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2nd PHARMACOECONOMICS AND
OUTCOME RESEARCH CONFERENCE 2014
"PHARMACOECONOMICS IN HEALTHCARE TRANSFORMATION: TOWARDS UNIVERSAL COVERAGE"
Conference Advisor : Prof. Dato' Dr. Syed Mohamed Aljunid Organising Chairperson : Dr. Soraya Azmi : Lee Sit Wai and Nurul Azwani Nadia Mansor THE HONOURABLE
MINISTER OF HEALTH,
Nurul Azwani Nadia Mansor Ainil Hawa Mohammed WELCOME MESSAGE from
Founding President,
Noorharlina Che Zakaria Scientific committee Prof. Dato' Dr. Syed Mohamed Aljunid
Dr. Faridah Aryani Md. Yusof Dr. Soraya Azmi
Message from the
Organizing Committee *
Poster and Podium Assoc. Prof. Sharifa Ezat Wan Puteh
Assoc. Prof. Asrul Akmal Shafie Judging Committee Dr. Nurnajayati Omar Siti Athirah Zafirah Treasury and Finance Conference At a Glance
Azuana Ramli
Prof. Dr. Samsinah Hj Hussain
Norhana Nawawi Suri Celynn Lim Ian Rhan Publicity and Publication Dr. Ramli Zainal
SYNOPSIS OF
Dr. Zafar Ahmed
Al-abed Ali Ahmed Mahpirat Abduweli List of Abstract
PROFILE OF SPEAKERS
Sarah Diyana Shafie Mohd Naqib Zainal Abidin Nurul Rahmah Abdul Rahim Siti Suhaila Hashim Noor Atiqah Mat Yusoff Puteri Juanita Zamri Treasury and Finance Malyanah Suparman




WELCOME MESSAGE from
Message from
MINISTER OF HEALTH,
First and foremost, I would like to thank the organizers for the invitation to pen a few Itgives me great pleasure to welcome all participants to this Second Onbehalf of the organizing committee, it is a pleasure to welcome you all to the second words on the occasion of the 2nd Pharmacoeconomics and Outcome Research biennial event that MySPOR is organizing as a Pharmacoeconomics and Outcome Conference 2014. We have chosen the theme society. Since the last conference in 2012, there Research Conference 2014. Heartiest this year as "Pharmacoeconomics in Healthcare has been an increasing interest in the field congratulations to the organizers of this Transformation: Towards Universal Coverage".
parallel to evolving changes within the important conference - the Malaysian Society Our focus on universal coverage is in-line with government submission processes particularly at for Pharmacoeconomics and Outcome the efforts made by many developing countries in the Pharmaceutical Services Division. As the Research (MySPOR), which is a chapter of the world today in re-shaping their health care country aspires to become a developed nation in the International Society for systems to extend health services to cover all 2020, it is heartening to see evidence-based Pharmacoeconomics and Outcomes sectors of the population. Researchers in the field decision-making being given an even greater Research (ISPOR). I would also like to thank of pharmacoeconomics will have the opportunity priority, in line with practices in other developed the United Nations University-International to deliberate on how we can contribute to assist countries in the region and the world. With these Institute for Global Health (UNU-IIGH) and policy makers in these countries to stretch scarce steps, after Thailand, Malaysia is the second the Pharmaceutical Services Division of the resources to achieve this noble goal. Continuing nation in South East Asia to take on Ministry of Health, as co-organisers of this increase in cost of drugs and medical equipment pharmacoeconomics in formulary decisions.
significant event, for their invaluable posed major challenges for developing countries contribution towards the success of this to meet healthcare needs and demand of the conference as well as their endeavour to growing population. MYSPOR, since its inception Thecurrent conference programme has been developed to build upon discussions and promote pharmacoeconomic research.
five years ago, set our mission to promote content presented at the last conference. The research and development in content was developed with several fold ealthcare delivery systems all around pharmacoeconomics. We are confident that the intentions, which were to delve deeper into the the world are faced with the perennial outcome of these studies will be utilised by various methods currently being used problem of rising costs and thus, efforts are decision makers in providing sustainable solution internationally, to give researchers space to share being made to enhance efficiency. In this to current issues affecting our nation's health their research work with the addition of posters cost-conscious era, pharmacoeconomic system. MYSPOR is also established to serve as and podium presentations this time around and, research has evolved to become a significant a platform for those interested in most importantly, to give an opportunity for all field of research and clearly has an important pharmacoeconomics to sharpen their skills and stakeholders to discuss issues and challenges role to play. Pharmacoeconomic evaluation knowledge in this discipline. faced especially given the context of healthcare identifies measures and compares the costs transformation that has been very topical. At the and benefits of pharmaceutical products and same time, we have also endeavoured to keep services in order to make rational therapeutic Onbehalf of MYSPOR, I would like to thank Ministry of Health Malaysia and United some basic and informative sessions to help choices, thus enhancing efficiency. Nations University International Institute for colleagues that are newly exposed to catch up to Global Health (UNU-IIGH) for providing the this rich and complex field of research which he theme of this conference, support to co-organize this Conference. Our melds clinical research with economics.
"Pharmacoeconomics in Healthcare sponsors from the industries have given us great Transformation: Towards Universal help to enable us to bring in speakers especially Coverage", reflects our noble goal of from outside Malaysia.
Totruly be able to conduct world-class and reliable research, good collaboration between achieving universal health coverage in different stakeholders is needed, ranging from Malaysia, which I am pleased to say, we are government to private institutions, NGOs and well on the road to achieving. I am also Iwould like to thank members of the organizing committee who has been working diligently to academia. Researchers, users of research and pleased that this conference will bring prepare the programme and bring in experts from health professionals from all backgrounds, must together local experts as well as experts various part of the world to this conference even come together to contribute in the pursuit for from abroad to exchange ideas and learn though they are working with the constraints of answers to important research questions. We from one another, with the noble aim of time and finance. I would like to acknowledge all anticipate that the formal discussions during the ensuring that our patients, who are after all our advisors who have given us valuable input to event as well informal discussions throughout the the centre of the healthcare Universe, will improve the organization as well as the content of next two days will offer a chance for everyone to ultimately benefit from our concerted efforts.
the conference programme.
seek new ways of working together and We are after all, a nation working together for exchanging information to build a strong platform better health.
Finally,it is my sincere hope that you will have to conduct good pharmacoeconomic research.
an enjoyable as well as fruitful time in the next Results of such research will help to make more inally, allow me to congratulate all three days and I look forward to meeting all of informed choices toward improving the lives and committee members as well as everyone you in this Conference. health of the population.
concerned, for their hard work and dedication in ensuring the success of this conference.
Wishing all of you a fruitful and memorable Itake this opportunity to thank all the sponsors of the conference for their generosity and support. Finally, I would also like to thank all my fellow organizing committee members, as well as all the volunteers for their hard work. With that, I wish you all a great conference! Y.B. Datuk Seri Dr. S. Subramaniam Prof Dato' Dr Syed Mohamed Aljunid




CONFERENCE AT A GLANCE
09:00-12:00pm MORNING SHORT COURSE ì WORKSHOP 1: INTRODUCTION TO PHARMACOECONOMICS AND
CRITICAL APPRAISAL OF ECONOMIC EVALUATION • Professor
08:00-09:00am EDUCATIONAL WORKSHOP Samsinah Haji Hussain, University Malaya; Dr Ramli Zainal, Institute of ì PHARMACOECONOMICS 102: INTERPRETING RESULTS: COST,
Health Systems Research OUTCOME, CE, ICERS • Dr Soraya Azmi & Dr Goh Bak Leong
ì WORKSHOP 2: CONDUCTING PHARMACO-EPIDEMIOLOGY RESEARCH
09:00-10:45am PANEL 4 Professor Li Shu Chuen, University of Newcastle, Australia ì COST-EFFECTIVENESS vs. COST-REDUCTION: THE BALANCE
14:30-17:30pm AFTERNOON SHORT COURSE BETWEEN ACCESSIBILITY, AFFORDABILITY AND AVAILABILITY
ì WORKSHOP 3: ACTIVITY-BASED COSTING • Professor Dato' Syed
COST-EFFECTIVENESS VS. COST REDUCTION – AN
Mohamed Aljunid, UNU-IIGH; Dr Amrizal Muhammad Nur, Dr Zafar AUSTRALIAN CASE STUDY • Professor Li Shu Chuen, Newcastle
University, Australia ì WORKSHOP 4: QOL INSTRUMENTS AND CALCULATION OF
COST-EFFECTIVENESS OF TREATING TO TARGETS WITH
UTILITY VALUES • Adrian Goh, Azmi Burhani Consulting; Assoc.
BIOLOGICS IN IMIDS • Dr. Carol Bao, AbbVie, USA
Professor Asrul Akmal Shafie, Universiti Sains Malaysia • THE CHALLENGE FOR PUBLIC HEALTH: PROVIDING
UNIVERSAL COVERAGE AND COST-EFFECTIVE TREATMENT •
Dr. Feisul Idzwan Mustapha, Ministry of Health, Malaysia 8 MARCH, SATURDAY 10:45-11:00am BREAK, EXHIBITS & POSTERS 08:15-09:45am KEYNOTE & LAUNCH ì KEYNOTE ADDRESS • Dato' Dr Noor Hisham Abdullah, Director-
11:00-12:20pm PANEL 5 General, Ministry of Health, Malaysia ì PHARMACOECONOMICS RESEARCH – ARE WE READY FOR IT?
ì Conference Launch: WELCOME ADDRESS • Professor Dato Syed
WHAT ARE THE COMPONENTS NEEDED TO CONDUCT
Mohamed Aljunid, MySPOR President PHARMACOECONOMICS RESEARCH? Adrian Goh, Azmi Burhani
ì OPENING SPEECH & CONFERENCE LAUNCH • Y.B. Dato' Seri Dr S.
Subramaniam, Minister of Health, Malaysia • DATA AVAILABILITY FOR PHARMACOECONOMICS RESEARCH •
Professor Dato' Syed Mohamed Aljunid, United Nations University 09:45-10:30am BREAK, EXHIBITS & POSTERS • HOW TAIWAN BUILT CAPACITY TO CONDUCT HTA
10:30-11:00am EDUCATIONAL WORKSHOP ASSESSMENTS • Dr Jasmine Pwu, Director of HTA, Center for Drug
Evaluation, Taiwan ì PHARMACOECONOMICS 101: DEMYSTIFYING PHARMACOECONOMIC
PHARMACOECONOMICS AS A TOOL FOR EVIDENCE-BASED
TERMINOLOGY • Adrian Goh, Azmi Burhani Consulting
MEDICINE • Dr. Sunita Bavanandan, Nephrologist, Hospital Kuala
11:00-12:30am PANEL 1 ì PHARMACOECONOMICS IN DECISION-MAKING – SHARING
12:20-13:20PM LUNCH SYMPOSIUM • AUSTRALIAN EXPERIENCE • Professor Li Shu Chuen, Newcastle
ì HEALTH TECHNOLOGY APPROACHES AND FIT FOR PURPOSE IN
University, Australia DEVELOPING HEALTH CARE SYSTEMS • Christoph Glaetzer, Janssen
THAILAND EXPERIENCE • Professor Nathorn Chaiyakunapruk,
Sunway Monash University, Malaysia 13:20-13:50pm BREAK, EXHIBITS & POSTERS • TAIWAN EXPERIENCE • Dr Jasmine Pwu, Director of HTA,
Center for Drug Evaluation, Taiwan 13:50-14:50pm RESEARCH PODIUM PRESENTATION ì Track 1: Quality of Life
ì Track 2: Cost & Cost effectiveness
12:30-13:30pm LUNCH Symposium ì Track 3: Pharmacoepidemiology, health services research,
ì UNIVERSAL COVERAGE: PHARMACOECONOMICS AND PATIENTS
utilisation and policy
ACCESS ISSUES AND CHALLENGES • Mendel Grobler, Pfizer
13:30-14:00pm BREAK, EXHIBITS & POSTERS 14:50-16:25pm PANEL 6 ì PHARMACOECONOMICS AND HEALTHCARE TRANSFORMATION–
14:00-15:45pm PANEL 2 COLLABORATIONS FOR THE FUTURE
ì PHARMACOECONOMICS IN HEALTHCARE TRANSFORMATION
STRENGTHENING DECISION-MAKING THROUGH COLLABORATIVE
ROLE OF PHARMACOECONOMICS IN MOH DECISION MAKING •
EFFORT • Dr Salmah Bahri, Ministry of Health Malaysia
Anis Talib, Ministry of Health, Malaysia • INDUSTRY'S ROLE - JOINING TOGETHER TO STRENGTHEN
THE FUTURE OF HEALTH INFORMATION SYSTEMS –
PHARMACOECONOMICS RESEARCH IN MALAYSIA • Yew Wei
POTENTIAL USE FOR OBSERVATIONAL RESEARCH • Dr Md
Tarng, President of PHAMA Khadzir Sheikh Ahmad, Ministry of Health, Malaysia • A PEEK INTO THE FUTURE MALAYSIAN HEALTHCARE
HTA IN MALAYSIA MOVING FORWARD • Noormah Darus, Ministry of
LANDSCAPE • Datuk Dr. Jeyaindran Tan Sri Sinnadurai, Deputy
Director-General (Medical), Ministry of Health, Malaysia 15:45-16:00pm BREAK, EXHIBITS & POSTERS 16:25-16:50 PRIZES & RECOGNITION 16:00-17:30pm PANEL 3 ì PRIZES PRESENTATION – PODIUM & POSTER
ì BRIDGING SCIENCE TO POLICY WITH PHARMACOECONOMICS
16:50-17:00pm CLOSING REMARKS • INTRODUCTION TO THE CE THRESHOLD • Assoc. Professor
ì Professor Dato Syed Mohamed Aljunid, MySPOR President Sharifa Ezat Wan Puteh, Universiti Kebangsaan Malaysia • DO WE NEED A THRESHOLD FOR MALAYSIA? • Assoc.
17:00pm TEA & END Professor Asrul Akmal Shafie, Universiti Sains Malaysia • VALUE-BASED PRICING • Professor Kenneth Lee, Sunway Monash
17:00 - 18:00pm AGM MySPOR University, Malaysia • MULTI-CRITERIA DECISION ANALYSIS (MCDA) AND OTHER
NEW IDEAS • Dr Soraya Azmi, Azmi Burhani Consulting


PHARMACOECONOMICS AND
CRITICAL APPRAISAL OF
Date/Time : FRIDAY, 7 MARCH 2014
Date/Time : FRIDAY, 7 MARCH 2014
9.00am to 12.15pm : Professor Samsinah Haji Hussain, Universiti of
: Prof. Dato' Dr. Syed Mohamed Aljunid, United
Nations University-International Institute for Global Dr. Ramli Zainal, Institute for Health Systems Research
Dr. Amrizal Muhammad Nur, International Training
Centre for Casemix and Clinical Coding he workshop is aimed to describe the fundamental principles of Dr. Zafar Ahmed, International Training Centre for
economic evaluation and provide an introduction to its Casemix and Clinical Coding interpretation. Different pharmaco-economic analysis will be shared including Cost Minimisation Analysis, Cost Effectiveness Analysis, Cost Utility Analysis and Cost Benefit Analysis. The workshop will Activity based costing is one of the costing methods used in Case- also provide tutorial of an appraisal of a published economic Mix system. It can be defined as an accounting method that evaluation study based on the fundamental principles using the enables the organization to determine the true costs related with their Drummond 10-point checklist. service based on the resources that are consumed. This workshop is suitable for those who involved in hospital management, hospital budget planning, and hospital information management. This workshop will include a practical session.
USING QUESTIONNAIRES TO
MEASURE QUALITY OF LIFE
Date/Time : FRIDAY, 7 MARCH 2014
Date/Time : FRIDAY, 7 MARCH 2014
9.00am to 12.15pm : Professor Li Shu Chuen, University of Newcastle,
: Adrian Goh, Azmi Burhani Consulting
Assoc. Professor Asrul Akmal Shafie, Universiti
he workshop will provide a brief summary of the types of pharmacoepidemiological research being conducted and their usefulness to public health as well as to decision makers. The This workshop will introduce the concepts of Quality of Life (QOL) and health utility, and their measurement using Patient Reported workshop will start with a short introduction of some of the basic Outcome (PRO) instruments. The workshop will describe the epidemiologic and other concepts used in conducting selection of appropriate PRO instruments and the use of PRO data pharmacoepidemiologic studies. This will be followed by hands-on to quantify QOL and health utility. The workshop will include a exercises on drug utilization review and pharmacoeconomic practical session. Participants will be required to bring a laptop installed with Microsoft Excel, version Excel 97 or later.
SYNOPSIS OF PRESENTATIONS
PHARMACOECONOMICS IN DECISION-MAKING – SHARING REGIONAL EXPERIENCES: EXPERIENCE FROM AUSTRALIA Professor Shu Chuen Li, Newcastle University, Australia The presentation will provide a brief history of the development of using pharmacoeconomics in decision making in Australia, the first country to require supplying economic data from pharmaceutical companies as mandatory requirement for drug reimbursement applications. The rationale for the introduction of such requirement is discussed and the impact as observed from different stakeholders with the introduction of pharmacoeconomic evaluation in decision-making will be evaluated. Finally the long-term effectiveness of such approach in reimbursement decision making is discussed.
HEALTH ECONOMICS IN DECISION-MAKING – SHARING THAILAND EXPERIENCES Professor Chaiyakunapruk, Sunway Monash University, Malaysia Health economics data become an important piece of information used during decision making in Thailand. National List of Essential Medicine under ministry of health requires health economics data for some pharmaceutical products. It is recommended to include health economics data during the dossier submission. National Health Security office, the largest payer for more than 75% of Thai population, has commissioned research organizations to conduct health technology assessment (including health economics) of interventions including diagnostics, pharmaceuticals, and programs. The findings are used to assist policy decision makers to consider whether the interventions will be included in their health benefit package. Health economics data are mostly based on local data and need to be provided to decision makers in a timely fashion. Key facilitators for having health economics studies used for decision making in Thailand are the followings: 1) Thai health technology assessment guideline 2) repository of health economics database in Thailand 3) Thai costing menu (including unit cost for most medical care services and average values for direct non-medical and indirect cost) and 4) the strong interest of policy makers in using such data as part of their decision making process.
PHARMACOECONOMICS IN DECISION-MAKING – SHARING REGIONAL EXPERIENCES (TAIWAN EXPERIENCE) Dr Jasmine Raoh-Fang Pwu, Centre for Drug Evaluation, Taiwan Thereimbursement and listing mechanism of National Health Insurance adopted that of the earlier Labor/Government Employee Insurances era, and it has been gradually modified into the current system. Unlike most other countries, the system allows National Health Insurance Administration (NHIA) to set reimburse prices based on the clinical value. Budget impact is weighted more in the decision making process, especially in the second-generation NHI era. However a price mark-up design (up to 10% if meets good quality local cost-effectiveness analysis criteria) has been introduced and it encouraged the development of the local capacity to conduct proper cost-effectiveness analysis. The following effects are observed: the willingness to invest on local studies (epidemiologic distribution, treatment patterns, cost analysis, and modelling), more acceptances on the concept of incremental cost-effectiveness ratio (ICER) or cost-effectiveness from all parties. THE FUTURE OF HEALTH INFORMATION SYSTEM – POTENTIAL USE FOR OBSERVATIONAL RESEARCH Dr Md Khadzir Bin Sheikh Hj Ahmad, Ministry of Health, Malaysia Health Information System gathers encounters of patient at any healthcare facilities. The system of collection is migrating from manual to electronic form and from collecting aggregated to granular data. The direction is to move into Health Data Warehouse that is a trusted source of information, which meet the diverse needs of timely health information provision and management, and acts as a platform for the standardization and integration of health data from a variety of sources. This can be leveraged to better manage the health system, provide surveillance information and in addition provides a valuable source of data for research. The data collected opens up to various cross sectional studies of a patient encounter across various spectrums of illnesses or services.
Among others is the potential to link data marts such as a study of stroke patient attending outpatient department to being admitted as in patient and later being followed up by physiotherapist or speech therapist. Study can also be conducted in time series since the data are census and dynamic in nature. As the system mature and with more data marts linked more potential use can be demonstrated especially in the area of monitoring Key Performance Indexes.
HTA in Malaysia, Past and Present HTA IN MALAYSIA MOVING FORWARD Noormah Mohd Darus, Ministry of Health, Malaysia Health Technology Assessment (HTA) is a multi-disciplinary activity which systematically examines the safety, clinical efficacy, effectiveness, cost, cost- effectiveness, organizational implications, social consequences, legal and ethical considerations of the application of a health technology usually a drug, medical device or clinical/surgical procedure. HTA broadly focuses on two questions: Clinical effectiveness – how do the health outcomes of the technology compare with available treatment alternatives; cost-effectiveness – are these improvements in health outcomes commensurate with the additional costs of the technology? HTA acts as ‘a bridge' between evidence and policy-making. The Health Technology Assessment (HTA) Unit was set up in Malaysia in August 1995 in the Ministry of Health Malaysia and has since grown tremendously in size and resources. To date, fifty-six in-depth assessments have been carried out, and the recommendations of these assessments were subsequently implemented. In addition, approximately 232 rapid assessment reports were produced in response to requests from mainly governmental policy and decision makers. HTA has been able to provide input into formulation of national and Ministry of Health Malaysia policies such as purchasing decisions. HTA also provides a basis for clinical practice guidelines development (seventy-five CPG's produced till date), control of drugs as well as non-drugs and medical devices, matters pertaining to regulation of medical practices, as well as advertisements related to health. In Malaysia, a major challenge is sustainability of the program, to be able to have competent trained personnel, a need to have constant efforts to create awareness on the utilities of HTA so that its full potential can be realized. The scope of services may also need to be expanded to include an early warning system such as the horizon scanning. Malaysia has successfully implemented a health technology program that has had some major impact (to a certain extent) on policy formulation and decision making at various levels in government and private health care delivery systems.
INTRODUCTION TO THE CE THRESHOLD Associate Professor Dr.Sharifa Ezat Wan Puteh, Cost effectiveness analysis (CEA) studies have gained momentum and regarded as one of the most important step, assisting countries and national health programs around the world in determining the most acceptable cost effective strategy. CEA studies are needed beside data on intended interventions' efficacy, effectiveness and safety. The CEA thus looks at the ICER (Incremental cost effectiveness ratio) i.e. the ratio of difference in cost over the differences in outcomes between different strategies; may it be drugs, vaccinations, programs or medical technologies. One of the most common ICER used nowadays is QALY (quality adjusted life years) saved/gained between intended interventions. This threshold level is then compared between different threshold values, such as GDP per capita of the country as advocated by WHO or proposed levels proposed by different related organizations. The presentation will outline a few accepted methods of ICER threshold determinations, its strengths and drawbacks.
DO WE NEED A THRESHOLD IN MALAYSIA? Associate Professor Asrul Akmal Shafie, Universiti Sains Malaysia Incontrast to other economic discipline, health economics usually employs cost-utility analysis in evaluation of alternatives. However, most new treatments are characteristically more expensive but also more effective. This requires external criterion in deciding its cost-effectiveness outside the net monetary benefit framework. The criterion, also called threshold was traditionally set at arbitrary value based on unknown origin or GDP per capita per disability- adjusted life year (DALY). There is a recent drive to seek empirical value of the threshold through monetary valuation of health. Although such empirical efforts can be traced back to other non-health economic studies in estimating value-of-a statistical-life (VSL), many health economists argued that the value should somehow reflect the preferences of the population which is affected by them both as potential recipients of medical services (patients) and as payers of taxes or social insurance contributions. Gains (or avoidance of losses) in (more) healthy lifetime are the typical target of health care and thus empirical value based on preference is of greater relevance in the economics of health care. This presentation would first introduce the rational and application of the threshold in economic evaluation. This is followed by overview of the theoretical framework as well as the strengths and shortfalls of the previous attempts made in Asia and Europe. Finally, the conceptual framework, tools, plans, and preliminary results of a current survey in Japan, Korea, Malaysia, and Thailand the threshold value and potential in Malaysia will be discussed.
VALUE-BASED PRICING Professor Kenneth KC Lee, Sunway Monash University, Malaysia Health care spending is increasingly a global issue especially in those high spending areas such as oncology, rheumatology and gastroenterology due to the introduction of many new innovative medicines. Many authorities have therefore implemented various measures to ensure expenditures are contained or if money has to be spent, it is spent in the most cost-effective manner. The concept of the "value" of a medicine has increasingly replaced the traditional parameters of "efficacy", "safety" and "cost" in assessing a new therapeutic agent. Value is now measured as "the health outcomes achieved per dollar spent" to ensure every dollar spent on health care is based on sound evidence and hence as a result, achieve a maximum return and a most favourable outcome. It is expected that new pricing strategies based on the value of a medicine will bring about a paradigm shift in the health care arena by becoming the corner stone for price determination in many jurisdictions. They are however relatively new concepts in most parts of Asia. It is hoped that the 20min presentation on "Value-based pricing" would throw some light to the future direction in health care financing in this part of the world. MULTI-CRITERIA DECISION ANALYSIS (MCDA) AND OTHER NEW IDEAS Dr. Soraya Azmi, Azmi Burhani Consulting Although the use of pharmacoeconomics and outcomes research as part of the formal decision making process is still evolving and new to Malaysia, this type of research has been around for many years beginning since the 1990s. The sub-categories of research that make up the field are many; ranging from patient reported outcomes (PROs) to decision analysis and modelling to cost-effectiveness and cost-utility analysis. Challenges faced by researchers and decision-makers constantly push the research boundaries to expand to greater breadth and depth with new thinking being applied. Internationally, among the newer issues and methods being discussed are personalized medicine and network meta-analysis, how to measure PRO in children and the use of electronic PRO instruments. One of the interesting recent debates has been about the use of multi-criteria decision analysis (MCDA), which aims to move the conversation beyond cost-effectiveness analysis and incremental cost effectiveness ratios (ICERs), to include other concerns decision-makers may have.
This is an example of how this field of research is being used to further improve the ability to make informed and transparent decisions. The debate also illustrates that one size may not fit all.
COST EFFECTIVENESS VS. COST REDUCTION: AN AUSTRALIAN CASE STUDY Professor Shu Chuen Li, Newcastle University, Australia The presentation will discuss the theoretical argument as whether the implementation of economic evaluation is a strategy to promote cost-effectiveness in health care delivery or a cost reduction measure in disguise. The presentation will examine the process of applying economic evaluation in drug reimbursement decision making and various methods used to promote cost-effective use of drug listed in the Pharmaceutical Benefits Scheme. Finally, a case of how incremental cost-effectiveness ratio can be used to negotiate a reduced acquisition price for a pharmaceutical product for the Pharmaceutical Benefits Scheme is presented.
