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Papers by Juraporn Pongwecharak

Patient Preference and Adherence, Apr 1, 2022

The aim of the study was to evaluate the medication safety knowledge, quality of the written medi... more The aim of the study was to evaluate the medication safety knowledge, quality of the written medicine information (WMI), and perceptions of taking the medicines in patients receiving package inserts (PIs) in comparison with patient information leaflets (PILs). Methods: A cross-sectional, comparative study was conducted from December 2020 to May 2021 at two university hospitals in Thailand. Outpatients who visited the pharmacy departments and were prescribed one of the three medicines: atorvastatin, celecoxib, or metformin were randomly selected by a permuted block randomization. The medication safety knowledge was measured using a set of validated and closed questions. The quality of the WMI was measured by the Consumer Information Rating Form (CIRF). Satisfaction with information and perceptions of the benefits and risks of medications were rated by the participants using a visual analog scale (0 to 10). Results: Of the 1150 invited patients, 750 completed the questionnaires (65.2%). A higher proportion of respondents with high level of medication safety knowledge was found in those reading the PILs than the PIs (44.5% and 20.8%, respectively). The type of leaflet received was a significant predictor of the high knowledge level (p < 0.001). The mean CIRF scores were significantly higher among those reading the PILs than the PIs (p < 0.001). Patients reading the PILs were also more satisfied with the information and had more positive perceptions of the benefits from taking medicines and intention to adhere than those reading the PIs. Patients' perceptions of risks after reading both leaflets were moderate (median score = 5.0), with the PIL group having slightly more concern about risks than the PI group. Conclusion: The PILs showed superior effectiveness to the PIs in enhancing knowledge about medication safety, providing greater satisfaction with the information, and positive perceptions of benefit and intention to comply with the medications. PILs should be provided more frequently to patients receiving medicines than PIs.

<p>Mean and median score for frequency of reading PILs, usefulness and anxiety after readin... more <p>Mean and median score for frequency of reading PILs, usefulness and anxiety after reading.</p

<p>Characteristics of patients completing both questionnaires, compared to non-respondents.... more <p>Characteristics of patients completing both questionnaires, compared to non-respondents.</p

Patient Preference and Adherence, 2021

Purpose: Written medicine information informs patients about the benefits and risks of medicines ... more Purpose: Written medicine information informs patients about the benefits and risks of medicines and supports their safe and effective use. In Thailand, patient information leaflets (PILs) are not obligatory and therefore not routinely supplied. This study aimed to explore the experiences and information needs of patients, their views on PILs and the likely impact of PILs on their knowledge, perceptions and behaviors towards medicines. These factors are important to establish the value of PILs. Methods: Semi-structured interviews with outpatients who received simvastatin or atorvastatin were conducted exploring their experiences of receiving medicine information, their views on the utility of and need for PILs, the impact of PILs on their behaviors, and recommendations for how PILs could be improved. All interviews were audio-recorded, transcribed verbatim, and analyzed using a framework approach. Results: Thirty interviews were conducted from which four themes emerged: experience of receiving medicine information, views of package inserts and PILs, impact of PILs on knowledge, perceptions and behaviors, and patients' need for medicine information. Most participants received verbal information from healthcare professionals, as well as written information. Verbal information was perceived as being particularly useful to inform about changes to medicine regimens or the long-term adverse effects of medicines. Patients perceived that the PILs had influenced their knowledge about medicines, and also their behaviors including safety awareness, adherence, and engagement with healthcare professionals. Participants suggested that the information in electronic format could provide an additional resource. Some changes to improve the content and general format of the PIL were identified. Conclusion: PILs are perceived as useful by patients and met their information needs, although they were viewed as an adjunct to verbal advice provided by healthcare professionals. PILs influenced patients' medicine taking behaviors and encouraged sharing of information with their physicians.

BMJ Open, 2021

ObjectiveTo translate and validate the consumer information rating form (CIRF) for use in Thai po... more ObjectiveTo translate and validate the consumer information rating form (CIRF) for use in Thai populations.DesignThe development of the CIRF was carried out in two phases: translation process and cognitive interview, and psychometric testing.SettingA university hospital and a tertiary hospital in northeast Thailand.Participants150 outpatients from medicine department: 30 for phase 1 and 120 patients for phase 2 study.MethodsThe CIRF was translated with cultural adaptation into Thai using cognitive interview technique in a sample of outpatients. A larger sample of outpatients then completed the CIRF in relation to either a package insert (PI) or a patient information leaflet (PIL) for one of three medicines: atorvastatin, celecoxib and metformin. Construct validity was assessed using principal component analysis (PCA) and internal consistency using Cronbach’s α coefficient. Known group validity was assessed by comparing mean consumers’ ratings for PIs and PILs.ResultsThirty participa...

