL-100(Fe), respectively. The ACF@M-MOFs release profiles showed slow release rates in phosphate buffer solutions at pH 6.8 and 7.4 as compared to the ACF@MIL-100(Fe). Conclusion: Therefore, M-MOFs showed a significant potential as a carrier for drug delivery systems.

Research paper thumbnail of Stability studies of lincomycin hydrochloride in aqueous solution and intravenous infusion fluids

Drug design, development and therapy, 2016

The purpose of this study was to evaluate the chemical stability of Lincocin(®) (lincomycin hydro... more The purpose of this study was to evaluate the chemical stability of Lincocin(®) (lincomycin hydrochloride) in commonly used intravenous fluids at room temperature (25°C), at accelerated-degradation temperatures and in selected buffer solutions. The stability of Lincocin(®) injection (containing lincomycin 600 mg/2 mL as the hydrochloride) stored at 25°C±0.1°C in sodium lactate (Hartmann's), 0.9% sodium chloride, 5% glucose, and 10% glucose solutions was investigated over 31 days. Forced degradation of Lincocin(®) in hydrochloric acid, sodium hydroxide, and hydrogen peroxide was performed at 60°C. The effect of pH on the degradation rate of lincomycin hydrochloride stored at 80°C was determined. Lincomycin hydrochloride w as found to maintain its shelf life at 25°C in sodium lactate (Hartmann's) solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution, with less than 5% lincomycin degradation occurring in all intravenous solutions over a 31-day p...

Research paper thumbnail of A questionnaire study of injections prescribed and dispensed for patients diagnosed with mild/moderate community-acquired pneumonia in Mongolia

PeerJ, 2015

Purpose.The study aimed to determine the extent of and factors influencing the prescribing of inj... more Purpose.The study aimed to determine the extent of and factors influencing the prescribing of injections for the treatment of mild/moderate community acquired pneumonia (CAP) in Mongolia.Methods.Questionnaires were developed and administered to medication providers (34 Pharmacists, 27 pharmacy technicians) and prescribers (22 general doctors and 49 medical specialists) working in Mongolia.Results.Cefalosporins were prescribed for patients with mild pneumonia and doctors tended to prescribe injectable cefalosporins (cefazolin) rather than oral dosage forms. This was supported by the questionnaire study with pharmacists and pharmacy technicians. Additionally, 23 pharmacists and pharmacy technicians indicated that OTC injectable cefalosporins (37.7%) and injectable aminopenicillins (33,9%) were frequently sold by pharmacies for the treatment of mild/moderate CAP. Doctors and particularly pharmacists in the questionnaire studies indicated choosing an injection was to avoid non-complianc...

Research paper thumbnail of A comparative evaluation of pharmacy services in single and no pharmacy towns

Australia and New Zealand health policy, Jan 26, 2006

Recent attention has focused on access of communities to pharmacy services in rural areas. To inc... more Recent attention has focused on access of communities to pharmacy services in rural areas. To increase access to pharmacy services in rural Western Australia some doctors have been granted a licence to dispense medication on the rationale that a pharmacy would not be economically viable in that community. However, there have been no studies conducted on whether a doctor dispensing service adequately provides a pharmacy service with respect to access and quality. Residents of seven single pharmacy towns and seven non-pharmacy rural towns were surveyed to evaluate pharmacy services delivered by a pharmacist and doctor. The towns were chosen to match closely on key demographic features, with an average population of 1,246 and 1,263 respectively. A random sample of 150 households from each town was sent the questionnaire on pharmacy services (1050 in each group). Data was also collected from the Health Insurance Commission (HIC) on dispensing locations for the residents of the two group...

