Faridah Aryani - Academia.edu (original) (raw)

Papers by Faridah Aryani

ResultsA total of 733 PRP participated in the survey and the response rate was 95.8%. Based on th... more ResultsA total of 733 PRP participated in the survey and the response rate was 95.8%. Based on the response received, 92.5% (n=678) felt that the one-year training period was just nice, 30.5% (n=223) felt that the logbooks were too complicated and 33.2% (n=241) said the targets set by the Pharmacy Board of Malaysia were too high. On a scale of 1 to 5, respondents rated 3.32 (SD 0.54) for mean score of job satisfaction. Significant factors influencing mean score of job satisfaction were perceived fairness at the work place, perceived self-competence after one year of training, preceptors' competence and pharmacy as a chosen career pathway.

MDM Policy & Practice

Objectives. The current health technology assessment used to evaluate respiratory inhalers is ass... more Objectives. The current health technology assessment used to evaluate respiratory inhalers is associated with limitations that have necessitated the development of an explicit formulary decision-making framework to ensure balance between the accessibility, value, and affordability of medicines. This study aimed to develop a multiple-criteria decision analysis (MCDA) framework, apply the framework to potential and currently listed respiratory inhalers in the Ministry of Health Medicines Formulary (MOHMF), and analyze the impacts of applying the outputs, from the perspective of listing and delisting medicines in the formulary. Methods. The overall methodology of the framework development adhered to the recommendations of the ISPOR MCDA Emerging Good Practices Task Force. The MCDA framework was developed using Microsoft Excel 2010 and involved all relevant stakeholders. The framework was then applied to 27 medicines, based on data gathered from the highest levels of available published...

Therapeutic Innovation & Regulatory Science

Introduction The National Pharmaceutical Regulatory Agency (NPRA) embarked on a regulatory-streng... more Introduction The National Pharmaceutical Regulatory Agency (NPRA) embarked on a regulatory-strengthening program and is evaluating its processes. Optimising Efficiencies in Regulatory Agencies (OpERA) is a regulatory-strengthening program that provides benchmarking data that can define performance targets and focus performance improvement. The objective of this study was to use OpERA methodology to determine where time is spent in the NPRA approval process and to form a baseline to measure the performance improvements. Methods The OpERA tool was used to collect specific milestone data that identify time periods, review stages, and data points for new active substances and biosimilars approved by NPRA in 2017. Results In 2017, 25 new active substances and 1 biosimilar were approved by NPRA in a median of 515 days, representing both agency and applicant time. The median time between dossier receipt and the initiation of NPRA scientific assessment was 135 days, but there was a wide var...

Currents in Pharmacy Teaching and Learning

Introduction: Medicines have made an appreciable contribution to improving patient care in recent... more Introduction: Medicines have made an appreciable contribution to improving patient care in recent years. However, European and other countries are increasingly struggling to fund new premium priced medicines. This has resulted in models to optimise their utilisation as well as multiple initiatives to improve the prescribing of established medicines including enhancing the use of low cost generics, improving adherence to prescribing guidance as well as access to medicines, ensuring adequate doses are prescribed and improving patient adherence rates especially in chronic asymptomatic conditions. Objective: Review a range of demand-side initiatives in ambulatory care across different countries and their resultant effects to provide future direction. Methodology: Principally a narrative review of case histories of published studies. Results: Measures to encourage the prescribing of low cost generics versus originators and patented products in a class can release considerable resources w...

Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness. Bot... more Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness. Both bevacizumab and ranibizumab are anti-vascular endothelial growth factors used for treatment of AMD. However the use of bevacizumab remains controversial as it was not approved for intravitreal use although there were several head-to-head comparison trial that shows that it was non inferior to ranibizumab. Despite the status of off-label, intravitreal bevacizumab is being used worldwide as it is 30-50 times cheaper than intravitreal ranibizumab. The case of intravitreal bevacizumab illustrates the use of “not-me” drug and different countries responds differently to its use.