Patient Preference and Adherence, 2020

Purpose: Written and electronic medicine information are important for improving patient knowledg... more Purpose: Written and electronic medicine information are important for improving patient knowledge and safe use of medicines. Written medicine information in Thailand is mostly in the form of printed package inserts (PIs), designed for health professionals, with few medicines having patient information leaflets (PILs). The aim of this study was to determine practices, needs and expectations of Thai general public about written and electronic medicine information and attitudes towards PILs. Patients and Methods: Cross-sectional survey, using self-completed questionnaires, was distributed directly to members of the general public in a large city, during January to March 2019. It explored experiences of using information, expectations, needs and attitudes, the latter measured using a 10-item scale. Differences between subgroups were assessed, applying the Bonferroni correction to determine statistical significance. Results: Of the total 851 questionnaires distributed, 550 were returned (64.2%). The majority of respondents (88%) had received PIs, but only a quarter (26.2%) had received PILs. Most respondents (78.5%) had seen medicine information in online form. High educational level and income increased the likelihood of receiving PILs and electronic information. The majority of respondents (88.5%) perceived PILs as useful, but 70% considered they would still need information about medicines from health professionals. Indication, drug name and precautions were the most frequently read information in PIs and perceived as needed in PILs. Three-quarters of respondents would read electronic information if it were available, with more who had received a PIL having previously searched for such information compared to those who had not. All respondents had positive overall attitudes towards PILs. Conclusion: Experiences of receiving PILs and electronic medicine information in Thailand are relatively limited. However, the general public considered PILs as a useful source of medicine information. Electronic medicine information was desired and should be developed to be an additional source of information for consumers.

International Journal of Pharmacy Practice, 2019

Objective This study aimed to explore practices among healthcare professionals in nonsteroidal an... more Objective This study aimed to explore practices among healthcare professionals in nonsteroidal anti-inflammatory drug (NSAID) information provision. Methods In-depth interviews were conducted with orthopaedic physicians (OPs), hospital and community pharmacists (CPs) in northeastern Thailand. Ten hospitals and 20 pharmacies in five provinces were purposively selected. Interviews followed a topic guideline, were audio-recorded, transcribed verbatim and analysed using a framework approach. Key findings Fifty-one participants were involved: 13 OPs, 20 hospital pharmacists and 18 CPs. Four main themes emerged: general information, safety information, differences between new and regular NSAID users and non-selective and selective NSAID users. Pharmacists mostly provided information on administration and indication. While all three groups informed of adverse effects, this was selective, related to factors including trading, time available, patients’ age and perceived ability to understand...

PLOS ONE, 2019

Introduction Thai patients do not routinely receive patient information leaflets (PILs) with medi... more Introduction Thai patients do not routinely receive patient information leaflets (PILs) with medicines, so awareness of safety issues is low. This study aimed: i) to develop Thai PILs for NSAIDs and subject these to user-testing, and ii) to assess the potential value of PILs from the patient perspective and effect on patient knowledge. Methods Four PILs for NSAIDs were developed and subjected to multiple rounds of user-testing by the general public. Self-administered questionnaires were distributed to orthopaedic outpatients prescribed one of these NSAIDs, assessing knowledge before and after providing a PIL. The follow-up questionnaire also sought use of and views on the PILs using a visual analogue scale (VAS). Results 1,240 baseline questionnaires were completed; only 13.5% of patients had good knowledge. 688 patients returned follow-up questionnaires (55.5%), of whom75% had good knowledge. In patients completing both questionnaires, mean knowledge score increased from 6.22±1.40 to 8.42±1.41 (p<0.001). Patients with high educational levels had high baseline scores (OR = 2.728) and showed greatest improvement in knowledge (OR = 5.628). 90% (625) of follow-up respondents indicated they read all information in the PILs. All also agreed that these PILs should distributed to all patients taking NSAIDs. The median VAS score for usefulness was 9.3 (IQR 8.6-10.0).

Primary Health Care Research & Development, 2018

AimThis study aimed to explore community pharmacists’ roles on screening for risk factors, provid... more AimThis study aimed to explore community pharmacists’ roles on screening for risk factors, providing safety information-related non-steroidal anti-inflammatory drugs (NSAIDs) to patients.BackgroundNSAIDs are widely dispensed without a prescription from pharmacies in Thailand, while they are frequently reported as causing adverse events.MethodsSelf-administered questionnaires were distributed to all accredited pharmacies in Thailand, inviting the main pharmacist in each pharmacy to participate in this study.FindingsOut of 406 questionnaires distributed, 159 were returned (39.2%). Almost all pharmacists claimed to engage in NSAID dispensing practice, but not all of them provided relevant good practice, such as, screening for risk factors (56.3–95.5%), communication on adverse drug reactions (ADRs) (36.9–63.2%) and ADR management (58.9–79.7%), history of gastrointestinal (GI) problems was frequently mentioned for screening, but many pharmacists did not screen for history of NSAID use (...

Journal of Evaluation in Clinical Practice, 2017

The version in the Kent Academic Repository may differ from the final published version. Users ar... more The version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.

International Journal of Clinical Pharmacy, 2016

The version in the Kent Academic Repository may differ from the final published version. Users ar... more The version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.