COST EFFECTIVENESS OF TREATING TO TARGETS WITH BIOLOGICS IN IMIDS Dr Carol Bao, AbbVie , USA Treat To Target, or T2T, is an international initiative to define RAtreatment targets and recommendations to measure disease severity and encourage earlier diagnosis and optimize treatment. While this guidance is gaining acceptance in clinical practice, the economic implications of such practice remain to be fully ascertained. In this presentation, the cost-effectiveness of three T2 strategies for achieving and maintaining remission among early RA patients is evaluated from German perspective. The treatment strategies are: (A) first-line adalimumab (ADA) + methotrexate (MTX); (B) first-line MTX monotherapy, followed by a hybrid approach with ADA + MTX for patients with high disease activity and one DMARD + MTX for patients with low or moderate disease activity after MTX failure; and (C) (current German treatment sequence): ADA + MTX after 2 conventional DMARDs. Both direct and indirect costs are assessed and utility is mapped based on disease severity measured by the Disease Activity Score (DAS) 28. The assessment shows strategies A and B to be cost effective compared with the current German sequence and the indirect costs savings are found to be critical in achieving cost effectiveness with earlier treatment. THE CHALLENGE FOR PUBLIC HEALTH: PROVIDING UNIVERSAL COVERAGE AND COST-EFFECTIVE TREATMENT Dr Feisul Idzwan Mustapha, Ministry of Health, Malaysia The prevalence of non-communicable diseases (NCDs) and NCD risk factors in Malaysia have risen substantially in the last two decades. This has resulted in significant pressure to the public health systems in providing appropriate and quality care to patients partly due to the shift from an acute care model to a more chronic care model as well as the existing separation of the public and private healthcare services in Malaysia. No country in the world has the answer on how best to provide universal coverage and cost effective treatment especially for NCDs. Even with the best treatment available, patients and their families play a major role in determining how well their disease is controlled and thus reducing the risk of complications and premature deaths. There is now a global monitoring framework for the prevention and control of NCDs with 25 indicators and 9 voluntary global targets which forms part of the Global Action Plan for the Prevention and Control of NCDs, adopted at the 66th World Health Assembly in May 2013. The World Health Organization has provided a menu of cost effective interventions and universal health coverage is pivotal in this endeavour. WHAT ARE THE COMPONENTS NEEDED TO CONDUCT PHARMACOECONOMICS RESEARCH? Adrian Goh, Azmi Burhani Consulting This presentation will describe the types of resources required to perform pharmacoeconomic analyses. It will touch upon the importance of the availability of local data and briefly discuss the options available to researchers in situations where such data is not readily available. DATA AVAILABILITY FOR PHARMACOECONOMICS RESEARCH Professor Dato' Dr Syed Mohamed Aljunid Allresearch agendas including pharmacoeconomics turn data from various sources into valuable information for decision-making. While the important of timely, accurate and reliable data is an important asset of any health system, getting access into such data is a major problem in developing countries.
Pharmacoeconomics research requires at least two types of data: costing data on certain interventions and outcome data to reflect effectiveness of such interventions. There a number of important reasons why these two sets of data are very scarce in less developed countries. Firstly, most health systems of developing countries do not invest enough resources to collate routinely data on cost and outcome. Secondly, lack of trained personnel with adequate knowledge and skill to plan and implement health management information system where data can be systematically collected. Thirdly, there is inadequate policy to support the concept of data sharing among major players in research and development. Academic staff in universities and higher learning institutions that have the technical capacity to use these data many a times faced bureaucratic obstacles to access data generated in government agencies even though the data was collected using fund from tax payers. It might also be true that sometimes certain data and information was protected from public access to cover-up corrupt practice, unprofessional conduct and provision of substandard care. Systematic transformation of the national health system is required if we are serious in encouraging the use of evidence to support decision-making. For the start, health policy makers in developing countries should embark on an open-door policy to facilitate data sharing among researchers in different sectors.
HOW TAIWAN BUILT CAPACITY TO CONDUCT HTA ASSESSMENTS Dr Jasmine Raoh-Fang Pwu, Centre for Drug Evaluation, Taiwan Capacity building is one of the most important issues when building up a Health Technology Assessment (HTA) system. Capacity in this area may be categorized into: clinical effectiveness assessors, economic (include utilization) assessors, system impact assessors, other ethical/legal/social impact (ELSI) experts, and who understands the HTA concept and help integrate the concept into decision-making mechanism. Each function requires variety of training, e.g., basic HTA concepts, basic specialty training (epidemiology, statistics, clinical medicine, economics, etc.), state-of-art assessment methodology (systematic review, meta-analysis, modelling studies, etc.), and ELSI courses. There are no Master or PhD degrees designed for HTA workers in Taiwan's universities, although specific courses can be found. Under these circumstances, we have made today by exploring the following routes: a) attend the decision making meetings whenever possible; b) identify the necessary core abilities and locate and invite proper trainers to provide coursers; c) study the advanced HTA agency reports, especially their integration with decision making processes; d) hold workshops/symposium to promote HTA and hear from all parties. THE RELEVANCE OF HEALTH ECONOMICS AND OUTCOMES IN CLINICAL PRACTICE Dr. Sunita Bavanandan, Ministry of Health, Malaysia Theincreasing influence of Evidence-based Medicine and Health Technology Assessment in policy-makers'decisions, clinical practice guidelines, and local management decisions may sometimes lead to the misperception that clinicians have lost their clinical freedom and play a secondary role in therapeutic decision-making. However, there is a need to reconcile the doctor's duty of responsibility to the individual patient to provide the most effective or best available alternative, regardless of cost, with the same doctor's population-health ethic of efficiency, based on providing the population with the best option according to limited available resources. This lecture will use examples taken from literature on diabetes, hyperlipidemia and chronic kidney disease to explore how clinicians may use the results of economic evaluations in their daily clinical practice, making decisions about cost-effectiveness on a case- by-case basis, and addressing both the patient's and society's needs. Through these examples, we can see the relevance of Health Economics in clinical practice 1. to help prioritize interventions 2. to identify target sub-populations for whom technology may be particularly cost-effective, thus facilitating individualised therapy 3. to identify factors with great impact on cost-effectiveness results - these can then be modified by clinicians for more efficient use of resources.
HEALTH TECHNOLOGY APPROACHES AND FIT FOR PURPOSE IN DEVELOPING HEALTH CARE SYSTEMS Christoph Glaetzer, Janssen The use of concept of health economics (HE) and Health technology assessments (HTA) to determine the value of treatment has been a cornerstone in coverage decisions in many countries with reimbursed healthcare system. There are two main approaches in these, the use of clinical effectiveness as primary decision criterion and/or the use of cost effectiveness implemented to address specific question in the respective market. Both are aimed to improve system efficiency and health outcomes as a whole under the umbrella of healthcare coverage. They represent however two different "schools of thought" that are different in methodology and the role in assisting decision making and therefore sometimes leading to similar and sometimes to different outcomes on coverage decisions. To adopt either approach in countries where the healthcare coverage is under development needs all-inclusive consideration for factors shown below. To understand the areas intended outcome to be improved and achieved is crucial before considering any model. Different approaches will provide different outcomes thus it must be "fit for purpose". Requirement in evidence and technical expertise for any model needs to be considered to be "feasible and customary" in a country contextual environment.The talk will briefly recapture the main aspects and differences of both models and highlight the relevant aspects and considerations in evaluating usefulness in emerging healthcare systems.
INDUSTRYS ROLE - JOINING TOGETHER TO STRENGTHEN PHARMACOECONOMICS RESEARCH IN MALAYSIA Yew Wei Tarng, PHAMA, Malaysia The Healthcare landscape is rapidly changing and is moving in the direction of One Healthcare where access to innovative medicine plays a key role. It is a key strategic component in our National Medicine Policy (DUNas). We agree strongly on the need to promote use of HTA in national frameworks and strengthening PE research. We can collaborate with all relevant stakeholders to ensure we provide technical assistance, technology and knowledge transfers. The increase in demand and cost, coupled with scarcity in resources are key barriers. We need to develop our capability and capacity to ensure we are able to generate local data.Herein lays the opportunity for us to work together and through better policy framework and guidelines we are able to develop and set reputable centres for research. At the moment, the industry has been providing strong supports in Clinical Research and we need to take a step further to align this well with the policy framework and also provide incentives. Finally we need to develop a clear roadmap together with strong collaboration from all stakeholders and sponsors from the government. Our goal is to ensure that we could provide access of innovative medicines to the patients and ensure best patient care and outcomes.
LIST OF ABSTRACT
PODIUM PRESENTATIONS
Quality of Life
Abstracts#

Bring Back Medication: A Study of Patients' Awareness, Cost Saved and Storage Practice in Selayang Hospital.
Clinical Impact of Empirical Antifungal Therapy on the Survival from Infection in Chemotherapy-Induced Febrile Neutropaenic Adult Patients.
Incidence and Causality in Adverse Drug Reaction-Related Admission to Hospital: A Systematic Review.
Perception, Acceptance and Tolerability of Patients Taking Innovator versus Generic Escitalopram.
Study on the Clinical Outcome of Pharmacist-Managed Diabetes Patients.
Health Related-Quality of Life (HRQoL) in Type 2 Diabetes Mellitus: A Study in Selangor District Hospitals.
Cost-Effectiveness of Warfarin Medication Therapy Adherence Clinic (WMTAC) Compared to Usual Medical Clinic (UMC) in Kuala Lumpur Hospital.
Cost-Effectiveness of Insulin Glargine for Type 2 Diabetes Mellitus.
Pilot Evaluation of Two Childhood Obesity Prevention Programs in Malaysia.
Cost Analysis of the Extemporaneous Preparation of Folic Acid 1mg/mL Syrup in Sungai Buloh Hospital Out Patient Pharmacy Department with the Use of either Simple Syrup or X-Temp Suspension as a Suspension Vehicle.
Exploring the Willingness to Pay for Voluntary Community-Based Health Insurance in Malaysia.
Measuring Childhood Obesity Based on Three Different Approaches: WHO, CDC and IOTF Criteria.
Pharmacoepidemiology, Health Services Research, Healthcare Utilization and Policy
Abstracts # Title

Glycaemic Control of Diabetic Patients in Pharmacist-Managed Telephonic Insulin Titration.
Antibiotic Use, Expenditure and Outcomes at Kajang Hospital: The Impact of Antibiotic-Medifact Program.
Medication Reconciliation in Hospital Banting Medical Wards: Identifying the Types and Factors Contributing to Medication Discrepancies.
An Audit of the Diabetes Medication Therapy Adherence Clinic (DMTAC) in Serdang Hospital.
Potential Drug-Drug Interaction among Elderly Admitted to Medical Wards of Serdang Hospital: A Prospective Study.
Gentamicin Pharmacokinetics in Neonates: Identification of Factors and Predictors for Local Pharmacokinetic Equations Of HTAR, Klang.
The Incidence of Adverse Effects due to Fluorouracil, Epirubicin and Cyclophosphamide (FEC) Chemotherapy in Breast Cancer Patients at Hospital Tengku Ampuan Rahimah (HTAR), Klang.
Evaluating the Prescribing Dosing Trends of Opioid Substitution Treatment Programme in Private Medical Practitioner Clinics by Calculating the Estimated Average Daily Dose (EADD) of Methadone and Buprenorphine After the Implementation of Psychotropic Permit in Malaysia.
Economic Evaluation of Food Water Borne Disease in Malaysia.
Overview of the Sampling Pattern of Suspected Paracetamol (PCM) Poisoning In Hospital Sungai Buloh (HSB).
Patient's Own Drugs: Profile of Drugs Cost and Wastage Usage of IV NAC in ICU Patient with Renal Insufficiency to Prevent Contrast-Induced Nephropathy Correlation of Phenytoin Level with Rhabdomylosis and Thrombocytopenia in Critically Ill Patients with Hypoalbuminaemia Pending Authorization in Outpatient Pharmacy of Hospital Sungai Buloh Prescribing Pattern of Broad-Spectrum Antibiotics in the Medical Wards of Hospital Sungai Buloh Outcome Status and Duration of Dual Antiplatelet Use Among Post-PCI Patients.
Length of Stay and Prognostic Factors for 30-day Readmission for Post-PCI Patients with Dyslipidaemia, Hypertension and Diabetes.
A Study on Drug Information Utilization and Accessibility at Kajang Hospital.
Incidence of Hypersensitivity Reaction in HIV-Infected Patient Starting NNRTI-Containing Regime: A Cross Sectional Study on HTAR Patients.
A Study of Patient's Satisfaction & Adherence to Ministry of Health Malaysia (MOH) Guidelines on Dispensing Methadone in Agensi Anti Dadah Kebangsaan (AADK) Hulu Langat, Selangor.
To Evaluate the Effectiveness of Medication Therapy Adherence Clinic (MTAC) in Psoriasis Patients in Selayang Hospital.
A Retrospective Analysis of Medication Possession Ratio in Predicting Virologic Outcomes among HIV Infected Adults on Second Line Antiretroviral Therapy in Sungai Buloh Hospital (HSB).
Quality of Life
A Study of Cephalosporin Use in Female Medical Ward in Hospital Banting.
Unauthorized Prescription in Outpatient Pharmacy Hospital Ampang.
Systematic Review of Economic Evaluation Models used for Cost-effectiveness Assessments of Health Promotion Programs for Childhood Determination of Cost-Effectiveness Threshold for Malaysia.
Economic Evaluation of Enhanced Asthma Management: A Systematic Review.
Health-Related Quality of Life (HRQOL) among Mothers with Thalassemia Children in Malaysia.
Drug Utilization and Cost of Antipsychotic in the Treatment of Schizophrenia at Kajang Hospital.
Economic Evaluation of Zoonotic Disease in Malaysia.
Factors Affecting Job Satisfaction amongst Public Sector Hospital Pharmacists Working in Selangor, Malaysia.
Pregnancy Outcomes in Insulin Treated Gestational Diabetes Mellitus Patient from Different Ethnicity in Hospital Sungai Buloh.
Tenofovir-Induced Renal Impairment in HIV-Infected Patients.
Evaluation of Continuous Infusion Vancomycin in Hospital Sungai Buloh: Retrospective Observational, Single-Centred Cohort Study.
Knowledge, Attitudes and Practice toward DRG System among Turkish Health Care Providers.
Relationship between Beliefs, Adherence and Quality of Life (QOL) Among Chronic Kidney Disease (CKD) Patients on Haemodialysis in Penang General Hospital.
Validation of EQ-5D-5L in the General Population of Malaysia.
Cost Effectiveness Study of Pantoprazole and Esomeprazole in the Treatment of Upper Gastrointestinal Bleeding at Hospital Taiping Comparing the Treatment Outcome for Anthral Gastritis and Non Ulcer Dyspepsia Using Pantoprazole versus Esomeprazole in an Outpatient Setting in Hospital Tengku Ampuan Rahimah (HTAR).
The Outcome of Home Medication Review Programme in Empowering Psychiatric Patients at HTAR Klang.
Clinical Outcomes of Premature Infants Receiving Total Parenteral Nutrition (TPN) Solution with Amino Acid Concentration of 2.5%W/V Versus 2.8%W/V in NICU, Hospital Selayang.
A Survey to Evaluate the Techniques of Medication Administration through Enteral Feeding Catheters (EFC) for Adult Patients in Nursing Practice in Serdang Hospital.
Structured Intervention for Acute Low Back Pain in Primary Care: A Randomised Control Trial Study.
Cost and Cost-effectiveness
Assessment of Healthcare Professionals' Knowledge on Interactions of Warfarin with Drugs, Supplements and Nutrients in Hospital Ampang, Coagulation Factor Concentrates Usage in Malaysia 2012.
Survey on Awareness of High Alert Medications among Doctors, Pharmacists and Nurses in Hospital Sungai Buloh (HSgB).
A Study on the Awareness and Compliance towards the After Office Hour Value Added Service in Hospital Sungai Buloh.
Prescriptions Study to Assess Drug Utilization Pattern and Estimate Direct Drug Cost: A Review of Existing Literature.
The Epidemiologic and Economic Impact of a Quadrivalent Human Papillomavirus Vaccine (6/11/16/18) in Malaysia's Gender Neutral Setting.
Formulary List Review of Sulphonylureas Using Medicines Scoring System (MedSS): Any Cost Savings Offered? A Survey on Self-Medication by Caregivers/Parents of Paediatric Patients in Hospital Tengku Ampuan Rahimah.
Health Services Research, Healthcare Utilization and Policy
Primary Care Setting in Klang: Are Antibiotics Usage Justified? A Survey on Knowledge of Oral Extemporaneous Preparations Amongst Pharmacist and Pharmacist's Assistants in Hospital Sungai Buloh.
The Effects of Pharmacist Patient Education on the Occurrence of Return Medications in an Inpatient Setting.
A Survey on the Performance of Clinical Pharmacists by Medical Providers in Hospital Sungai Buloh.
Review of Off Label Prescribing in Paediatric Patients in Hospital Sungai Buloh: A Prospective Study.
The State of Health Economics Research in Malaysia.
Analysis of Medication Returned to Hospital Outpatient Pharmacy: A Qualitative focus Group Study.
A Study to Evaluate Patient's Knowledge and Satisfaction to the Topical Treatment in Chronic Skin Disease.
Study on the Use of the Intravenous Fish Oil Lipid Emulsion in Premature Neonates Requiring Parenteral Nutrition. judicious use of antibiotics by prescribers in nonspecific upper respiratory THE CONTENTS OF THESE ABSTRACTS MAY NOT REFLECT THE
tract infection (URTI). Methods: A total of 2,359 prescriptions with a
VIEWS OF, AND MAY NOT BE ENDORSED BY THE SOCIETY. THIS
diagnosis of infection from 24 – 28 June 2013 were collected from 10 DOCUMENT IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY
government clinics. Prescriptions for nonspecific URTI were then randomly selected to review the appropriateness of antibiotic use based on the McIssac Score, choice of antibiotics, and dosing. Results: The top three
diagnoses were nonspecific URTI (62.2%), soft tissue injury (STI) (9.1%) THE INCIDENCE OF ADVERSE EFFECTS DUE TO FLUOROURACIL,
and urinary tract infection (UTI) (9.5%). The antibiotic prescribing rate for EPIRUBICIN AND CYCLOPHOSPHAMIDE (FEC) CHEMOTHERAPY IN
nonspecific URTI was 27%, STI 85%, and UTI 83.9%. The most commonly BREAST CANCER PATIENTS AT HOSPITAL TENGKU AMPUAN
prescribed antibiotics were amoxicillin (52.7%) for URTI, cloxacillin (89.1%) RAHIMAH (HTAR), KLANG.
for STI, and cephalexin (52.2%) for UTI. The most preferred choice of Norima MN1, Mazni MTN1, Yeow WJ1, Chong YT1, Yeoh JJJ1 antibiotic for nonspecific URTI and UTI, deviates from local guidelines i.e.
Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1 phenoxymethylpenicillin for URTI and trimethoprim for UTI. For non-specific Objectives: This study aimed to determine the incidence of adverse effects
URTI, 84.1% of patients prescribed with antibiotics had McIsaac score of <2 due to FEC chemotherapy in HTAR Klang. Methods: Sampling population
(antibiotic is likely to be not necessary). Also, 95.2% of patients were first- of 20 patients were obtained with the inclusion criteria of female patients visit patients – indicating that the antibiotic delay strategy is not popular more than 18 years old given at least one cycle of FEC regimen in hospital among prescribers. Conclusions: This study revealed the choice of
in the year 2012. All haematological and non-haematological adverse effects antibiotic for both URTI and UTI were inconsistent with local guidelines and and its management were recorded. Results: The incidences of
that there was inappropriate prescribing in URTI. Besides adhering to haematological adverse events were neutropenia (20%), neutropaenic prescribing guidelines, healthcare providers could have a collaborative effort sepsis (15%) and anaemia (5%) while the incidences of non-haematological to improve antibiotic prescribing.
adverse events were nausea and vomiting (20%), alopecia (20%), extravasation (5%), cough (5%) and headache (5%). Dose delay and dose reduction due to adverse events were observed in 30% and 15% of patients A STUDY OF CEPHALOSPORIN USE IN FEMALE MEDICAL WARD IN
respectively. Secondary prophylaxis with GCSF and antibiotic were used in 8.3% and 1.6% of the total cycle delivered for management of neutropenia Te CY1, Azwa A1, Norhamiza H1, Nurul Izzaty A1 or neutropenia sepsis. Supportive care such as anti-emetics and scalp Department of Pharmacy, Banting Hospital1 cooling were given to patients who experienced non-haematological Introduction: Bacterial infections continue to present a major threat to
adverse events to improve quality of life. Conclusions: Adverse events
human health. Nowadays there are more than 100 of antimicrobials in the observed in this study were generally in line with published data and market. The proper selection antimicrobial therapy is based on several literature. A prospective study is recommended in near future to add more factors. The cephalosporin are the largest and most diverse family of beta- information on the incidence and clinical management of FEC related lactam antibiotics. Inappropriate use of antimicrobials is a risk factor for the adverse events.
emergence of antibiotic resistant bacteria. Hence, we conducted a study of cephalosporin use in medical ward in Hospital Banting. Objectives: The
objective of the present study was to evaluate the appropriateness use of GLYCAEMIC CONTROL OF DIABETIC PATIENTS IN PHARMACIST-
cephalosporins in female medical wards Hospital Banting in term of MANAGED TELEPHONIC INSULIN TITRATION
indication, dose, frequency and duration of antibiotics. Methods: A cross Ramelan A1, Lin SN1, Woon SM1, Mohd Noh FA1, Wong KM1, Ibrahim NF1 sectional study was done for patients in the female medical ward (ward 3) Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1 who was treated with any of the cephalosporin antibiotics between January Objectives: To compare the reduction of HbA1c between patients who are
and April 2013. National Antibiotic Guideline, Sanford Antibiotic Guide 2000 under pharmacist-managed insulin titration-by-phone program compared to were used to determine the appropriateness. All statistical analyses were standard care and to study the association between the frequencies of performed using SPSS version 17 (SPSS Inc, Chicago, IL) and compared telephone contacts by pharmacists with the reduction in HbA1c. Methods:
using chi-square (X2) tests. Results: The proportion of inappropriate
A retrospective study on diabetic patients under endocrine clinic follow-up in therapy with Cephalosporin was higher in empiric therapy compared with one year between June 2011 and June 2012 in HTAR was conducted.
treatment with 61.4% and 38.6% respectively. More patients receive Patients with uncontrolled type 1 or type 2 diabetes mellitus and whose inappropriate therapy when bacteria investigations were not done (50%) HbA1cis>7% were included. Reduction in HbA1c within a minimum of 12 compared with those whom bacteria growth was proven (13.6%) and no months of referral to the service when compared to baseline was evaluated.
growth was proven (36.3%) by bacteria investigations. There was a Results: A total of 110 patients with 57 patients in the pharmacist-managed
significance association between the type of antibiotic and inappropriate use insulin titration-by-phone group and 55 patients standard care group were of Cephalosporin (p<0.006). The most common antibiotic that has been included in the analysis. Between-group comparison demonstrated a used inappropriately is Ceftriaxone with 45.5%. Conclusions: The use of significant difference in median change in HbA1c favouring pharmacist antibiotics in this study was not fully in line with the compared antibiotics management (0.9% for pharmacist-managed group; 0.1% for standard care, guidelines especially the duration of antimicrobial therapy. More patients p=0.027). Within-group comparisons demonstrated significant correlation receive inappropriate therapy during empirical treatment. Future studies are between frequency of telephone contacts by pharmacists and reduction in needed to promote rationale use of cephalosporin antibiotics in female HbA1c level from baseline (r=0.351, p=0.08) in the pharmacist-managed medical ward in Hospital Banting.
titration-by-phone group. Conclusions: Pharmacist-managed insulin
titration-by-phone service under the DMTAC program resulted in significant improvement in HbA1c levels compared to standard care in patients with BRING BACK MEDICATION: A STUDY OF PATIENTS' AWARENESS,
diabetes mellitus, and the magnitude of reduction in HbA1c correlates with COST SAVED AND STORAGE PRACTICE IN SELAYANG HOSPITAL
the frequency of contacts by pharmacists. Khoo HF1, Ang YJ1, Lim XY1, Cheok KY1, Sabastian SS1, Lim CH1, Geh SW1, Department of Pharmacy, Selayang Hospital1 PRIMARY CARE SETTING IN KLANG: ARE ANTIBIOTICS USAGE
Introduction: "Bring Your Medications" awareness has been introduced to
create patients' awareness to bring along their medications during ward Cheang CYM1, Norharlina S1, Gan KZ1 admission, where medication reconciliation can be done to minimize Pharmacy Unit, Klang District Health Office1 wastage and save cost. However, these medications are no longer assured Objectives: To study the antibiotics prescribing pattern in government
of their quality due to unknown storage conditions. Objectives: This study
primary care clinics in Klang; detailing the type of antibiotics used for the aim to determine the awareness of patients in bringing their medication upon infections treated in primary care. This study further investigates the ward admission, cost saved and to survey on patients' general storage practice of medication. Methods: This was a prospective, non-interventional
Objectives: To study the effect of empirical antifungal therapy on the
study. 170 of patients admitted into Selayang Hospital's Nephrology and survival from infection in persistent febrile, neutropaenic patients treated for Medical wards in 30 days who brought along their medications were haematological malignancies. Methods: This study was conducted from recruited. CP1 Medication History Assessment Forms were used to assess April to December 2012 and from January to March 2013 in PPUKM. Adult and record patients' previous medications. Interview sessions were (>18 years old) patients who were hospitalised to receive chemotherapy for conducted by pharmacists using an adapted version of a previously haematological malignancies and developed neutropenia with absolute validated questionnaire to survey patients' storage practice of medication.
neutrophil count ≤ 1.0 x 109/L for at least 72 hours, had persistent fever Upon discharge, the number of pills saved was estimated according to ?380C with unknown source, had received empirical antibiotic for at least 72 patients' balance medication from previous supply which can still be used.
hours and were given empirical antifungal therapy were included in the The total cost saved was estimated with reference to the hospital's cost list.
study. Haematopoietic stem cell transplant patients were excluded. Results:
Patients' awareness was expressed in terms of percentage of patients who 38 patients were enrolled in this study. 31 patients (81.6%) responded to brought back medications upon admission. Results: 53% of patients
empirical antifungal therapy while 7 patients (18.4%) did not respond.
brought back their medications on admission. There is an increase of 40.3% Survival at 30 days after the last dose of the antifungal drug was 92.1%.
from the 12.7% achieved from an earlier study in 2011. This may be There was only 1 case of IFI-attributable mortality during the therapy. Older attributed to the continuous "Bring Back Medication" awareness promoted patients (mean age 63 ± 9 years) had poorer response compared to younger hospital wide. A total of 20,450 pills with a total cost of RM 4,647.82 were patients (42 ± 15 years; p=0.001) (r=0.467; p=0.002). Patients who did not saved. 77.4% of patients brought their medications in the original packaging.
respond to empirical antifungal were associated significantly with prolonged 62.3% of the patients kept their medications in drawers/cabinets, 28.5% in neutropaenic period (19 ± 4.5 days versus 10 ± 7 days; p=0.001) (r=0.508; open area, 4.2% in the fridge, and 5.0% in other conditions e.g. in car and p=0.001) and severe neutropenia (ANC 0.17 ± 0.21 x 109/L versus 0.57 ± bags. Of the 239 patients interviewed, 28% were aware of and checked the 0.31 x109/L; p=0.002) (r=-0.478; p=0.001). Amphotericin B (42.9%) was the expiry dates of medications, 60.3% were aware of but did not check the most common empirically prescribed antifungal agent. However, almost half expiry dates and only 11.7% were not aware of the expiry dates.
of the patient population treated with amphotericin B (11/38, 28.9%) Conclusions: Patients' awareness of bringing back their medications upon
experienced drug-related side effects especially hepatic dysfunction, renal admission has increased since 2011. A total cost of RM 4,647.82 was saved.
insufficiency and hypokalaemia. All patients recovered from the side effects Majority stored their medications in appropriate conditions but did not check when they were switched from amphotericin B to newer antifungal drugs.
for expiry dates. Continuous promotion for patients to bring back medications need to be carry out to further increase the awareness to a target of 80% as agreed by the hospital administrative level.