Research paper thumbnail of Clinical setting influences off-label and unlicensed prescribing in a paediatric teaching hospital

PloS one, 2015

To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediat... more To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediatric teaching hospital in Western Australia. A 12-month retrospective study was conducted at Princess Margaret Hospital using medication chart records randomly selected from 145,550 patient encounters from the Emergency Department, Inpatient Wards and Outpatient Clinics. Patient and prescribing data were collected. Drugs were classified as off-label or unlicensed based on Australian registration data. A hierarchical system of age, indication, route of administration and dosage was used. Drugs were classified according to the Anatomical Therapeutic Chemical Code. A total of 1,037 paediatric patients were selected where 2,654 prescriptions for 330 different drugs were prescribed to 699 patients (67.4%). Most off-label drugs (n = 295; 43.3%) were from the nervous system; a majority of unlicensed drugs were systemic hormonal preparations excluding sex hormones (n = 22, 32.4%). Inpatients were...

Research paper thumbnail of Enhanced pharmacy services, barriers and facilitators in Australia's community pharmacies: Australia's National Pharmacy Database Project

Objective To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's ... more Objective To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's community pharmacies and to analyse barriers and facilitators for providing priority services. Setting A large representative sample of community pharmacies in Australia in 2002. Method Questionnaires were mailed to owners or managers of a stratified, representative sample of Australia's community pharmacies; 1131of 1391 consenting pharmacies responded (81.3%). Specifically trained staff, fees charged, structural and other components and plan to introduce EPS were analysed. The barriers and facilitators for all EPS were rated by a Likert scale. Logistic regression models tested for predictors for providing one or more EPS and those related to Australia's National Health Priorities. Key findings Eighty-eight per cent of Australia's community pharmacies offered ≥1 EPS. More than 40% offered EPS for asthma, diabetes, methadone, herbal medicines, hypertension and wound care. Pharmacies with higher turnover (odds ratio (OR), 1.90; 99% confidence interval (CI) = 1.05-3.42) and younger owners (OR for age, 0.69; 99% CI = 0.48-0.99) were predictors for providing ≥1 EPS. Higher turnover was a predictor for diabetes care. Enclosed counselling area was a predictor for hypertension care. Owners and managers committed to continuing education was a predictor for diabetes and hyperlipidaemia services. Significant barriers perceived were lack of confidence for diabetes care and not being regarded as 'part of the job' for asthma, diabetes, hypertension and weight-management services. Conclusion The percentages of pharmacies in Australia that provided equivalent EPS were similar or higher than the UK, New Zealand and USA. The frequency of existing and planned EPS appeared disproportionately low to satisfy national health priorities. Significant barriers and facilitators and pharmacy characteristics for providing EPS were identified. The results assist national bodies to increase the uptake of EPS by pharmacies. Community pharmacies in developed countries have evolved into diversified practices with a range of specialised, extended or enhanced pharmacy services (EPS). 1,2 EPS refer to the health-related services provided in pharmacies other than the routine provision of prescribed and non-prescribed therapeutic agents. EPS have become important for many reasons. These include the national maldistribution of primary care workers, international dissatisfaction with existing primary care provision, the use of costly higher levels of healthcare especially of hospitals where equivalent services exist in primary care, and the acceptance of non-medical primary care workers. 3-6 Additionally, pharmacists are seeking new forms of revenue to compensate them for the rising costs and declining fees for dispensing prescribed medicines. 7 This study reports the frequency and nature of EPS provision by community pharmacies in Australia and quantifies the facilitators and barriers to improving EPS provision. Community pharmacies have a long history of providing a range of health-related services. 8 The growth in knowledge and health technologies have led to higher expectations of pharmacies providing more primary care services. Health and pharmacy bodies have

Research paper thumbnail of Comparative Effects of Sandalwood Seed Oil on Fatty Acid Profiles and Inflammatory Factors in Rats