Clinical Therapeutics, 2015

Previous studies using a liver damage model treated with the immunemodulator metallo-peptide (IMM... more Previous studies using a liver damage model treated with the immunemodulator metallo-peptide (IMMP) showed lessening in the degree of inflammation. Therefore, this study was set up to evaluate the anti-inflammatory effect of IMMP in obese Zucker fa/fa rats. We used Zucker-Lepr fa/fa and Zucker-Lean in this protocol. Material and Methods: The groups received IMMP 50 ng/kg by i.p., 3 times per week for 8 weeks. Blood samples were collected by cardiac puncture and the serum was preserved at −80°C until analysis; the liver was excised and preserved in formaldehyde 4%. Analyses were performed to determine cytokine, insulin, glucose, triglyceride and cholesterol levels in serum, and histological analysis was also performed. Results:: IMMP treatment of obese rats resulted in decreased levels of proinflammatory cytokines (leptin, IL-6, IL-1β , IFN-γ) and a chemokine (MCP-1), and increased levels of anti-inflammatory adipokine (adiponectin). In addition, treatment decreased the damage and hepatic steatosis generated in the tissue of obese rats and avoids changes in thymus and spleen in the same animals. Conclusions: The IMMP exerted an anti-inflammatory effect in obese rats and therefore may be an effective and safe therapeutic alternative in the treatment of metabolic syndrome.

International Journal of Clinical Pharmacy, 2015

Background The importance of promoting the use of patient-oriented medicines leaflets is recogniz... more Background The importance of promoting the use of patient-oriented medicines leaflets is recognized in many countries. Leaflets should include basic information plus specific warnings, and be provided with all medicines, but there is little attempt at enforcement of these requirements in Thailand. Objective To determine content and availability of Thai information leaflets for nonsteroidal anti-inflammatory drugs (NSAIDs). Methods Leaflets for all NSAIDs available for purchase from 34 pharmacies in a large city were evaluated against a checklist and number of leaflets assessed against number of medicine packs available in each pharmacy. Results Of the 76 leaflets for ten different NSAIDs, 67 (88 %) were for locally manufactured products. Only 22 % of 76 leaflets were sufficient in number for distribution with medicines, while only 4 % had patient-oriented leaflets. No leaflet covered all topics in the checklist. Less than half included safety information, such as contraindications (46 %), precautions (47 %), and adverse drug reactions (34 %). Locally-produced leaflets provided less information than those for originator products and no leaflet included all the warnings required by Thai regulations. Conclusion This study illustrates the variable availability and quality of NSAID information leaflets. The lack of accessible essential information about medicines in Thailand requires urgent attention to enable patients to minimise adverse reactions.

A descriptive was conducted study to assess non-compliance with drug therapy regimens, adverse dr... more A descriptive was conducted study to assess non-compliance with drug therapy regimens, adverse drug reactions and drug interactions in patients with cardiovascular diseases, and to determine the prevalence of drug-related admissions and the incidence of drug-related problems during hospitalization. The information obtained will be used for improving the provision of pharmaceutical care in Songkhla Hospital. There were 100 cardiovascular patients admitted a total of 113 times to two medical wards of Songkhla Hospital. Seventy drug-related problems ("cases") were identified; 59 (84%) of these from noncompliance, 8 (11%) from adverse drug reactions and 3 (4%) from drug interactions. During hospitalization, there was 1 case of non-compliance caused by patient's lack of knowledge of drug therapy and inadequate drug counseling by the health professional. There were also 3 cases of unpreventable adverse drug reactions. No case of drug interaction was found. At follow-up, 2 cases of non-compliance (2%), and 3 cases of adverse drug reactions (4%), but none of drug interaction, were identified in 84 of these patients. The problems could be attributed to both the patients themselves and to the health-care professionals. Life style modification is the other problem area in the cardiovascular disease patients. In this study, pharmacy counseling significantly improved patients' compliance in salty and fatty diet control, comparing between the first admission and follow up. This study showed that drug-related hospital admissions of the cardiovascular patients were preventable. Pharmaceutical- care provision could identify and reduce the incidence of preventable drug-related problems.