COAGULATION FACTOR CONCENTRATES USAGE IN MALAYSIA 2012
Nursabrina AA1, Gan CB1, Nasreen N1, Heng SC1, Lim YS1 Department of Pharmacy, Ampang Hospital1 ASSESSMENT OF HEALTHCARE PROFESSIONALS' KNOWLEDGE ON
Introduction: In Malaysia, the number of patient diagnosed with haemophilia
INTERACTIONS OF WARFARIN WITH DRUGS, SUPPLEMENTS AND
is increasing throughout the years in Malaysia from 1,034 patients in year NUTRIENTS IN HOSPITAL AMPANG, MALAYSIA.
2006 to 1,188 patients in year 2010. Thus, so is the usage of clotting factor Lo SH1, Md Shukor NZA1, Md Yunus YA1, Kong SS1, Foo WF1, Lee WLW1, concentrates from 2006 to 2010; 10,250,000IU to 14,810,000IU for factor VIII and 5,000,000IU to 8,590,000IU for factor IX. Objectives: To estimate
Department of Pharmacy, Ampang Hospital1 the cost and budget required for the coming year from usage of coagulation Introduction: Warfarin is a highly effective anticoagulant in the
factor concentrated in year 2012. Methods: A cross sectional study was
management of thromboembolic disease. Anticoagulants are identified by carried out by distributing a data collection form to a total of 132 government the National Patient Safety Agency (NPSA) as one of four high risk hospitals listed on Kementerian Kesihatan Malaysia (KKM) from 1st medications that require multidisciplinary interventions to ensure its safe December 2012 until 30th March 2013. Results: From this study, each
use. Besides, frequent drug and food interactions limit warfarin's use due to hospital did use different brand and types of coagulation factor potential fluctuations of INR. Objectives: This study aims to evaluate
concentrates, mostly depending on patient treatment requirement and healthcare professionals' knowledge towards interaction of warfarin with availability. The highest usage is factor VIII brand Alleviate® (35534 vials), drugs, supplements and dietary vitamin K in Hospital Ampang. Methods: and least used are combination clotting factor concentrates brand Feiba® Healthcare professionals were surveyed using a validated questionnaire (111 vials). Conclusions: A total of RM 28,054,079.85 was estimated as
that are comprised of Part I: Drug-Supplement Interactions with Oral budget required for clotting factor concentrates in 2013.
Warfarin and Part II: Food Interactions with Oral Warfarin. The study sample included 127 healthcare professionals consisting of 82 physicians, 40 ABSTRACT #9 (WITHDRAWN) pharmacists and 5 dieticians based on proportional stratified sampling. This was a prospective study using a survey that took three months to complete.
Results: The mean scores (±SD) on the overall test were 60.17±1.3 for
dieticians, 55.43±10.1 for pharmacists and 44.6 ±8.1 for physicians, with UNAUTHORIZED PRESCRIPTION IN OUTPATIENT PHARMACY
100 being the perfect score. Test results revealed that pharmacists scored significantly highest in Part I drug- supplement interactions with 45.62±13.3.
Sithambaranathan C1, Zakiah BA1, Erliana NR1, Lam WY1, Loh YF1, For Part II food interactions, dieticians scored significantly highest with Jamaliah J1, Haiza MMN1 Department of Pharmacy, Ampang Hospital1 mean score of 84.5±1.1 (p<0.05). Physicians from Haematology Introduction: Outpatient Department (OPD) provides optimal pharmaceutical
Department scored significantly higher than physicians from the other cares to the patient. Since OPD is frequently a patient's first experience with departments for the Part I and overall scores (p<0.05). Besides, healthcare the hospital, achieving waiting time less than 30 minutes has been set as professionals were able to correctly identify Vitamin K rich food, scoring an one of the Key Performance Index (KPI) by Ministry of Health Malaysia in average of 86-100 %. Conclusions: Pharmacists and dieticians scored well
order to provide positive experience and satisfaction among patients.
in their respective areas of expertise, which is the drug and food interactions Unauthorized prescription is one of the examples of incomplete prescription respectively, but did not perform so well in other areas. Physicians exhibited which could contribute to increase in waiting time. Objectives: This study
lack of knowledge in drug-nutrient interactions of warfarin. Thus, additional helps to identify the extent to which unauthorized prescription contributes to training and collaboration between specialties are vital to ensure optimal total waiting time more than 30 minutes in OPD Hospital Ampang. Methods:
A cross sectional study was carried out by using a data collection form which was place at the dispensing counter of OPD Hospital Ampang and generated data from e-His from 25th February 2013 until 30th June 2013.
CLINICAL IMPACT OF EMPIRICAL ANTIFUNGAL THERAPY ON THE
Results: Throughout 18 weeks of this study, an average processing time
SURVIVAL FROM INFECTION IN CHEMOTHERAPY-INDUCED FEBRILE
obtained was 14.8 minutes. It was found that, 2,467 (3.85%) out of total NEUTROPAENIC ADULT PATIENTS
64,061 prescriptions had waiting time more than 30 minutes. Out of this, 136 Chong SC1, Thomas PT2, Birinder K3 (5.4%) over total of 2,498 unauthorized prescriptions took more than 30 Department of Pharmacy, Ampang Hospital1; Faculty of Pharmacy, National minutes to be dispensed meanwhile 240 (9.61%) unauthorized prescriptions University of Malaysia2; Department of Pharmacy, UKM Medical Centre3 were authorized between 15 to 30 minutes. Conclusions: At the end of this
Introduction: Invasive fungal infections (IFIs) are severe complications in
study, it was found that unauthorized prescription does increased the total neutropaenic cancer patients. They often receive empirical antifungal waiting time in OPD. Although the result obtained showed that unauthorized therapy when fever does not resolve after 4-7 days of broad-spectrum prescription only causes a small percentage in affecting waiting time more antibiotics. In 40-50% of febrile neutropaenic patients received empirical than 30 minutes, a future research could be conducted to further identify antifungal therapy, the incidence of IFI is only 10-15%. By taking into factors which could possibly lead to an increase in waiting time.
consideration of high antifungal drug costs and the risk of unnecessary initiation of empirical antifungal drugs, is the empirical approach really beneficial to those persistent febrile, neutropaenic patients? Changing epidemiology of IFIs and availability of new, effective and safer antifungal drugs prompt the need to re-evaluate the older paradigms for this strategy.
preventing 100% of overweight respondents becoming obese. Attitude COST-EFFECTIVENESS OF WARFARIN MEDICATION THERAPY
score was higher among SS's cohort but practice score was higher among ADHERENCE CLINIC (WMTAC) COMPARED TO USUAL MEDICAL
BB's cohort. BB had a lower average cost per participants and more cost- CLINIC (UMC) IN KUALA LUMPUR HOSPITAL
effective compared to SS. Conclusions: In summary, BB was more
Subramaniam T1, Shafie AA1, Mohamed Azmi AH1, Jeyaindran S2 effective and cost-effective than SS in reducing the percentage of obese Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, cohort and improving the level of knowledge, and practice after 6 months.
Malaysia1; Department of General Medicine, Kuala Lumpur Hospital, Objectives: Structured anticoagulation management clinic is recommended
SYSTEMATIC REVIEW OF ECONOMIC EVALUATION MODELS USED
to manage warfarinized atrial fibrillation (AF) patient. In Malaysia, the FOR COST-EFFECTIVENESS ASSESSMENTS OF HEALTH
service is recently introduced as pharmacist managed Warfarin Medication PROMOTION PROGRAMS FOR CHILDHOOD OBESITY
Therapy Adherence Clinic (WMTAC). The primary objective of this study Lim CC1, Shafie AA1, Ahmad Hassali MA1, Baba Y2, Hamzah F2 was to assess the cost-effectiveness of WMTAC compared to the usual School of Pharmaceutical Sciences, Universiti Sains Malaysia1; MySihat2 medical clinic (UMC) from the provider perspective in Kuala Lumpur Introduction: Childhood obesity leads to obesity and cardiovascular
Hospital, Malaysia. Methods: This was a six month retrospective cohort
diseases. Long term evaluation of health promotion program for childhood study of the anticoagulation management models. A random number obesity is difficult to be conducted, costly and time consuming. This review generator was used to recruit patients. The mean total cost of clinic includes explores the current methods utilized to evaluate health promotion program the cost of monitoring, clinic consultation, drug and adverse event. As for for childhood obesity. Objectives: To evaluate and compare economic
effectiveness, the mean proportions of time within target range were used.
evaluation models used for cost-effectiveness assessments of health Incremental cost-effectiveness ratios (ICERs) were calculated and promotion programs for childhood obesity. Methods: The search was
uncertainty was explored by one-way sensitivity analysis and bootstrapping.
limited to studies published in English language, covering literature until Results: A total of 92 patients were sampled from each clinic where the 6
January 2013. First stage screening was done at title-keyword-abstract month cost (SD) was MYR 537.38 (352.39) for the UMC and MYR 352.62 level. In second stage screening, full text of included studies were obtained (180.21) for WMTAC, which was significantly higher (p<0.001). The average and screened for true full economic evaluation. Results: The literature
cost (SD) per patient per month attending UMC was MYR 73.39 (21.07), search identified thirteen studies used to model health promotion program whereas the WMTAC was MYR 54.61 (18.32). Proportions of TTR were also for childhood obesity. Currently, there are only four variations of models significantly higher in the WMTAC patients than in UMC (66.1% vs. 48.3%; used for economic evaluation of health promotion programs for childhood p<0.001). WMTAC dominated over the UMC, with a high probability of cost obesity. All modelling methods utilized transition probabilities to model effectiveness. The study was not powered to detect adverse events.
lifetime progression of childhood obesity. The current models were able to Conclusions: WMTAC produced better anticoagulation control, lower
relate cost averted (DALYs) and benefit gained (QALYs) with intervention hospitalization rate and more cost-effective for managing warfarinized atrial but health states chosen were based on demographic groups and not fibrillation (AF) patient than UMC. These findings will impact local warfarin clinical events in the development of cardiovascular diseases model for patient management services.
childhood obesity. Conclusions: It is essential, that improvement in the
model for childhood obesity based on clinical events, that relates to cardiovascular diseases is explored based on the perspectives of health COST-EFFECTIVENESS OF INSULIN GLARGINE FOR TYPE 2
policy decision makers.
Azmi Burhani Consulting1 DETERMINATION OF COST-EFFECTIVENESS THRESHOLD FOR
Objectives: To assess the cost-effectiveness of insulin glargine (Lantus)
compared to neutral protamine hagedorn insulin (NPHI) in Malaysian adult Lim YW1, Shafie AA1, Chua GN1, Hassali MA1 type 2 Diabetes Mellitus (T2DM) patients who are uncontrolled with oral anti- School of Pharmaceutical Sciences, Universiti Sains Malaysia1 diabetics (OADs). Methods: A Markov decision-analytical model was
Objectives: Decision on the cost-effectiveness (CE) of healthcare
developed using TreeAge Pro 2013 to simulate the cost and effects of technologies usually creates an argument especially when alternatives are treatment with Lantus and NPH for T2DM patients uncontrolled on OADs.
more expensive but more effective. In this situation, external criterion in the Based on transition rate probabilities, the patients could end each yearly form of CE threshold or willingness-to-pay for a quality-adjusted life-year cycle in one of nine health states, including alive, dead or one of the 7 (WTP/QALY) needs to be applied to decide on its CE. Nevertheless, the lack complications of DM. Model inputs were derived from local data and of empirical and well-accepted CE threshold in Malaysia is recognized as supplemented by published information from various sources. The base one of the most important barriers in using health technology assessment in case model was analysed over 5 years with all cost and outcomes policy decisions. This study is mainly to determine the monetary values of a discounted at 3% per year to the analysis reference year of 2013. The QALY across Malaysian population. Methods: A cross-sectional, contingent
analysis was performed from the perspective of the Ministry of Health.
valuation study was conducted using stratified multistage cluster random Results: The base case analysis showed that over 5 years, treatment with
sampling technique in Penang, Kedah, Selangor and Kuala Lumpur.
NPHI would cost RM 6,949 to gain 3.514 QALY as compared to RM 12,521 Respondents were asked for the socioeconomic background, quality of life for 3.646 QALY gained with Lantus. The incremental cost effectiveness ratio and their WTP for a hypothetical scenario (treatment, extended life in (ICER) for Lantus compared to NPHI was RM 42,002 per QALY. Results of terminal illness and lifesaving situations with three severities and two QALY one-way and scenario sensitivity analyses did not substantially differ from gained levels – 0.2 QALY and 0.4 QALY) using pre-designed the base case analysis. Conclusions: Lantus would be a cost-effective
questionnaires. Interval model analysis was applied to determine the CE treatment compared to NPHI for T2DM patients uncontrolled with OADs, threshold. Results: One thousand thirteen respondents aged between
based on the WHO cost-effectiveness threshold of between one and three 20–60 years old who can understand either English or Malay language were times GDP per capita.
interviewed face-to-face. The mean value of CE threshold was determined at the range of MYR 19,919.00 to MYR 28,495.00 ( USD 6,200 to USD 8,900). Conclusions: By comparing our results to Malaysian GDP per
PILOT EVALUATION OF TWO CHILDHOOD OBESITY PREVENTION
capita in the year 2011; MYR 50,560 ( USD 15,800), we noted that mean PROGRAMS IN MALAYSIA
WTP/QALY ranged between 0.39–0.56 times of GDP per capita.
Lim CC1, Shafie AA1, Ahmad Hassali MA1, Baba Y2, Hamzah F2 School of Pharmaceutical Sciences, Universiti Sains Malaysia1; MySihat2 Introduction: Programs that prevent childhood obesity are vital to reduce
EVALUATING THE PRESCRIBING DOSING TRENDS OF OPIOID
obese adult and CVD problem. Therefore, programs' effectiveness must be SUBSTITUTION TREATMENT PROGRAMME IN PRIVATE MEDICAL
evaluated to optimize resources for childhood obesity prevention programs.
PRACTITIONER CLINICS BY CALCULATING THE ESTIMATED
Objectives: To assess intermediate cost-effectiveness of childhood obesity
AVERAGE DAILY DOSE (EADD) OF METHADONE AND
health promotion program. Methods: This quasi-experimental study
BUPRENORPHINE AFTER THE IMPLEMENTATION OF
compared intermediate outcomes between NGOs, Sahabat Sihat (SS) and PSYCHOTROPIC PERMIT IN MALAYSIA
Be Best (BB), childhood obesity health promotion programs within a 6 Dzafarullah D1, Mohd Bokhari MN1, Bahirah B1, Mohd Nazri MD2 months period. Data on health related quality of Life (EQ-5D and EQ-VAS), Pharmacy Enforcement, Ministry of Health, Malaysia1; Pharmacy Practice & KAP questionnaire and biomedical data were obtained from health booklets Development, Ministry of Health, Malaysia2 prepared by MySihat for health promotion programs for childhood obesity.
Objectives: The psychotropic permit to purchase and use methadone and
Data on cost was obtained from expenditure records of the respective health buprenorphine was introduced in 2011 to promote rational prescribing to promotion programs. The association between EQ-5D, EQ-VAS, knowledge patients under the opioid substitution treatment program in private medical score, attitude score, practice score and biomedical was explored using practitioner clinics in Malaysia. This study aims to evaluate the prescribing Mann-Whitney and Friedman test. Descriptive statistics were utilized in the dosing trends and to compare them with the average daily dose analysis of the cost results. Results: BB and SS were successful in
recommended by the Ministry of Health Clinical Guidelines Practice (MOHCGP) for methadone and buprenorphine. Methods: The quota and
the number of patients estimated from the psychotropic permits that had been issued from 2011 to 2013 were studied. A formula to calculate the ANTIBIOTIC USE, EXPENDITURE AND OUTCOMES AT KAJANG
estimated average daily dose (EADD) of buprenorphine and methadone HOSPITAL: THE IMPACT OF ANTIBIOTIC-MEDIFACT PROGRAM
was derived as follows: Sarah Diyana S1, Farizan AG1, Zaiton K1, Lim LL1, Ling TC1, Ramadas A1, "Estimated Average = Estimated Quota (mg)/Daily Dose (mg) Yee CP1, Zarif Naim A1 Estimated Number of Patients x 365 days" Department of Pharmacy, Kajang Hospital1 Results: From the EADD calculations, the results obtained were: (a) 2011–
Introduction: In 2010, among ten government hospitals in Selangor,
methadone (20.8mg), buprenorphine (3.93mg), (b) 2012-methadone Kajang Hospital was reported to be the ‘top users' for 6 types of antibiotics (18.96mg), buprenorphine (1.84mg), (c) 2013 - methadone (11.31mg), and had the highest expenditure for antibiotics. These may indicate buprenorphine (1.2mg). The EADD of methadone and buprenorphine excessive and inappropriate usage of antibiotics. Objectives: The purpose
prescribed were found to be lower than average daily dose recommended of this study is to evaluate the impact of a multidisciplinary antibiotic program by the MOHCGP for methadone (30mg-60mg) and buprenorphine (8mg- (Antibiotic-MEDIFACT) on the antibiotic consumption, expenditure and 16mg). Conclusions: Patients who have undergone opioid drug addiction
bacterial resistance. Methods: The program was formed in June 2011 with
treatment programme at private medical practitioner clinics were found not 4 strategies: Standard antibiotic order forms with preauthorization to have been prescribed with the recommended daily dose of methadone requirements for 9 restricted antibiotics, education, audits and feedbacks.
and buprenorphine. Accreditation of private medical practitioners should be Use of antibiotics was recorded in defined daily doses per 1000 patient- made a prerequisite to apply for the permit which would help practitioners to days. Costs of antibiotic expenditures were collected 1.5 years before and provide better treatment to their patients.
1.5 years after the intervention. Fluctuation in drug prices were eliminated by using the average cost of each antibiotic dosage form over the 3 years of the study period. Average bed occupancy over 3 years of the study period was used in order to avoid overestimation of economic impacts of the ECONOMIC EVALUATION OF ENHANCED ASTHMA MANAGEMENT: A
intervention. Bacterial resistance rates were recorded based on antibiogram data from pathology laboratory data. Results: The intervention was
associated with a significant reduction of use of Cefoperazone/Sulbactam School of Pharmaceutical Sciences, Universiti Sains Malaysia1 (p=0.007), Ceftriaxone (p=0.019) and Vancomycin (p=0.007). Usage of Objectives: To evaluate, compare, and assess the quality of the studies on
other antibiotics i.e. Cefuroxime, Meropenem, Imipenem, Piperacillin/ the cost-effectiveness of enhanced management (either as adjunct to usual Tazobactam and Polymyxin B has reduced but it was not statistically care or alone) vs. usual care alone or none at all. Methods: Scientific significant. Total reduction in antibiotic expenditure was RM 268,069.60 and databases (Science Direct, Wiley Online Library, (Ebsco Host– MEDLINE, reduction in expenditure of 9 restricted antibiotics was RM 15768 per month CINAHL, PSYInfo), (OvidSP– EMBASE, MEDLINE), and Scopus) were in post intervention period (95% CI RM 6259–RM 25278; p=0.001). The searched for published journal articles in English language from year 1990 frequency of Ceftazidime-resistant Pseudomonas aeruginosa strains have to 2012, using the search terms "asthma AND (intervene OR manage) AND been decreased from 22% to 7% (p=0.04). The frequency of Polymyxin B- (pharmacoeconomics OR economic evaluation OR cost effectiveness OR resistant Acinetobacter baumannii strains, Pseudomonas aeruginosa strains cost benefit OR cost utility)". Hand search was done for local publishing.
and Escherichia coli strains have been decreased from 11%, 5% and 3% to Only studies with full economic evaluation on enhanced management 0%, 1%, and 1% respectively. Conclusions: The Antibiotic-MEDIFACT program
(either as adjunct to usual care or alone) were included. Selected studies was associated with reduction in antibiotic use, cost and bacterial resistance.
were data abstracted and assessed for their quality of economic evaluation This results support the notion that a systematic antibiotic program.
using the Quality of Health Economic Studies (QHES) instrument, and quality of evidence. Results: A total of 14 studies were included. There were
three distinct modes reviewed: environmental control, self-management, education. Most of the enhanced managements were found to be cost- DRUG UTILIZATION AND COST OF ANTIPSYCHOTIC IN THE
effective with ICER ranged from dominant to $26,700.00 per unit of TREATMENT OF SCHIZOPHRENIA AT KAJANG HOSPITAL.
outcome. Overall, the mean score of QHES was 76.69% (SD 9.26).
Shafie SD1, Kamarruddin Z1, Tan KZ1, Zainal Abidin MN1, Zainal H1, Tey SY1, Evidence sources for all data components in the 14 studies were ranked Bakhtiar A1, Aziz MS1, Abdullah AS1, Shukhairi AN1, Roslee AR1, Zakariah high quality except one study's source for ‘utilities' component ranked low quality because it used visual analogue scale to obtain patient preference Department of Pharmacy, Kajang Hospital1 values. Conclusions: Despite the moderate qualities of the reviewed
Introduction: Examination of antipsychotics (AP) medication use patterns
studies, it overall suggests that enhanced management (either as adjunct to has suggested that current prescribing practices do not mirror usual care or alone) is mostly cost-effective than the usual care or none at recommended treatment guidelines and may have adverse economic consequences. Objectives: To describe medication treatment patterns of
Schizophrenia patients with reference to Malaysian Clinical Practice Guidelines for Schizophrenia, among Ministry of Health (MOH) and Ministry of Higher Education (MOE) psychiatrists practicing in Kajang Hospital.
HEALTH-RELATED QUALITY OF LIFE (HRQOL) AMONG MOTHERS
Methods: A retrospective cross sectional drug utilization study of
WITH THALASSEMIA CHILDREN IN MALAYSIA
prescriptions for schizophrenia patients was conducted from January 2012 Mohd Miskam H1, Juhari R1, Yaacob SN1, Abu Talib M1 until December 2012 in outpatient pharmacy. Preparation of the protocol Department of Human Development and Family Studies, Faculty of Human was as per the WHO – DUS guidelines. Results: Total number of drug
Ecology, University Putra Malaysia, Selangor, Malaysia1 encounters for 678 prescriptions was 1,477. Average number of drugs per Objectives: This study aspires to examine the level of and factors that
prescription was 2.18 + 1.03 SD. Monotherapy prescribing were more significantly predict health-related quality of life of mothers with Thalassemia frequently observed as compared to polytherapy prescribing by both MOH children. Methods: This cross-sectional study was conducted using face to
(79.2%;N=590) and MOE (87.5%;N=88) psychiatrists (p=0.067). In face interview involving 388 mothers who have children with Thalassemia monotherapy treated patients (N=544), significantly higher number of from ten government hospitals in Malaysia. National Medical Research atypical AP (AAP) drugs prescribed as compared to typical AP drugs by both Registration (NMRR) approval was obtained prior to the study. Established MOH (71.9%;N=467) and MOE (83.1%;N=77) psychiatrists (p=0.040). Both and reliable instruments were used to measure key variables, namely, MOH (53.7%; N=467) and MOE (40.3%; N=77) prescribed most commonly SF12v2 were used to measuring HRQOL, Parental Stress Scale to measure Risperidone (51.6%). Other commonly prescribed AP were Chlorpromazine maternal stress, Financial Concern for financial problem and Severity (16.8%) and Olanzapine (13%). Perphenazine (0.9%) and Zuclopenthixol Assessment Tools for severity of child illness. Reliability of SF12v2 was (0.4%) were the least prescribed. In polytherapy treated patients (N=134), estimated using internal consistency and factor analysis was extracted variation in combination therapies were as followed: oral AAP with depot AP using EFA. Multiple linear regression analysis was used to identify preparations (36.6%), oral typical AP with depot AP preparations (25.4%), predictors of the dependent variable. Results: Results illustrated that
oral AAP and oral typical AP (20.1%) and combination of both oral typical AP maternal stress, financial concern and severity of illness were significantly (5.9%). Combinations of both oral AAP found during switching from one to and negatively related to both PCS ad MCS. Interestingly, financial concern another oral AAP and for treatment of resistant schizophrenia were 8.2% was found to be the strongest predictor of maternal health related quality of and 3.7% respectively. Co-prescribed drugs (N=665) were central life – Mental Component (MCS) (beta=-0.310), whereas severity of illness anticholinergic drug (49.8%), anti-anxiety drugs (35.9%), selective serotonin was the strongest predictor for the Physical Component – PCS (beta=- reuptake inhibitors (13.4%) and mood stabilizers (0.9%). Central 0.260). Conclusions: In conclusion, financial concern and severity of child
anticholinergic drug was co-prescribed in 39% patients on AAP illness played significant roles in shaping health-related quality of life of monotherapy. Conclusions: Overall, the principles of rational prescribing
mothers with Thalassemia children in Malaysia. Mothers who are burdened with reference to guideline were followed by both MOH and MOE financially and in constant worries due to the severity of the child's illness psychiatrists. The practice of using combination of AP was as per current seemed to be more impaired. Intervention programs should not neglect the recommendations. Combination of both oral typical AP requires importance of these two factors in helping these mothers to cope with the consideration/attention to adverse events and drug interactions. Rational use of anti-anxiety drugs requires attention to duration of usage with AP.
Routine use of anticholinergic drug along with AAP could not be justified and and 75% of all emerging pathogens. Objectives: To determine economic
should be used only in selected cases of patients.
burden of three prevalent zoonotic diseases in Malaysia which is Leptospirosis, Malaria and Chikugunya by calculating the provider's cost in managing the cases involved. Methods: This cross sectional study will be
INCIDENCE AND CAUSALITY IN ADVERSE DRUG REACTION-
conducted from June 2014 till December 2014. The cost of treatment of RELATED ADMISSION TO HOSPITAL: A SYSTEMATIC REVIEW
three zoonotic diseases will be calculated based on Clinical Pathways and Siti MK1, Yvonne HM1, Amudha PS1 Activity Based Costing methods. Secondary data from the Ministry of Health Department of Pharmacy, Kajang Hospital1 will be used to estimate the cost. Results: This study is expected to give the
Introduction: Adverse drug reaction related hospitalization has related to
total cost of the three zoonotic diseases in view of provider's cost. Cost the increase in the physical cost of treatment, admissions rates to get acute modelling of burden and projected burden for the next 5 years also expected treatments, prolonged bed occupancy, as well as time and energy for the to be calculated from this study. Conclusions: The current and projected
staff to accommodate the congestion. Objectives: To assess the incidence
cost burden estimations can help the nation to place strategic management of reported adverse drug reaction related admissions to hospitals including focus on areas of neglect and improve collaborative efforts between the presentation in various hospital departments. Methods: A systematic
medical and veterinary fraternity for the further future progress and literature review in Medline. Papers included were preventable and non- improvement in these areas.
preventable adverse drug reactions admitted to hospital following the WHO definition of adverse drug reactions, adult patients (above 18 years old) and ABSTRACT #24
papers that were published from year 1973 until present. Trial drugs, OVERVIEW OF THE SAMPLING PATTERN OF SUSPECTED
intentional drug overdosing, expert opinions, editorials as well as PARACETAMOL (PCM) POISONING IN HOSPITAL SUNGAI BULOH
conference abstracts and non-English papers were excluded. MeSH terms and keywords such as adverse drug reactions, drug toxicity, drug Nurfareeza NK1, Ang SY1 hypersensitivity, hospitalization, hospital admission and adult were used.