Lipids, 2012

The aim of the present study was to investigate the effect of sandalwood seed oil on fatty acid (... more The aim of the present study was to investigate the effect of sandalwood seed oil on fatty acid (FA) profiles and inflammatory factors in rats. Fifty male Sprague-Dawley rats were randomly divided into five different dietary groups: 10 % soybean oil (SO), 10 % olive oil (OO), 10 % safflower oil (SFO), 10 % linseed oil (LSO) and 8 % sandalwood seed oil blended with 2 % SO (SWSO) for 8 weeks. The SWSO group had a higher total n-3 polyunsaturated fatty acids (PUFA) levels but lower n-6:n-3 PUFA ratios in both adipose tissue and liver than those in the SO, OO and SFO groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Although the SWSO group had a much lower 18:3n-3 level (4.51 %) in their dietary lipids than the LSO group (58.88 %), the levels of docosahexaenoic acid (DHA: 22:6n-3) in liver lipids and phospholipids of the SWSO group (7.52 and 11.77 %) were comparable to those of the LSO group (7.07 and 13.16 %). Ximenynic acid, a predominant acetylenic FA in sandalwood seed oil, was found to be highly incorporated into adipose tissue (13.73 %), but relatively lower in liver (0.51 %) in the SWSO group. The levels of prostaglandin F(2α), prostaglandin E₂, thromboxane B₂, leukotriene B₄, tumor necrosis factor-α and interleukin-1β in both liver and plasma were positively correlated with the n-6:n-3 ratios, suggesting that increased n-6 PUFA appear to increase the formation of pro-inflammatory cytokines, whereas n-3 PUFA exhibit anti-inflammatory activity. The present results suggest that sandalwood seed oil could increase tissue levels of n-3 PUFA, DHA and reduce the n-6:n-3 ratio, and may increase the anti-inflammatory activity in rats.

Research paper thumbnail of Stability of apomorphine in solutions containing ascorbic acid and bisulfite and effects of antioxidants on apomorphine-induced cage climbing and hypothermia in mice

Journal of Pharmaceutical Sciences, 1980

Page 1. in the experiment by Levy and Guciniki (9) the fish exposed to seco-harhital apparently d... more Page 1. in the experiment by Levy and Guciniki (9) the fish exposed to seco-harhital apparently did fit the model, which led these investigators to conclude that secoharhital was ahsorhed in both the unionized and ion-ized forms. ...

Research paper thumbnail of Appropriateness of prescribing in selected healthcare facilities in Papua New Guinea

Health Policy and Planning, 2013

The objective of this study was to evaluate the level of appropriateness of prescribing to outpat... more The objective of this study was to evaluate the level of appropriateness of prescribing to outpatients in selected healthcare facilities in Papua New Guinea (PNG), using health department guidelines as the benchmark. Methods A prospective study was carried out at Losuia Health Centre (LHC), Alotau Provincial Hospital (APH) and Port Moresby General Hospital (PMGH) in PNG. At each setting >300 consecutive prescriptions were evaluated in 2010. Diagnosis and prescribing data were collected from written prescription orders, patient health books and by patient interview. The appropriateness of prescribing was evaluated with respect to the relevant PNG Health Department guidelines. Differences in prescribing indices were evaluated using chi-squared tests as appropriate. Results There were 1090 patients (748 adults; 341 children) enrolled in the study with 356 at LHC, 318 at APH and 416 at PMGH. A total of 2495 medicines were prescribed. The most common were amoxicillins (355), paracetamol (344), artemether/artesunate (186) and chloroquine (162). The average number of drugs prescribed per patient was 2.3 (range: 1-7). The most common diseases treated were malaria (23.2%), acute soft tissue injuries (10.4%), anaemia (8.9%), respiratory problems (8.7%) and cough (5.9%). Overall, inappropriate prescribing was 33.4% in adults and 39.9% in children, the difference mainly arising from inappropriate drug dosage. There were statistically significant differences observed for the level of inappropriate prescribing by prescriber category on drug selection (P < 0.0001), drug dosage (P < 0.0001) and drug duration (P < 0.0001). Conclusion The level of inappropriate prescribing was as high as 53.8% in the selected locations in PNG, which is of great concern with respect to the quality of PNG healthcare delivery. Appropriate interventions such as review/upgrade of the guidelines, supervision/oversight of compliance to guidelines and/or publication of ongoing supervision/audit oversight reports need to occur to address the underlying causes.