Problem-based learning (PBL) is a student-centered educational method to enhance interactive and ... more Problem-based learning (PBL) is a student-centered educational method to enhance interactive and integrated learning through small group activities. In the 1994 academic year, the Faculty of Pharmaceutical Sciences, Prince of Songkla University, started implementing PBL in the Dispensing Pharmacy Laboratory course for fourth year students. In the 2002 academic year, PBL was further introduced into Pharmacognosy I for third year students and Pharmacognosy II for fourth year students, as well as Modern Pharmacognosy courses. The purpose of the present study was to survey the understanding and opinions of pharmacy students as well as facilitators of the PBL teaching-learning practice. The subjects were fourth (N=112) and fifth (N=101) year pharmacy students, plus 19 faculty members who had served as PBL facilitators in the Department of Clinical Pharmacy and Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University. Learning and teaching methods in the PBL courses were described. A questionnaire was designed to determine the following: (1) understanding of students and facilitators of the PBL process, facilitator roles, and student roles; and (2) opinions of students and facilitators on the PBL process. The self-administered questionnaires were scored on a Likert scale rating and check-list, designed separately for students and facilitators. The overall response rates were 66% and 53% for students and facilitators, respectively. The questionnaire survey showed that 73% and 85% of fourth and fifth year pharmacy students, respectively, had good understanding of the PBL, while 90% of facilitators, had the understanding at an excellent level. In contrast, 32% and 57% of fourth and fifth year pharmacy students, respectively, and 10% of facilitators had a very poor understanding of facilitator roles. Several positive and negative aspects of the students’ and facilitators’ opinions were revealed. For both student and facilitator PBL received its highest ratings in the areas of student-facilitator-interaction, autonomous learning, critical thinking, and two-way communication. The lowest rating was in the area of time consumed. Overall, they suggested that more PBL should be incorporated into the curriculum. The study results showed both students and facilitators identified both pros and cons with the PBL teaching method. The results also indicated a need to provide more orientation on the PBL process and roles of facilitators and students.

International Journal of Clinical Pharmacy, 2014

When clinical pharmacists spend more time at the wards, they provide more information to the pati... more When clinical pharmacists spend more time at the wards, they provide more information to the patients. • If the management of the hospital considers increasing the level of provision of medication information to ward patients, they can ask clinical pharmacists to spend more time on the wards.

Pharmacy World & Science, 2010

Objectives To identify subjects with prehypertension and elevated cardiovascular risk factors in ... more Objectives To identify subjects with prehypertension and elevated cardiovascular risk factors in a community pharmacy and to assess their readiness to adopt lifestyle changes. Setting An accredited community pharmacy in Songkla province, Thailand. Method Subjects aged C 35 years old and reporting no hypertension or other cardiovascular disease were included. Blood pressure was measured using the Microlife BP 3AC1-1. Those with pre-hypertension or hypertension defined by the JNC 7, and reporting no diabetes and/or dyslipidemia, were checked for blood glucose and/or total cholesterol with the Accutrend GCT monitor. Other risk factors were collected. Their readiness to adopt healthy lifestyles was evaluated. Main outcome measure The prevalence of pre-hypertension and elevated cardiovascular risk factors. Results 350 subjects met the study criteria. Approximately 36 and 29% were pre-hypertensive and hypertensive, respectively. Two of these had blood glucose [ 200 mg/dl but about 47% had total cholesterol [ 200 mg/dl. Most common modifiable cardiovascular risks were inadequate exercise and elevated body mass index (*52% each). Almost 40% were ready to adopt healthy lifestyles within 1-6 months. Conclusion Subjects at risk for hypertension and cardiovascular disease can be identified by community pharmacists, with the use of point-of-care devices and careful interview. Keywords Blood pressure Á Cardiovascular risks Á Community pharmacy Á Diabetes Á Dyslipidemia Á Hypertension Á Pharmacist Á Point-of-care Á Screening Á Thailand Impact of findings on practice statement • An opportunistic health screening for elevated cardiovascular risk factors in subjects without a history of the diseases can be conducted by community pharmacists. • Potential new cases of hypertension and dyslipidemia can be identified with point-of-care devices and careful interview performed by community pharmacists. • From the perspective of early disease detection and prevention, health screening, health promotion and education by pharmacists should be considered as part of providing pharmaceutical care services.

Journal of the American Pharmacists Association, 2011

Objective: To evaluate a model for community pharmacists to screen and recommend lifestyle change... more Objective: To evaluate a model for community pharmacists to screen and recommend lifestyle changes for patients with prehypertension/hypertension and other elevated modifiable cardiovascular risk factors.

Expert Opinion on Drug Safety, 2016

To determine sources of information about NSAIDs used by out-patients, factors related to receipt... more To determine sources of information about NSAIDs used by out-patients, factors related to receipt of information and patient attitudes towards receiving safety information. Cross-sectional survey, using self-completed questionnaires distributed directly to 500 outpatients prescribed any NSAIDs from an orthopaedic clinic in Thailand, over a 4-month period. There were 548 patients approached and 474 completed questionnaires returned (94.8%). The most frequent aspects of medicines information that were provided related to administration (97.2%), mostly provided by pharmacists, and indication (85.8%), mostly provided by physicians. Information on identifying, monitoring and managing adverse effects was received by fewer than 50% of patients. Safety information was received significantly more frequently by younger patients (P&amp;amp;lt;0.01), those using non-selective COX-2 inhibitors (P&amp;amp;lt;0.001), intermittent NSAIDs (P&amp;amp;lt;0.05) and fewer concomitant medicines (P&amp;amp;lt;0.05). Only 14.1% patients used additional information sources. Attitudes towards receiving medicines safety information were positive. Most patients agreed they should know about ADRs (98.1%) and receive information leaflets with first prescription (96.8%). Patients received medicines information mostly from healthcare professionals, but safety information was limited. Type of NSAIDs, regularity of NSAID use and age affected receipt of safety information about NSAIDs. Provision of more medicine information is needed, particularly written documents.