Department of Pharmacy, Sungai Buloh Hospital1 The review followed PRISMA statement guidelines. The data abstraction Introduction: Paracetamol (PCM) is a popular poisoning agent. Main
tool were used to extract the data and finally cross-reviewed by two concern with paracetamol overdose is the hepatoxicity effect and N- assessors. Results: The median percentage for incidence rate was 5.5%
acetylcysteine (NAC) known to be its effective antidote. Wrong sampling that ranges from 0.1% to 53% according to the included studies. The median time and delayed results obtained may lead to mismanagement of PCM percentage of preventable adverse drug reaction related admissions was poisoning. Hence, the aim of the study is to observe the sampling pattern of 63% ranging from 2.6% to 91%. Common drugs causing adverse drug the TDM in the management of the suspected PCM poisoning in HSB.
reactions were antipsychotics (23.5%) followed by analgesics (12.4%) and Objectives: To evaluate the appropriateness of the sampling time and
cardiovascular agents (10.8%). Apparently, the body systems that were processing time of the acetaminophen TDM samples, the factors identified most affected by adverse drug reactions were gastro-intestinal (12.2%), skin for delayed release of the acetaminophen level result and also the (11.4%) and circulatory system (10.2%). Eight studies reported more than appropriate use of NAC in the management of acetaminophen toxicity.
70% preventability rate particularly in the geriatric population while death Methods: This cross sectional study was conducted in HSB. All orders sent due to ADRs were reported from 0.05% (n=1) to 0.23% (n=73). The for TDM PCM toxicity from 1st January 2012 to 31st October 2012 was Newcastle-Ottowa quality assessment scale by Wells et al (2009) was collected through the electronic hospital information system (eHIS).
tested on 31 cohorts, 22 cross-sectional and five case control studies. Of the Incomplete data and rejected sample was excluded. Appropriateness of included studies, 82.2% scored a minimal five point and above and can thus sampling and processing time as well as usage of NAC were expressed in be categorized as moderate to good study quality. Conclusions: The
percentage while the identified factors (status of order (urgent/ routine) and findings from this systematic review suggest that the frequencies for the time of sample received) affecting the delay of processing time was incidence rates and preventable ADRs reported during hospital admissions analysed using chi-square test where p<0.05 were considered significant.
were widely varied between eligible studies. The incidence rates have not Results: 26% of the 185 samples are suspected of PCM poisoning and changed significantly over the years despite the high rates of potential others are of other poisoning. This inadequate practice may cause wastage of reagent and manpower. 34% of the samples were taken correctly, 4-24 hours post PCM ingestion. Most samples are processed within 2 hours upon sample received. 59.4% of samples ordered as urgent compared to routine ECONOMIC EVALUATION OF FOOD WATER BORNE DISEASE IN
was processed within 2 hours after sample received. However, it is insignificant (p=0.490). Significant results of sample received after office Mohd Dawam ND1, Wan Puteh SE1 hours will take more than 2 hours to be processed. About 40% of cases with Department of Community Medicine, UKM Medical Centre1 NAC were non-toxic while about 50% of these cases are not applicable as Introduction: Food borne disease causing a significant impact on economic
the sample taken was less than 4 hours. Conclusions: Sampling time and
if the incidence of the disease is keep increasing without proper surveillance inappropriate practices in HSB need to be improved and revised by adhering and outbreak control. Food borne disease in Malaysia is in the rise and the to the guidelines in managing paracetamol poisoning.
direct and indirect cost management of these diseases will become one of the most common issues to face by the government. Therefore, these study will analyse the cost involve in managing food water borne disease and how SURVEY ON AWARENESS OF HIGH ALERT MEDICATIONS AMONG
it related to economic burden to the individual, provider and community.
DOCTORS, PHARMACISTS AND NURSES IN HOSPITAL SUNGAI
Objectives: To determine economic burden of food water borne disease in
Malaysia by calculating the cost and DALY of Cholera, Typhoid and Food Sia HP1, Bay EL1, Tei YM1 Poisoning specifically. Methods: A cross-sectional study to be carried out in
Department of Pharmacy, Sungai Buloh Hospital1 April 2014 until December 2014 that combines economic evaluation Introduction: Improving medication safety for High Alert Medications
methods and Disability Adjusted Life Year (DALY) to estimate the economic (HAMs) remains a major concern for health professionals. Most medication burden of food and water-borne diseases as well as the costs involved in the errors may cause no harm to patients but inappropriate administration of management of this disease specifically for Cholera, Typhoid and Food HAMs can cause serious injuries and deaths. The purpose of this research Poisoning. These study locations are in National University Hospital, Kajang is to assess the awareness of HAMs among the health professionals in Hospital, Kuala Lumpur Hospital and two districts namely Hulu Langat and HSgB. Objectives: This study is done to explore the awareness of High
Petaling. Results: Expected results of the study are the total cost of food
Alert Medication among health professionals, to assess the awareness of water borne disease in view of healthcare provider and patient. Other than staffs on interventions done by the High Alert Medication committee at that, the burden of the food borne disease will be show by calculating the improving awareness about High Alert Medication and to identify common Disability Adjusted Life Years. At the end of the study expected to show the causes of medication errors involving High Alert Medication based on staff economic burden of the food water borne disease by calculating cost per perception. Methods: A cross-sectional survey based study was conducted.
disability adjusted life years (DALY). Conclusions: Economic evaluation
Survey comprising of 15 items were randomly distributed within 2 weeks to studies of food water borne disease are intended to show the real burden of 77 participants which included doctors, pharmacists and nurses serving in food water borne disease by showing the total cost and calculating cost per selected critical and non-critical wards of HSgB. Selected critical wards disability adjusted life years.
include Intensive Care Unit (ICU), High Dependency Ward (HDW) and Coronary Care Unit (CCU) while selected non-critical wards include Ward 4A, 4C, 4D, 5C and 7B. SPSS Software and Microsoft Excel were used for ECONOMIC EVALUATION OF ZOONOTIC DISEASE IN MALAYSIA
data analysis. Data was analysed using descriptive statistics. Results: Out
Omar N1, Wan Puteh SE1 of the 77 respondents, 32.5% were doctors, 14.3% were pharmacists and Department of Community Medicine, UKM Medical Centre1 53.3% were nurses. Only 46.8% respondents attended HAM briefing before Introduction: Zoonoses have been defined as diseases and infections that
taking part in this study. 81.8% respondents considered the measures are naturally transmitted between vertebrate animals and humans. Globally, implemented were able to increase their awareness and knowledge on HAM zoonoses are said to account for 60% of all infectious disease pathogens while 75.3% felt that these able to help prevent or reduce medication error involving HAM. 87% respondents practiced close monitoring on adverse reactions and medication errors involving HAM in their setting. 63.6% were PATIENT'S OWN DRUGS: PROFILE OF DRUGS' COST AND WASTAGE
aware about the changes of brand or packaging of HAM. Look Alike Sound Tan JN1, Nadia AR1 Alike (LASA) medications ranked as the top reason for the occurrence of Department of Pharmacy, Sungai Buloh Hospital1 medication error involving HAM (51.9%). Conclusions: The awareness of
Introduction: Patient's Own Drugs (PODs) are medications that patients
HAM among doctors, pharmacists and nurses in HSgB was found to be have obtained in the community setting and have brought with them to the satisfactory, with the highest awareness among the nurses.
hospital upon admission. When patients bring their previous medications, often these medications are not being used as they are supplied to the patients by inpatient pharmacy. This leads to wastage on hospital resources FACTORS AFFECTING JOB SATISFACTION AMONGST PUBLIC
and patients' own supply can be used instead. The aim of this study is to SECTOR HOSPITAL PHARMACISTS WORKING IN SELANGOR,
determine the cost of wastage incurred when PODs brought from home were not used during hospital stay. The classification and quantity of PODs Hing YL1, Ezmiza N1 as well as the most costly medication are also determined. Objectives: 1.
Department of Pharmacy, Sungai Buloh Hospital1 To calculate the total cost that would have incurred if PODs are not being Introduction: Job satisfaction (JS) studies targeting public sector hospital
used. 2. To identify the quantity and classes of PODs brought in. 3. To pharmacists working in Malaysia is still largely an unexplored area. Thus, JS determine the class of drug that has the highest cost. Methods: This is a
levels and factors affecting them were measured amongst public sector descriptive study. A total of 100 patients admitted into both male and female hospital pharmacists working in the state of Selangor, Malaysia. Methods:
medical ward of Hospital Sungai Buloh were recruited during the period of A previously validated JS questionnaire was mailed to all 327 active one month from 15th September to 15th October 2011. Subjects were pharmacists working in all Selangor public hospitals. Data was collected recruited via convenient sampling and patients who were admitted during from mid-April to end of June 2012. The questionnaire contained questions; the weekends or medications that were changed by doctors during hospital graded with a 5-point "strongly agree" (5) to "strongly disagree" (1) scale; stay were excluded from this study. The study data was analysed using that examined extrinsic and intrinsic factors and assessed job satisfaction Microsoft Excel software. Results: A total of 45 subjects were analysed.
levels via two separate scales, abbreviated as JS1 and JS2, to allow Eight classes of drugs were identified – oral hypoglycaemic agents, anti- reliability and correlativity cross checking with analysed factors. Results:
hypertensives, lipid-lowering agents, diuretics, cardiovascular agents, anti- 179 completed questionnaires were returned, eliciting a response rate of platelets, psychiatric agents and others. Total cost for these medications 54.7%. Most pharmacists were somewhat satisfied with their job, scoring on was RM 250.30. Out of the eight classes, anti-hypertensive drugs were the average 3.09 + 0.92 and 3.20 + 0.89 for JS1 and JS2 respectively.
most costly with RM 97.91. On average, the cost of medications per patient Spearman correlation scores indicated significant correlation between per day was RM 0.46. Assuming if beds are occupied throughout the year intrinsic factors (rJS1=0.55, rJS2=0.47, P<0.01) and extrinsic factors in both male and female medical ward, the total cost saving if medications (rJS1=0.66, rJS2=0.52, P<0.01) with JS. Most intrinsic factors were are taken from patients' own supply can be approximately RM 9,402.40.
addressed fairly well, with job creativity and importance as significant Conclusions: In conclusion, medication wastage is evident in the inpatient predictors for JS. Management concern and opportunity for advancement setting when patients' own supply of medications was not used instead.
were extrinsic factors that needed improvement given they are significantly However, a more thorough audit is needed to determine the exact cost and linked to JS. Stepwise multiple regression revealed only extrinsic factors its' impact of using patients' own drugs. It provides as a platform to were significantly correlated with JS (r2JS1=0.56, P<0.0001; r2JS2=0.27, implement a healthcare policy on patients' own drugs in the future.
P<0.0002), implying that extrinsic factors are predominant significant predictors towards JS. Such findings may be due to socioeconomic and cultural influences of Malaysian society towards JS. Conclusions: Overall,
STUDY ON THE CLINICAL OUTCOME OF PHARMACIST-MANAGED
Selangor hospital pharmacists were quite satisfied with their job. More attention should be paid to extrinsic factors which have stronger influence Siti AZ1, Hasnur SH1, Chin KC1, Zaili ME1 over job satisfaction compared to intrinsic factors.
Department of Pharmacy, Sungai Buloh Hospital1 Introduction: Glycaemic control is the key to reduce both micro- and
macro-vascular complications associated with type 2 Diabetes Mellitus. In PERCEPTION, ACCEPTANCE AND TOLERABILITY OF PATIENTS
Hospital Sungai Buloh, pharmacists play their role in managing diabetic TAKING INNOVATOR VERSUS GENERIC ESCITALOPRAM
patients through interventions done in Diabetes Medication Therapy Hing YL1, Lim SY1.
Adherence Clinic (DMTAC) which is in operation since 2008. Objectives: To
Department of Pharmacy, Sungai Buloh Hospital1 evaluate the clinical outcomes in diabetic patients in terms of reduction in Introduction: Generic drugs have been introduced into government
HbA1c and fasting blood sugar (FBS) through interventions done in hospitals to help reduce healthcare expenditure. A study aiming to evaluate Diabetes Medication Adherence Clinic (DMTAC). Methods: A retrospective
patient's perception and acceptance towards the generic version of and observational study among patients enrolled in the DMTAC program Escitalopram (Espran®) after switching from the innovator version was conducted between February 2012 and July 2013. Data was included (Lexapro®) was conducted in Sungai Buloh Hospital. Methods: A list of 67 from patients with uncontrolled DM having glycosylated haemoglobin patients who were on innovator Escitalopram (Lexapro®) during September (HbA1c) more than 8% and who had visits more than three times with the and October 2012 were generated via the hospital's computer database (e- pharmacists. The descriptive analysis was used to analyse data on patients HIS). Throughout the study period from 1st of September 2012 to 31st demographic and medication regimens associated with diabetes. For March 2013, all sampled patients were switched from innovator statistical analysis, a paired t-test and Wilcoxon Signed-Rank test was used Escitalopram (Lexapo®) to generic Escitalopram (Espran®). Patients were to evaluate the differences between pre- and post-values of HbA1c and surveyed before and after switching their medication via an interviewer- FBG. Results: A total of 65 patients were included in the analysis. Most administered validated questionnaire through phone on demographic patients in this study aged between 51 to 60 years old (36.9%). Majority of background, acceptance and side effect tolerability, knowledge on generic the patients were males (60%). Malays dominate the highest ranking medicines, preference towards innovator or generic medicines and the (80.3%), followed by Indians (11.8%) and Chinese (7.9%). For macro reasons behind their choices. Patients were excluded if they received complications, 70.8% patients do not state any macro complication.
Escitalopram treatment for less than a month, refused to participate, not However, 26.2% of all patients are complicated with angina. The most contactable, did not switch to generic, or stopped treatment. Results: 38
common micro complication is diabetic nephropathy (21.5%), retinopathy patients completed the survey. 43% have heard of the term ‘Innovator' and (18.5%) and neuropathy (7.7%). A mean reduction in HbA1c of 1.168% 'Generic'. However, two-thirds of the samples do not understand the term ' (p<0.001) and mean reduction in FBG of 3.87mmol/l (p=0.004) were Generic' and 5% misunderstood the meaning of 'Generic' drug. 48.5% of the achieved. Conclusions: The pharmacist-managed diabetes patients sample preferred innovator Escitalopram (Lexapro®), 30% preferred program resulted in significant improvements in HbA1c and fasting glucose generic Escitalopram (Espran®) and 21.5% had no preference. There was a significant difference in patient's acceptance (p=0.038) plus incidence and tolerability of side effects (p=0.038) which favoured the innovator version. A near 50% increment in side effect cases were reported after patients USAGE OF IV NAC IN ICU PATIENT WITH RENAL INSUFFICIENCY TO
switched to generic Escitalopram. Patient's preference towards which PREVENT CONTRAST-INDUCED NEPHROPATHY
version of the medication was directly correlated to patient's acceptance Hannah MM1, Nur Syazreen AS1 towards the medication (p=0.001). Conclusions: Generic Escitalopram was
Department of Pharmacy, Sungai Buloh Hospital1 less preferred and accepted by patients as compared to innovator Introduction: Nephrotoxicity is a major complication that occurs within 3
Escitalopram because of lesser efficacy and significantly associated with days of administration of iodine contrast medium intravenously. Studies more intolerable adverse effects.
have shown that combined hydration therapy with oral NAC given a day prior to and on the day of administration of contrast medium, may prevent nephrotoxicity event in chronic renal failure patients. When there is a time constraint, IV administration of NAC immediately before the administration of contrast and additional dose over subsequent 4 hours has been advocate haemorrhage or epilepsy. Sub-therapeutic (less than 40 µmol/L) and toxic for preventing contrast-induced nephropathy (CIN). However, the level (more than 80 µmol/L) of phenytoin were associated with increased CK effectiveness of NAC for this indication is still under investigation.
level compared to normal phenytoin level. However, it was not statistically Objectives: The aim of this study is to assess the outcome of using IV NAC
significant (p>0.05). Toxic level of phenytoin compared to sub-therapeutic in preventing CIN in ICU patient with impaired renal function and to and normal level of phenytoin was associated with significant investigate the correlation between the risk factor and CIN. Methods: Data
thrombocytopenia (platelet less than 100 x 109/L; p<0.05). Very low albumin were retrospectively collected from eHIS system of ICU patients who had level (less than 20 g/l) was associated with significant phenytoin toxicity received IV NAC 10,000mg given as 2000mg for the first hour followed (p<0.05). Conclusions: Rhabdomyolysis is easily affected by other factors,
500mg/hour for the next 16 hours. Six readings of serum creatinine were thus Creatine Kinase (CK) is not a strong indicator to predict phenytoin level.
taken i.e. when patient admitted to the hospital, a day before patient Thrombocytopenia and very low albumin level may play a role in predicting undergo CT scan, 12-hours, 24-hours, 48-hours and 72-hours after phenytoin toxicity.
receiving NAC. Results were analysed using Microsoft Office Excel 2007, Paired T-test and Pearson Correlation. Results: Decrement of serum
creatinine at 12-hours post-NAC has been seen in 52% of 57 patients while TENOFOVIR-INDUCED RENAL IMPAIRMENT IN HIV-INFECTED
55% patient shows decrement at 24-hours post-NAC. At 48-hours and 72- hours post NAC, 57% and 65% of patients shows decrement of serum Preethi R1, Aiman M1 creatinine respectively. However, the decrement of the serum creatinine is Department of Pharmacy, Sungai Buloh Hospital1 only statistically significant at post 72 hours of NAC. Correlation study shows Introduction: Tenofovirdisoprovilfumarate (TDF) was the preferred
a positive correlation that contrast medium caused increased serum nucleoside reverse transcriptase inhibitor (NRTI) when starting therapy for creatinine in the first 48 hours in patient with acute hypotension, sepsis, HIV patient with exception in pregnant women. Tenofovir is mainly chronic kidney disease, diabetic and patient who received nephrotoxic eliminated through kidneys hence its use was associated with reduced renal drugs. Conclusions: With regards to serum creatinine level, administration function. TDF was considered safe drug, well tolerated and recommended of IV NAC appears to be an agent that gives protection to renal function for as a first line in the triple agent combination therapy. Upon practice use, it patient receiving contrast medium.
was found out that there was not uncommon number of patients develop renal impairment. Objectives: To estimate the prevalence of Tenofovir-
induced renal impairment in HIV-infected patients and to determine whether PREGNANCY OUTCOMES IN INSULIN TREATED GESTATIONAL
median eGFR after Tenofovir was started differ from median eGFR before DIABETES MELLITUS PATIENT FROM DIFFERENT ETHNICITY IN
Tenofovir was started. Methods: A retrospective cross sectional study was
HOSPITAL SUNGAI BULOH
conducted among outpatient department (OPD) patient (n=73) receiving Nur Atiqah S1, Lee XY1, Teo Y1 TDF in Hospital Sungai Buloh from January 2012 till January 2013 with Department of Pharmacy, Sungai Buloh Hospital1 duration of eGFR ranging from 2 weeks to 5 years. Patients with Introduction: Gestational Diabetes Mellitus (GDM) is associated with
comorbidities, pre-existing renal impairment, does not take serum creatinine substantial rates of maternal and perinatal complications such as baseline level prior to TDF treatment, does not follow up and discharged to macrosomia, preeclampsia, low birth weight, caesarean delivery and other hospital was excluded from the study. A definition from National Kidney neonatal hypoglycaemia. Unquestionably, there are ethnic differences in the Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) was prevalence of GDM. Most studies found Asian women are at higher risk of used to defined the renal impairment which was GFR less than 60 getting GDM especially Indian and Chinese ethnicity compared to mL/min/1.73m2. Results: The result was one patient (1.37%) having his
Caucasian. However, lack of related studies can be found in Malaysia.
eGFR value fall below 60 mL/min/1.73m2. There was a significant difference Objectives: The objective of the study is to determine prevalence of GDM
(p<0.05) in median eGFR before and after TDF was initiated. Conclusions:
in different ethnicity and to evaluate adverse pregnancy outcomes from In conclusion, prevalence of renal impairment in patient taking TDF was 14 different ethnicity in Insulin treated GDM. Methods: Retrospective study of
in 1,000 patients and renal function was significantly reduce after TDF was all women who delivered at Hospital Sungai Buloh (n=5,957) which initiated, hence it was advisable for all patient receiving TDF to be counsel diagnosed with GDM patient. Adverse pregnancy outcomes including birth on the possible side effect of renal impairment and close monitoring of renal weight, gestational age, preeclampsia, delivery method, NICU stay more function is warranted among patients with risk factors.
than 24 hours were recorded. Kruskal-Wallis analysis for continuous variables and Pearson's chi-square for categorical variables were used.
Results: In our study from January 2013 until June 2013, the prevalence for PENDING AUTHORIZATION IN OUTPATIENT PHARMACY OF
gestational diabetes mellitus among pregnant women is 11.52%. From HOSPITAL SUNGAI BULOH
5,957 women, only 696 women were diagnosed with GDM. Among of all, 156 patients were treated by insulin. Indians contributed in gestational Department of Pharmacy, Sungai Buloh Hospital1 diabetes mellitus prevalence the most (25.1%), followed with the Chinese Introduction: In Outpatient Pharmacy of Hospital Sungai Buloh, pending
12.4% and Malays 11.1%. As for method of delivery, caesarean delivery was authorization has been identified as one of the factors that may increase significantly higher compared to spontaneous delivery (p<0.05). However, patients waiting time as well as increase pharmacists workload. Objectives:
there is no significant difference between different ethnicity for other Objectives of the study are to determine the time taken for authorization of outcomes (p>0.05). Conclusions: The prevalence GDM in this study
pending prescriptions and to identify the department that has the highest (11.52%) fall in high risk population. Indians contributed the highest unauthorized prescriptions. Methods: The study was carried out as a cross
prevalence among others ethnic. In this study, ethnicity was found to have a sectional study over a period of 1 month starting from 1st October 2013 until significant difference in caesarean method delivery. Further study is needed 30th October 2013 in Outpatient Pharmacy of Hospital Sungai Buloh. A form to study the relationship between pregnancy outcome and ethnicity. Hence, was used to record details of unauthorized prescriptions, while total number we can intensify the treatment in high risk ethnic.
of patients, prescriptions and time of prescriptions prescribed and authorized were generated from eHis. Results: In October 2013, a total
number of 13,067 patients visited OPD of Hospital Sungai Buloh with a total CORRELATION OF PHENYTOIN LEVEL WITH RHABDOMYLOSIS AND
number of 17,344 prescriptions received. Out of these, a total of 698 THROMBOCYTOPENIA IN CRITICALLY ILL PATIENTS WITH
prescriptions with pending authorization were obtained from data collection.
It counts for about 4% of the total prescription received in October.
Rahela AK1, Shing Chyi L1, Sinn Yin A1, Norirmawath S1, Hannah MT1, Ee Conclusions: Department with the highest unauthorized prescriptions is
Ling B1, Wee Leong L1, Shanthi R1 identified as ENT clinic (38%). Whereas, PSY clinic took the longest time Anaesthesiology Department, Sungai Buloh Hospital1 (57.2hours/prescriptions) to authorize prescriptions and department with the Introduction: Phenytoin is widely used for traumatic brain injury patients in
highest percentage of prescriptions left unauthorized is Orthopaedic clinic Intensive Care Unit (ICU) of Hospital Sungai Buloh (HSgB). Phenytoin has (89.6%). A future study could be conducted to further identify factors which been reported to induce rhabdomyolysis, where there is breakdown of could possibly lead to high number of unauthorized prescriptions that may muscle fibres and results in raised Creatine Kinase (CK) level. In addition, cause an increase in waiting time of Outpatient Pharmacy.
phenytoin is known to induce thrombocytopenia, a rare but serious haematological adverse effect. Objectives: To evaluate the impact of sub-
therapeutic or toxic levels of phenytoin towards rhabdomyolysis and thrombocytopenia, and investigate other factors that may affect phenytoin COST ANALYSIS OF THE EXTEMPORANEOUS PREPARATION OF
level. Methods: Medical records of 70 patients admitted to Intensive Care
FOLIC ACID 1MG/ML SYRUP IN SUNGAI BULOH HOSPITAL OUT
Unit of HSgB prescribed with phenytoin from October 2011 to May 2012 PATIENT PHARMACY DEPARTMENT WITH THE USE OF EITHER
were retrieved. 61 patients with hypoalbuminemia (albumin <35 g/L) were SIMPLE SYRUP OR X-TEMP SUSPENSION AS A SUSPENSION
identified for inclusion. CK level, platelet level, albumin level and phenytoin level were collected and the data was analysed using 2 way chi-square test.
Md. Sani R1, Hing YL1, Lee CC1 Results: The mean age of the 61 patients was 31.8 ± 8.7 years (range 20 to Department of Pharmacy, Sungai Buloh Hospital1 57 years). The subjects had traumatic brain injury, subarachnoid Introduction: Folic Acid syrup is most commonly prepared by utilizing
simple syrup (RM 16.50/3.6L) as suspending vehicle but with short shelf life (p<0.05) but not in the SMOFlipid group (p>0.05). Conclusions: Fish oil-
(14 days). There another suspending vehicle exists which is X-TEMP based lipid emulsion (SMOFLipid) was potentially beneficial in protecting the suspension (RM 50/L) with longer shelf life (60 days). Shorter shelf life of liver. A lower incidence of parenteral nutrition associated liver diseases suspending vehicle will lead to frequent refills, increasing workload, and (PNALD) was seen in premature neonates receiving SMOFLipid compared increasing consumption of consumables thereby causing increases in to those receiving Intralipid. Reduction of total bilirubin also indicates overall cost of preparations. Thus, a cost analysis study conducted to promising effect of SMOFLipid in protecting the liver.
determine which suspending vehicle would offer the lowest overall cost.
Objectives: To determine the direct cost and indirect cost associated with
the use of simple syrup and X-temp as a suspension vehicle to prepare FA PRESCRIBING PATTERN OF BROAD-SPECTRUM ANTIBIOTICS IN THE
syrup, which will both be factored in to estimate the overall cost of a bottle MEDICAL WARDS OF HOSPITAL SUNGAI BULOH
of dispensed FA syrup. Methods: It is cross-sectional cost analysis study by
Nadiah AB1, Yeap JSS1 doing cost calculations based on direct cost (prices of various paraphernalia Department of Pharmacy, Sungai Buloh Hospital1 and personnel labour costs) and indirect cost (lost opportunity cost and Introduction: Hospital-acquired infections (HAI) made up 13.9% of total
transportation cost). The price of paraphernalia was obtained from hospital admissions in Malaysia in 2010. Appropriate antimicrobial therapy Pharmacy Inventory Management and personnel labour cost to prepare and is necessary to reduce morbidity and mortality. Traditionally, guidelines from dispense Folic Acid syrup were calculated based on a time recording form.
western countries recommend the use of broad-spectrum penicillin as first However, a set of questionnaire was distributed to patients who have been line regime for HAI based on pathogens in their settings. However, the started on Folic Acid syrup using simple syrup then continued with X-TEMP microbial ecology may not be similar in our setting. There is a need to for the next visits in order to obtain indirect costs. Results: The frequency
determine if our empirical antimicrobial prescription adequately covers our of refill is 2 times per month for simple syrup but 1 times per month for X- most frequent pathogen(s). Objectives: This study attempted to observe
TEMP. So, the overall cost of making Folic Acid syrup with simple syrup as the prescribing pattern of broad-spectrum antibiotics (BSAb), identify the suspending vehicle is RM 675.12/patient/year which would be most prevalent pathogen of HAI, identify the most commonly used broad- approximately 2 times higher than that of X-TEMP which costs RM spectrum antibiotic, and evaluate appropriateness of empirical 358.92/patient/year. Conclusions: Folic Acid syrup made by using X-TEMP
antimicrobials prescribed according to microbiological cultures. Methods:
as suspending agent is more cost saving than simple syrup.