The Medical journal of Malaysia, 2008

The National Medicines Use Survey (NMUS) which started in 2004 and is still ongoing was conducted... more The National Medicines Use Survey (NMUS) which started in 2004 and is still ongoing was conducted with the intent to continuously and systematically collect data on the use of medicines, to provide an overview on the use of medicines in Malaysia. The objective of the NMUS is therefore to quantify the present state and time trends of medicines utilization at various levels of our health care system whether national, regional, local or institutional. From the data available, for the Year 2005, the most commonly used medicine in Malaysia were anti-diabetic medications, of which glibenclamide is the most common followed by metformin, were the top 2 of the list of drugs utilized in DDD/1000 population/day. Collectively, however, taking into account the various antihypertensives by therapeutic groups, anti-hypertensive medicines were more commonly used than anti-diabetics. Hypertension and diabetes mellitus are the two most prevalent chronic disorders in the country and thus, such high me...

The Medical journal of Malaysia, 2010

The EQ-5D is a quality of life instrument that measures five dimensions of health. This study inv... more The EQ-5D is a quality of life instrument that measures five dimensions of health. This study investigated the reliability and validity of its use in the Malaysian dialysis population. Test-retest reliability, convergent and discriminant validity were assessed. Responses of 86 subjects who completed both surveys were used in analysis. Test-retest reliability using Cohen's kappa was acceptable in four out of five dimensions, with the exception of self-care. Convergent validity was present. Discriminant validity was found in only two out of six hypotheses tested. In conclusion, the EQ-5D has potential in this population but further study is required.

Expert Review of Anti-infective Therapy, 2015

Background: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. T... more Background: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this. Method: An extensive literature search from 1990-2014. Results: 19 articles were included; 8 in ambulatory care, 7 in hospital settings, and 4 in both, across all countries. Physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. Moreover, some physicians although aware that antibiotics are of limited benefit in some conditions still prescribed them. Several factors influenced prescribing including patients' expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients, and influence of pharmaceutical companies. Pocket-sized guidelines seen as an important source of information for physicians. Conclusion: Inadequate knowledge of prescribing is prevalent among physicians. However, many physicians were interested in improving their antibiotic prescribing. Multifaceted interventions targeting all key stakeholders including patients are needed to improve future antibiotic prescribing. Key words: antibiotics, irrational use of medicines, patients, prescribing behaviour, physicians, systematic reviews, resistance caused by antibiotic resistant bacteria, are becoming more difficult to treat, causing life-threatening illnesses and potentially death (16). The combination of overuse of antibiotics for minor infections, misuse and under use due to lack of access and financial support in certain settings, has been a key driver of resistance. This phenomenon has been termed selective pressure (15). Increasing antibiotic resistance poses a threat to health and healthcare systems in both developed and developing countries (17). In high-income countries, continuing high rates of antibiotic use in hospitals, the community, and agriculture have contributed to selection pressure that has sustained resistant strains (18), forcing a shift to more expensive and more broad spectrum antibiotics. In lowincome and middle-income countries (LMICs), the high burden of infectious diseases and the unregulated access to antimicrobials has resulted in the emergence of antibiotic resistance (17). This is not helped by the increasing use of antibiotics to treat viral upper respiratory tract infections (URTIs), inappropriate prescribing of antibiotics for infections such as pneumonia, purchasing of antibiotics without a prescription as well as the challenges involved with determining current antimicrobial usage and AMR rates in LMIC countries to provide a baseline for future interventions and policies (19-25). Inappropriate use of antibiotics is also not helped by currently limited adherence to guidelines among physicians in LMIC countries; greater though among physicians in public (40%) than private-for-profit sector facilities at <30% (26). It is now acknowledged that the rational use of antibiotics is one of the most important steps to slow down the development and spread of resistant bacteria (27). The inappropriate use of antibiotics has been attributed to a number of factors. These include physicians' non-adherence to treatment guidelines, lack of knowledge and training regarding antibiotics, lack of diagnostic facilities, uncertainty over the diagnosis, pressure from pharmaceutical industry, fear of clinical failure, financial benefits for physicians, pressure from patients to prescribe antibiotics regardless of the indication coupled with lack of time of physicians to educate patients. In LMIC countries, there are also concerns with the extent and implementation of regulations surrounding the dispensing of antibiotics including self purchasing (19, 21, 24, 25, 28-34). Moreover, antibiotic misuse or overuse has promoted the perception among the public that these medicines are the preferred treatment for instance for URTIs. This in turn induces patients to demand antibiotics, hastening the growth of resistant bacteria (25, 30, 35). To help combat the irrational use of antibiotics, stringent diagnostic criteria for URTIs have been recommended by the Centers for Disease Control and Prevention (CDC) in collaboration with the American academy of Paediatrics (AAP) and the American Academy of Family Physicians. In United Kingdom, the National Institute for Health and Clinical Excellence (NICE) introduced in 2008 a guideline for antibiotic prescribing in respiratory tract infections. Despite these efforts and guidelines, physicians still manage URTIs with considerable variation (19, 20, 30, 36-38). Consequently, a better understanding of the determinants of antibiotic prescribing among physicians is essential for introducing and implementing targeted interventions to reduce future antibiotic prescribing and potential resistance (17, 20, 21, 26), with physician prescribing behaviour playing a key role in the utilisation of antibiotics (39). Hence, adequate knowledge and appropriate education are essential. Physicians' understanding of when antibiotics are needed, and more importantly when they are not, should subsequently reduce their prescribing (40, 41). However, there will be challenges especially in LMIC countries (19, 21, 33, 34, 42). Since changes in prescribers' knowledge and behavior are prerequisite for changes in antibiotic prescribing pattern, it is important to understand what physicians know about antibiotics, how they acquire and maintain their knowledge, and what factors influence their prescribing practice. Understanding prescribers' perspectives could lead to the development of more effective interventions and strategies to promote the rational use of antibiotics. Consequently, the aim of this paper is to systematically review the knowledge, perceptions, and behavior of physicians regarding antibiotic prescribing to guide future strategies. Methodology An extensive literature search was performed to identify published studies related to medical practitioners' perceptions, knowledge, attitude, practice, belief, and behaviour regarding antibiotic prescribing and antibiotic use. The search strategy was to identify cross-sectional observational studies and experimental studies; applied either qualitative or quantitative methods or both. PRISMA

