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

Effects of chemotherapy counseling in breast cancer patients by pharmacist

Kanokkoj Budnampet — 2025-09-15

Breast cancer is the most common cancer among women. General treatment typically involves surgery, with some patients also requiring one of chemotherapy, radiotherapy, hormonal therapy or combination of these. However, non-compliance, often stemming from a lack of information and fear, can lead to recurrence and metastasis. Therefore, multidisciplinary care teams, incorporating pharmacists to provide information and counseling on cancer treatment, are crucial for improving patient adherence. Objectives: To compare pre-test and post-test knowledge scores regarding chemotherapy among breast cancer patients following pharmacist-led counseling. Additionally, this study aimed to assess treatment compliance, and the severity and management of adverse drug reaction (ADRs) to chemotherapy. Method: This prospective, descriptive study included 41 patients undergoing surgery during October 2018 to October 2019 at Nopparat Rajathanee Hospital. Patients received chemotherapy counseling from a pharmacist on two occasions: first, post-surgery (within one week) and second, at their follow-up appointment. Pretest and posttest scores were collected. ADRs were documented for patients receiving chemotherapy. Results: Among 41 patients, the median post-counseling knowledge score (9 points) was significantly higher than the pre-counseling score (7 points) (p < 0.001). A significant improvement (p = 0.001) was observed in the correct response to the question: ‘Is chemotherapy necessary for all cancer patients?’ Most patients (95.1%) initiated or continued chemotherapy/hormonal therapy on schedule; 4.9% experienced delays due to other medical procedures. The most frequently reported ADRs were gastrointestinal, including nausea (36.6%) and vomiting (22%). Most ADRs were non-severe. The highest severity reported was grade 3 vomiting (2.4%), requiring hospitalization. Conclusion: Pharmacist-led counseling contributed to improve patient knowledge regarding chemotherapy and supported the timely continuation of chemotherapy/hormonal therapy.

Adjusted relative weight, Medical expense, Reimbursement and Medical cost outcomes for patients transferred from regional hospitals to community hospitals in Sisaket Province

Wachira Sumethiwit — 2025-09-15

The transfer of hospitalized patients from regional hospitals to community hospitals is essential for resource management in the healthcare system. Objectives: To analyze adjusted relative weight, medical expense, reimbursement and medical cost outcomes for patients treated at community hospitals, with or without referral for injectable antibacterial drugs from regional hospitals. Methods: This descriptive study analyzed data from October 2022 to September 2023. The sample was divided into two groups: one receiving intravenous antibiotics from regional hospitals and the other receiving from community hospitals. The Mann-Whitney U-test was applied to determine statistical significance. Results: There were 522 (23.97%) cases of patients receiving injectable antimicrobial drugs at regional hospitals. Most patients were male 1,385 (63.59%). A total referred to community hospitals for treatment at Khunhan Hospital, Khukhan Hospital, and Kanthararom Hospital, which were the top three referring hospitals. The overall adjusted relative weight was 3.21, medical expense of 41,334.75 THB, reimbursement of 27,867.63 THB, and medical cost outcomes of -13,467.13 THB. Adjusted relative weight, medical expense, reimbursement for injectable antimicrobial drugs was higher in regional hospitals than in community hospitals (p-value< 0.001). However, the medical cost outcome of injectable antimicrobial drugs in regional hospitals was lower than in community hospitals (p-value <0.001). Transferred patients had a total medical expense amount of 90,027,098.20 THB, with a total reimbursement of 60,695,692.22 THB, leading to a financial loss of 29,331,405.98 THB for hospitals. The top three disease groups contributing to financial losses were digestive system diseases, infectious and parasitic diseases, and injuries, poisoning, and certain other consequences of external causes, respectively. Conclusion: Patients who were transferred from regional hospitals to community hospitals and received medicine from the regional hospital had higher adjusted relative weight, medical expense, reimbursement. However, when looking at the final medical cost outcomes, they lost more money compared to those who did not receive medicine from the regional hospital.

Patterns and Outcomes of Dual Antiplatelet Therapy in Elderly Patients with Acute Coronary Syndrome at Maharaj Nakorn Chiang Mai Hospital

Nattanicha Pengtawong — 2025-09-15

It is unclear whether antiplatelets are of benefit to older patients who are at high risk for both ischemia and bleeding. The aims of this study were to explore the prescription patterns of antiplatelet therapy and to evaluate efficacy and safety outcomes in elderly patients with acute coronary syndrome (ACS) at Maharaj Nakorn Chiang Mai Hospital. Methodology: This retrospective cohort study collected data from medical records of elderly patients aged 70 years or older with ACS who visited Maharaj Nakorn Chiang Mai Hospital between May 1st, 2020 and May 31st,2021. Pattern of dual antiplatelet therapy was the primary endpoint, while efficacy outcome (all-cause mortality, myocardial infarction and stroke) and safety outcome (Bleeding Academic Research Consortium (BARC) criteria) were the secondary ones. Data analysis included descriptive statistics (frequency, mean and standard deviation) and inferential statistics using Fisher’s exact test and independent t-test. Result: A total of 72 elderly patients with ACS were included, of whom 38 (66.7%) were prescribed aspirin with ticagrelor. The overall incidence of efficacy outcome was 2.78 %. The efficacy outcome occurred in 4.17% of patients who received aspirin with clopidogrel versus 2.08% of those who received aspirin with ticagrelor. There was no statistically significant difference in efficacy outcomes between the two groups (p-value = 1.000). The overall incidence of safety outcome was 11.11%. No significant difference in safety outcomes was observed between the clopidogrel group (4.17%) and the ticagrelor group (14.58%) (p-value = 0.255). Conclusion: The most common antiplatelet prescription patterns in elderly patients with ACS was aspirin with ticagrelor. There was no statistically significant difference in efficacy and safety outcome between aspirin- clopidogrel and aspirin- ticagrelor groups.