The prospective observational study took place in the medical wards at Hospital Sungai Buloh. Data was collected from April to June 2012. All patients started on BSAb, namely Cefepime, Tazocin and Carbapenems, EVALUATION OF CONTINUOUS INFUSION VANCOMYCIN IN
were included within the study period. However, patients whose antibiotic(s) HOSPITAL SUNGAI BULOH: RETROSPECTIVE OBSERVATIONAL,
were started in other hospitals, or were transferred to other hospitals, were SINGLE-CENTRED COHORT STUDY
excluded. Results: There were 105 patients started on BSAb for HAI; 98
Koh HM1, Ang SY1, Mageespary R1 patients were started empirically. 49.5% were empirically started on Department of Pharmacy, Sungai Buloh Hospital1 cefepime and 29.5% on tazocin, while 20% were prescribed carbapenems Introduction: Continuous infusion of vancomycin (CIV) is increasingly
based on definitive cultures (n=105). 8% of patients did not have their blood preferred as an alternative to intermittent infusion vancomycin (IIV) in cultures taken within 24 hours of receiving antibiotics. 53% (n=98) of Sungai Buloh Hospital. Continuous infusion has been proven to provide patients receiving empirical antibiotics did not have any growth from more predictable and constant serum concentrations, where the target microbiological cultures sent. ESBL Klebsiella was the most common serum concentration 15-25mg/L was acquired faster. In addition, this mode pathogen (10.2%); however, the predominant choice of empirical of infusion also found to have lower risk of nephrotoxicity. Objectives: This
antimicrobial was cefepime (49.5%). 58% of antibiotics were stopped after study was designed to evaluate the effectiveness and safety of continuous results showed no growth. De-escalation or stopping of antimicrobial infusion vancomycin in Sungai Buloh Hospital. Methods: This was a
therapy was done in almost all the patients, except those for which there retrospective observational, single-centred cohort study, where patients was reason to continue or escalate the choice of antibiotic. Conclusions:
previously given vancomycin continuous infusion were followed through The most commonly prescribed BSAb for HAI was cefepime, followed by their duration of treatment. Period of study was from October 2010 until tazocin. More than 90% of the patients on empirical BSAb had blood October 2013. Proportion of patients attaining desired vancomycin level (15- cultures taken within 24 hours of starting antibiotics. However, since the 25mg/L) and average time taken to reach desired level were obtained.
most common pathogen was ESBL Klebsiella, it is worth considering Results: A total of 10 patients (3 females & 7 males) with age group between ertapenem as first line choice for empirical antimicrobial in HAI.
14-53 years were studied and 80% of them achieved target vancomycin levels of 20-25mg/L. 10% of patients attained therapeutic level within 24-48 hours. Average time to reach therapeutic level was 6 days. 1 out of 10 A STUDY ON THE AWARENESS AND COMPLIANCE TOWARDS THE
patients (10%) developed nephrotoxicity during continuous infusion AFTER OFFICE HOUR VALUE ADDED SERVICE IN HOSPITAL SUNGAI
vancomycin which could also be attributed to concomitant polymyxin use.
Conclusions: CIV practice is still not well established in Sungai Buloh
Darshini S1, Aqilah AR1 Hospital, since only 10 patients administered for the period of 3 years.
Department of Pharmacy, Sungai Buloh Hospital1 However, it has shown to be a reliable alternative method for patients with Introduction: The After Office Hour Service (AOH) is one of the value
severe MRSA infections who were unable to reach therapeutic levels with added services provided in Hospital Sungai Buloh, outpatient pharmacy for IIV. CIV dosing regimens especially those for neurological-related infections patients who have balance medication collection to make. Patients will have need to be improved to achieve target levels faster.
to call the outpatient pharmacy 2 days prior to collection, to make an order; collections will be made in the emergency pharmacy anytime between 5.30pm to 11.30pm, Monday to Friday. However, many patients showed STUDY ON THE USE OF THE INTRAVENOUS FISH OIL LIPID
unawareness to the existence of this program and the existing patients EMULSION IN PREMATURE NEONATES REQUIRING PARENTERAL
showed high non-compliance in making orders every month for collection.
This study aims to discover the factors co-relating to this problem and to Aida MS1, Lee VJ1 identify where further improvements can be done within the program, in Department of Pharmacy, Sungai Buloh Hospital1 order to perfect the service so that it proves to be beneficial to both, Introduction: Premature infants possess limited energy and fat reservoir as pharmacy and patient. Objectives: The objective of this study is to ascertain
they have missed the important period of nutrient accretion and storage. The general patient awareness on this AOH service and assess the compliance nutritional needs are usually dependent on parenteral nutrition (PN).
of patients who have registered in this program. It aims to identify factors Intravenous lipid emulsion (ILE) is an essential part of PN regimen in within the service itself which contribute to existing patient non-compliance neonates Although PN is lifesaving; it has been associated with PN- towards the AOH program. Methods: A quantitative, descriptive, cross-
associated liver disease (PNALD) when used for prolonged duration.
sectional study was carried out via questionnaires and interviews for a Objectives: To compare the incidence of parenteral nutrition associated
period of 1 month in the outpatient pharmacy. 2 groups were targeted; first liver disease (PNALD) in premature neonates receiving either SMOFlipid or were from the general patient population that visited the outpatient Intralipid. Methods: Retrospective study from January 2009 to October
pharmacy, who have not signed up for any value added services, second 2013 in 59 premature neonates receiving at least 7 days of PN containing group was all registered active patients within the AOH program itself who either Intralipid (n=28) or SMOFLipid (n=31). Liver parameters including made orders consistently for 3 months or more; The former investigated the direct bilirubin, total bilirubin, ALT and ALP were recorded at baseline (before awareness component and the later the compliance component. Data was starting PN) and on day 14 were recorded. Results: 3 out of 28 neonates in analysed using Microsoft Excel. Results: 68% of the respondents were
Intralipid group developed PNALD while receiving parenteral nutrition.
unaware of the service. Lack of publicity and promotion, no interest, long Whereas, in the SMOFlipid group no incidence of PNALD was reported.
waiting time in clinics, lack of information available on how to sign up, lack Total bilirubin on day 14 vs. baseline was slightly reduced in neonates of confidence in the service, low credibility and popularity of the program receiving SMOFLipid group while a significant increase was seen in the were the main factors that contributed to the low awareness. More than 78% Intralipid group. An increase in ALT level on day 14 vs. baseline was seen in were non-compliant due to timing inconvenience, day-to-day personal both groups. However, the increment was only significant in Intralipid group matters, rigid rules and non-flexibility of the program. 8% of respondents claimed that the pharmacy occasionally forget to process their prescriptions.
Conclusions: Majority of patients visiting the outpatient pharmacy was
A SURVEY ON THE PERFORMANCE OF CLINICAL PHARMACISTS BY
unaware of this AOH program. The high non-compliance was due to many MEDICAL PROVIDERS IN HOSPITAL SUNGAI BULOH
factors contributed by both the pharmacy department and patient's Chong PF1, Ramalingam M1, Yeo BH1 themselves. It was noted that many areas within the program itself could be Department of Pharmacy, Sungai Buloh Hospital1 improved to increase patient's compliance to the program once registered to Introduction: Clinical pharmacists are able to offer information on drug
management to both patients and the medical team as they are specially trained in therapeutics. This study was done to evaluate the satisfaction among medical staff on the performance of the clinical pharmacist in HSB.
A SURVEY ON KNOWLEDGE OF ORAL EXTEMPORANEOUS
Objectives: This study is done to evaluate the participation and contribution
PREPARATIONS AMONGST PHARMACIST AND PHARMACIST'S
of clinical pharmacists with the healthcare providers in HSB, to assess the ASSISTANTS IN HOSPITAL SUNGAI BULOH
involvement of clinical pharmacists in providing relevant pharmacy-related Darshini S1, Hon MY1, Nordiyana S1 services to discharged patients/ patients' caretaker/ patients' family and to Department of Pharmacy, Sungai Buloh Hospital1 assess the personal skills of clinical pharmacists at a working environment.
Introduction: Oral extemporaneous preparation is widely used in all
Methods: In this cross-sectional questionnaire-based survey, a pilot study
hospitals in Malaysia to fulfil patients' needs. Lack of commercially available was done. 130 questionnaires were distributed in August 2013, and 101 oral liquid preparations in the market poses a challenge in providing were collected from the HSB medical staffs serving in wards that have a medications to patients. Pharmacists and pharmacist's assistant are often clinical pharmacist, including medical officers, specialists, consultants, required to prepare extemporaneous preparation to meet the needs of these nurses and sisters. Participants were randomly selected from the wards, patients however, pharmaceutical profile such as stability, efficacy, expiry, according to the ratio of professions in each ward. Sample size was taste and many more should be take into consideration before the determined using Altman plotting. For each question, the respondents preparation is carried out. The question then arises if the majority of indicated their degree of satisfaction on a 4-point Likert Scale; very pharmacy staffs have sufficient knowledge and skills needed in preparing satisfying, moderate satisfactory, not satisfactory, and poor. SPSS software extemporaneous as they are the one who will be responsible in preparing it was utilized for descriptive analysis. Results: For participation and with accurate concentration and dosages. Objectives: The purpose of this
contribution of clinical pharmacists, 67.5% are moderately satisfied, 27.1% study was to measure the current level of knowledge on oral are very satisfied while only 5.4% are not satisfied. For the provision of extemporaneous preparation amongst pharmacists and assistant services to patients, 65.3% are moderately satisfied, 29.2% are very pharmacists in Hospital Sungai Buloh and to identify the common problems satisfied, leaving only 1.5% of dissatisfaction. 99.5% of the respondents are that are frequently encountered when preparing extemporaneous at least moderately satisfied with the personal skills. For the overall preparations. Methods: The data comprise of 92 respondents; 40
performance, all respondents were at least moderately satisfied.
pharmacists, 19 provisionally registered pharmacists and 33 assistant Conclusions: The clinical pharmacists shall provide more CME to medical
pharmacists. The questionnaire was divided into several sections: staffs as there is still space for improvement. Since majority of the demography, awareness, extemporaneous knowledge and experience in respondents were satisfied, the services of clinical pharmacists shall be preparing extemporaneous preparation. 6 questions on general continued and expanded to other wards as well.
extemporaneous knowledge were used to measure the level of knowledge.
The data was analysed using Likert Scale. Results: The data analysis
showed the current level of knowledge amongst personnel was good, REVIEW OF OFF LABEL PRESCRIBING IN PAEDIATRIC PATIENTS IN
accounting for 36% from total respondents. Majority of pharmacists had HOSPITAL SUNGAI BULOH: A PROSPECTIVE STUDY
very good level of knowledge; assistant pharmacist had good level of Hon MY1, Yew SF1, Shamala B1, Nurul F1 knowledge while provisionally registered pharmacists had fair level of Department of Pharmacy, Sungai Buloh Hospital1 knowledge. The common problem encountered when preparing Introduction: Off label prescribing of medication is defined as the
extemporaneous preparations was, they did not know what diluent to use unauthorized use of a drug for a purpose other than that approved by the when preparing the preparations. Conclusions: Continuous professional
authorized organization. Unavailability of suitable registered medicine and education would be beneficial, especially to the provisionally registered lack of clinical trials in paediatrics result in high percentage of off label pharmacists in improving their knowledge and skills in oral extemporaneous prescribing in paediatrics. This prospective study is to determine the preparations. This would also shorten the time needed to process and proportion of off label prescribing in paediatrics in Hospital Sungai Buloh prepare the extemporaneous solutions.
(HSB). Objectives: The objectives of this study are to identify the classes
of medication associated with off label prescribing among paediatric patients; to identify the most common medications frequently prescribed as THE EFFECTS OF PHARMACIST PATIENT EDUCATION ON THE
off label medication and to document the common types of off label OCCURRENCE OF RETURN MEDICATIONS IN AN INPATIENT
prescribing. Methods: Data was collected from all paediatric patients
admitted into paediatric wards of HSB for over 4 weeks. Paediatric patients Chong PF1, Ang ASY1, Balakrisnan N1 under Dental observation or in intermediate and conva of Neonatal Intensive Department of Pharmacy, Sungai Buloh Hospital1 Care Unit were not included. Data collected included patient identification Introduction: Majority of elderly patients take 4-5 types of prescription
number, age, gender, race, diagnosis and details of all drugs administered.
drugs and 2 over-the-counter medications. Medication Return Campaign All data obtained was analysed using Microsoft Office Excel 2007. Results:
done in Hospital USM (2009) has helped reduce poly-pharmacy and 333 paediatrics were admitted during data collection period with a total of adverse drug reactions amongst elderly patients. Objectives: The
1,427 medicines prescribed. 81% of medicines prescribed were listed in objectives of the study were to identify the reasons for return medications, Ministry of Health (MOH) Formulary and 19% were used off label (17% listed to identify the prevalence of poly-pharmacy in medical ward patients, to in MOH Formulary for other indications, dose, frequency or permissible age assess patient's compliance to their home medications and to estimate the while 2% were not listed in MOH Formulary). Off label dosing (28%), age cost of savings achieved through returned medications. Methods: This is a
(27%), and extemporaneous preparations (18%) accounted for the most prospective convenience sampling method. Data is collected using the common types of off label prescribing. Antibiotics (such as modified CP1 form that was validated via pilot studies which were carried amoxicillin+clavulanate and benzylpenicillin) prescribing were the main drug out. The types and the amount of medication returned were recorded. This class that were prescribed off label. Conclusions: Out of 1,427
was done after the patient was admitted and educated about the returned prescriptions, 19% prescribed medicines in the paediatric wards were off medication system being practices at Hospital Sungai Buloh. Results: A
labelled. Safety and efficacy data should be obtained for children to total of 60.7% (p= 0.304) patients had returned their medications after determine whether these medicines used as off-label are warranted or safe.
counselled to do so by the pharmacist. However, 39.3% of patients did not return their medications due to several reasons such as, family member was ABSTRACT #44
unable to bring the medication on time before the patient was discharged or KNOWLEDGE, ATTITUDES AND PRACTICE TOWARD DRG SYSTEM
the patient did not remember to bring in their medications during admission AMONG TURKISH HEALTH CARE PROVIDERS
in spite of being informed to do so. The pharmacist's education about the Saad Ahmed AJ1, 2,Aljunid SM1, 2, Dastan I3, Dilmac E4,Nur Sulku S5, Kahveci return medication movement was effective as it increased the occurrence of R6, Tutuncu T6, Gulcu E6 returned medication to 15.7%. 62.7% (p= 0.334) of patients involved in this United Nations University-International Institute of Global Health (UNU- intervention was found to be compliant to their medication. Most of the IIGH), UKM Medical Centre1; International Centre for Case-Mix and Clinical patients were not compliant due to multiple medications prescribed and Coding (ITCC), UKM Medical Centre, Kuala Lumpur, Malaysia2; Department being forgetful. There are no occurrences of poly-pharmacy because of Economics, Izmir University of Economics, Izmir, Turkey3; Health patients were well informed of their medications as they had good social Research General Directory, Ministry of Health of Turkey, Ankara, Turkey4; support. The average cost of medications returned was RM 22.41 with a Department of Econometrics, Economics and Management Sciences standard deviation of RM 34.89. The total cost of medications returned was Faculty, Gazi University, Ankara, Turkey5; Health Technology Assessment RM 3338.54. Conclusions: The occurrence of returned medications
Unit (ANHTA), Ankara Numune Training and Research Hospital, Ankara, increased after the pharmacist educates the patient or family member.
Objective: Diagnosis-related group (DRG) system is patient classification
vaccination of 13-14 year old females and males (coverage of 89.62%).
system designed to produce limited number of classes which are relatively Results & Conclusions: Routine vaccination would prevent 107,056
similar in terms of resource consumption and clinical characteristics. The cases of cervical cancer, 28,872 deaths from cervical cancer, 282,800 cases aim of this study was to assess the level of knowledge, attitude and practice of HPV 16/18 related CIN1, 659,3545 cases of CIN2/3, 128,625 cases of (KAP) of Turkish health care providers toward DRG system implemented in HPV 6/11 related CIN1 and 2,480,823 cases of HPV 6/11 related genital Turkey. Methods: A total of 302 healthcare providers were conveniently
warts among women and men over a 100-year period. Vaccination of 13-14 selected from five public hospitals in Turkey. A self-administered modified years females and males with a Quadrivalent HPV vaccine demonstrated a questionnaire on KAP regarding various aspects of DRG system was greater reduction in HPV related disease incidences and cost as compared recruited to collect data. Results: Two third of healthcare providers showed
to the current scenario of screening and treatment only. The ICER per QALY poor knowledge (66.6%) and poor practice (61.3%) about DRG system, but in a gender neutral vaccination was 13,477 MYR/Years (In 2012, Malaysia's 63.6% of them showed good attitude based on chi-square and multiple threshold for cost effectiveness was 55,207 MYR), which indicates that the logistic regression results. There was significant difference between age, Quadrivalent HPV vaccination is a highly cost effective strategy in Malaysia.
gender, occupation groups and whether the respondents have attended a workshop for DRG system in terms of KAP (p>0.05). Conclusions: These
results indicated the need for further actions to implement DRG system in FORMULARY LIST REVIEW OF SULPHONYLUREAS USING
terms of creation of suitable environment and increasing awareness among MEDICINES SCORING SYSTEM (MEDSS): ANY COST SAVINGS
healthcare providers, especially male, elderly, and those who have never attended a workshop, in addition to regular review to ensure the program Ramli A1, 3, Aljunid SM1, 2, Sulong S2, Md Yusof FA3 would reach its targets.
United Nations University International Institute for Global Health (UNU- IIGH), Kuala Lumpur, Malaysia1; International Centre for Casemix and Clinical Coding (ITCC), UKM Medical Centre, Kuala Lumpur, Malaysia2; PRESCRIPTIONS STUDY TO ASSESS DRUG UTILIZATION PATTERN
Pharmaceutical Services Division, Ministry of Health, Petaling Jaya, AND ESTIMATE DIRECT DRUG COST: A REVIEW OF EXISTING
Objectives: Sulphonylureas are widely used for the management diabetes.
Lee SW1, 2, Aljunid SM1, 2, Ahmed Z1 In Malaysia available sulphonylureas include glibenclamide, gliclazide, International Training Centre for Casemix and Clinical Coding (ITCC) 1; glimepiride and glipizide providing varying degree of benefits and risks. In National University Malaysia, United Nations University-International this study we review and compare overall utility values of sulphonylureas Institute for Global Health2 using medicines scoring system (MedSS). Potential cost savings resulting Objectives: To review the current literature on the usage of prescriptions to
from recommended medicine utilization ratio was calculated. Methods:
assess drug utilization pattern and estimate the direct cost of drugs.
MedSS, a previously developed scoring framework based on multicriteria Methods: Literature search was undertaken on Scientific databases
decision analysis that systematizes evaluation of the various drug attributes (Science Direct, Emeralds, Wiley Online Library), Google scholar using was used. An expert panel of 3 endocrinologists, 1 family physician and 5 keywords including drug prescription study, drug cost, drug utilization pharmacists were formed. A group of medicine reviewers assisted in pattern, prescription pattern, prescription drug use. The articles were then evidences search and reviews. In a series of meetings, attributes identified analysed for the usage of prescriptions in determine the utilization of the and selected for analysis were efficacy (clinical efficacy, clinical endpoints), drugs and direct drug cost. Literatures using other methods than safety (interactions, serious side effects, hypoglycaemia, documentation, prescriptions such as patient interviews, questionnaire, review of medical cardiovascular effects, combination with insulin, frequent side-effects and records and laboratory data were excluded. Results: Prescription studies
use in special population), patients' acceptability (formulation, dose were quite commonly used in drug utilization and estimate of direct drug frequency, weight change), and cost. The average weights assigned by cost. 10 articles were reviewed. Most of the studies were done in developing panel members for efficacy, safety, patients acceptability and cost were countries like India, Saudi Arabia, Pakistan, China, Hong Kong and 23.89%, 43.89%, 20.33%, and 11.89%, respectively. Based on evidences, Malaysia. 8 studies were done in outpatient setting, 1 in inpatient setting and attribute scores were allocated and added up to provide the total utility score 1 in both inpatient and outpatient setting. 8 studies were done in single (TUS). Results: The five sulphonylureas were successfully scored and
hospital and 2 studies were done in a few health facilities. In single hospital, ranked using MedSS. Gliclazide (both forms) scored consistently high for the longest duration of study is 4 years with 12,000 prescriptions collected both efficacy and safety attributes resulting in total utility score (TUS) of 68.5 and the shortest duration of study is 1 month with 1,206 prescriptions and 67.4 for gliclazide modified release and gliclazide respectively.
collected. In multiple healthcare facilities, a study with total of 2,382 Glibenclamide scored high for both efficacy and cost however safety prescriptions collected at 10 facilities in 1 day and a study with total 3,769 concerns lowered its TUS to 56.8. In addition to more patients benefiting prescriptions collected at 5 facilities in 3 months. The average number of from the use of better drug gliclazide, over RM 3 million per year potential drugs per prescription is 1.9 at outpatient setting and 7.2 at inpatient setting.
medicine cost savings were predicted when the use of glibenclamide (drug The direct drug cost is calculated from the unit cost obtained from Hospital with lowest TUS) is reduced to 5%. Conclusions: MedSS successfully
Drug Formulary and unit price charged by dispensing chemist in hospital.
organize the attributes and utilities of the medicines compared. Benefits of Conclusions: Prescriptions studies are more commonly used at outpatient
clinicians' involvement can be twofold: better acceptance of any changes setting due to the monitoring of drug utilization in chronic condition like planned for the formulary list leads to improved prescribing pattern and diabetes and hypertension. It is also used in specialist clinics to monitor the better management of medicine expenditures. specific drug use in specific group of patients like paediatric and pregnant women. Prescription studies were mostly done in developing countries due to the availability of the prescription data. The direct drug cost is normally OUTCOME STATUS AND DURATION OF DUAL ANTIPLATELET USE
calculated from the unit cost by respective hospital procurement.
AMONG POST-PCI PATIENTS.
Azmi S1, Abdul Aziz SH1, Wan Azman WA2, Sim KH3 Azmi Burhani Consulting1; Department of Medicine, Universiti Malaya THE EPIDEMIOLOGIC AND ECONOMIC IMPACT OF A
Medical Centre2; National Heart Association Malaysia3 QUADRIVALENT HUMAN PAPILLOMAVIRUS VACCINE (6/11/16/18) IN
Objective: To compare patient outcomes based on duration of dual
MALAYSIA'S GENDER NEUTRAL SETTING
antiplatelet use following percutaneous coronary intervention (PCI).
Wan Puteh SE1, Kulkarni AS2, Shcheprov A3, Surinder Singh BSG4, Hsu TY5, Methods: The National Heart Association Malaysia collects and reports
data on patients undergoing PCIs in the NCVD-PCI registry. The NCVD-PCI Department of Community Health, Faculty of Medicine, UKM Medical registry database was analysed to assess the outcomes of interest. Patients Centre, Malaysia1; Global Health Outcomes, Merck & Co., Inc., Whitehouse with PCI procedures performed between 2010-2012 and received dual Station, New Jersey, USA2; Reveille Technologies, Inc., Winston-Salem, antiplatelet therapy (DAPT) at time of discharge were selected. DAPT was North Carolina, USA3; Global Medical Affairs, Merck Sharp &Dohme defined as combination of aspirin and clopidogrel or ticlopidine. We then (Malaysia) Sdn. Bhd., Selangor, Malaysia4; Global Medical Affairs, MSD identified patients' dual antiplatelet use at 30-days, 6-months and 1-year Pharma (Singapore) Pte. Ltd., Singapore5; Department of Obstetrics and follow-up. Descriptive analysis was performed using STATA version 11.2.
Gynaecology, Faculty of Medicine, UM Medical Centre, Malaysia6 Results: Between 2010-2012, a total of 11,567 patients received DAPT at
Objectives: Evaluate the public health and economic impact associated
discharge following PCI procedure. More than half of patients were male with the introduction of routine vaccination of a Quadrivalent Human (82.6%). Majority of patients had dyslipidaemia (71.6%) or hypertension Papillomavirus Vaccine (6/11/16/18) in Malaysia. Methods: A validated
(73.1%), while almost half had a diagnosis of diabetes mellitus (45.9%).
dynamic transmission model was adapted to the Malaysian setting. The About half of patients only received DAPT at discharge (51.5%) whereas model used an age-structured Malaysian population stratified by gender and 14.8%, 11.0% and 18.9% received DAPT up to 30-days, 6 months and 1- sexual activity group to simulate heterosexual HPV transmission and the year. Patient outcome after 1-year follow up was different among the DAPT occurrence of HPV-related diseases. The model captured both direct and usage duration. The proportion of patients who had died were highest for indirect (herd immunity) benefits. Model inputs were obtained from literature, among those who received the DAPT up to 30-days (3.5%), followed by up unpublished data and expert opinion. The vaccination strategy assessed to 6-months (2.7%), only at discharge (1.1%) and up to 1-year (0.2%).
was of combining current screening and treatment practices with routine Conclusions: Approximately half of post PCI patients who were given
DAPT, received DAPT only at discharge, while approximately 20% were on EQ-5D-5L than EQ-5D-3L by an average of 24.5%, but there was an DAPT up to one year. Results showed that patients who received the average 11.7% loss for relative discriminatory power. Convergence of EQ- medication up to 1-year may have better outcome.
5D-3L and EQ-5D-5L with VAS improved slightly with 5L versus 3L except for usual activities. Conclusions: Greater absolute informativity and lower
ceiling effect were noted in EQ-5D-5L compared to EQ-5D-3L. EQ-5D-5L LENGTH OF STAY AND PROGNOSTIC FACTORS FOR 30-DAY better describes various health states and has acceptable convergent READMISSION FOR POST-PCI PATIENTS WITH DYSLIPIDAEMIA, validity EQ-VAS.