Introduction: End-stage renal disease is on the rise in Malaysia. Dialysis prevalence has grown f... more Introduction: End-stage renal disease is on the rise in Malaysia. Dialysis prevalence has grown from 171 per million populations (p.m.p.) in 1997 to 460 p.m.p. (11,767 patients) at the end of 2004. In tandem with this increase, the Ministry of Health (MOH) has expanded its dialysis programme which comprised 137 dialysis centres nationwide in 2005. Previous research on the cost effectiveness of the Ministry of Health (MOH) was done with life expectancy as the primary outcome measure. (Hooi, et al 2005). This study expands on these findings by incorporating quality of life outcomes into the analysis. Objectives: The objectives of this study were to determine the life expectancy, the improvement in quality of life associated with haemoglobin, the utility of the dialysis patients, and the cost utility as cost per quality-adjusted life year (QALY) saved. Methods: This is a multi-centre observational study for MOH dialysis patients. The life expectancy of dialysis patients was estimated u...

The Medical journal of Malaysia, 2013

Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evalua... more 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. 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…

Value in Health, 2012

To estimate a EQ-5D value set for Malaysia by using time trade-off (TTO) and visual analogue scal... more To estimate a EQ-5D value set for Malaysia by using time trade-off (TTO) and visual analogue scale (VAS) valuation methods. TTO and VAS valuations were obtained from face-to-face surveys of a convenience sample of patients, caregivers, and health professionals conducted at nine government hospitals in 2004 and 2005. Forty-five EQ-5D questionnaire health states were valued, divided into five sets of 15 health states. Analysis was conducted by using linear additive regression models applying N3 and D1 specifications. Model selection was based on criteria of coefficient properties, statistical significance, and goodness of fit. One hundred fifty-two respondents were interviewed, yielding 2174 TTO and 2265 VAS valuations. Respondents found TTO valuations to be more difficult than VAS valuations, and there were more inconsistencies in TTO valuations. All the independent variables in the models were statistically significant and consistent with expected signs and magnitude, except for the D1 specification modeled on TTO valuations. The N3 model provided the best fit for the VAS valuation data, with a mean absolute error of 0.032. This study provides a Malaysian EQ-5D questionnaire value set that can be used for cost-utility studies despite survey limitations.