Drug Use Review of Non-Vitamin K Antagonist Oral Anticoagulants at Fort Sunpasitthiprasong Hospital

Kanjanarak Ungjaroenwathana — 2025-09-15

The prescribing rate of NOACs has been increasing in recent years. Each agent has distinct prescribing considerations, which may pose a risk for inappropriate use. Therefore, it is essential to implement monitoring and oversight of their utilization. Objective: To review the prescription patterns of NOACs at Fort Sunpasitthiprasong Hospital. Methods: A retrospective, cross-sectional study was conducted using the hospital database between January 1 and December 31, 2022. The study assessed the conformity of prescriptions with prescribing criteria regarding indications, dosage, administration, and concomitant use with drugs that potentially harmful drug interactions. Results: Among 764 prescriptions from 127 patients, 66.93% were male with a mean age of 75.55 ± 10.08 years. Common comorbidities were hypertension (74.02%). Based on the diagnosis, 96.47% of prescriptions were for atrial fibrillation, Dabigatran and rivaroxaban accounted for 60.86% and 39.14% of all prescriptions, respectively. For the results of the drug use review, it was found that only 43.98% of the prescriptions conformed to all prescribing criteria. However, when considered separately by indications, dosage, and administration, conformity rates increased to 98.28%, 77.62%, and 53.53%, respectively. None of the prescriptions were found to have severe drug interaction. Conclusion: The prescribing of NOACs was found to be largely appropriate with respect to indications. However, there remains a need for improvement in aspects related to the method of administration and dosage to ensure more optimal prescribing practices within the hospital.

Border Crossing and Situation on Problems of Medicine and Health Products along Thailand’s Borders – the Case of Corticosteroids

Supanai Prasertsuk — 2025-09-15

The distribution and usage of high-risk corticosteroids along Thailand's border areas reveal vulnerabilities in regulatory systems under the complex borderland contexts, affecting public health nationwide. This study aims to understand these phenomena to highlight structural realities and propose appropriate community-level and policy-level solutions. Methods: This qualitative study collected data through literature reviews, field notes, in-depth interviews, and participant observation. The research spanned Thailand's border provinces with Laos, Cambodia, Myanmar, and Malaysia, involving health officials, public health personnel, migrant workers, local vendors, and patients. Data underwent triangulation and thematic analysis, with insights validated through expert consultations between October 2024 and April 2025. Results: Thailand’s border regions face significant challenges related to the smuggling of unregulated and substandard pharmaceuticals, notably health products containing banned substances such as Dexamethasone. These findings underscore inadequacies in regulatory mechanisms, evident in all Thai border areas despite existing checkpoints. Border areas serve as hubs for medication access among local populations and migrant workers who lack formal health coverage due to systemic inequalities in neighboring countries. This has led to reliance on purchasing medicines from local vendors and markets, with many utilizing informal ‘YA - CHUD’ (a combination of different drugs in the form of a capsule or tablet and packed in small plastic bags) or counterfeit drugs with temporary efficacy. Overuse of certain drugs, such as Lincomycin injections at clinics, has also been observed. Conclusion: The Landscape of border medicine situation along Thailand’s borders highlights critical gaps in regulatory frameworks, particularly for high-risk drugs. Addressing these issues requires an understanding of the informal and pragmatic governance evident in these areas, where illegal but socially accepted practices persist alongside the transboundary movement of people, goods, and cultural exchanges. Recommendations include improving regulatory processes, leveraging surveillance technologies, fostering international collaboration, and empowering border-area volunteers to enhance public health and state security sustainably.

Drug Use Review of Ceftazidime/Avibactam in Tertiary care hospital

Chuleephorn Pitayakittiwong — 2025-09-15

Antimicrobial resistance, particularly Carbapenem-Resistant Enterobacterales (CRE), is a growing public health concern, and rational antibiotic use may help to delay the progression. This includes the use of ceftazidime/avibactam, an effective option against CRE. Objectives: To study the use pattern of ceftazidime/avibactam in tertiary care hospital, Thailand. Methods: A retrospective observational study of adult patients receiving ceftazidime/avibactam. The compliance with indication, dosage, administration, and duration of therapy was assessed based on The Thailand Essential Drug List guideline 2022. Monitoring of efficacy and safety during the drug use were compared with the criteria developed in this study. Treatment outcomes at the end of therapy was also studied. Results: There were 148 treatment episodes (n) of ceftazidime/avibactam in 134 patients (N) during the study period. Most of them were critically ill (99 patients, 66.9% (n)) and admitted to medicine wards (100 patients, 67.6% (n)). The most common indications were bacteremia (58 treatment episodes, 33.5%). The majority of causative pathogens were carbapenem-resistant Klebsiella pneumoniae and Escherichia coli. The indication, dosage regimen, administration, and duration of therapy were complied with The Thailand Essential Drug List guideline 2022 in 68 treatment episodes (46%), 84 treatment episodes (56.8%), 75 treatment episodes (50.7%) and 94 treatment episodes (63.5%), respectively. Efficacy and safety monitoring were conducted in 138 treatment episodes (93.2%) and 141 treatment episodes (95.3%), respectively. Treatment outcomes showed that 77 patients (n, 52%) were cured. Conclusion: Ceftazidime/avibactam use in this hospital showed moderate compliance with the recommendation by The Thailand Essential Drug List guideline 2022 in terms of indication, dosage, and administration, but monitoring of treatment efficacy and safety was consistently high. Most patients achieved clinical recovery. To achieve national antimicrobial resistance control, the ceftazidime/avibactam use aligning with the established guideline should be encouraged.