Thai Journal of Pharmacy Practice

Cover and Content

2025-03-21T08:26:18+07:00

Development of a Tool for Evaluating the Quality of Medication Management in Schools

2024-10-21T15:38:31+07:00

Objective: To develop a tool for assessing the quality of medication management in schools within Thailand for use in monitoring the problems and improving quality in this domain. Methods: The study consisted of 5 phases. Phase 1 involved the collection of the criteria for assessing medication management in schools from previous studies. Phase 2 involved the online-interviews with 6 experts in medication management in schools during February 2024 to obtain their opinions for improving the collected criteria. Phase 3 was a Delphi survey with an online questionnaire in 21 experts to find out their agreement with the criteria on a scale of 1-5 (strongly disagree to strongly agree). The survey was conducted from March to April 2024. Phase 4 involved another Delphi survey with an online questionnaire in 28 experts on appropriate timeline for implementing each criterion with 5 choices (never implement, implement immediately, implement in the next 2, 5, or 7 years). The survey was conducted from May to June 2024. Phase 5 was the development of assessment methods for the criteria identified as critical defects. Failure to meet these criteria resulted in failing the overall assessment. The study conducted through a 110-minute online brainstorming and online-interviews among 8 experts in school medication management during August 2024. Results: In phase 1, the researchers identified 40 criteria for assessing medication management with 37 non-critical defect criteria and 3 critical defect criteria. Following the interviews with experts in phase 2, the number of criteria was expanded to 49. Results from the Delphi survey at the first round in phase 3 indicated that the experts reached a consensus on the use of all criteria with 40 criteria having a median of 5.00 (strongly agree) and an IQR of 0.00, and 9 criteria with a median of 5.00 and an IQR of 1.00. The survey on criteria agreement was therefore conducted only once. The number of criteria was expanded to 51 after phase 3 study. The Delphi survey at the first round in phase 4 reached a consensus on the immediate use of all 51 criteria with 42 criteria having a median of 5.00 and an IQR of 0.00, 7 criteria with a median of 5.00 and an IQR of 1.00, and 2 criteria with a median of 5.00 and an IQR of 0.25. The survey in phase 4 was conducted once. The study resulted in 51 criteria for the assessment of medication management in school with 43 non-critical defect criteria and 8 critical defect criteria. Additionally, specific assessment methods for the critical defect criteria were formulated in phase 5. Conclusion: The development of the assessment tool for medication management in school, through a variety of processes with the involvement of experts in relevant area, has resulted in a tool ready for further testing.

Knowledge, Attitudes, and Readiness of Thai Community Pharmacists Regarding the Provision of Alcohol Brief Intervention

2024-11-25T11:17:39+07:00

Objective: To survey knowledge, attitudes, and readiness of the drugstore pharmacists regarding the provision of the alcohol brief intervention (ABI), and to identify factors affecting the readiness for providing the ABI. Method: The subjects consisted of 524 community pharmacists selected by simple random sampling from the population of independent community pharmacies all over the country. The study sent invitation letters for the study by post and collecting data using a self-administered questionnaire including the personal characteristics, knowledge, attitude, readiness regarding the provision of the ABI and reasonable reimbursement. Results: There were 263 respondents who completed the questionnaires (50.2%). The researchers collected data from an additional 30 new subjects to reach the required minimum sample size of 293. Community pharmacies where 23.5% of the respondents worked were listed by the Pharmacy Council as quality drug stores. Overall mean of knowledge regarding the ABI was 4.42 (SD=2.78) out of a full score of 12. Overall mean of attitude toward the ABI was 3.51 (SD=0.65) from a total score of 5. The mean of readiness to provide the ABI was 1.80 (SD=1.66) out of the full score of 5. Highest readiness score was found in the information system (48.1% of total sample), online training (47.8%), and officially registered for providing daily service (46.1%). However, only 16.4% were ready for knowledge regarding the ABI, and only 21.5% were ready for the skill in providing the ABI. Both knowledge and attitudes regarding the ABI were the statistically significant factors associated with the readiness for providing the ABI with adjusted odds ratio of knowledge at 1.14 (P = 0.02; 95%CI 1.02 - 1.27) and that of attitudes at 4.45 (P <0.001; 95%CI 2.56 – 7.92). Conclusion: Community pharmacists had insufficient knowledge regarding the ABI and were not ready to practice although they had a positive attitude toward the ABI. Knowledge and attitude were significantly associated with the readiness for providing the ABI. Therefore, it is crucial to promote knowledge and attitude regarding the ABI for the development of the capacity and readiness to effectively provide the ABI.