Patient Preference and Adherence, Apr 1, 2022

The aim of the study was to evaluate the medication safety knowledge, quality of the written medi... more The aim of the study was to evaluate the medication safety knowledge, quality of the written medicine information (WMI), and perceptions of taking the medicines in patients receiving package inserts (PIs) in comparison with patient information leaflets (PILs). Methods: A cross-sectional, comparative study was conducted from December 2020 to May 2021 at two university hospitals in Thailand. Outpatients who visited the pharmacy departments and were prescribed one of the three medicines: atorvastatin, celecoxib, or metformin were randomly selected by a permuted block randomization. The medication safety knowledge was measured using a set of validated and closed questions. The quality of the WMI was measured by the Consumer Information Rating Form (CIRF). Satisfaction with information and perceptions of the benefits and risks of medications were rated by the participants using a visual analog scale (0 to 10). Results: Of the 1150 invited patients, 750 completed the questionnaires (65.2%). A higher proportion of respondents with high level of medication safety knowledge was found in those reading the PILs than the PIs (44.5% and 20.8%, respectively). The type of leaflet received was a significant predictor of the high knowledge level (p < 0.001). The mean CIRF scores were significantly higher among those reading the PILs than the PIs (p < 0.001). Patients reading the PILs were also more satisfied with the information and had more positive perceptions of the benefits from taking medicines and intention to adhere than those reading the PIs. Patients' perceptions of risks after reading both leaflets were moderate (median score = 5.0), with the PIL group having slightly more concern about risks than the PI group. Conclusion: The PILs showed superior effectiveness to the PIs in enhancing knowledge about medication safety, providing greater satisfaction with the information, and positive perceptions of benefit and intention to comply with the medications. PILs should be provided more frequently to patients receiving medicines than PIs.

<p>Mean and median score for frequency of reading PILs, usefulness and anxiety after readin... more <p>Mean and median score for frequency of reading PILs, usefulness and anxiety after reading.</p

<p>Characteristics of patients completing both questionnaires, compared to non-respondents.... more <p>Characteristics of patients completing both questionnaires, compared to non-respondents.</p

Patient Preference and Adherence, 2021

Purpose: Written medicine information informs patients about the benefits and risks of medicines ... more Purpose: Written medicine information informs patients about the benefits and risks of medicines and supports their safe and effective use. In Thailand, patient information leaflets (PILs) are not obligatory and therefore not routinely supplied. This study aimed to explore the experiences and information needs of patients, their views on PILs and the likely impact of PILs on their knowledge, perceptions and behaviors towards medicines. These factors are important to establish the value of PILs. Methods: Semi-structured interviews with outpatients who received simvastatin or atorvastatin were conducted exploring their experiences of receiving medicine information, their views on the utility of and need for PILs, the impact of PILs on their behaviors, and recommendations for how PILs could be improved. All interviews were audio-recorded, transcribed verbatim, and analyzed using a framework approach. Results: Thirty interviews were conducted from which four themes emerged: experience of receiving medicine information, views of package inserts and PILs, impact of PILs on knowledge, perceptions and behaviors, and patients' need for medicine information. Most participants received verbal information from healthcare professionals, as well as written information. Verbal information was perceived as being particularly useful to inform about changes to medicine regimens or the long-term adverse effects of medicines. Patients perceived that the PILs had influenced their knowledge about medicines, and also their behaviors including safety awareness, adherence, and engagement with healthcare professionals. Participants suggested that the information in electronic format could provide an additional resource. Some changes to improve the content and general format of the PIL were identified. Conclusion: PILs are perceived as useful by patients and met their information needs, although they were viewed as an adjunct to verbal advice provided by healthcare professionals. PILs influenced patients' medicine taking behaviors and encouraged sharing of information with their physicians.

BMJ Open, 2021

ObjectiveTo translate and validate the consumer information rating form (CIRF) for use in Thai po... more ObjectiveTo translate and validate the consumer information rating form (CIRF) for use in Thai populations.DesignThe development of the CIRF was carried out in two phases: translation process and cognitive interview, and psychometric testing.SettingA university hospital and a tertiary hospital in northeast Thailand.Participants150 outpatients from medicine department: 30 for phase 1 and 120 patients for phase 2 study.MethodsThe CIRF was translated with cultural adaptation into Thai using cognitive interview technique in a sample of outpatients. A larger sample of outpatients then completed the CIRF in relation to either a package insert (PI) or a patient information leaflet (PIL) for one of three medicines: atorvastatin, celecoxib and metformin. Construct validity was assessed using principal component analysis (PCA) and internal consistency using Cronbach’s α coefficient. Known group validity was assessed by comparing mean consumers’ ratings for PIs and PILs.ResultsThirty participa...