Expert Review of Anti-infective Therapy, 2015

Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Thei... more Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Their irrational use can increase costs and resistance. Assess knowledge, attitude and prescribing of antibiotics for URTIs in Selangor, Malaysia, using a cross-sectional survey among general practitioners (GPs) working in private clinics in 2011. One hundred and thirty-nine physicians completed the questionnaire (response rate = 34.8%). 49.6% (n = 69) agreed antibiotics are helpful in treating URTIs, with most GPs agreeing antibiotics may reduce URTI duration and complications. The majority of GPs reported they felt patients expected antibiotics, with 36.7% (n = 51) agreeing patients would change doctors if they did not prescribe antibiotics and 21.6% (n = 30) agreeing when requested they prescribe antibiotics even if they believe them to be unnecessary. When assessed against six criteria, most GPs had a moderate level of knowledge of prescribing for URTIs. However, antibiotic prescriptions...

Therapeutic Innovation & Regulatory Science

Bmc Health Services Research, Nov 12, 2012

Background: The roles of pharmacists have evolved from product oriented, dispensing of medication... more Background: The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia.

Integrated Pharmacy Research and Practice, 2016

BMC Health Serv Res, 2012

BACKGROUND: The roles of pharmacists have evolved from product oriented, dispensing of medication... more BACKGROUND: The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. METHODS: This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. RESULTS: Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. CONCLUSIONS: This study demonstrates the importance of pharmacists working in collaboration with other healthcare providers especially the medical doctors in identifying and resolving pharmaceutical care issues to provide optimal care for patients with chronic diseases.

ResultsA total of 733 PRP participated in the survey and the response rate was 95.8%. Based on th... more ResultsA total of 733 PRP participated in the survey and the response rate was 95.8%. Based on the response received, 92.5% (n=678) felt that the one-year training period was just nice, 30.5% (n=223) felt that the logbooks were too complicated and 33.2% (n=241) said the targets set by the Pharmacy Board of Malaysia were too high. On a scale of 1 to 5, respondents rated 3.32 (SD 0.54) for mean score of job satisfaction. Significant factors influencing mean score of job satisfaction were perceived fairness at the work place, perceived self-competence after one year of training, preceptors' competence and pharmacy as a chosen career pathway.

MDM Policy & Practice

Objectives. The current health technology assessment used to evaluate respiratory inhalers is ass... more Objectives. The current health technology assessment used to evaluate respiratory inhalers is associated with limitations that have necessitated the development of an explicit formulary decision-making framework to ensure balance between the accessibility, value, and affordability of medicines. This study aimed to develop a multiple-criteria decision analysis (MCDA) framework, apply the framework to potential and currently listed respiratory inhalers in the Ministry of Health Medicines Formulary (MOHMF), and analyze the impacts of applying the outputs, from the perspective of listing and delisting medicines in the formulary. Methods. The overall methodology of the framework development adhered to the recommendations of the ISPOR MCDA Emerging Good Practices Task Force. The MCDA framework was developed using Microsoft Excel 2010 and involved all relevant stakeholders. The framework was then applied to 27 medicines, based on data gathered from the highest levels of available published...