Development of a Model for Monitoring, Handling and Warning Regarding Unsafe Health Products in Rattaphum District, Songkhla Province

2024-11-28T10:32:48+07:00

Objective: To develop and evaluate a model for monitoring, handling and warning of unsafe health products (UHPs) in Rattaphum District, Songkhla Province. Method: This study was two-cycle action research. The participants were the Working Group on Health Consumer Protection Development in 13 primary care units, totaling 327 people, including village health volunteers, community leaders, public health officers, teachers in the FDA Juniors project, and officials in local administrative organizations. The researcher provided feedback on the problems of UHPs in the area to the Working Group, and jointly determined the approach for UHP surveillance, management and warning. The finalized model was the WMA 1.1. W (watch) consists of 6 elements: 1. N (network) or network establishment; 2. E (education) or providing knowledge on the 6 prime questions; 3. P (practice) or applying the knowledge into practice by members of the network; 4 P (proactive surveillance activities) or organizing proactive surveillance activities; 5 F (flow report) or setting up the reporting process, and 6 P (pride) or creating pride in those who report the problems on UHPs. M (management) consists of 4 elements including C (consumer) or managing problems of UHP uses by consumers; 2. P (product) or managing UHPs; 3. F (flow manage) or setting up the management process, and P (proactive problem solving activities) or organizing proactive activities to resolve important problems in the area. A (Alert) is UHP warning. The model was evaluated according to the criteria set before and after the 4-month intervention. Results: After model implementation, average knowledge on UHPs surveillance among the working group increased significantly from 11.71±2.97 to 16.83±2.57 (from the total score of 20) (P<0.001). The reporting of UHPs was 100% correct. The surveillance and identification of UHPs increased from 15 to 95 cases. All problems of UHPs and UHP users were managed. The risk level of UHPs decreased from high to low. The numbers of role models in UHPs surveillance and warning increased from 21 to 41. The community health warning centers of primary care units passed the criteria with 3 at the improving level and 9 at the strong level. Conclusion: The WMA model 1.1 increased the Working Group's knowledge of UHPs surveillance. The surveillance, management and warning of UHPs were improved.

Effects of the Development of a Prescription Screening System for Inpatients on Medication Errors at Krathumbaen Hospital, Samut Sakhon Province

2024-11-28T10:46:54+07:00

Objective: To develop a prescription screening system for inpatient pharmacy services and to compare the rate of prescribing errors (PEs) before and after the development of the system. Method: This study was an action research with 4 phases. Phase 1 or planning consisted of a) data collection of work processes, criteria for screening prescription and PEs data in 3 periods, i.e., the period without screening of drug orders (January to September 2022), the period with prescription screening (October 2022 to June 2023), and the period with criteria for prescription screening (October 2023 to March 2024), b) analysis of PEs data in the 3 periods, and c) determination of the process for system development. Phase 2 was the implementation of the system or the developed prescription screening program (April to June 2024). Phase 3 or observation involved data collection of the effects of the implementation of the planned system, including the system development process and PEs data. Phase 4 involved reflection of system implementation and the improvement of the system. This phase consisted of a) evaluation of the outcomes of system implementation b) improvement of system by having pharmacists on duty at prescription screening point (July to September. 2024) and c) outcome evaluation by comparing PEs before and after system implementation at different time periods and those when pharmacists available at prescription screening points. Results: The developed processes in the system included development of a prescription screening program, determination of appropriate criteria for prescription screening, support in policies, technology, and personnel, development of pharmacists' knowledge and skills in prescription screening, participation of practitioners and multidisciplinary professionals in system development, and improvement of the completeness of prescription screening according to the criteria. After the implementation of the prescription screening system, more PEs were identified and resolved than those before system development. Identified PEs increased from 2.41 per 1,000 hospital days to 4.61 per 1,000 hospital days (P=0.001). After the implementation of the prescription screening program, more PEs could be discovered and resolved than those before implementing the program, with identified PEs increasing from 5.02 per 1,000 hospital days to 8.74 per 1,000 hospital days (P=0.009). Conclusion: The development and implementation of the prescription screening system and having a prescription screening program enable pharmacists to identify and resolve more PEs than before the system development, resulting in more appropriate drug use and drug safety in patients.