Patient Preference and Adherence, 2020

Purpose: Written and electronic medicine information are important for improving patient knowledg... more Purpose: Written and electronic medicine information are important for improving patient knowledge and safe use of medicines. Written medicine information in Thailand is mostly in the form of printed package inserts (PIs), designed for health professionals, with few medicines having patient information leaflets (PILs). The aim of this study was to determine practices, needs and expectations of Thai general public about written and electronic medicine information and attitudes towards PILs. Patients and Methods: Cross-sectional survey, using self-completed questionnaires, was distributed directly to members of the general public in a large city, during January to March 2019. It explored experiences of using information, expectations, needs and attitudes, the latter measured using a 10-item scale. Differences between subgroups were assessed, applying the Bonferroni correction to determine statistical significance. Results: Of the total 851 questionnaires distributed, 550 were returned (64.2%). The majority of respondents (88%) had received PIs, but only a quarter (26.2%) had received PILs. Most respondents (78.5%) had seen medicine information in online form. High educational level and income increased the likelihood of receiving PILs and electronic information. The majority of respondents (88.5%) perceived PILs as useful, but 70% considered they would still need information about medicines from health professionals. Indication, drug name and precautions were the most frequently read information in PIs and perceived as needed in PILs. Three-quarters of respondents would read electronic information if it were available, with more who had received a PIL having previously searched for such information compared to those who had not. All respondents had positive overall attitudes towards PILs. Conclusion: Experiences of receiving PILs and electronic medicine information in Thailand are relatively limited. However, the general public considered PILs as a useful source of medicine information. Electronic medicine information was desired and should be developed to be an additional source of information for consumers.

International Journal of Pharmacy Practice, 2019

Objective This study aimed to explore practices among healthcare professionals in nonsteroidal an... more Objective This study aimed to explore practices among healthcare professionals in nonsteroidal anti-inflammatory drug (NSAID) information provision. Methods In-depth interviews were conducted with orthopaedic physicians (OPs), hospital and community pharmacists (CPs) in northeastern Thailand. Ten hospitals and 20 pharmacies in five provinces were purposively selected. Interviews followed a topic guideline, were audio-recorded, transcribed verbatim and analysed using a framework approach. Key findings Fifty-one participants were involved: 13 OPs, 20 hospital pharmacists and 18 CPs. Four main themes emerged: general information, safety information, differences between new and regular NSAID users and non-selective and selective NSAID users. Pharmacists mostly provided information on administration and indication. While all three groups informed of adverse effects, this was selective, related to factors including trading, time available, patients’ age and perceived ability to understand...

PLOS ONE, 2019

Introduction Thai patients do not routinely receive patient information leaflets (PILs) with medi... more Introduction Thai patients do not routinely receive patient information leaflets (PILs) with medicines, so awareness of safety issues is low. This study aimed: i) to develop Thai PILs for NSAIDs and subject these to user-testing, and ii) to assess the potential value of PILs from the patient perspective and effect on patient knowledge. Methods Four PILs for NSAIDs were developed and subjected to multiple rounds of user-testing by the general public. Self-administered questionnaires were distributed to orthopaedic outpatients prescribed one of these NSAIDs, assessing knowledge before and after providing a PIL. The follow-up questionnaire also sought use of and views on the PILs using a visual analogue scale (VAS). Results 1,240 baseline questionnaires were completed; only 13.5% of patients had good knowledge. 688 patients returned follow-up questionnaires (55.5%), of whom75% had good knowledge. In patients completing both questionnaires, mean knowledge score increased from 6.22±1.40 to 8.42±1.41 (p<0.001). Patients with high educational levels had high baseline scores (OR = 2.728) and showed greatest improvement in knowledge (OR = 5.628). 90% (625) of follow-up respondents indicated they read all information in the PILs. All also agreed that these PILs should distributed to all patients taking NSAIDs. The median VAS score for usefulness was 9.3 (IQR 8.6-10.0).

Primary Health Care Research & Development, 2018

AimThis study aimed to explore community pharmacists’ roles on screening for risk factors, provid... more AimThis study aimed to explore community pharmacists’ roles on screening for risk factors, providing safety information-related non-steroidal anti-inflammatory drugs (NSAIDs) to patients.BackgroundNSAIDs are widely dispensed without a prescription from pharmacies in Thailand, while they are frequently reported as causing adverse events.MethodsSelf-administered questionnaires were distributed to all accredited pharmacies in Thailand, inviting the main pharmacist in each pharmacy to participate in this study.FindingsOut of 406 questionnaires distributed, 159 were returned (39.2%). Almost all pharmacists claimed to engage in NSAID dispensing practice, but not all of them provided relevant good practice, such as, screening for risk factors (56.3–95.5%), communication on adverse drug reactions (ADRs) (36.9–63.2%) and ADR management (58.9–79.7%), history of gastrointestinal (GI) problems was frequently mentioned for screening, but many pharmacists did not screen for history of NSAID use (...

Journal of Evaluation in Clinical Practice, 2017

The version in the Kent Academic Repository may differ from the final published version. Users ar... more The version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.

International Journal of Clinical Pharmacy, 2016

The version in the Kent Academic Repository may differ from the final published version. Users ar... more The version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.

