Isan Journal of Pharmaceutical Sciences, IJPS (Isan J Pharm Sci)

Knowledge General Medicine, Knowledge of Paracetamol, Paracetamol use Behaviors, and Factors Associated Rational Paracetamol Use among Thai Patients at Subdistrict Health Promotion Hospital, Mueang Khon Kaen District, Khon Kaen Province

Oomchoo Saiphet — 2026-05-28

Irrational medicine use leads to public health issues in both Thai and global settings as it can cause effect on population health. Objectives: To study the knowledge of general medicine, knowledge of paracetamol, behavior of using paracetamol, and the factors associated with rational paracetamol use among Thai patients. Methods: A total of 247 patients from six subdistrict health promotion hospitals in Khon Kaen participated in this study. Structured questionnaires were used to collect data from December 15, 2024, to January 31, 2025. Descriptive statistics and binary logistic regression were used to analyze data. Results: Most of the respondents were female aged between 18-73. Of 10 scores, mean knowledge score of general medicine was 7.94 (SD=1.91), and 65.59% of them had sufficient knowledge. The mean knowledge score of Paracetamol was 6.23 (SD=1.92) and 29.15% of them showed sufficient knowledge. In terms of behaviors, of 8 scores, the mean score of behaviors of rational paracetamol use was 5.41 (SD=2.18) and 53.0% of them showed behaviors of rational paracetamol use. The factors significantly associated with rational paracetamol use included the main source of medicines (aOR =4.44, 95%CI=1.40-20.98, p = 0.014), general knowledge of medicines (aOR =2.02, 95%CI=1.09-3.76, p = 0.026), and knowledge of paracetamol (aOR =3.48, 95%CI=1.93-6.28, p < 0.001). Conclusion: Although more than half of the patients showed behaviors of rational paracetamol use and had sufficient knowledge of general medicines, the knowledge of paracetamol was insufficient. Patients who received medicines from both drug stores and private hospitals tended to use paracetamol rationally than those who received medicines from the government hospitals. Moreover, patients who had sufficient general knowledge of medicines were more likely to use medicines rationally than those who had lower knowledge. According to the associated factors, the main source of medicines and knowledge level of medicines, these can be a threshold for developing plans to promote rational medicine use, providing effective medication counselling, developing skills for general medicine and paracetamol use, including promoting activities that strengthen rational medicine use.

Outcomes of Telepharmacy Services Combined with Medication Delivery by Mail in Breast Cancer Patients

Jintana Tangsitchanakul — 2026-05-28

Medication knowledge and continuity of endocrine therapy are critical determinants of treatment outcomes in breast cancer. The integration of telepharmacy services with mailed medication delivery has been proposed as a strategy to enhance access to pharmaceutical care and mitigate travel-related barriers. Objective: To evaluate medication knowledge, drug-related problems (DRPs), medication adherence, patient satisfaction, and economic savings resulting from the integration of telepharmacy services and mail-order medication among breast cancer patients receiving endocrine therapy. Methods: A prospective quasi-experimental study was conducted at Khon Kaen Hospital from March 31 to December 31, 2025. Eighty-five patients receiving endocrine therapy were enrolled in a telepharmacy program integrated with mail medication delivery under the Medically Integrated Dispensing (MID) framework. Medication knowledge was assessed using a five-item structured test. Medication adherence was quantified using the Modified Medication Possession Ratio (mMPR). Patient satisfaction was evaluated using a five-point Likert scale, and travel-related expenditures were recorded. The Wilcoxon signed-rank test and descriptive statistics were used to analyze the data, with a two-tailed significance level set at p<0.05. Results: All participants were female (n = 85), with a mean age of 58.11 ± 9.72 years. Tamoxifen was the most frequently prescribed medication (57.65%). Post-program analysis demonstrated a statistically significant increase in median knowledge scores, from 4 to 5 (p< 0.05). DRPs were identified in 41.18% of patients, with hot flashes being the most common reported issue (24.71%). Mean mMPR was 97.36%, exceeding the predefined adherence threshold of 80%. Satisfaction scores were consistently high (mean range: 4.65–4.88). The intervention was associated with a mean reduction in travel costs of 496.06 ± 431.52 THB per visit. Conclusion: The integration of telepharmacy services with mailed medication delivery was associated with improved medication knowledge, high levels of adherence, high patient satisfaction, and reduced travel-related financial burden among breast cancer patients receiving endocrine therapy.