Factors Affecting Mortality of Patients with Bloodstream Infection Caused by Ceftriaxone-resistant Enterobacterales at Chonburi Hospital

2024-12-03T07:37:42+07:00

Objective: To determine factors affecting mortality of patients with bloodstream infection caused by Ceftriaxone-resistant (CRO-R) Enterobacterales at Chonburi Hospital. Methods: A retrospective cohort study was conducted by collecting relevant information from medical records. Eligible patients were adults aged ≥ 18 years with bloodstream infection caused by CRO-R Enterobacterales and hospitalized at Chonburi Hospital from April 1, 2023 to March 30, 2024. The study employed binary logistic regression to determine factors affecting mortality. Results: There were 86 participants. The majority were female (n=38 or 57.58%), Mean age was 62.48 ± 15.16 years. Three most common sources of bloodstream infection were urinary tract infection, primary bacteremia with unknown source and gastrointestinal and intra-abdominal infection. Multivariate analysis revealed that two factors having significant association with mortality of patients with bloodstream infection caused by (CRO-R) Enterobacterales were primary bacteremia (aRR 11.88, 95%CI: 1.25, 113.13, P = 0.031) and septic shock (aRR 51.91, 95%CI: 4.19, 643.03, P = 0.002). Conclusion: Primary bacteremia and septic shock were factors affecting mortality of bloodstream infection patients caused by CRO-R Enterobacterales. However, the limitations of this study include small sample size and study setting focused only on internal medicine ward. Therefore, further studies should explore additional factors to enhance the accuracy of mortality predictions.

Applying the Levenshtein Distance Algorithm to Detect Look-alike Drug Names

2024-12-14T08:56:42+07:00

Objective: To apply the Levenshtein distance algorithm (LDA) as a tool for detecting look-alike drug names in the Krabi hospital’s drug list for fiscal year 2024. Methods: This experimental study applied the LDA to detect look-alike drug names, focusing solely on drug names and their strength shown on the drug labels on containers dispensed to patients. The study compared the outcomes of similarity assessment of 150 pairs of drug names by using the LDA at threshold levels of 50, 60, and 70 and those by 24 participants who were staff of the pharmacy department at Krabi hospital. Evaluation of the algorithm's performance at each threshold level was based on F-scores and the proportion of false negatives in assessment of drug name pairs, i.e., judged as not being look-alike pairs by the LDA, but judged as being look-alike pairs by the participants. Results: Results of the LDA application at thresholds levels of 50 and 60 to assess the similarity of drug names were not statistically significantly different from those assessed by the participants (P > 0.05). The LDA at a threshold level of 50 showed the highest performance with an F-score of 0.80 and the lowest number of false negative outcomes of assessment (12 drug name pairs). Conclusion: The LDA at a threshold level of 50 can be used as a tool for detecting look-alike drug names. Its detection of look-alike drug names on the drug labels was consistent to those assessed by human. The study provides information for selecting drug name pairs to be included in the hospital's look-alike drug names list. The list could be distributed for alerting health professionals on the risky drug name pairs that may cause medication errors, and for using in the risk management plans for patient drug safety accordingly.