Clinical Therapeutics, 2015

Previous studies using a liver damage model treated with the immunemodulator metallo-peptide (IMM... more Previous studies using a liver damage model treated with the immunemodulator metallo-peptide (IMMP) showed lessening in the degree of inflammation. Therefore, this study was set up to evaluate the anti-inflammatory effect of IMMP in obese Zucker fa/fa rats. We used Zucker-Lepr fa/fa and Zucker-Lean in this protocol. Material and Methods: The groups received IMMP 50 ng/kg by i.p., 3 times per week for 8 weeks. Blood samples were collected by cardiac puncture and the serum was preserved at −80°C until analysis; the liver was excised and preserved in formaldehyde 4%. Analyses were performed to determine cytokine, insulin, glucose, triglyceride and cholesterol levels in serum, and histological analysis was also performed. Results:: IMMP treatment of obese rats resulted in decreased levels of proinflammatory cytokines (leptin, IL-6, IL-1β , IFN-γ) and a chemokine (MCP-1), and increased levels of anti-inflammatory adipokine (adiponectin). In addition, treatment decreased the damage and hepatic steatosis generated in the tissue of obese rats and avoids changes in thymus and spleen in the same animals. Conclusions: The IMMP exerted an anti-inflammatory effect in obese rats and therefore may be an effective and safe therapeutic alternative in the treatment of metabolic syndrome.

International Journal of Clinical Pharmacy, 2015

Background The importance of promoting the use of patient-oriented medicines leaflets is recogniz... more Background The importance of promoting the use of patient-oriented medicines leaflets is recognized in many countries. Leaflets should include basic information plus specific warnings, and be provided with all medicines, but there is little attempt at enforcement of these requirements in Thailand. Objective To determine content and availability of Thai information leaflets for nonsteroidal anti-inflammatory drugs (NSAIDs). Methods Leaflets for all NSAIDs available for purchase from 34 pharmacies in a large city were evaluated against a checklist and number of leaflets assessed against number of medicine packs available in each pharmacy. Results Of the 76 leaflets for ten different NSAIDs, 67 (88 %) were for locally manufactured products. Only 22 % of 76 leaflets were sufficient in number for distribution with medicines, while only 4 % had patient-oriented leaflets. No leaflet covered all topics in the checklist. Less than half included safety information, such as contraindications (46 %), precautions (47 %), and adverse drug reactions (34 %). Locally-produced leaflets provided less information than those for originator products and no leaflet included all the warnings required by Thai regulations. Conclusion This study illustrates the variable availability and quality of NSAID information leaflets. The lack of accessible essential information about medicines in Thailand requires urgent attention to enable patients to minimise adverse reactions.

A descriptive was conducted study to assess non-compliance with drug therapy regimens, adverse dr... more A descriptive was conducted study to assess non-compliance with drug therapy regimens, adverse drug reactions and drug interactions in patients with cardiovascular diseases, and to determine the prevalence of drug-related admissions and the incidence of drug-related problems during hospitalization. The information obtained will be used for improving the provision of pharmaceutical care in Songkhla Hospital. There were 100 cardiovascular patients admitted a total of 113 times to two medical wards of Songkhla Hospital. Seventy drug-related problems ("cases") were identified; 59 (84%) of these from noncompliance, 8 (11%) from adverse drug reactions and 3 (4%) from drug interactions. During hospitalization, there was 1 case of non-compliance caused by patient's lack of knowledge of drug therapy and inadequate drug counseling by the health professional. There were also 3 cases of unpreventable adverse drug reactions. No case of drug interaction was found. At follow-up, 2 cases of non-compliance (2%), and 3 cases of adverse drug reactions (4%), but none of drug interaction, were identified in 84 of these patients. The problems could be attributed to both the patients themselves and to the health-care professionals. Life style modification is the other problem area in the cardiovascular disease patients. In this study, pharmacy counseling significantly improved patients' compliance in salty and fatty diet control, comparing between the first admission and follow up. This study showed that drug-related hospital admissions of the cardiovascular patients were preventable. Pharmaceutical- care provision could identify and reduce the incidence of preventable drug-related problems.

Problem-based learning (PBL) is a student-centered educational method to enhance interactive and ... more Problem-based learning (PBL) is a student-centered educational method to enhance interactive and integrated learning through small group activities. In the 1994 academic year, the Faculty of Pharmaceutical Sciences, Prince of Songkla University, started implementing PBL in the Dispensing Pharmacy Laboratory course for fourth year students. In the 2002 academic year, PBL was further introduced into Pharmacognosy I for third year students and Pharmacognosy II for fourth year students, as well as Modern Pharmacognosy courses. The purpose of the present study was to survey the understanding and opinions of pharmacy students as well as facilitators of the PBL teaching-learning practice. The subjects were fourth (N=112) and fifth (N=101) year pharmacy students, plus 19 faculty members who had served as PBL facilitators in the Department of Clinical Pharmacy and Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University. Learning and teaching methods in the PBL courses were described. A questionnaire was designed to determine the following: (1) understanding of students and facilitators of the PBL process, facilitator roles, and student roles; and (2) opinions of students and facilitators on the PBL process. The self-administered questionnaires were scored on a Likert scale rating and check-list, designed separately for students and facilitators. The overall response rates were 66% and 53% for students and facilitators, respectively. The questionnaire survey showed that 73% and 85% of fourth and fifth year pharmacy students, respectively, had good understanding of the PBL, while 90% of facilitators, had the understanding at an excellent level. In contrast, 32% and 57% of fourth and fifth year pharmacy students, respectively, and 10% of facilitators had a very poor understanding of facilitator roles. Several positive and negative aspects of the students’ and facilitators’ opinions were revealed. For both student and facilitator PBL received its highest ratings in the areas of student-facilitator-interaction, autonomous learning, critical thinking, and two-way communication. The lowest rating was in the area of time consumed. Overall, they suggested that more PBL should be incorporated into the curriculum. The study results showed both students and facilitators identified both pros and cons with the PBL teaching method. The results also indicated a need to provide more orientation on the PBL process and roles of facilitators and students.