Pharmacist Interventions for Prevention of Drug-Related Problems and Cost Avoidance among Cardiovascular Patients at Queen Sirikit Heart Center, Khon Kaen University

Naowakun Ariyapim — 2026-05-28

Cardiovascular patients often undergo complex pharmacotherapy, which increases the risk of Drug-Related Problems (DRPs) and subsequent healthcare costs. Given the limited economic data on pharmaceutical care outcomes in this population, evaluating cost avoidance is crucial to reflect the profession's economic value and support the allocation of the pharmacist workforce. Therefore, this study aimed to analyze the types of DRPs identified through pharmacist interventions and to evaluate the cost avoidance in outpatients at the Queen Sirikit Heart Center of the Northeast, Khon Kaen University. Methods: A retrospective study was conducted over a one-year period (October 1, 2020, to September 30, 2021). Data were collected from outpatient prescriptions involving DRPs documented in pharmacist intervention records and computer key-in errors. The types of DRPs and associated medications were analyzed using descriptive statistics. Additionally, cost avoidance was calculated using an equation based on the probability of potential adverse drug events. Results: Out of 80,737 reviewed prescriptions, 9,400 computer key-in errors (11.64%) and 860 DRPs requiring pharmacist interventions (1.06%) were identified. Patient counseling and monitoring needs (24.77%) and inappropriate dosing, including over- and under-dosing (24.18%), were identified as the two most common DRPs requiring pharmacist intervention. The top five medications most commonly associated with problems were warfarin, atorvastatin, carvedilol, insulin, and amiodarone, respectively. Regarding economic outcomes, pharmacist interventions generated a total cost avoidance of 10,337,200 THB per year. This comprised 7,205,200 THB from resolving key-in errors and 3,132,000 THB from managing DRPs. Interventions related to over-dosing yielded the highest value of cost avoidance. Conclusion: Pharmaceutical care, systematically delivered through prescription reviews and pharmacist interventions, effectively prevents and resolves DRPs. Furthermore, it results in cost avoidance, thereby enhancing both medication safety and the overall quality of care for cardiovascular patients.

Polypharmacy and Potentially Inappropriate Medication Use among Elderly Patients with Cancer in a Tertiary Care Hospital

Tipawan Hirunmapron — 2026-05-28

Polypharmacy (PP) in elderly cancer patients undergoing chemotherapy may lead to an increased odds of potentially inappropriate medications (PIMs), increasing the risk of adverse events such as confusion, falls, and delayed treatment. Therefore, evaluating medication use and analyzing associated factors is essential to avoid inappropriate medications, raise awareness, and improve medication safety for elderly cancer patients. Objective: This study aimed to determine the prevalence of PP and PIMs among elderly cancer patients at the chemotherapy unit of Srinagarind Hospital, using the 2023 AGS Beers Criteria and 2023 START/STOPP Criteria version 3. We also identify factors associated with PIMs in this patient population for improving medication safety. Method: A retrospective cross-sectional study was conducted in elderly cancer patients (Age ≥ 65 years old) at the chemotherapy unit of Srinagarind Hospital between January 1, 2023, and December 31, 2023 (12 months). Results: A total of 390 elderly cancer patients were evaluated, with a male predominance (58.0%) and a median age of 69 years (IQR:67-73). The overall prevalence of PP was 91.0% (n=355), sub-classified into PP (5-9 medications) at 65.4% and excessive polypharmacy (≥10 medications) at 25.6%. The overall prevalence of PIMs was 71.0%. When assessed separately, PIMs were identified by the 2023 Beers criteria in 65.9% of patients and by the 2023 START/STOPP Criteria in 53.8% of patients. Commonly identified PIMs included benzodiazepines and prokinetic agents. In univariate analysis, the number of medications (p<0.001) and the number of comorbidities (p<0.001) were significantly associated with PIMs. Multivariate analysis revealed that diabetes mellitus (AOR=1.78, 95%CI:1.05-3.03, p=0.032), excessive polypharmacy (AOR=9.27, 95%CI:3.78-22.73, p<0.001), and a lung cancer diagnosis (AOR=8.58, 95%CI:1.09-67.59, p=0.041) were significant factors for PIMs. Conclusion: Most elderly cancer patients were treated with polypharmacy. The combined use of 2023 Beers Criteria and 2023 START/STOPP Criteria provides a more comprehensive detection of PIMs compared to using either criteria alone. The START/STOPP criteria provide superior efficacy in patient-specific clinical assessment. The number of prescribed medications and the number of comorbidities were factors associated with the occurrence of PIMs.