Outcomes of the Implementation of Health Riders and Mail Services to Deliver Medications to Patients with Telepharmacy in Patients with Chronic Diseases at Vachiraphuket Hospital

2024-12-19T07:48:07+07:00

Objectives: 1) To develop drug delivery methods via Health Riders, where village health volunteers or hospital staff act as mobile units to deliver medications to patients’ homes, and via post, with telepharmacy services in Vachira Phuket Hospital, 2) To compare the outcomes of pharmacy services provided via 4 channels including Health Rider, postal service, drugstores, and hospitals, and 3) To compare understanding of drug use and self-care among patients receiving services from all 4 channels. Method: This research was a mixed-method study. The study developed drug delivery via Health Riders and postal service, along with telepharmacy services, where pharmacists communicated with patients via the Mor Prom or Line platforms or telephone. The quantitative research was a quasi-experimental study that compared outpatients with chronic diseases in the experimental group who received pharmacy services via Health Riders (n=44), postal service (n=44), and drugstores (n=26), and the control group receiving pharmacy services from the hospital (n=44). Qualitative research employed patient interview on their problems and suggestions relating to the services. Results: The average times for the provision of pharmacy services in each method were significantly different (P<0.05). The service times via pharmacies, Health Riders, post and hospitals were 13, 7, 5 and 3 minutes, respectively. The overall means of patient satisfaction with the services were significantly different (P<0.05). Means of the satisfaction with services via post, pharmacies, Health Riders, and hospitals were 4.68 ± 0.32, 4.66 ± 0.31, 4.64 ± 0.36, and 4.22 ± 0.51, respectively (out of 5 full scores). Understanding of medication use and appropriate self-care of patients receiving care from each channel was significantly different (P<0.05). That in patients receiving services via pharmacies, post, Health Riders, and hospitals were 4.46 ± 0.41, 4.23 ± 0.61, 4.19 ± 0.47, 4.07 ± 0.52 (out of 5 full scores), respectively. Conclusion: Patients are satisfied with the services via Health Riders and post together with telepharmacy services. This model allows more time for pharmacy services and leads to understanding of drug use and appropriate self-care, with no differences from the provision of service in the hospital and drugstores.

Legal Measures for Controlling Pharmacies to Prevent the Sale of Drugs Subject to Abuse

2024-12-19T07:47:17+07:00

Objective: To study the legal measures to control pharmacies to prevent the sale of drugs subject to abuse. Method: This research was a documentary research that collected data from laws, articles, theses, research, academic documents, and databases on internet in both Thai and English. The collected data included drug classification and legal measures to control drugs, namely tramadol, dextromethorphan, diphenhydramine, and promethazine, in Thailand and nine other countries. The data were collected between June and August 2023. Results: Most of the studied countries legally classify drugs into at least 3 groups, The classification has an effect on increasing the professional role of pharmacists in using discretion to dispense non-prescription drugs and pharmacist only drugs. Many legal measures were established to control drug abuse. The first measure is classification of drugs with different levels of control to manipulate their access, such as classifying the drugs as narcotics with more restrictive measures than drugs, classifying the drugs as prescription drugs, non-prescription drugs and pharmacist only drugs. The second measure is setting legal requirement for drug sales by restricting the age of the buyers, the quantity and frequency of sales, and bookkeeping and report of drug sales and recording sales of non-prescription drugs and pharmacist only drugs via electronic systems. Conclusion: The government should strictly require pharmacies to have pharmacists on duty during their business hours, along with allowing pharmacists to exercise professional judgment in appropriate drug distribution. Moreover, programs for electronically recording drug sales should be used to track the amount and frequency of drug dispensing.