Therapeutic Innovation & Regulatory Science

Introduction The National Pharmaceutical Regulatory Agency (NPRA) embarked on a regulatory-streng... more Introduction The National Pharmaceutical Regulatory Agency (NPRA) embarked on a regulatory-strengthening program and is evaluating its processes. Optimising Efficiencies in Regulatory Agencies (OpERA) is a regulatory-strengthening program that provides benchmarking data that can define performance targets and focus performance improvement. The objective of this study was to use OpERA methodology to determine where time is spent in the NPRA approval process and to form a baseline to measure the performance improvements. Methods The OpERA tool was used to collect specific milestone data that identify time periods, review stages, and data points for new active substances and biosimilars approved by NPRA in 2017. Results In 2017, 25 new active substances and 1 biosimilar were approved by NPRA in a median of 515 days, representing both agency and applicant time. The median time between dossier receipt and the initiation of NPRA scientific assessment was 135 days, but there was a wide var...

Currents in Pharmacy Teaching and Learning

Introduction: Medicines have made an appreciable contribution to improving patient care in recent... more Introduction: Medicines have made an appreciable contribution to improving patient care in recent years. However, European and other countries are increasingly struggling to fund new premium priced medicines. This has resulted in models to optimise their utilisation as well as multiple initiatives to improve the prescribing of established medicines including enhancing the use of low cost generics, improving adherence to prescribing guidance as well as access to medicines, ensuring adequate doses are prescribed and improving patient adherence rates especially in chronic asymptomatic conditions. Objective: Review a range of demand-side initiatives in ambulatory care across different countries and their resultant effects to provide future direction. Methodology: Principally a narrative review of case histories of published studies. Results: Measures to encourage the prescribing of low cost generics versus originators and patented products in a class can release considerable resources w...

Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness. Bot... more Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness. Both bevacizumab and ranibizumab are anti-vascular endothelial growth factors used for treatment of AMD. However the use of bevacizumab remains controversial as it was not approved for intravitreal use although there were several head-to-head comparison trial that shows that it was non inferior to ranibizumab. Despite the status of off-label, intravitreal bevacizumab is being used worldwide as it is 30-50 times cheaper than intravitreal ranibizumab. The case of intravitreal bevacizumab illustrates the use of “not-me” drug and different countries responds differently to its use.

The Medical journal of Malaysia, 2008

The National Medicines Use Survey (NMUS) which started in 2004 and is still ongoing was conducted... more The National Medicines Use Survey (NMUS) which started in 2004 and is still ongoing was conducted with the intent to continuously and systematically collect data on the use of medicines, to provide an overview on the use of medicines in Malaysia. The objective of the NMUS is therefore to quantify the present state and time trends of medicines utilization at various levels of our health care system whether national, regional, local or institutional. From the data available, for the Year 2005, the most commonly used medicine in Malaysia were anti-diabetic medications, of which glibenclamide is the most common followed by metformin, were the top 2 of the list of drugs utilized in DDD/1000 population/day. Collectively, however, taking into account the various antihypertensives by therapeutic groups, anti-hypertensive medicines were more commonly used than anti-diabetics. Hypertension and diabetes mellitus are the two most prevalent chronic disorders in the country and thus, such high me...

The Medical journal of Malaysia, 2010

The EQ-5D is a quality of life instrument that measures five dimensions of health. This study inv... more The EQ-5D is a quality of life instrument that measures five dimensions of health. This study investigated the reliability and validity of its use in the Malaysian dialysis population. Test-retest reliability, convergent and discriminant validity were assessed. Responses of 86 subjects who completed both surveys were used in analysis. Test-retest reliability using Cohen's kappa was acceptable in four out of five dimensions, with the exception of self-care. Convergent validity was present. Discriminant validity was found in only two out of six hypotheses tested. In conclusion, the EQ-5D has potential in this population but further study is required.