HYPERTENSION AND DIABETES Azmi S1, Abdul Aziz SH1, Wan Azman WA1, Sim KH3 Azmi Burhani Consulting1; Department of Medicine, Universiti Malaya COST EFFECTIVENESS STUDY OF PANTOPRAZOLE AND Medical Centre2; National Heart Association Malaysia3 ESOMEPRAZOLE IN THE TREATMENT OF UPPER Objectives: To describe the differences in length of stay (LOS) and
GASTROINTESTINAL BLEEDING AT HOSPITAL TAIPING prognostic factors for 30-day readmission for patients undergoing PCI who Jiun CS1, Shafie AA2, Pei SP1, Shah Jehan RD1, Megat Fauzi SH1, Wan- have dyslipidaemia, hypertension or diabetes mellitus. Methods: The
Omar WA1, Yi BX1, Umasangar R3 National Heart Association Malaysia collects and reports data on patients Department of Pharmacy, Taiping Hospital1; School of Pharmaceutical undergoing percutaneous coronary intervention (PCI) in the NCVD-PCI Sciences, Universiti Sains Malaysia2; Surgical Department, Taiping Hospital3 registry. We utilized registry data of patients who underwent PCI between Objectives: Upper gastrointestinal bleeding is a life threatening emergency
2010-2012 who also had a diagnosis of dyslipidaemia, hypertension or which requires urgent assessment and pharmacological management. The diabetes mellitus and compared their LOS and 30-day readmission rates.
clinical practice guideline recommends proton pump inhibitors as the Descriptive and regression analyses were performed using STATA version mainstay therapy for upper gastrointestinal bleeding. However, there are no 11.2. Results: In the registry, among patients who had undergone PCI
published head-to-head cost effectiveness comparison between between 2010-2012, there were 9,560 (71.7%) patients with a diagnosis of pantoprazole and esomeprazole. This study aimed to evaluate the clinical dyslipidaemia, 9,791 (73.5%) with hypertension and 6,076 (45.6%) with effectiveness and cost effectiveness of pantoprazole and esomeprazole in diabetes. The percentage of dyslipidaemic, hypertensive and diabetic the treatment of upper gastrointestinal bleeding, from the healthcare payer patients having 30-day readmission was 3.6%, 3.3% and 3.8%, respectively.
perspective. Methods: A total of 31 patients were recruited and randomly
Meanwhile, LOS was similar for all three conditions, at an average of assigned into pantoprazole (n=17) and esomeprazole (n=14) group. Clinical approximately 5 days. However, different factors influenced the 30-day effectiveness was determined by the duration of treatment until bleeding readmission between these comorbidities. For dyslipidaemic patients, the stops and the occurrence of re-bleeding event. The cost included factors were Killip Class 2 (HR=1.43, p-value=0.019) and intra-aortic balloon medications, hospitalization, outpatient, medical procedures, imaging and pump use (HR=2.93, p-value=0.004). For hypertensive patients, the laboratory investigation. The primary outcomes were cost effectiveness ratio readmission rate was only affected by Killip Class 2 (HR=1.52, p- and incremental cost effectiveness ratio for one bleeding-free day and re- value=0.009). For diabetic patients, the prognostic factor was the PCI status bleeding event averted between pantoprazole and esomeprazole. Results:
of acute myocardial infarction (HR=2.11, p-value=0.010). Conclusions: The
The direct cost per patient for pantoprazole and esomeprazole regimen was LOS for these three comorbidities was similar at 5 days. However, different RM 4,817.60 and RM 4,745.74. Esomeprazole achieved earlier bleeding- factors were found to influence 30-day readmission rate.
free day (2.07 days vs. 2.3 days), and averted more re-bleeding event (100% vs. 82.35%) than pantoprazole. Esomeprazole dominate over pantoprazole for additional one bleeding free-day re-bleeding event. The RELATIONSHIP BETWEEN BELIEFS, ADHERENCE AND QUALITY OF
sensitivity analysis showed that the cost effectiveness values were most LIFE (QOL) AMONG CHRONIC KIDNEY DISEASE (CKD) PATIENTS ON
sensitive to shorter duration to achieve bleeding-free day as well as the HAEMODIALYSIS IN PENANG GENERAL HOSPITAL
reduction of blood transfusion cost. Conclusions: Esomeprazole is more
Said SH1, Shafie AA2 cost effective compared to pantoprazole in the treatment of upper Department of Pharmacy, Tumpat Hospital1; School of Pharmaceutical Sciences, Universiti Sains Malaysia2 Objectives: The objectives of this study are to assess the relationship
between patient's specific beliefs about medications (necessity and EXPLORING THE WILLINGNESS TO PAY FOR VOLUNTARY
concerns), their adherence level and QOL. Methods: This study was a
COMMUNITY-BASED HEALTH INSURANCE IN MALAYSIA
cross-sectional study among CKD patients on regular haemodialysis in Shafie AA1, Hassali MA1, Chan CY1 Penang General Hospital. Validated self-administered BMQ specific, MMAS Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia1 and EQ-5D questionnaires were used in 50 patients. Results: The result
Introduction: Healthcare in Malaysia is funded primarily through taxation
from BMQ-specific shows the mean necessity scale (19.6, SD=4.1) (98%) but is no longer sustainable. One funding option is community-based outweighs the concerns scale (15.6, SD=4.2) with positive necessity- health insurance (CVHI). The purpose of this study is to assess the factors concerns differential (Means =4.6, SD=5.0). Majority of the participant (82%) affecting of Malaysian willingness to pay (WTP) for voluntary CVHI.
had a necessity outweighs the concerns scale. Even though reported Methods: A cross sectional study was carried out in the Penang between
medications adherence level was low (mean 5.5 ± 1.84), the findings August and September 2009 on 472 randomly selected respondents. The support that patient's necessity towards their prescribed medications was respondents were asked to select their preferred health financing scheme having significant relationship in influencing the adherence rate with among three (totally private funding, compulsory health insurance and statistically significant positive correlation (r=0.368, p<0.05). There is no CVHI). The extent of the participants' WTP for the described CVHI scheme significant relationship between beliefs or adherence in QOL though they was assessed using contingent valuation (CV) method. Results: 54% of the
reported moderate to severe problems especially involving pain/discomfort.
participants were female with mean age of 34 years (SD=11.9). A majority Conclusions: Educational intervention and medication counselling to
had a monthly income of MYR 2,001-4,000. 63.1% of the respondents emphasize the necessity of their medication may be useful to influence indicated their willingness to join and contributed an average of MYR 196.12 patient's medications adherence.
per month toward VHI. The odds of those married to choose VCHI rather than total out-of-pocket is 2.95 times greater than those who are not married, adjusting for health insurance, and education level. WTP is VALIDATION OF EQ-5D-5L IN THE GENERAL POPULATION OF
positively influenced by ethnicity, education level, household monthly incomes, types of chronic disease and insurance coverage (p<0.05).
Shafie AA1, Chan CY1 Conclusions: Most Malaysians are willing join the CVHI and WTP an
School of Pharmaceutical Sciences, Universiti Sains Malaysia1 average of MYR 191.12 (USD 56) per month for the scheme. Their choice Purpose: The EQ-5D-5L is an expanded version of EQ-5D-3L to
of financing scheme is associated with their marriage status, current health compensate its lack of descriptive richness and high ceiling effect. Our aim insurance and education level. The amount that they are willing to pay for was to determine the validity of EQ-5D-5L in the general population of CVCHI is influenced by income, ethnicity and marriage status.
Malaysia. Methods: A cross-sectional study was conducted among
Malaysian adults in six states of Malaysia using random cluster technique.
Selected sample were provided with interviewer assisted EQ-5D-3L, EQ- THE STATE OF HEALTH ECONOMICS RESEARCH IN MALAYSIA
5D-5L and EQ-VAS questionnaire to determine their health state.
Redistribution response, ceiling effect, discriminatory power, and Clinical Research Centre, Malaysia1; Medtronic2 convergent validity of EQ-5D-5L were evaluated. Results: A total of 421
Objectives: Economic evaluation has immense potential to contribute
participants (mean age 22.7 years; male 28.0%) were enrolled. The towards cost-effective delivery of health care services and technology in proportion of inconsistent response was 1.3%. Redistribution from EQ-5D- Malaysia. However, little is known about the state of economic evaluation 3L to EQ-5D-5L using VAS was validated except 3L2-5L level for usual studies in the country. The aim of the study is to evaluate the characteristics activity. The ceiling effect of EQ-5D-5L (45.4%) was lower compared to EQ- health economics researches in Malaysia. Methods: A literature search was
5D-3L (52.3%). The absolute discriminatory power was improved for the conducted in January 2014 using PubMed, Medline and EconLit databases to identify economic evaluation (including cost analysis) studies related to identified i.e. improving the quality of medicines related information Malaysia published between 01/01/1990 to 01/01/2014. Only original provision to patients and promoting greater efficiency at every stage of the studies published in English peer-reviewed journals addressing a health- repeat prescribing and dispensing process.
related topic in Malaysia were included. Results: Only 30 articles met the inclusion criteria. These studies covered 11 disease areas, most of which were cost analyses (n=17) rather than economic evaluation studies (n=13), HEALTH RELATED-QUALITY OF LIFE (HRQOL) IN TYPE 2 DIABETES
involved an average of 6 authors per publication, led by local researchers MELLITUS: A STUDY IN SELANGOR DISTRICT HOSPITALS
(first authors) (n=20), mostly published after 2010 (n=18). Conclusions: Ainur Fadlina MN1, Nurliana AL1, Zati Iwani I1, Ang LC1, Intan Nor Hafizah There are only limited conducts of health economics studies in Malaysia. It MJ2, Khairatun Hisan MN1, Jeyasridevi S1, Piriya Dharshini T1, Teh WY3 is imperative to evaluate the quality of these studies and to ensure more and Department of Pharmacy, Kuala Kubu Bharu Hospital1; Department of better quality health economics studies in Malaysia to advise evidence- Pharmacy, Tanjung Karang Hospital2; Department of Pharmacy, Tengku based allocation of resources for health care.
Ampuan Jemaah Hospital3 Introduction: Diabetic patients need to adhere to severe dietary restrictions
and daily self-administration of oral medications or insulin. These may A STUDY ON DRUG INFORMATION UTILIZATION AND ACCESSIBILITY
adversely affect diabetic patient's quality of life. Due to this, it is crucial to AT KAJANG HOSPITAL
assess health-related quality of life (HRQoL) of diabetic patients so that Sarah Diyana S1, Zaiton K1, Nur Adlina S1, Haizun Athirah I1, Nur Farah A1 interventions can be designed and implemented that will further enhance Department of Pharmacy, Kajang Hospital1 patient's compliance and lifestyle. Objectives: To compare quality of life
Introduction: Despite the importance of drug information resources, there
(QOL) between age groups and to compare QOL between patients on oral is little knowledge about which are actually used in practice by prescribers.
anti-diabetic agent (OAD) with insulin treated patient with or without OAD.
Objectives: To determine the accessibility and utilization of drug information Methods: This cross sectional study use convenient sampling method to
resources among prescribers in Kajang Hospital (HKJ). Methods: A
assess HRQoL among diabetic patients from three district hospitals in questionnaire survey used consists of 2 sections: 1) Prescribers were Selangor; Hospital Kuala Kubu Bharu, Hospital Tanjung Karang and needed to indicate drug information resources used from the 23 list of drug Hospital Tengku Ampuan Jemaah. Face to face interviews were conducted information resources 2) Questions pertaining to awareness, utilization, and among 150 respondents from Out-patient Pharmacy and Diabetic Clinic by quality of services provided by Drug Information Service (DIS) Pharmacy using validated World Health Organization Quality of Life Questionnaire Department, HKJ. A check list form was used to audit the availability of drug (WHOQOL-BREF). It is divided into four domains; domain 1 (physical information resources in all wards and clinics in HKJ. Results: Among 114
health), domain 2 (psychological health), domain 3 (social health) and prescribers, the top 3 type of drug information resources used were drug domain 4 (environmental health). It were calculated in score from 0 - 100.
information provided by pharmacist (78.9%), formularies (73.7%), and MOH The higher the mean score is, the higher the QOL. Results: Age "40 – 49
Clinical Practice Guidelines (CPG) (63.2%). The least use type of resources years old" group has the highest mean score in domain 2 and 4 which was was journal articles. Findings from survey were essentially similar to findings 64.48 and 61.48 respectively. Nevertheless, group "50 - 59 years old" record from audits. Audits results showed that drug information resources most highest mean score in domain 1 and 3 (61.76 and 66.94). Respondents who frequently available/readily accessible in wards and clinics were CPG were treated with tablet(s) only have higher mean scores in domain 1 and 2 (72.2%), MIMS (66.7%), and Hospital Drug Formulary (55.5%). Assessment when compared with the subjects who treated with insulin (p<0.05).
on quality of DIS findings showed that majority of the prescribers (94.8%) Conclusions: No significance difference shown between age group.
indicated that drug information provided by the DIS to be useful and helps However, patients who were treated with tablets only are significantly having them during prescribing process. Conclusions: Although prescribers
a good quality of life in term of physical and psychological health than frequently obtain drug information from tertiary resources they often consult patients who are treated with insulin with or without OAD.
pharmacists for drug information resources. There is a need for training awareness for healthcare professionals on utilization of drug information resources as the current focus is on evidence-based medicine to ensure INCIDENCE OF HYPERSENSITIVITY REACTION IN HIV-INFECTED
safe and effective medical therapy. Since the choice of drug information PATIENT STARTING NNRTI-CONTAINING REGIME: A CROSS
resources depends on one's place of employment and its availability there SECTIONAL STUDY ON HTAR PATIENTS
is a need for pharmacists role to monitor and ensure readily accessible, up Oon HY1, Amir Hamzah SA1, Abdul Latip WSS1, Wong WW1, Wan Mohd to date and quality drug information resources in all wards and units. Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1 Objectives: This study aimed to determine and compare the incidence of
ANALYSIS OF MEDICATION RETURNED TO HOSPITAL OUTPATIENT
hypersensitivity reactions in HAART-naïve HIV patient taking EFV or NVP PHARMACY: A QUALITATIVE FOCUS GROUP STUDY
based regimens, to assess risk factors associated with the hypersensitivity Ping LS1, Syarifah Naemah SH1, Vigayakumaran JR1, Haniza MA1, Sarah reactions and to study the prescribing trend of NNRTI regimen in HTAR.
Diyana S1, Zaiton K1, Yee LW1 Methodology: This retrospective study included antiretroviral drug-na˚ve
Department of Pharmacy, Kajang Hospital1 patients initiated with either EFV or NVP-based HAART that undergone Introduction: Studies on medication return are vital to curb spiralling costs
follow up at the Medication Therapy Adherence Clinic (MTAC), Hospital to ascertain wastage in prescribing and usage. To augment the findings of Tengku Ampuan Rahimah, Klang from January 2006 until March 2013. The the quantitative research on returned medications, in-depth qualitative incidence of HSR is extracted from patients' medication record using a self- research is needed to explore reasons, perceptions and experiences of structured, piloted data collection form. Results: A total of 112 patients were
medicines excess being return. Objectives: To delve further into the reasons included in the study, 47 in NVP-based group and 65 in the EFV-based and perceptions behind returned medications among patients from group. Hypersensitivity developed in 11 patients (9.8%) in the NVP-based healthcare personnel group. Methods: Purposive sampling was used to
group and 2 patients (1.8%) in EFV-based group with a significant p value recruit patients from healthcare personnel group who have returned of 0.001. No significant risk factor could be assessed. Prescribing rate of medications to Outpatient Pharmacy Kajang Hospital. Two focus group EFV is higher than NVP in HTAR. Conclusions: Incidence of
discussion (FGD) sessions were held consisted of 6 participants in each hypersensitivity in patient initiated with NVP is higher than EFV. No session. Audio recording, transcription and textual analysis were conducted significant risk factor associated with risk of developing hypersensitivity for FGD. Audio recording, transcription and textual analysis were conducted towards NNRTI could be concluded due to limited power of the research.
for FGD. Results: Most of participants stated reasons for excess
Prescribing rate of EFV is higher than NVP.
medications returned was due to treatment changes accounted by medication being stopped and changed in dose/medication prescribed.
Some of the participants pointed out reasons was due to discontinuation of COMPARING THE TREATMENT OUTCOME FOR ANTHRAL GASTRITIS
own medication attributed by personal beliefs that medications were AND NON ULCER DYSPEPSIA USING PANTOPRAZOLE VERSUS
unnecessary, ineffective and harmful. Other reasons for excess medications ESOMEPRAZOLE IN AN OUTPATIENT SETTING IN HOSPITAL
returned stated were discrepancy between duration of drugs prescribed and TENGKU AMPUAN RAHIMAH (HTAR)
the subsequent prescribers' appointment with patients and patients being Chevena A1, Khoo CC1, Yong SY1, Sarmilah A1 prescribed for same disease indication by more than one prescribers at Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1 different health institutions follow ups, patients' experienced of unpleasant Objectives: To compare the treatment outcome between Esomeprazole
side effects, medications that are prescribed as a needed/PRN basis and versus Pantoprazole in the outpatient surgical department at HTAR.
medications which had expired. All of the participants agreed that return Methods: A cross sectional study was carried among non-ulcer/functional
medication program helped them to manage their excess medication and is related dyspepsia and anthral gastritis patients aged from 18 to 80 years old a practical method to avoid wastage and reduces government expenses. All who are prescribed with either Pantoprazole or Esomeprazole in the were adamant that sharing excess medications should not be a practice.
Outpatient Surgical Clinic. A total of 47 patients were recruited from March Conclusions: Reasons for excess medications returned ranging from
to August 2013 using research assisted questionnaires which was prepared deliberate choices on the part of patients through involuntary personal and in both English and Malay and were then cross validated amongst the system related variables. Various interventions should therefore be pharmacists in HTAR. The result was tabulated using Chi-square Test.
passed away, 2 of them were transferred out before the end of the study Results: This study showed that after 1 month of the therapy, there is no
period and 2 of them had disrupted total parental nutrition regimen). A total significant difference between Esomeprazole and Pantoprazole in overall of 111 premature infants were eligible for the study. Electronic medical symptoms improvement (p>0.05). Esomeprazole has greater improvement records were reviewed to obtain the following parameters: gestational age, compared to Pantoprazole to reduce the abdominal ache or pain before birth weight, date of commencement and date of ending of total parental meals or when hungry or right after meals or at night (p<0.05). This study nutrition, length of mechanical ventilation, length of stay in neonatal also shows that there is no significant difference between Esomeprazole intensive care unit, time taken to achieve birth weight (in days), presence of and Pantoprazole in the reduction of the frequency of dyspeptic symptoms TPN-associated cholestasis and renal impairment. Results: There is no
(p>0.05). Conclusions: The difference in symptoms improvement between
significant difference (p>0.05) in the mean of birth weight and gestational the two treatment arms is statistically insignificant. However, Esomeprazole age between the two groups of infants. No significant difference was exhibited greater improvement in reducing pre-meal abdominal ache or observed for time taken to achieve birth weight (in days), length of abdominal pain during hunger, post meal or nocturnal abdominal ache.
mechanical ventilation, length of hospital stay, number of episodes of TPN- associated cholestasis and renal impairment between infants who received TPN with 2.5%w/v amino acid concentration and 2.8%w/v amino acid THE OUTCOME OF HOME MEDICATION REVIEW PROGRAMME IN
concentration. However, the duration of parenteral nutrition was shorter and EMPOWERING PSYCHIATRIC PATIENTS AT HTAR KLANG
there were less episodes of sepsis in premature infants receiving TPN with Anusuya K1, Larry LLS1, Parimala VI1 amino acid concentration of 2.8%w/v (p-value<0.05). Conclusions: The
Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1 small difference of amino acid concentration between the two groups Objectives: To investigate the effect of pharmacist's involvement under
(2.5%w/v versus 2.8%w/v) could be insufficient to cause significant HMR programme in CPU on the rate of patient's readmission to psychiatry difference in the aforementioned outcomes. However, TPN containing ward within three months of the last discharge. Methods: 510 patient's
higher amino acid concentration (2.8%w/v) seems to be a better choice of records from 2009 to 2012 were reviewed. Prior to 2011, there was no nutrition in premature infants and a further study with a bigger sample size pharmacist's involvement in CPU. From 2011 onwards, pharmacist has and larger difference in amino acid concentrations should be conducted.
been actively participating in patient's care under HMR programme.
Results: There were 60 readmissions from 79 patients in 2009 which
ABSTRACT #63
resulted in 6.3% of readmission rate. In 2010, there were 52 readmissions AN AUDIT OF THE DIABETES MEDICATION THERAPY ADHERENCE
from the total patient of 120, this contributed to 3.6% of readmission rate.
CLINIC (DMTAC) IN SERDANG HOSPITAL
There were 141 patients in 2011 and total readmission was 8 which resulted Khaw MJ1, Rasyidah CS1 in 0.47% of readmission rate. In 2012, there were 13 readmissions from170 Department of Pharmacy, Serdang Hospital1 patients resulting in 0.63% of readmission rate. It was found that there were Introduction: An increase in prevalence of diabetes has made it a national
significant reduction in the rate of readmission into psychiatry ward within healthcare concern. Poor glycaemic control leads to diabetic-related three months of the last discharge after pharmacist's involvement in CPU complications as well as increases healthcare cost. To date, there is a patient care under HMR programme, from 6.3% (2009) and 3.6% (2010) to dearth of evidence regarding the role of pharmacist in managing the disease 0.47% (2011) and 0.63% (2012). Conclusions: This study shows that
in Malaysia. The impact of the pharmacist-run DMTAC in Hospital Serdang pharmacist's involvement in CPU under HMR programme does help to remains unknown. Objectives: To evaluate the standard of care of patients
optimise patient's healthcare and thus reducing the rate of patient in the DMTAC programme in Serdang Hospital by assessing the current readmission into psychiatry ward.
practice against the protocol outlined by the Ministry of Health and to provide evidence on the quality of care of patients. Methods: This is a retrospective
study, where a total of 208 patients involved in the MTAC programme at MEDICATION RECONCILIATION IN HOSPITAL BANTING MEDICAL
Serdang Hospital from the year 2008 to 2013. Only 89 patients were WARDS: IDENTIFYING THE TYPES AND FACTORS CONTRIBUTING TO
included in the study as the rest does not meet the criteria (completed at least 4 visits). Three categories of data were collected from Feb to Jun 2013, Cheong WK1, Mohd Khalimi NZ1, Mohd. Fathir N1 (i) Structure (based on DMTAC policy and patients record); (ii) Process; and Department of Pharmacy, Banting Hospital1 (iii) Outcome. As for (ii) and (iii), data were collected from patients who Introduction: Medication reconciliation is a formal process for creating the
completed a minimum of 4 visits. Results: In terms of adequacy of the
most complete and accurate list possible of a patient's current medications structure of care in DMTAC, documentation was found to be inadequate. As and comparing the list to those in the patient record or medication orders.
for process care indicators, medication knowledge was lacking, while the While medication discrepancies are defined as unexplained differences other six indicators fulfilled the minimum requirement (more than 70%). For among documented regimens across different sites of care. This aspect has outcome care indicators, compliance was found to have no significant become one of the factor in which attention is required to improve the quality improvement after 4 visits (p=0.467). Contrary, by using different length of and safety of healthcare. Objectives: To conduct medication reconciliation
time between visits, there is a significant decrease in HbA1c (p=0.003) after in patients who admitted to medical wards and to identify types of each visit with 47.5% of patients achieving a mean reduction of 1.24%. The medication discrepancies and factors contributing to medication number of drug-related problems encountered as well as interventions discrepancies. Methods: An observational study on medication
decreased, 35% and 32%, respectively. Conclusions: The criteria
discrepancies amongst patients that are admitted to medical wards of assessed met the target standards except for documentation (under Hospital Banting. Results: The percentage of medication discrepancies
structure) and DFIT (under process). MTAC also found to be effective in obtained in this study of 60 samples are 14.29%, and the types of improving patient's glycaemic control after 4 visits. However the outcome of medication discrepancies commonly occurring in the Medical Wards of improving adherence was not met after 4 visits. It is suggested that Hospital Banting are (1) omission of drug; (2) change in the dose; (3) adherence should be analysed after the completion of 8 visits.
change in frequency; (4) change of drug; (5) addition of new drug; all in order of the most common to the least common. Conclusions: This study
ABSTRACT #64
identified the factors that lead to medication discrepancies that commonly A SURVEY TO EVALUATE THE TECHNIQUES OF MEDICATION
occur are either the Patient factor or the System factor. The common factors ADMINISTRATION THROUGH ENTERAL FEEDING CATHETERS (EFC)
resulting discrepancies are; non-adherence, unable to tolerate side effects, FOR ADULT PATIENTS IN NURSING PRACTICE IN SERDANG
unneeded prescription, conflicting information and unrecognized cognitive impairment. Medications commonly associated with medication discrepancies are antihypertensives, antihyperglycaemic, antidyslipidaemia, Department of Pharmacy, Serdang Hospital1 antiasthmatics, and cardiovascular (in order or most common to the least Introduction: Medication administration through EFC in adult patients can
be difficult to administer and when administered wrongly, can cause complications including patient fatality. Objectives: The objectives of this
study were to compare and contrast the techniques of medication CLINICAL OUTCOMES OF PREMATURE INFANTS RECEIVING TOTAL
administration through EFC in nursing practice throughout 5 disciplines in PARENTERAL NUTRITION (TPN) SOLUTION WITH AMINO ACID
Serdang Hospital, to identify common drugs contributing towards catheter CONCENTRATION OF 2.5%W/V VERSUS 2.8%W/V IN NICU, HOSPITAL
obstruction, to determine the frequency of medication causing EFC obstruction, to identify common complications other than catheter Leon IGW1, Lim PL1, Ruffehe NS1, Ismail NS1, Lau SY1, Tan YH1 obstruction and to determine nurses' satisfaction on their current skills and Department of Pharmacy, Selayang Hospital1 perception for more training on this area of practice. Methods: Medical,
Objectives: To compare the clinical outcomes of premature infants
Surgical, Acute Intensive Care, Cardiology and Cardiothoracic disciplines receiving TPN solution with different amino acid concentrations (2.5%w/v were chosen and using formula with finite population correction in sample versus 2.8%w/v) in Neonatal Intensive Care Unit (NICU), Hospital Selayang.
size calculator for prevalence studies, 122 nurses were needed for this Design: Retrospective study Setting: Hospital Selayang neonatal intensive study. 160 surveys were distributed out. Nurses were selected via care unit. Methods: A total of 151 premature infants were hospitalized but
randomized, proportionate sampling according to discipline and approached 40 were excluded (28 of them had birth weight more than 1.25kg, 8 of them to self-administer the validated questionnaire on EFC techniques. Results:
144 surveys were returned. All respondents regardless of specialty were patients who were admitted to medical ward have moderate severity of routinely crushing enteric coated medications (94.2%) while 97% were potential drug-drug interactions and such interactions have significant crushing sustained-release medications. When medications are due at the association with increased number of drugs prescribed. Future studies on same time, respondents will administer medications together through EFC, drug-drug interaction may focus on evaluation of physician's awareness on with the highest number of respondents from Surgical (100%), followed by potentially harmful drug interactions as well as assessment on clinical Cardiology (94.2%), Cardiothoracic (88.9%), Medical (66.7%) and AIC pharmacist intervention in order to improve inappropriate prescribing in (61.5%) and there is a significant differences among the disciplines (p- elderly inpatients as well as outpatients with polypharmacy. value=0.018).Common drugs thought to contribute to catheter obstruction are calcium polystyrene sulfonate powder (54.3%) and potassium chloride (13.6%). Of total catheters encountered per week, catheter obstruction due A STUDY TO EVALUATE PATIENT'S KNOWLEDGE AND SATISFACTION
to medication occurs about 50% of the time. Common complications other TO THE TOPICAL TREATMENT IN CHRONIC SKIN DISEASE
than catheter obstruction are aspiration from enteral feeding (26.4%) and tube dislodgement (20.4%). Majority of respondents think they have learned Department of Pharmacy, Serdang Hospital1 the proper technique (92.8%) and feel confident with their current skills Introduction: Patients with chronic skin diseases rely on topical
(92.9%). However, 80.4% still prefer more training in this area of practice.
medications to control their skin problems. One of the reasons of treatment Conclusions: 86.1% of the total respondents have three or more
failure is the lack of knowledge or understanding on the appropriate use of inappropriate techniques. International guidelines on medication topical medications. Poor knowledge may affect the patient's adherence and administration through EFC should be adapted and tailored as reference for thus lead to poor treatment outcome. When this happens, it may affect the local setting.
patient's satisfaction level. Objectives: To evaluate the patient's knowledge
level on the proper use of topical medications; and the satisfaction level to the topical treatment and service provided by the Hospital Serdang A STUDY OF PATIENT'S SATISFACTION & ADHERENCE TO MINISTRY
pharmacy. To study the association between the level of knowledge to OF HEALTH MALAYSIA (MOH) GUIDELINES ON DISPENSING
patients' age, education level, duration of skin disease, number of topical METHADONE IN AGENSI ANTIDADAH KEBANGSAAN (AADK) HULU
medications prescribed and the satisfaction level. Methods: Patients who
fulfil the study criteria were interviewed to assess their knowledge and Ng SY1, Siti Maryam AR1 satisfaction level using a validated questionnaire. For the knowledge part, Department of Pharmacy, Serdang Hospital1 patients were asked regarding the name, site, frequency, duration and how Introduction: Methadone is used as a substitution therapy for opioid
to apply the topical medications; whereas for the satisfaction part, patients dependence patient who abuses heroine and morphine. In October 2005, were asked about the pharmacy services and treatment satisfaction.