The Clinical Characteristics of Hypersensitivity Reactions to NSAIDs: A Comparison between COX-1 and COX-2 Inhibitors

Pranee Suecharoen — 2026-05-28

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common cause of drug-induced hypersensitivity reactions (HSRs). These reactions present with diverse clinical manifestations, ranging from cross-reactive responses related to cyclooxygenase-1 (COX-1) inhibition to selective immunologically mediated reactions. However, real-world comparative data on HSRs between COX-1 and COX-2 inhibitors remain limited. This study aimed to compare the clinical characteristics, severity, and seriousness of NSAID-induced HSRs between COX-1 inhibitors and COX-2 inhibitors. Methods: We conducted a retrospective case-only study at Srinagarind Hospital between 1 January 2021 and 31 December 2023. Adult patients with NSAID-related HSRs were identified using diagnostic codes and subsequently validated through detailed review of clinical documentation. Causality was assessed using the Naranjo algorithm. Patients were classified according to the type of NSAID exposure into COX-1 inhibitor and COX-2 inhibitor groups. Clinical manifestations, severity, and seriousness of HSRs were compared between groups. Multivariable log-binomial regression analysis was performed to identify factors independently associated with differences in HSR characteristics, using a complete-case approach. Results: Among 1,167 patients (COX-1: n=939; COX-2: n=228), baseline characteristics were similar, although the COX-2 inhibitor group was older (p<0.001). Musculoskeletal disorders were more frequent in COX-2 users, while respiratory and genitourinary diseases were more common in COX-1 users (p<0.05). Cutaneous reactions predominated in both groups. Anaphylaxis was more common with the COX-1 inhibitor (6.84% vs 3.12%, p=0.037), whereas fixed drug eruption, Stevens–Johnson syndrome, and mucositis were more frequent with the COX-2 inhibitor (p<0.05). Severity and seriousness profiles did not differ significantly. Age was significantly associated with differences in the clinical characteristics of HSRs among patients. (adjusted risk reduction (aRR) 1.01 per year; 95% CI 1.01–1.02; p<0.001). Conclusion: Cyclooxygenase-1 inhibitors and cyclooxygenase-2 inhibitors have different patterns of clinical manifestations but similar levels of severity, and age is associated with differences in the characteristics of clinical manifestations within the group of patients who develop hypersensitivity reactions.

Outcome of vancomycin therapeutic drug monitoring service at Srinagarind Hospital

Cheardchai Soontornpas — 2026-05-28

Therapeutic drug monitoring (TDM) is a clinical pharmacy service that helps optimize medication dosages for individual patients. The Faculty of Pharmaceutical Sciences, Khon Kaen University, has provided vancomycin TDM services at Srinagarind Hospital since 1997. However, there is still a lack of data regarding changes in drug consumption following the implementation of this service. The objective of this study is to collect data on the outcomes of vancomycin TDM services and to compare the estimated vancomycin consumption with the actual consumption volume. Methods: This was a retrospective descriptive study conducted in inpatient subjects aged 18 years and older with stable renal function. Participants received intravenous vancomycin and vancomycin TDM services at Srinagarind Hospital during the 2025 fiscal year. Data were collected from TDM service reports, electronic databases, and patient medical records. Outcome data were analyzed, and consumption volumes were compared using descriptive and inferential statistics. Results: A total of 143 patients met the screening criteria, involving 374 TDM service instances. Drug levels were within the therapeutic range in 28.9% of cases, below the range in 30.5%, and above the range in 39.6%. Pharmacists provided recommendations to adjust the dosage in 47.6% of cases, withhold the dose in 16.6%, and maintain the current dose in 26.7%. Physicians followed these recommendations at a rate of 81.6%. This associated to a statistically significant increase in the proportion of drug levels within the therapeutic range (from 15.4% to 38.3%) and a decrease in levels outside the range (from 84.6% to 61.7%) (p-value < 0.05). Regarding consumption differences, the actual volume used was 111.47 DDD lower than the estimated consumption, representing a value of 38,766 Baht; however, this was not statistically significant (p = 0.091 and 0.125, respectively). Conclusion: Vancomycin TDM facilitated dosage adjustment, increasing the likelihood of patients reaching the therapeutic range while slightly reducing overall vancomycin consumption. Nevertheless, monitoring of peak and drug levels should be encouraged, along with follow-up on drug concentrations and clinical results after treatment.