Expert Review of Anti-infective Therapy, 2015

Background: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. T... more Background: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this. Method: An extensive literature search from 1990-2014. Results: 19 articles were included; 8 in ambulatory care, 7 in hospital settings, and 4 in both, across all countries. Physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. Moreover, some physicians although aware that antibiotics are of limited benefit in some conditions still prescribed them. Several factors influenced prescribing including patients' expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients, and influence of pharmaceutical companies. Pocket-sized guidelines seen as an important source of information for physicians. Conclusion: Inadequate knowledge of prescribing is prevalent among physicians. However, many physicians were interested in improving their antibiotic prescribing. Multifaceted interventions targeting all key stakeholders including patients are needed to improve future antibiotic prescribing. Key words: antibiotics, irrational use of medicines, patients, prescribing behaviour, physicians, systematic reviews, resistance caused by antibiotic resistant bacteria, are becoming more difficult to treat, causing life-threatening illnesses and potentially death (16). The combination of overuse of antibiotics for minor infections, misuse and under use due to lack of access and financial support in certain settings, has been a key driver of resistance. This phenomenon has been termed selective pressure (15). Increasing antibiotic resistance poses a threat to health and healthcare systems in both developed and developing countries (17). In high-income countries, continuing high rates of antibiotic use in hospitals, the community, and agriculture have contributed to selection pressure that has sustained resistant strains (18), forcing a shift to more expensive and more broad spectrum antibiotics. In lowincome and middle-income countries (LMICs), the high burden of infectious diseases and the unregulated access to antimicrobials has resulted in the emergence of antibiotic resistance (17). This is not helped by the increasing use of antibiotics to treat viral upper respiratory tract infections (URTIs), inappropriate prescribing of antibiotics for infections such as pneumonia, purchasing of antibiotics without a prescription as well as the challenges involved with determining current antimicrobial usage and AMR rates in LMIC countries to provide a baseline for future interventions and policies (19-25). Inappropriate use of antibiotics is also not helped by currently limited adherence to guidelines among physicians in LMIC countries; greater though among physicians in public (40%) than private-for-profit sector facilities at <30% (26). It is now acknowledged that the rational use of antibiotics is one of the most important steps to slow down the development and spread of resistant bacteria (27). The inappropriate use of antibiotics has been attributed to a number of factors. These include physicians' non-adherence to treatment guidelines, lack of knowledge and training regarding antibiotics, lack of diagnostic facilities, uncertainty over the diagnosis, pressure from pharmaceutical industry, fear of clinical failure, financial benefits for physicians, pressure from patients to prescribe antibiotics regardless of the indication coupled with lack of time of physicians to educate patients. In LMIC countries, there are also concerns with the extent and implementation of regulations surrounding the dispensing of antibiotics including self purchasing (19, 21, 24, 25, 28-34). Moreover, antibiotic misuse or overuse has promoted the perception among the public that these medicines are the preferred treatment for instance for URTIs. This in turn induces patients to demand antibiotics, hastening the growth of resistant bacteria (25, 30, 35). To help combat the irrational use of antibiotics, stringent diagnostic criteria for URTIs have been recommended by the Centers for Disease Control and Prevention (CDC) in collaboration with the American academy of Paediatrics (AAP) and the American Academy of Family Physicians. In United Kingdom, the National Institute for Health and Clinical Excellence (NICE) introduced in 2008 a guideline for antibiotic prescribing in respiratory tract infections. Despite these efforts and guidelines, physicians still manage URTIs with considerable variation (19, 20, 30, 36-38). Consequently, a better understanding of the determinants of antibiotic prescribing among physicians is essential for introducing and implementing targeted interventions to reduce future antibiotic prescribing and potential resistance (17, 20, 21, 26), with physician prescribing behaviour playing a key role in the utilisation of antibiotics (39). Hence, adequate knowledge and appropriate education are essential. Physicians' understanding of when antibiotics are needed, and more importantly when they are not, should subsequently reduce their prescribing (40, 41). However, there will be challenges especially in LMIC countries (19, 21, 33, 34, 42). Since changes in prescribers' knowledge and behavior are prerequisite for changes in antibiotic prescribing pattern, it is important to understand what physicians know about antibiotics, how they acquire and maintain their knowledge, and what factors influence their prescribing practice. Understanding prescribers' perspectives could lead to the development of more effective interventions and strategies to promote the rational use of antibiotics. Consequently, the aim of this paper is to systematically review the knowledge, perceptions, and behavior of physicians regarding antibiotic prescribing to guide future strategies. Methodology An extensive literature search was performed to identify published studies related to medical practitioners' perceptions, knowledge, attitude, practice, belief, and behaviour regarding antibiotic prescribing and antibiotic use. The search strategy was to identify cross-sectional observational studies and experimental studies; applied either qualitative or quantitative methods or both. PRISMA