MOH introduced methadone maintenance therapy programme. Retention in Results: Most patients were ‘satisfied' for the monthly supply (42.7%),
the programme showed a better client's satisfaction. MOH has produced packing (66.7%) and treatment given (60.0%); whereas for the knowledge two guidelines on dispensing and counselling of methadone. Auditing part, most patients answered wrongly for the name of topical medications service helps identify areas of clinical care and service delivery that require (36.0%), followed by the site of application (28.0%), how to apply (22.7%), changes and improvement. Therefore, this study is done to assess the frequency (18.7%) and duration of use (1.3%). Only 36.0% of patients quality of methadone dispensing in our centre. Objectives: To assess
understood the different strength of corticosteroids. There was no significant patient's satisfaction, to determine whether the dispensing of methadone in association between the level of knowledge with patient's age (p=0.856), our centre adhere to MOH guidelines and to determine the side effects of education level (p=0.570) and duration of disease (p=0.899). However, methadone. Methods: Part I: A cross sectional study was carried out via
there was a significant negative relationship between level of knowledge questionnaire adapted from Client Satisfaction Questionaire-8 items (CSQ- and number of topical medications prescribed (p=0.008); and a positive 8) from March to May 2013. Two additional questions were added where relationship between level of satisfaction and knowledge (p=0.001).
one of the questions was open ended. The sample population is all patients Conclusions: Knowledge was poorer as the number of topical medications
in enrolled in the programme except dropouts (missed attendance more increased. Result also demonstrated a positive relationship between level of than two weeks) during the data collection period. Part II: An audit has been satisfaction and knowledge.
carried out using a review form via face to face interview. The data obtained was evaluated against the "Garis Panduan Pendispensan Methadone" and "Garis Panduan Kaunseling Methadone" as outlined by the MOH. Results:
GENTAMICIN PHARMACOKINETICS IN NEONATES: IDENTIFICATION
Part I: Out of 60 patients, only 55 patients completed the questionnaire.
OF FACTORS AND PREDICTORS FOR LOCAL PHARMACOKINETIC
Majority (96.4%) were satisfied whereas the others (3.6%) were very EQUATIONS OF HTAR, KLANG.
satisfied. In the voluntary open-ended question, 63.6% commented, mostly Rusli RA1, Cheng LP1, Ahmad Fuad FI1, Woo SJ1 on the opening hours and take away policy. Part II: A total of 40 subjects Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1 were interviewed with their medical records reviewed. The results showed Introduction: Concerns of individualised pharmacotherapy in
that the dispensing of methadone practiced in our centre was in accordance aminoglycoside antibiotic led to this study of gentamicin in neonatal to MOH's guidelines. All subjects experienced the side effects of methadone population. Previous literatures have established pharmacokinetic commonly drowsiness, constipation and excessive sweating. Conclusions:
equations of aminoglycoside antibiotics; however, the population In conclusion, our patients were satisfied with the programme and it is in parameters that are used for estimation of pharmacokinetic profiles in accordance to the MOH's guidelines.
neonates are mainly taken from adult population parameters with limited references on local neonatal population. Objectives: To determine local
population pharmacokinetic parameters; clearance rate, volume of POTENTIAL DRUG-DRUG INTERACTION AMONG ELDERLY
distribution (Vd) and half-life of gentamicin and factors that influence the ADMITTED TO MEDICAL WARDS OF SERDANG HOSPITAL: A
pharmacokinetic parameters. Methods: Data were collected on 143
neonates receiving gentamicin from February to June 2013. Out of this, 90 Nurul Khalilah K1, Nurul Huda Y1, Tan SY1 neonates were included for analysis. Data on serum concentration of Department of Pharmacy, Serdang Hospital1 gentamicin were retrieved from TDM request form whereas other data i.e.
Introduction: Medication therapy in elderly patients is difficult to manage
patient's medical and drug history was gathered from the patients' bed head and has the potential of being hazardous especially in elderly with multiple ticket and medication chart. Variables such as patients' gestational and co-morbid diseases. Objectives: The objectives of the study were to assess postnatal age, birth weight (BW) and creatinine clearance were analysed.
polypharmacy incidence among elderly, to evaluate the frequency of drug- Maximum and minimum concentrations, Vd, clearance and half-life were drug interaction of an elderly hospitalised population admitted to medical calculated for each case. Results: About one-third of the subjects were born
ward of Serdang Hospital and to identify the most common medication prematurely with mean gestational age of36.7 weeks (±3.03). The mean involved. Methods: The prescriptions of a total of 206 elderly in-patients
values for creatinine clearance, elimination rate constant (Ke), Vd and half- were collected prospectively using convenient sampling from March until life of gentamicin are 37.0ml/min (±19.31), 0.112hr-1 (±0.06), 0.78L/kg June 2012. All prescriptions were checked for potential drug-drug (±0.36) and 7.35 hours (±3.12) respectively. The clearance rate is increased interactions using a computerized detection program from with increasing postnatal age and birth weight among patients weighing less mimsgateway.com. The inclusion criteria included hospitalized elderly than 2.5kg (p<0.05). Birth weight is a good predictive variable of Ke patients who were admitted in medical ward and was prescribed with at least (p=0.002). There is a significant linear relationship between half-life of 4 in-ward medications. Results: It was found that 96% of elderly patients
gentamicin and patients' gestational age (p<0.001). However, volume of admitted to medical wards have polypharmacy. Out of this, 36.1% patients distribution was not influenced by any of the above variables (BW, had received more than 10 drugs. Among 155 study population, 81.3% was gestational and postnatal age). Furthermore, the mean creatinine clearance discovered to have potential drug-drug interaction (pDDI). From this 81.3%, of premature neonates is significantly lower than full term neonates it was found that 50.8% elderly patients having major pDDI, 39% moderate (p=0.007, 95% CI -19.12, -3.12). Conclusions: The mean Vd differs
while only 10.3% falls under minor category. The common drugs involved in significantly from international data but comparable to the local ones. Inter- DDIs were Salicylates (10.2%), Diuretic (6.8%), Statins (7.6%) and ACE patient variability is an important aspect to consider in determining optimal inhibitors (5.1%). Conclusions: This study showed majority of elderly dosing regimen.
difference of pre and post PASI after MTAC (Z=-4.238, p<0.000). The A SURVEY ON SELF-MEDICATION BY CAREGIVERS/PARENTS OF
differences of DLQI score during pre 10.5 (15.25) and post MTAC 8.5 (12) PAEDIATRIC PATIENTS IN HOSPITAL TENGKU AMPUAN RAHIMAH
shown a significant improvement with Z=-3.703, p<0.000. The differences of Lee JL1, Tahir B1, Lim FP1 MMS between pre 5 (3) and post MTAC 6 (2.25) was shown to be Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1 statistically significant with Z=-3.066, p<0.002. Conclusions: Medication
Introduction: Self-medication is defined as obtaining and consuming drugs
Adherence Therapy Clinic (MTAC) psoriasis has shown to improve psoriasis without the advice of physician/pharmacist either for diagnosis, prescription patients in addition to the standard therapy given. or treatment. Tendency to treat children by parents/ care givers by means of self-medication has been quantified in several studies from other countries.
However, the incidence of this practice in Malaysia has not been reported.
STRUCTURED INTERVENTION FOR ACUTE LOW BACK PAIN IN
Objectives: To determine the extent of family self-medication among
PRIMARY CARE: A RANDOMISED CONTROL TRIAL STUDY
children admitted to paediatric medical ward in Hospital Tengku Ampuan Aziz NA1, Syahnaz MH1, Muhammad Irfan YAU2, Shamsul AS3 Rahimah (HTAR). Methods: A cross sectional study was conducted using
Department of Family Medicine, Faculty of Medicine, UKM Medical Centre1; structured questionnaires which were distributed to parents or caregivers of Family Medicine Specialist, Klinik Kesihatan Semporna, Sabah2; child admitted to 4 paediatric medical wards in HTAR, between March to Department of Community Medicine, Faculty of Medicine, UKM Medical June 2013. Results: A total of 390 questionnaires were distributed and all
responded. 63.8% have practice self-medication on their children. Common Background: Acute low back pain is a common complaint, imposing a huge
illnesses that prompted self-medication were cough (29.7%), cold or flu cost in medical care. Back exercise program which was also known as (20.9%) and fever (18.5%). 28.7% of respondents were confident in self- "Back School" program was developed since 1969 for treatment of low back medicating their child. Majority of the surveyed parents viewed that pain. Objectives: To assess the effectiveness of structured back exercise
pharmacists has high level of professionalism on medication (81.8%) and program as a treatment for acute low back pain, in comparison with the they agreed that pharmacists should provide advice on medication (89%).
standard care alone in terms of pain improvement and changes in functional Race, age of child, education level and income of caregivers do not predict status in primary care setting. Methods: This was open-labelled randomized
the practice of self-medication in children by care givers. Conclusions:
clinical trial conducted at a primary care clinic. A total of 90 patients who met Self-medication is common among the care givers of paediatric patients in the study criteria were randomized into two groups. 45 patients in the HTAR, which largely involved management of minor ailments.
intervention group received both standard care of treatment followed with a structured back exercise program. The remaining 45 patients in the control group received standard care of treatment alone which were analgesics and MEASURING CHILDHOOD OBESITY BASED ON THREE DIFFERENT
advice on back pain. The patients were followed until eight weeks.
APPROACHES: WHO, CDC AND IOTF CRITERIA
Outcomes: The main outcomes were the mean pain score using Visual
Dastan I1, Delice ME1 Analogue Score (VAS) and functional status by using Oswestry Disability Izmir University of Economics, Turkey1 Index Questionnaire (ODQ) between intervention and the control group at Objectives: This study compares body mass index (BMI) and childhood
baseline and after eight weeks. Results: Using per protocol analysis, in both obesity ratios by using three different cut-points based on growth curves groups, Visual Analogue Score (VAS) and Oswestry Disability Index generated by World Health Organization (WHO), International Obesity Task Questionnaire (ODQ) were significantly reduced after eight weeks duration Force (IOTF), and the US Centers for Disease Control (CDC). Methods:
(p<0.05), but the difference between the control and intervention group post Prevalence estimates are calculated by using these three BMI cut-points.
study was not significant. Conclusions: The addition of structured back
Estimates are based on a data from 1,271 school children (659 females and exercise program in intervention group in patient with acute non-specific low 612 males) that are between 8 and 17 years old from different schools in city back pain do not show significant improvement in pain score and functional of Izmir, Turkey. Heights, weights, socio-economic and demographic status compared to standard care of treatment alone. Keywords: Back
information of children are also measured. Results: Prevalence estimate of
School program, back exercise program, acute low back pain, Oswestry childhood obesity is much higher with WHO criteria (8.8%) than with CDC (4.7%) or with IOTF (1.8%). Prevalence estimates of childhood overweight/obesity are similar based on CDC (15.6%) and IOTF (15.3%), but higher when based on WHO criteria (21.1%). Conclusions: Prevalence
A RETROSPECTIVE ANALYSIS OF MEDICATION POSSESSION RATIO
estimates of childhood obesity and other BMI categories change IN PREDICTING VIROLOGIC OUTCOMES AMONG HIV INFECTED
considerably when different cut-points are employed. This may result in ADULTS ON SECOND LINE ANTIRETROVIRAL THERAPY IN SUNGAI
variations in prevalence of childhood obesity estimates in the literature, thus BULOH HOSPITAL (HSB)
it is necessary to establish a generally accepted standardization in cut- Raghavan P1, Kok KL1, Mak WY1 points to determine BMI categories.
Department of Pharmacy, Sungai Buloh Hospital1 Introduction: Adherence to ART is a predictor of virologic suppression,
emergence of HIV drug resistance, disease progression and death.
TO EVALUATE THE EFFECTIVENESS OF MEDICATION THERAPY
Monitoring of adherence is often necessary to identify patients at risk of poor ADHERENCE CLINIC (MTAC) IN PSORIASIS PATIENTS IN SELAYANG
clinical outcomes. One of the widely used measures to assess medication adherence is medication possession ratio (MPR). Objectives: The aim of
Ng HW1, Khairul Syazwani1, Chee YY1, Teo KW1, Nik Nur Shairah1, Zukifli this study is to determine whether MPR can be a predictor of viral load outcome among patients who had failed first line ART. Methods: We
Department of Pharmacy, Selayang Hospital1 conducted a cross sectional study by collecting data from Sungai Buloh Introduction: Psoriasis is a chronic skin disorder which affects
Hospital (HSB) computer prescribing system (eHIS) dated from 2008-2013.
approximately 3% of Malaysians which i.e. 400,000. Psoriasis has a MPR was defined as the days of medications dispensed divided by the profound negative impact on patients' quality of life. Medication Therapy number of days between the first and last prescription refill. Association Adherence Clinic (MTAC) psoriasis is an intervention where the pharmacist between MPR and viral load outcome was then determined by cross provides education and information about psoriasis symptoms, causes, risk, tabulation of results. Results: MPR was determined for a total of 76
triggering factors and treatment options in addition to standard care of patients. Mean duration of prescription days was 155 days. Median and treatment. Objectives: The objective of this study is to measure the
mean MPR was 85.81% and 74.40% respectively. Viral load of all 76 effectiveness and impact of MTAC based on severity of disease, quality of patients were not suppressed. Results showed that more than half of them life and patient's compliance in psoriasis patients. Methods: We recruited
(69.8%) had poor and suboptimal MPR. This implied that most of the 42 subjects using convenient sampling from Dermatology Clinic Selayang patients who had failed first line therapy had poor or suboptimal MPR.
Hospital from May until September 2013. The clinical outcome was Conclusions: This study proved that MPR can be one of the predictors of
measured by doctors and pharmacists using Psoriasis Area and Severity virologic outcome in patients on ART. Hence it can be a supporting tool to Index (PASI) to access on the disease severity, Dermatology Life Quality identify patients at risk of suboptimal adherence. Although not definite, it can Life (DLQI) to evaluate on patient's quality of life, Modified Morisky Score be incorporated as one of the measures to determine HIV patients' (MMS) to evaluate on patient's compliance. Subjects were given medication adherence in HSB.
appointment monthly and undergo a three-month MTAC programme. The clinical outcome was measured during pre and post-three-month MTAC programme. Results: Out of 42 subjects, 30 subjects have completed the
3-months MTAC programme. The results shown that disease severity, quality of life, and patient's compliance significantly improved for psoriasis patients after completing MTAC programme. The result shows statistically significant improvement at post-MTAC compared to pre-MTAC using Wilcoxon Signed-Rank Test. The median (IQR) of pre PASI and post PASI were 10.5 (14.43) and 7.7 (10.8), which elicit a statistically significant PROFILE OF SPEAKERS
United Arab Emirates, Vietnam and Ghana. He is the one of the Co-Developer and owner of the patents for drian has over a decade of experience in health casemix groupers United Nation Case Based Groups economics and outcomes research and is (UNU-CBGs), Malaysian DRGs (MY-DRGs) , and currently a health economist at Azmi Burhani Clinical Costing Modelling Software (CCM) for Consulting. He has previously worked as a patient level costing researcher for the Clinical Research Centre of the Ministry of Health, Malaysia and has consulted for Currently he appointed as the Casemix Consultant to the World Health Organisation and the Ministry of Philippine Health Insurance to develop Phillipine Health, where he was appointed to the technical DRG Tariff for Philhealth Reimbursement, committee to develop the Malaysian pharmacoeconomic Consortium of Private Hospital (FEMI) Uruguay to guidelines. He studied economics at Macquarie develop Uruguay DRG Tariff for reimbursement and University, Australia and the National University of Centre of Financing and Social Health Security MOH Malaysia. He has published scientific papers in the Indonesia (Jamkesmas) to develop INA-CBGs Tariff areas of cost-effectiveness analysis, health registry for Jamkesmas Reimbursement. He has published data, and estimation of health utility tariffs using and co-author several articles in journals and modelling approaches. His recent work has centred presented in conferences in areas of health on building cost-effectiveness decision models and economics and public health in general the adaptation of global cost effectiveness models to local and regional settings.
DR AMRIZAL MUHAMMAD NUR Puan Anis is the Deputy Director of Formulary and Pharmacoeconomics Branch in Pharmaceutical Dr Amrizal Muhammad Nur is a Research Fellow, Services Division. She has 31 years of working United Nation University- International Institute for experience in various departments within the Ministry Global Health (UNU-IIGH). He obtained his MD from of Health (MOH). She plays a key role in the Faculty of Medicine Andalas University of Indonesia implementation of evidence-based evaluation on in 1993, and continuing Master Program (MSc) in drugs to be listed in the MOH drug formulary Medical Science (Health Care Service Management) (FUKKM). Under her leadership, the branch is now at School of Medicine Universiti Sains Malaysia in building capacity to have their own Health 2002 and PhD in Public Health (Casemix Technology Assessment (HTA) unit with a special Management & Health Economics) from National focus on drugs. This is especially important as the University of Malaysia Kuala Lumpur in 2007. He unit will provide crucial inputs on safety, efficacy and started his housemanship at Mohammad Jamil cost-effectiveness of pharmacotherapy for the Hospital (Provincial & Teaching Government development of National Health Policy. Pn Anis is Hospital), Padang (West Sumatera), and later as also directly involved in the publication of Deputy Director of Muara Labuh Hospital (District Pharmacoeconomics Guidelines which serves as Government Hospital) in West Sumatera Indonesia reference for researchers who would like to conduct (1994-1997). He has worked as a Casemix Pharmacoeconomics study in Malaysia. Her efforts Coordinator in Casemix Unit Hospital University have led to the development of Centre of Kebangsaan Malaysia for 9 years (2002-2010). He Pharmacoeconomics, a pilot project under also appointed as a Medical Lecturer and Casemix Pharmaceutical Services Division together with the Consultant in International Centre for Casemix and other key stake holders such as the academics, Clinical Coding (ITCC) National University of Medical Development Division (National Institutes of Malaysia from April 2008 till November 2010. From Health and Casemix Unit) and Agensi Inovasi 1st December 2010 until now, he has been Malaysia (AIM). Besides that, she has headed the appointed as a Research Fellow at UNU-IIGH Kuala team in initiating drug scoring system to classify Lumpur to conduct research & capacity building on drugs within the same class according to their Accessibility, Efficiency and Quality of Care in Health efficacy, safety and economic profiles. This activity System (especially in casemix management) to involves multi-disciplinary experts in order to ensure support casemix implementation in developing that it is comprehensive and has a high standard. So country. His main interest is to assist developing far, the branch has succeeded in scoring the drugs countries in casemix management implementation within the statin and sulfonylurea groups. On top of (especially in patient data analysis, costing data that, she took another initiative to improve the current analysis) and cost analysis in Health Care System drug listing system with the New Submission through research and development in health Guideline underway. To date, there are 8 formularies economics and financing. He is currently involves in under her care that are used nationwide namely, the supporting a number of developing countries to National Drug Formulary, the National Essential develop and implement casemix management, a Medicines List, MOH Drug Formulary (FUKKM), health management and information tool to enhance Hospital Drug Formulary, Health Clinics Formulary, quality and efficiency of healthcare services provided 1Malaysia Mobile Clinics Formulary, 1Malaysia under Social Health Insurance programmes. He Clinics Formulary, Rural Clinics Formulary.
works together with Prof Syed Mohamed Aljunid on casemix system in UNU-IIGH covers research and capacity building programmes in Malaysia, Indonesia, Philippines, Uruguay, Yemen, Kenya, ASSOCIATE PROFESSOR ASRUL PROFESSOR CHAIYAKUNAPRUK Professor Chaiyakunapruk joined Monash University Asrul A Shafie is a registered pharmacist in Malaysia as a Professor of Health Economics. He earned his since 2001 and completed his PhD degree in bachelor in Pharmaceutical Sciences from pharmacoeconomic in Cardiff University, UK in 2007.
Chulalongkorn Univesity and Doctor of Pharmacy His research interests are in the application of (Pharm.D.) from the University of Wisconsin- economic evaluation in pharmaceutical services and Madison. He completed his Ph.D. in Pharmaceutical product, and pharmacy practice. He is now leading Outcomes Research and Policy Program from the and co-investigating a number of researches in University of Washington in Seattle, USA. He is best pharmacy practice, PRO instrument validation and known for his research expertise in systematic valuation, and health technology assessment where review and meta-analysis, health economics, and he has published more than 200 peer reviewed pharmacoepidemiology/outcomes research. He has journal articles/abstracts in various international more than 50 international publications. He has journals including Value in Health, Social Science & applied his expertise in a wide range of research Medicine, Quality of Life Research, BMC Public topics in pharmacy, medicine, and public health.
Health and Pharmacoeconomics, and six Dr.Chaiyakunapruk has been very active at both books/monographs. He regularly reviewed national and international levels. He was a co- manuscripts for international and local publications founder of the ISPOR Asia Consortium (International including British Medical Journal, Bulletin WHO and Society of Pharmacoeconomics and Outcomes Value in Health. He was invited to speak in more than Research), ISPOR Thailand Chapter, and Asia fifty international and domestic scientific events in Pacific Evidence-based Medicine Network. He UK, US, South Korea, Indonesia, Japan, China, currently serves as an education chair of ISPOR Asia Thailand and Singapore. He is also an appointed consortium and an executive member and a scientific expert member for the UK National Institute for committee member for ISPOR Asia-Pacific meetings.
Health Research Committee, Malaysia Health He is also a member of Health economic board of Techonology Assessment Agency (MaHTAS), National Essential Drug List Selection Committee, Malaysia Pharmacoeconomic Guidelines Signal Detection Committee of Thai FDA, Pharmacy Development Committee, Malaysia National Network in Tobacco Control Committee, and Medicine Policy Steering Committee, Ministry of advisory board of Research and Development Health's Quality Use of Medicine Committee, Institute, Governmental Pharmaceutical Organization.
Malaysia Health Promotion Board, Institute of Health He is also a co-author of Thai Health Technology Service Research, Malaysia Pharmacy Advisory Assessment Guideline. He has also been working as Board and Malaysia Pharmacoeconomic Technical a consultant for WHO in vaccine-related health Committee. He plays an active and vital role in economics, malaria control, and pharmaceutical professional societies and served as the Chair-Elect economics. He has also published numerous articles for ISPOR Good Outcomes Research Practices & in peer-reviewed medical, public health, pharmacy, Publications Committee, Co-editor for ISPOR News and economics journals including Annals of Internal Across Asia, Board Member for HTAsiaLink Network Medicine, Chest, Clinical Infectious Disease, JAMA and former Chairman for Malaysian Pharmaceutical Dermatology, Journal of Thrombosis and Society (Penang Branch). In 2010, he was awarded Haemostasis, Drug Safety, Tobacco Control, value in the prestigious International Fellowship for health, and Pharmacoepidemiology and Drug Safety.
International Society of Pharmacoeconomics and Dr Chaiyakunapruk also serves as a co-editor Outcomes Research. At present, Dr Asrul is an ofValue in Health Regional Issue, a member of an Associate Professor and Chairman in social and editorial board of Journal of Medical Economics and administrative pharmacy in Universiti Sains a reviewer for several prestigious international Malaysia, where he teaches pharmacoeconomic, journals such as the British Medical Journal, JAMA, statistic and epidemiology to both undergraduates Annals of Internal Medicine, Vaccine, Value in and postgraduates in the university and four other Health, International Journal of Pharmacy Practice, local institutions.
and Pharmacotherapy. As part of the recognition, he has received several research awards. They include William Rutala Award for his antiseptic research work in year 2001, Nagai Research Award in year 2006, 2009, 2011, Distinguished Research Award of Carol Bao is a Director of Global Health Economics Naresuan University in year 2007, 2008, 2009, 2011 and Outcomes Research at AbbVie in the greater Distinguished Routine to Research Award in year Chicago area in the U.S., leading the international 2008, Best research in community pharmacy award team for immunology supporting HUMIRA all in year 2011, best presentation at Society of Medical indications. She joined Abbott, now AbbVie, in April Decision Making –Asia Pacific conference in 2014 2008 as a manager and in the last 6 years, she changed her roles from dermatology lead, to the lead in Cross Indication Strategic Initiatives and later to CHRISTOPH GLAETZER the global lead for HUMIRA rheumatology, before her current role. Aside from industry experience, Carol ì More than 18 years global experience in the spent one year in the greater Boston area as a senior development and implementation of scientist with Abt Associates, Inc., now part of the pharmaceutical market access strategies United Biosource Corporation. She has worked ì Responsible for various commercial and market extensively on projects spanning across clinical trial access related functions in Europe, US and Asia data and administrative claims data base analyses, cost-effectiveness and budget impact models, ì International thought leader and speaker on patient/physician surveys, retrospective chart review Pharmaceutical Market Access aspects studies and value dossiers. Carol holds her doctoral ì Representative of Janssen/J&J at various and master degree in Economics from the University international forum and initiatives (e.g. PhRMA, of Illinois at Chicago and has a bachelor degree in Gates Foundation, GHC, ISPOR, HTAi ) Economics from Fudan University in Shanghai, ì Currently Vice President Market Access Asia China. She was born and raised in Shanghai, China Pacific responsible for access and pricing and now lives in the greater Chicago area with her strategies for all pharmaceutical products husband and two daughters. ì Last position before moving to AP in 2011 Head of Global Pricing ì Co-designer of the Janssen Access Framework ì Champion of the Janssen Equity Based Tiered Pricing Strategy ì Educational background: Economist, Trained Health Economist and Black Belt Negotiator DR FEISUL IDZWAN MUSTAPHA Evaluation in Taiwan. Her division (CDE/HTA) works closely with the Bureau of National Health Insurance Dr. Feisul Idzwan Mustapha graduated with an for reimbursement and pricing decisions. Her MBBS degree from the University of Newcastle- experiences has led to her participation in several upon-Tyne, United Kingdom in 1997. He research projects designed to aid health policy subsequently obtained an MPH in Epidemiology and decision-making in areas such as anti-HBV Biostatistics from the National University of Malaysia treatment, cervical cancer screening and HPV in 2006. He was inducted as a member of the vaccination. Prior to CDE, she worked as a Academy of Medicine, Malaysia, in 2008. He joined consultant, for both government and industry, the Disease Control Division (Non-Communicable conducting economic evaluation studies. Dr. Pwu is Diseases Sector), Ministry of Health, Putrajaya as a also an adjunct Assistant Professor at the Taipei Public Health Specialist in 2006, where he is Medical University.
currently engaged in the practice of public health in the prevention and control of non-communicable diseases (NCD), with special focus on diabetes and obesity. He led the development of the "National DR JEYAINDRAN SINNADURAI Strategic Plan for Non-Communicable Diseases" (NSP-NCD), which was launched in December 2010.