Research paper thumbnail of An evaluation of prescribing practices for community-acquired pneumonia (CAP) in Mongolia

BMC Health Services Research, 2013

Background: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality ... more Background: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality in all age groups worldwide. It may be classified as mild/moderate or severe, the latter usually requiring hospitalisation. Although, there are many studies reported in relation to CAP, there is relatively little known about the treatment of CAP and its antibiotic use in Mongolia. The study aim was to evaluate prescribing practices for the treatment of mild/moderate CAP in Mongolia with respect to national prescribing guidelines. Methods: Written prescriptions with a written diagnosis of CAP included were collected prospectively and sequentially for ten weeks from a purposefully selected sample of community pharmacies in rural and urban areas of Mongolia. The data collected included the patient's age, gender, medication details, frequency and number of doses prescribed. Evaluation was with respect to the Mongolian Standard Treatment Guidelines (2005, 2008). Statistical differences between groups were tested using the Chi-squared and Fisher's exact tests. Results: Prescriptions were collected from 22 pharmacies and represented the prescribing practices of 118 doctors. The study enrolled 394 (193 adults and 201 children) patients, with a median age for children of 2.0 years (range: 0.03-12) and adults of 33.0 years (range: 13-92). The most commonly prescribed drugs were aminopenicillins, vitamins, and mucolytics, with the median number of drugs being three per prescription. Inappropriate drug selection was similar for adults (57.7%) and children (56.6%), and the major reason for an overall frequency of inappropriate prescribing for adults was 89.0% and for children 78.0%. Doctors in urban areas prescribed more inappropriate drugs than those in rural areas for both children and adults, p = .0014. The proportion of prescribed injections was 28.4% for adults and 9.0% for children, and for adults was significantly higher in urban areas. The prescribing standard for non-hospitalized patients in Mongolia states that injections should not be prescribed. Conclusions: The high level of inappropriate prescribing for mild/moderate CAP highlights the need to develop comprehensive and reliable procedures nationwide to improve prescribing practices in Mongolia.

Research paper thumbnail of Medication supply to residential aged care facilities in Western Australia using a centralized medication chart to replace prescriptions

BMC Geriatrics, 2012

Background: Current model of medication supply to Residential Aged Care Facilities (RACFs) in Aus... more Background: Current model of medication supply to Residential Aged Care Facilities (RACFs) in Australia is dependent on paper-based prescriptions. This study is aimed at assessing the use of a centralized medication chart as a prescription-less model for supplying medications to RACFs. Methods: Two separate focus groups were conducted with general practitioners (GPs) and pharmacists, and another three with registered nurses (RNs) and carers combined. All focus group participants were working with RACFs. Audio-recorded data were compared with field notes, transcribed and imported into NVivo W where it was thematically analyzed. Results: A prescription-less medication chart model was supported and it appeared to potentially improve medication supply to RACF residents. Centralization of medication supply, clarification of medication orders and responding in real-time to therapy changes made by GPs were reasons for supporting the medication chart model. Pharmacists preferred an electronic version of this model. All health professionals cautioned against the need for GPs regularly reviewing the medication chart and proposed a time interval of four to six months for this review to occur. Therapy changes during weekends appeared a potential difficulty for RNs and carers whereas pharmacists cautioned about legible writing and claiming of medications dispensed according to a paper-based model. GPs cautioned on the need to monitor the amount of medications dispensed by the pharmacy. Conclusion: The current use of paper prescriptions in nursing homes was identified as burdensome. A prescription-less medication chart model was suggested to potentially improve medication supply to RACF residents. An electronic version of this model could address main potential difficulties raised.