Introduction: End-stage renal disease is on the rise in Malaysia. Dialysis prevalence has grown f... more Introduction: End-stage renal disease is on the rise in Malaysia. Dialysis prevalence has grown from 171 per million populations (p.m.p.) in 1997 to 460 p.m.p. (11,767 patients) at the end of 2004. In tandem with this increase, the Ministry of Health (MOH) has expanded its dialysis programme which comprised 137 dialysis centres nationwide in 2005. Previous research on the cost effectiveness of the Ministry of Health (MOH) was done with life expectancy as the primary outcome measure. (Hooi, et al 2005). This study expands on these findings by incorporating quality of life outcomes into the analysis. Objectives: The objectives of this study were to determine the life expectancy, the improvement in quality of life associated with haemoglobin, the utility of the dialysis patients, and the cost utility as cost per quality-adjusted life year (QALY) saved. Methods: This is a multi-centre observational study for MOH dialysis patients. The life expectancy of dialysis patients was estimated u...

The Medical journal of Malaysia, 2013

Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evalua... more 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. 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…

Value in Health, 2012

To estimate a EQ-5D value set for Malaysia by using time trade-off (TTO) and visual analogue scal... more To estimate a EQ-5D value set for Malaysia by using time trade-off (TTO) and visual analogue scale (VAS) valuation methods. TTO and VAS valuations were obtained from face-to-face surveys of a convenience sample of patients, caregivers, and health professionals conducted at nine government hospitals in 2004 and 2005. Forty-five EQ-5D questionnaire health states were valued, divided into five sets of 15 health states. Analysis was conducted by using linear additive regression models applying N3 and D1 specifications. Model selection was based on criteria of coefficient properties, statistical significance, and goodness of fit. One hundred fifty-two respondents were interviewed, yielding 2174 TTO and 2265 VAS valuations. Respondents found TTO valuations to be more difficult than VAS valuations, and there were more inconsistencies in TTO valuations. All the independent variables in the models were statistically significant and consistent with expected signs and magnitude, except for the D1 specification modeled on TTO valuations. The N3 model provided the best fit for the VAS valuation data, with a mean absolute error of 0.032. This study provides a Malaysian EQ-5D questionnaire value set that can be used for cost-utility studies despite survey limitations.

Expert Review of Anti-infective Therapy, 2015

Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Thei... more Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Their irrational use can increase costs and resistance. Assess knowledge, attitude and prescribing of antibiotics for URTIs in Selangor, Malaysia, using a cross-sectional survey among general practitioners (GPs) working in private clinics in 2011. One hundred and thirty-nine physicians completed the questionnaire (response rate = 34.8%). 49.6% (n = 69) agreed antibiotics are helpful in treating URTIs, with most GPs agreeing antibiotics may reduce URTI duration and complications. The majority of GPs reported they felt patients expected antibiotics, with 36.7% (n = 51) agreeing patients would change doctors if they did not prescribe antibiotics and 21.6% (n = 30) agreeing when requested they prescribe antibiotics even if they believe them to be unnecessary. When assessed against six criteria, most GPs had a moderate level of knowledge of prescribing for URTIs. However, antibiotic prescriptions...

Therapeutic Innovation & Regulatory Science

Bmc Health Services Research, Nov 12, 2012

Background: The roles of pharmacists have evolved from product oriented, dispensing of medication... more Background: The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia.

Integrated Pharmacy Research and Practice, 2016

BMC Health Serv Res, 2012

BACKGROUND: The roles of pharmacists have evolved from product oriented, dispensing of medication... more BACKGROUND: The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. METHODS: This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. RESULTS: Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. CONCLUSIONS: This study demonstrates the importance of pharmacists working in collaboration with other healthcare providers especially the medical doctors in identifying and resolving pharmaceutical care issues to provide optimal care for patients with chronic diseases.