Datuk Dr. Jeya graduated from the National NSP-NCD now provides the framework for University of Malaysia (UKM ) in 1981 and initially Malaysia's response to the increasing burden of worked at the Kuala Lumpur General Hospital and he NCD in the country. Specifically for improving the later worked at the Klang General Hospital .Over the quality of care of diabetes at the primary care level, years, he has had extensive working experience and he led the development of the National Diabetes postgraduate training at major hospitals in New York, Registry (or NDR), a web-based application, which Singapore, London and Dublin. Datuk Dr. Jeya has went live on 1 January 2011. In addition to being a earned great distinction for research in the fields of disease registry, NDR supports the implementation Critical Care with an emphasis in both Pulmonology of the "Diabetes Clinical Audit" and the new Diabetes and Cardiology, both of which he has a strong Quality Assurance (QA) Programme for MOH Health interest In 1990, in recognition of his contributions to Clinics entitled "Quality of Diabetes Care at MOH the field of Respiratory Medicine, Datuk Dr. Jeya was Healthcare Facilities: Glycaemic Control", both of awarded the "British High Commissioner's- which were implemented nationally in 2009. He Chevening Award" to pursue a postgraduate course represents Malaysia at various international in Thoracic Medicine at the Royal Brompton National meetings, conferences and workshops relating to the Heart and Lung Institute London. He completed his prevention and control of NCD, and has also been course in 1991 and became the first Asian to be invited by the World Health Organisation as a awarded a distinction in that field by the University of temporary advisor for their technical meetings. In London. He has presented more than 150 scientific addition, he is currently involved in several studies papers in cardiology, pneumonias and asthma. He relating to diabetes and obesity in Malaysia, has also published papers both in local and providing expertise in epidemiology and biostatistics.
International medical journals covering these topics.
He was chair of the Technical Working Group for Recognised as international expert and opinion NCD risk factors in the recent 2011 National Health leader in these fields, he has been invited to chair and Morbidity Survey (NHMS).
local and international meeting both locally and overseas. Datuk Dr. Jeya also serves as a member of several committees of the Ministry of Health. He is DR GOH BAK LEONG also a member of the committee which was responsible for the development and implementation Dr Goh Bak Leong is the Head and Senior of Clinical Practices and has an interest in better Consultant Nephrologist in Serdang Hospital. He management of patients. In this respect he is a became a member of the Royal College of strong advocate of Clinical Governance and Patient Physicians in United Kingdom MRCP (UK) in 1996.
safety. Datuk Dr. Jeya is currently a Senior He obtained his further training as Renal Fellow at Consultant Pulmonary and Critical Care Physician Monash Medical School, Alfred Hospital. He was and with effect from 1st March 2013 was appointed awarded the Fellowship of Royal College of as the Deputy Director General of Health (Medical) of Physicians and Surgeons of Glasgow in 2002. Dr the Ministry of Health, Malaysia. Datuk Dr. Jeya is Goh has published numerous original articles in the also a Fellow of the American College of Chest international peer review journals in the field of Physicians, Fellow of the Royal Academy of general nephrology, dialysis and transplantation. He Medicine Ireland, Fellow of the Royal College of has special interest in CAPD. He has published great Physicians of Ireland, Fellow of the Faculty of quantity of PD access related articles in Seminars in Occupational Medicine, Ireland. He also part of the Dialysis and Peritoneal Dialysis International. He has teaching faculty of the Universiti Kebangasan presented great number of scientific papers in Malaysia, Univeristi Putra Malaysia and MAHSA. He international meetings and congresses. He is a serves The Royal College of Physicians of Ireland as member of many Registries, and Clinical Practice The Dean of Examinations –Malaysia, Examiner – Guidelines. He also sits in many panel / committee / Clinical Examinations, The Regional advisor to the advisory boards as well as professional societies at Royal College of Physicians of Ireland and The both national and international level. American College of Chest Physicians. He is also a Member of the Global Initiative in Asthma (GINA) advisory council which advises the WHO on the DR JASMINE RAOH-FANG PWU current treatment and management of asthma, Member of the WHO Consultation Panel for the Dr. Pwu obtained her PhD from College of Public Development of a Comprehensive Approach for the Health, National Taiwan University: and the subject Global Prevention and Control of Chronic of her dissertation was the application of cost- Respiratory Diseases and Member of the WHO effective analysis using examples from vaccine and working group on Dengue.
anti-viral treatments. Trained as an epidemiologist, Dr. Pwu has been an expert in both observational research and large database analysis. She later became interested in economic evaluations, especially modelling studies. In this area, she has nearly 20 years of research experience. Dr. Pwu is currently Director of the Health Technology Assessment Division for the Center for Drug PROFESSOR KENNETH KC LEE discharges of inpatient and those attending Day Care Services. He is also involved in the implementation Kenneth Lee is Professor of Pharmacy and Head of of Hospital Information System and Malaysia Health Pharmacy Discipline, Monash University, Malaysia.
Before he moved to Malaysia, he was Professor and Associate Director (External Affairs) of the Chinese University of Hong Kong (CUHK) School of Pharmacy where he was one of the founding members and had subsequently worked for 18 years.
Mendel Grobler is the Director, Access and Public He was appointed as a Justice of the Peace by the Affairs at Pfizer Australia (Pty Ltd) and is responsible government of Hong Kong in 2003 for his services to for reimbursement strategy and public affairs for the the community. Prof Lee received his pharmacy company's products in Australia and New Zealand, undergraduate training from the University of as well as advising Pfizer Inc. on regional and global Washington in Seattle. His subsequent higher approaches to Health Technology Assessment. He qualifications were from the CUHK and the University has been working in the field of health care funding of Oxford, UK. He is widely recognised as one of the and financing for more than twenty years and also pioneers in pharmacoeconomics and outcomes has extensive experience across the pharmaceutical research in Asia focusing on comparative industry including manufacture, product effectiveness research, health technology development, registration, distribution and assessment and healthcare policy development. He community/hospital pharmacy. He has previously has published extensively in peer-reviewed represented the industry on the Economic Sub- international journals and has been author/editor of Committee of the Pharmaceutical Benefits Advisory several textbook chapters. He has been the Editor- Committee (PBAC) and also served as advisor to the in-chief of the Journal of Medical Economics since Australian Department of Veterans' Affairs. Over the 2006 and is serving on the editorial board of a past few years he has accepted invitations to number of international journals including Value in contribute to various government- industry Health. He served as Adjunct Professor of School of discussions about equitable funding policy in Korea, Pharmacy, the CUHK, and Honorary Professor of China and Taiwan. He has published a number of School of Public Health, the University of Hong Kong research papers in peer-reviewed and other journals, from 2010-13. From 2008-11, he was also appointed and delivered presentations at international medical as visiting Professor of University of London School and health economic conferences. He is a member of Pharmacy. He has been recently appointed as the of the Australian Health Economics Society, the Chairman of the Scientific Advisory Committee of the International Health Economics Association and Malaysian Medicinal and Aromatic Plants (MyMAP) Health Technology Association International. Mendel project, a collaborative project between Monash was recently awarded the 2012 Pat Clear Award, University and the Prime Minister's Office of Medicines Australia's most prestigious honour. The Malaysia. Prof Lee has served in a number of award is presented annually to recognise an positions in the International Society for outstanding level of commitment by an individual, Pharmacoeconomics and Outcomes Research group or team for the benefit of the Australian (ISPOR). He was the major driving force and later a medicines industry.
founding member of the first ISPOR regional consortium - ISPOR Asia Consortium which was established in 2004. He served as president of the NOORMAH MOHD DARUS Consortium from 2006-8. Before this, he also spearheaded and became the founding chair of the first ISPOR local chapter in Asia – ISPOR Hong Noormah Mohd Darus is currently the Senior Kong Chapter in 1999. He had been a member of the Principal Assistant Director working at the Malaysian organizing committee of several ISPOR Asia Pacific Health Technology Assessment Section, Medical Conferences from 2004-11. He had also taught in a Development Division, and Ministry of Health number of ISPOR short courses. Currently he is one Malaysia (MOH). She has 32 years of experience in of the co-editors of Value in Health Regional Issue, many areas such as health technology assessment, an official publication of ISPOR. In May 2012, he was evidence-based medicine, evidence-based elected as a member of the ISPOR Board of healthcare, public health research, pharmacy Directors for 2012-4.
services and health outcomes research. Currently her work is focused on systematic reviews and she is involved in producing HTA reports, technology DR MD KHADZIR BIN SHEIKH assessment reviews for the Ministry of Health and training of MOH personal / University post graduate students on evidence based medicine. Prior to this position, she had vast experiences as a pharmacist Dr. Md Khadzir is a certified Occupational Health and researcher at several MOH institutions such as Physician and received MD degree from National Sungai Buloh Hospital, National Pharmaceutical University of Malaysia, Master degree in Bureau, Kuala Lumpur Hospital, Clinical Research Occupational Medicine from National University of Centre, and Institute for Medical Research. She is Singapore and PhD degree in Occupational Health also actively involved in creating awareness amongst from The University of Birmingham, UK. He had been the healthcare professionals on evidence-based drafting Health Laws; Medical Ethics and medicine and health technology assessment. She instrumental in initiating the Traditional and holds a degree on Bachelor of Pharmaceutical Complementary Medicine Services in the pioneer Sciences (medical doctor) from Mansourah Hospital Kepala Batas, Hospital Putrajaya and University (Egypt)and Masters of Science in Clinical Hospital Sultan Ismail. The program includes Epidemiology from Erasmus University, Rotterdam, registration of Traditional and Complementary medicine practitioner in Malaysia. Currently since late 2008, he is heading the development and operation of electronic Health Information and Management System and the development of Health Informatics Standards for Malaysia. He is now leading the development of Malaysian Health Data Warehouse Project, Acquiring and development of POC of SNOMED CT for implementation in Ministry of Health Hospitals; Development of Malaysian Health Data Dictionary; and development and rolling out of Web Based version of Medical Care Information System that collect granular data for PROFESSOR DR SAMSINAH HAJI Dr Ramli Zainal is currently the Head of Healthcare Financing and Economic Research Division at the Institute for Health Systems Research (IHSR). He Dr. Samsinah Haji Hussain was conferred a degree graduated from Universiti Sains Malaysia (USM) in in Bachelor of Pharmacy (Hons) from Universiti Pharmacy and completed a Masters degree from Sains Malaysia (USM) Penang in 1984 and was University of Bradford. He then returned to USM and awarded a PhD degree in 1987 from Leeds was awarded a PhD degree in Pharmacoeconomics.
University, United Kingdom in the field of As a researcher, Dr Ramli Zainal is the principle neuroendocrinology under the USM fellowship. In investigator for projects funded by UNDP and the 2005 she completed her Graduate Certificate in National Institute of Health. He also collaborates in Pharmaco-economics specialty training at Monash various projects and currently actively involved in University, Australia and was promoted to Professor conducting trainings in the field of economics of Pharmacy in 2008. Dr. Samsinah is an appointed evaluation in healthcare. He is an expert member to member to the National Professor Council under the the Ministry of Health Malaysia, Pharmacoeconomics Pharmacy and Applied Science Cluster (2011 – Technical Working Group, Health Technology now), appointed member of the Malaysian Drug Assessment group and is an appointed member of Control Authority (DCA) from 2001 until 2013 and the Pharmacy Board Malaysia. He has served the also an expert member for the Ministry of Health World Health Organisation (WHO) as a consultant for Malaysia Pharmacoeconomics Technical Working the Training of Trainer in QA/QI in Papua New Group. She actively conducts training workshops Guinea and the Pacific Islands. He is also involved in pertaining to pharmacoeconomics evaluation in the training for QA/QI at national level and for healthcare on invitation for the Pharmacy Services countries within the WHO Western Pacific Regional Division and Health Technology Assessment Section Office. Prior to joining IHSR, he had served and held (MaHTAS) Medical Development Division under the various positions in the National Pharmaceutical Malaysia Ministry of Health, Ministry of Defence Control Bureau as a GMP Auditor, Head of Cosmetic Malaysia, multinational pharmaceutical companies Unit, Head of Secretariat Unit and Head of and the Malaysian Pharmaceutical Society and is Organisational Development & IT Division. He has often invited to be the external examiner and also worked as a Drug Enforcement Officer in reviewer for universities and international journals.
Penang and as a Hospital Pharmacist in Gerik and She is also a member of several professional Seremban. He is currently the Secretary to the societies and non-government organizations. She is Malaysian Society for PharmacoEconomics and currently the vice-president of the Malaysia Society Outcomes Research (MySPOR) and a member of for Pharmacoeconomics and Outcome Research the Malaysian Pharmaceutical Society (MPS).
(MySPOR) and also the Head of the Student Empowerment & Research Unit (SERU) under University of Malaya Student Affairs Division. Dr.
Samsinah research interests include economic evaluation and outcome research in the areas of healthcare resource utilization, drug formulary Dr. Salmah Binti Bahri graduated with a B.Sc in management, paediatric asthma and obstructive Pharmacy from the University of Baghdad, Republic sleep apnea syndrome, diabetes and metabolic of Iraq in 1981. She continued her advanced degree disorders. In addition her research interests also studies in 2001 and received her M.Sc (Pharmacy) include areas relating to student empowerment and and Ph.D in Drug Policy and Management from the holistic student development.
Universiti Sains Malaysia in 2002 and 2007 respectively. Her areas of expertise include Medicines Policy and Management, Quality Use of ASSOCIATE PROFESSOR DR.
Medicines, Medicines Pricing and Good Governance in Medicines. She is currently the Director of SHARIFA EZAT WAN PUTEH Pharmacy Practice & Development, Pharmaceutical Services Division, Ministry of Health Malaysia Dr. Sharifa Ezat Wan Puteh is a trained Medical (MOH). She leads the strategic planning, Doctor from UKM. She obtained her Masters in implementation and the development of the Public Health (Hospital and Health Management) pharmacy practice activities in Malaysia. She is the and PhD in Public Health-Health economics from the advisor the National Pharmacy Research & United Nations University-International Institute for Development Committee, MOH and chairman of Global Health (UNU-IIGH). Her main interests are in various committees such as, Implementation areas of health inequality and health economics. She Committee for Comprehensive National Project on is also a coding and casemix consultant (with UNU- the Quality Use of Medicines by Consumers, IIGH and International Training Centre and Clinical Implementation Committee for Good Governance in Coding UKM Medical Centre) with developing Medicines, Advisory Group for the Medicine Price countries and ITCC. She is also a UKM member Monitoring Program in Malaysia, and Technical consultant on Cost benefit analysis on industries and Committee for Implementation of National Drug occupational diseases in the country. From 1st Policy. In addition, she is a member of the Malaysian December 2010 until now, she has been appointed Board of Pharmacy, Malaysian Drug Control as a casemix consultant (with UNU-IIGH and ITCC Authority and Panel of the MOH Drug Formulary.
UKM) Kuala Lumpur to conduct research & capacity Internationally, she is a member of the ASEAN building on Accessibility, Efficiency and Quality of Working Group on Pharmaceutical Development and Care in Health System (especially in casemix WHO panel member for the development of the management) to support casemix implementation in WHO Guideline on Pharmaceutical Pricing Policies.
developing country. She is currently the assistant Dr Salmah Bahri is also an active researcher in editor for the Malaysian Journal of Public Health (an MOH. Among her important national research Scopus indexed journal) and reviewer of a few projects are the Drug Utilization in the Treatment of journals locally and abroad. She has published Diabetes Mellitus in the Ministry of Health Facilities numerous papers locally and abroad and book on and National Survey on the Use of Medicines by cost effectiveness of vaccination against cervical Malaysian Consumers (2007) and (2012). She has cancer. She has presented many papers and also published some international peer reviewed proceedings locally and abroad and is a a member articles, mostly in collaboration with USM, and on HTA reviews on cost effectiveness, a member of various proceedings, compendiums, research the Health Economics Association Malaysia, the reports, articles, bulletins and newsletters for the Malaysian Public Health Physicians Association, MOH. She has also co-authored a few book chapters MySPOR (Malaysian Pharmacoeconomics and and was recently the main author of a book entitled Outcome Research Group) and One Health with the National Medicine Policy-A Malaysian Perspective Global Health Institute. She also is an active member in NGO activities and CSR, having participated in "Doctor Turun Ke Desa" and Program PROFESSOR DATO' DR SYED "Kami Prihatin" with local companies and organisations. PROFESSOR SHU CHUEN LI Dr Syed Aljunid is a Professor of Health Economics and Interim Director of United Nations University- Professor Shu Chuen Li is Chair Professor and International Institute for Global Health. Prior to this Head, Discipline of Pharmacy & Experimental he served as a Senior Consultant in Public Health Pharmacology, School of Biomedical Sciences, Medicine and Head of Department of Community University of Newcastle. Prior to this, Professor Li Health, Faculty of Medicine, National University of has worked as an academic at the National Malaysia (UKM). He obtained his MD from Universiti University of Singapore (NUS) and as Acting Director Kebangsaan Malaysia, Master of Science in Public & Deputy Director, Pharmaceutical Evaluation Health from National University of Singapore and Section (PES) of Pharmaceutical Benefits Branch, PhD in Health Economics and Financing Australian Commonwealth Department of Health & Programme, London School of Hygiene and Tropical Ageing. During his period in Singapore, Professor Li Medicine. He is now the head of International Centre also served as the Visiting Specialist /Consultant to for Casemix and Clinical Coding of UKM. He is the Health Sciences Authority (HSA), and has been currently involves in supporting a number of instrumental in developing the Pharmacoeconomics developing countries to develop and implement and Drug Utilization Unit at the Centre for Drug casemix system under Social Health Insurance Administration. In his capacity as Acting Director & programmes. His work on casemix system in UNU- Deputy Director of PES in Australia, Professor Li was IIGH covers research and capacity building among the few pioneers that put the principles of programmes in Malaysia, Indonesia, Philippines, pharmacoeconomic evaluation into practice for Mongolia, Vietnam, China, Saudi Arabia, United Arab regulatory affairs, and has been involved in Emirates, Sudan, Nepal, Uruguay, Iran, Chile, Kenya implementing the 1st version of the Australian and Ghana. He is the developer of international Pharmacoeconomics Guidelines and developing the casemix grouper UNU-CBGs as well as Clinical Cost 2nd version of the same Guidelines. Professor Li Modelling Software (CCM Version 2.0). Currently, he was a Director of ISPOPR from 2006 -2008, and a serves as the co-chair of Morbidity Technical founding member of the ISPOR Asia Consortium.
Advisory Group of ICD-11 Revision of World Health Additionally, Professor Li have held many other Organisation-Family of International Classification.
consultative positions in Australia and in various He is actively involves in teaching public health Asian countries both for the pharmaceutical industry medicine, health economics and health management as well as for governments. Besides his expertise in courses in MPH, MBA and PhD programmes jointly health technology assessment and pharmaceutical run by UNU-IIGH and its partner universities in policy, Professor Li is a very active researcher in health Malaysia, Nepal, Yemen, United Arab Emirates and service research and pharmacoepidemiology. He Sudan. He served as consultant and adviser to a has published more than 350 scientific manuscripts number of international agencies including and conference abstracts and has been invited to International Atomic Energy Agency, World Health present in numerous international conferences.
Organisations, GTZ, AUSAID, UN-AIDS, UNDP, UNICEF, GAVI, Asian Development Bank and the World Bank in various international projects. He is the Past-President of the Public Health Medicine Specialists' Association of Malaysia and Founding President of Malaysian Health Economics Having trained as a physician at the University of Association (MY-HEA) and Malaysian Society of Adelaide, Australia, and obtained a Masters in Public Pharmacoeconomics and Outcome Research (MY- Health at Harvard, Soraya is founder and Managing Director of Azmi Burhani Consulting, a health research services company, and Veras Research, a clinical research organization. Her career in clinical research has spanned more than a decade. She began her career in the Malaysian Ministry of Health, Malaysia, first as a physician then a researcher.
Presently the Managing Director of Eisai (Malaysia) Health economics and outcomes research is one of Sdn. Bhd, Yew Wei Tarng is also the President of the her main areas of interest. After earning her Masters Pharmaceutical Association of Malaysia (PhAMA).
degree, she worked in the United States for the Mr Yew began his journey within PhAMA as the United Nations Population Fund and Pfizer Chairman of the Human Resource Committee from Pharmaceuticals (New York headquarters) as well as 2006 - 2008. He then went on to become the the consulting arm of NDCHealth in Arizona (now Chairman of Regulatory Affairs Committee with the part of Wolters Kluwer). Soraya is a current association and continues to hold this position to committee member of the Malaysian National date. ln 2006, Mr Yew became Vice President of Committee for Clinical Research (NCCR) chaired by PhAMA, a position he has held until he became the the Director-General of Health, committee member President of the association in September 2012.
for the Malaysian Society of Pharmacoeconomics Besides PhAMA, Mr Yew has also been active in and Outcomes Research (MySPOR) and is the other associations such as the ASEAN organizing committee chair for the 2014 Pharmaceutical Research lndustry Association Pharmacoeconomics and Outcomes Research (APRIA), where he was chairman of the association Conference organized by MySPOR. Soraya also for a year. APRIA is a regional association serves on the management board of Asia CRO Alliance, representing the research-based pharmaceutical a network of clinical trial partners across Asia. companies in ASEAN, committed to ensuring optimal regulatory environment for the continued development of the pharmaceutical industry to DR. SUNITA BAVANANDAN further improve the health and well-being of ASEAN patients. Mr Yew holds a Bachelor of Pharmacy with a minor in Management from Universiti Sains Dr. Sunita Bavanandan is a Consultant Nephrologist Malaysia followed by a traineeship at the National at the Department of Nephrology, Hospital Kuala Pharmaceutical Control Bureau and the Kuala Lumpur. She graduated from the University of Lumpur Hospital. He then went on to participate in Queensland Australia in December, 1991 and the Duke Program for Manager Development at obtained her qualifications as a Member of the Royal Duke University in North Carolina and he studied as College of Physicians United Kingdom in 1997 and well at the Kellogg School of Management in as a Fellow of the Royal College of Physicians Edinburgh in 2007. Her special interests are in Chronic Kidney Disease, Hypertension, Diabetic Kidney Disease and Peritoneal Dialysis. (Universiti Teknologi Malaysia). His research interest includes Disease burden and economic burden of Dr. Ahmed is a Senior Lecturer at the International disease, economic evaluation of health interventions, Center for Casemix and Clinical Coding Faculty of and disease and economic modeling. Apart from his Medicine Kebangsan Malaysia. He is a Consultant consultancy work with UNU-IIGH, he is a Clinical Health Economist and Casemix Consultant. He was Coordinator/Consultant of Casemix Unit in Hospital involved as a Consultant in the development and University Kebangsaan Malaysia. This is the implementation of Casemix System in Mongolia, Department in the university which pioneered the Indonesia, Philippines, Uruguay and Vietnam. His development of DRG base solution for hospital in consultancy in those countries involved the UKM. Furthermore, he is a consultant for COHORT development of Benefit Package for the Malaysia, first ever COHORT in Malaysia and part of reimbursement on Case base Tariffs developed on Asian COHORT Consortium. Malaysian COHORT is DRG system. He is also one of the Consultants who to study 100,000 sample in Malaysia for studying the developed first Case-Mix Online project for Casemix chronic disease in Malaysia. Beside this he has training online. Among his involvement in Casemix extensive experience in evaluating the Hospital project are ongoing Casemix implementation in Information System (HIS) in Malaysian hospitals. He Vietnam, the recently concluded implementation of has special interest in developing the Decision Casemix in all kemkes (Ministry of Health Indonesia) Support Systems (DSS) in the clinical environment, hospitals in Indonesia, 25 hospitals in Uruguay, especially in the pharmacy environment, for that he development of national tariff in the context of has worked with various hospitals, both in public and Casemix for the social health insurance in the private sector, to develop Drug decision support Philippines, and Casemix system implementation in system using existing drug knowledge bases.
Uruguay, Mongolia and Vietnam. Dr Zafar Ahmed is Majority of his publications and research papers are actively involved in graduate level teaching both at Economic Evaluation in healthcare, Casemix UKM (Universiti Kebangsaan Malaysia), and UTM implementation and Health Care System.

Source: http://myspor.my/wp-content/uploads/2014/05/Programme_2nd_Pharmacoeconomics_and_Outcome_Research_Conference_2014.pdf

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MILITARY MEDICINE, 177, 9:1015, 2012 Healing Touch With Guided Imagery for PTSD in Returning Active Duty Military: A Randomized Controlled Trial Shamini Jain, PhD*†; CDR George F. McMahon, NC USN‡; LCDR Patricia Hasen, NC USN‡; CDR Madelyn P. Kozub, NC USN‡; Valencia Porter, MD, MPH∥; Rauni King, RN, MIH, CHTP§; Erminia M. Guarneri, MD§ ABSTRACT Post-traumatic stress disorder (PTSD) remains a significant problem in returning military and warrantsswift and effective treatment. We conducted a randomized controlled trial to determine whether a complementarymedicine intervention (Healing Touch with Guided Imagery [HT+GI]) reduced PTSD symptoms as compared totreatment as usual (TAU) returning combat-exposed active duty military with significant PTSD symptoms. Active dutymilitary (n = 123) were randomized to 6 sessions (within 3 weeks) of HT+GI vs. TAU. The primary outcome was PTSDsymptoms; secondary outcomes were depression, quality of life, and hostility. Repeated measures analysis of covariancewith intent-to-treat analyses revealed statistically and clinically significant reduction in PTSD symptoms ( p < 0.0005,Cohen's d = 0.85) as well as depression ( p < 0.0005, Cohen's d = 0.70) for HT+GI vs. TAU. HT+GI also showedsignificant improvements in mental quality of life ( p = 0.002, Cohen's d = 0.58) and cynicism ( p = 0.001, Cohen's d =0.49) vs. TAU. Participation in a complementary medicine intervention resulted in a clinically significant reductionin PTSD and related symptoms in a returning, combat-exposed active duty military population. Further investigation ofGT and biofield therapy approaches for mitigating PTSD in military populations is warranted.

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Workshops und Vorträge für mehr Lebensqualität in den Bereichen Psychologie, Gesundheitsförderung, Sucht und Lebensgestaltung Kanton Bern Gehirngerechtes Arbeiten und beruflicher ErfolgWir leben in einer schnelllebigen und hektischen Zeit ständiger Erreichbarkeit und weltweiter Vernetzung. Die modernen Techno-logien sind für viele ein Segen, der Umgang damit wird für man-che zum Fluch. Arbeiten wir noch effektiv und effizient? Schaffen wir noch echten Mehrwert? Oder hetzen wir bloss noch rastlos von einem Termin zum nächsten? Jürg Dietrich setzt in seinem Referat aktuelle Erkenntnisse aus der Hirnforschung in Bezug zum alltäg-lichen Arbeitsverhalten und gibt sofort umsetzbare Anregungen mit auf den Weg für ein gehirngerechteres Verhalten.