Community pharmacists' involvement in tobacco control and their perceived role and barriers were assessed. In part I, a self-administered questionnaire was mailed to 164 community pharmacists who applied for community pharmacy accreditation from the Thai Pharmacy Council in 2003. In part II, an in-depth interview was conducted among 13 community pharmacists who participated in the 1-day smoking cessation services training. Main outcome measures were tobacco control-related activities, perceived tobacco control role, and perceived barriers. The questionnaire response rate was 51% (83/164 pharmacists), with half of the respondents (42/83, 51%) reporting active tobacco control activities. Of these pharmacists, seven (7/42, 17%) reported participating in public or policy advocacy by campaigning against smoking in the community. Thirty-four (34/42, 81%) and thirty-six (36/42, 86%) reported engaging in activities in their own pharmacies by providing educational materials and smoking cessation services, respectively. Even though the perceived roles in tobacco control of these pharmacists were high, they also reported several barriers, especially in five categories: lack of client demand, lack of educational materials, lack of smoking cessation products, lack of knowledge and skill, and lack of follow-up visits. On the other hand, lack of time and lack of reimbursement were not indicated as important barriers. Data from in-depth interviews confirmed these findings. This study revealed that Thai community pharmacists were engaged in various levels of tobacco control-related activities. Most of them perceived the significance of tobacco control activities. However, several barriers were also reported and need to be addressed further.
Over the past few years, several training programs have been run in support of smoking cessation services within community pharmacy circles in Thailand. These have included a comprehensive training program offered by the Thai Pharmacy Network for Tobacco Control (TPNTC) and brief training programs run by other agencies. This study provides an estimate of the scale of smoking cessation activities among Thai pharmacies, and examines the impact of both the brief and comprehensive training programs on the provision of smoking cessation services. A self-administered questionnaire was mailed to 3,600 Thai community pharmacists. A total of 1,001 questionnaires were returned (response rate: 27.8%). Smoking cessation services were provided by 71.1% of the respondents, and 47.4% of such services gave only brief advice. Comprehensive services (defined by the 5A's: ask, advise, assess, assist, and arrange follow-up) accounted for 15.3% of the respondents. Only 293 pharmacists (29.6%) said they had received cessation training; 62.5% of whom had received such training from TPNTC. The receipt of brief and comprehensive training was associated with a higher rate of the provision of brief advice, when compared with no training, showing adjusted odds ratios (ORs) of 2.93 (95% CI, 1.66-5.18) and 5.93 (95% CI, 3.18-10.17) respectively, while evidence of differences between these training programs was not observed, having an adjusted OR of 1.94 (95% CI, .89-4.21). TPNTC trained pharmacists were 4.98 times (95% CI, 2.24-11.05) more likely than those who received other brief training to provided the 5A's cessation services. All types of training program help to promote the provision of brief counseling by pharmacists. Comprehensive training is associated with the increased provision of both 4A's and 5A's cessation services.
Inappropriate medication supplies could increase the risks of CHF-related and all-cause hospitalizations. Both undersupply and oversupply of medication had significantly higher health-care costs.
BackgroundMedication oversupply is an important problem in the healthcare systems. It causes unnecessary avoidable healthcare costs. Although some studies have determined the magnitude and financial loss due to medication oversupply in western countries, they may not be applicable to Asia-pacific countries. This study aims to determine the prevalence, financial loss, and patterns of medication oversupply and the factors associated with such oversupply in Thailand.MethodsA retrospective database analysis was used from 3 public hospitals. Patients visiting the outpatient department of the hospitals in 2010 and receiving at least 2 prescriptions within 6 months were included. The modified medication possession ratio (MPRm) was used to determine the medication supply. Patients having MPRm > 1.20 were defined as receiving a medication oversupply. The measures were prevalence of medication oversupply, the number of oversupplied medications, and financial loss (2012 dollars) due to medication oversupply. Hierarchical logistic regression was used to determine the factors associated with the prevalence of medication oversupply.ResultsA total of 99,743 patients were included. Patients were on average 49.7 ± 21.2 years of age, and 42.8% were male. Most of them were adult (53.7%). Among those patients, 60.2% of the patients were under universal coverage schemes. Around 13.4% of all the patients received a medication oversupply, and the patients in regional hospitals had a higher prevalence of medication oversupply than patients in district hospitals (13.8% VS 8.2%). The patients under civil servant medical benefit schemes (CSMBS) (13.6%) had the most prevalence of medication oversupply. The total financial loss was $189,024 per year. The average financial loss was $1.9 ± 19.0 per patient/year. Patients under CSMBS experienced the highest average financial loss (2.6 ± 23.2 $/patient/year). Age, gender, health insurance schemes, and the number of medications that the patients received were the factors associated with medication oversupply.ConclusionsMedication oversupply is an important problem for the health system. Patients receiving care from regional hospitals had a higher likelihood of medication oversupply. Policymakers may consider developing policies for preventing medication oversupply. The policy should be implemented in regional hospitals and especially in children or patients with poly-pharmacy.
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