International Journal of Clinical Pharmacy, 2014

When clinical pharmacists spend more time at the wards, they provide more information to the pati... more When clinical pharmacists spend more time at the wards, they provide more information to the patients. • If the management of the hospital considers increasing the level of provision of medication information to ward patients, they can ask clinical pharmacists to spend more time on the wards.

Pharmacy World & Science, 2010

Objectives To identify subjects with prehypertension and elevated cardiovascular risk factors in ... more Objectives To identify subjects with prehypertension and elevated cardiovascular risk factors in a community pharmacy and to assess their readiness to adopt lifestyle changes. Setting An accredited community pharmacy in Songkla province, Thailand. Method Subjects aged C 35 years old and reporting no hypertension or other cardiovascular disease were included. Blood pressure was measured using the Microlife BP 3AC1-1. Those with pre-hypertension or hypertension defined by the JNC 7, and reporting no diabetes and/or dyslipidemia, were checked for blood glucose and/or total cholesterol with the Accutrend GCT monitor. Other risk factors were collected. Their readiness to adopt healthy lifestyles was evaluated. Main outcome measure The prevalence of pre-hypertension and elevated cardiovascular risk factors. Results 350 subjects met the study criteria. Approximately 36 and 29% were pre-hypertensive and hypertensive, respectively. Two of these had blood glucose [ 200 mg/dl but about 47% had total cholesterol [ 200 mg/dl. Most common modifiable cardiovascular risks were inadequate exercise and elevated body mass index (*52% each). Almost 40% were ready to adopt healthy lifestyles within 1-6 months. Conclusion Subjects at risk for hypertension and cardiovascular disease can be identified by community pharmacists, with the use of point-of-care devices and careful interview. Keywords Blood pressure Á Cardiovascular risks Á Community pharmacy Á Diabetes Á Dyslipidemia Á Hypertension Á Pharmacist Á Point-of-care Á Screening Á Thailand Impact of findings on practice statement • An opportunistic health screening for elevated cardiovascular risk factors in subjects without a history of the diseases can be conducted by community pharmacists. • Potential new cases of hypertension and dyslipidemia can be identified with point-of-care devices and careful interview performed by community pharmacists. • From the perspective of early disease detection and prevention, health screening, health promotion and education by pharmacists should be considered as part of providing pharmaceutical care services.

Journal of the American Pharmacists Association, 2011

Objective: To evaluate a model for community pharmacists to screen and recommend lifestyle change... more Objective: To evaluate a model for community pharmacists to screen and recommend lifestyle changes for patients with prehypertension/hypertension and other elevated modifiable cardiovascular risk factors.

Expert Opinion on Drug Safety, 2016

To determine sources of information about NSAIDs used by out-patients, factors related to receipt... more To determine sources of information about NSAIDs used by out-patients, factors related to receipt of information and patient attitudes towards receiving safety information. Cross-sectional survey, using self-completed questionnaires distributed directly to 500 outpatients prescribed any NSAIDs from an orthopaedic clinic in Thailand, over a 4-month period. There were 548 patients approached and 474 completed questionnaires returned (94.8%). The most frequent aspects of medicines information that were provided related to administration (97.2%), mostly provided by pharmacists, and indication (85.8%), mostly provided by physicians. Information on identifying, monitoring and managing adverse effects was received by fewer than 50% of patients. Safety information was received significantly more frequently by younger patients (P&amp;amp;lt;0.01), those using non-selective COX-2 inhibitors (P&amp;amp;lt;0.001), intermittent NSAIDs (P&amp;amp;lt;0.05) and fewer concomitant medicines (P&amp;amp;lt;0.05). Only 14.1% patients used additional information sources. Attitudes towards receiving medicines safety information were positive. Most patients agreed they should know about ADRs (98.1%) and receive information leaflets with first prescription (96.8%). Patients received medicines information mostly from healthcare professionals, but safety information was limited. Type of NSAIDs, regularity of NSAID use and age affected receipt of safety information about NSAIDs. Provision of more medicine information is needed, particularly written documents.