Drug-Drug Interactions of Metformin in Diabetes Treatment

2025-01-12T16:53:07+07:00

Metformin is a blood sugar-lowering medication in the biguanide class. Its mechanism of action involves inhibiting glucose production in the liver, which suppresses gluconeogenesis and lipolysis. Additionally, it reduces the secretion of growth hormone, adrenocorticotropic hormone (ACTH) and follicle stimulating hormone (FSH) from the pituitary gland, thereby decreasing insulin resistance. The effectiveness of metformin in lowering HbA1c ranges from 1-2% from baseline. After absorption into the bloodstream, metformin is distributed throughout the body via OCT1 and OCT3 transporters. It does not undergo hepatic metabolism and is excreted unchanged through OCT1 and MATE1 transporters found in the liver and kidneys. Concomitant use of metformin with drugs that inhibit OCT and MATE transporters can increase metformin levels in the bloodstream. Such drugs include INSTI antiviral drugs, trimethoprim, cephalexin, rifampicin, pyrimethamine, H₂ receptor inhibitors, proton pump inhibitors, ranolazine, anti-cancer drugs, and beta-adrenergic blockers. Additionally, the use of metformin with drugs that increase gastric emptying time, such as anticholinergics, may enhance metformin absorption in the small intestine. Furthermore, exposure to radiographic contrast agents that are nephrotoxic can lead to acute kidney failure, reducing metformin excretion and increasing the risk of lactic acidosis. Heavy alcohol consumption may also contribute to lactic acidosis. Therefore, patients taking metformin should avoid excessive alcohol intake to minimize the risk of this condition. Drug interactions that increase metformin levels may lead to severe adverse effects, including metformin-induced lactic acidosis (MILA) or metformin-associated lactic acidosis (MALA). Thus, drug interaction is a critical issue to be concerned together with comorbidities and concurrent medications. Patient counseling is essential to prevent severe adverse effects resulting from drug interactions.

Effectiveness and Adverse Drug Reactions of Phyllanthus emblica with Andrographis paniculata Dry Extract Cough Syrup in Long COVID Patients

2025-02-02T16:28:15+07:00

Objective: To study the effectiveness and adverse reactions of Phyllanthus emblica and Andrographis paniculata dry extract cough syrup in Thai Traditional and Alternative Medicine Center. Methods: The subject consisted of 401 participants who presented with a chronic cough lasting more than two months due to long COVID and were treated at the Thai Traditional and Alternative Medicine Center between June and December 2024. The outcomes were measured twice i.e., before treatment and after 7 days of treatment. The study assessed effectiveness using the scale on severity of the cough modified from the Cough Severity Diary (CSD) with 0-4 range of score, and 4 being the highest severity. Moreover, patients reported their experiences on adverse effects during a follow-up visit at the Center. Results: The majority of participants were female (60.35%), with an average age of 46.53±16.46 years. Assessment of cough severity revealed that frequency of coughing decreased from 3.21±0.82 to 1.97±0.69 after treatment. Cough severity reduced from 2.75±0.77 to 0.89±1.12, while the impact on daily activities decreased from 3.08±1.03 to 2.11±0.73. Sleep disturbance reduced from 3.22±1.15 to 2.40±0.70. All changes were statistically significant (P<0.001). Reported adverse effects included localized itching on the arms and frequent urination. Conclusion: The Phyllanthus emblica and Andrographis paniculata dry extract cough syrup has a promising tendency in reducing cough severity and cough impact on daily activities in patients with long COVID-19 and persistent dry cough. Further randomized controlled trials are warrant to confirm its efficacy.

Community Pharmacists' Perspectives on Delivering Minor Ailment Services under the National Health Security System

2025-01-31T07:20:31+07:00

Objective: To study the perspectives of community pharmacists on motivation to participate in the minor ailment services project of pharmacies in the National Health Security System, as well as problems and barriers, success factors, suggestion of further improvement, and social value of participation in the project. Method: This qualitative study collected data from 13 pharmacists who participated in the project through face-to-face interviews and 2 rounds of focus groups with 17 new informants from all health regions. Results: The main motivations for participation in the project included the need to help patients, professional development, decreasing public health problems of hospital overcrowding, and promoting the pharmacy business. Meanwhile, the identified barriers were patients’ misunderstanding of the service and technical problems in the service system. The success factors of the project included support from the government, effective management, and cooperation from community networks. The social value of the service provision found in this study included helping to enhance the professional image of pharmacists and improving the patients’ quality of life, as well as reducing hospital overcrowding. Suggestions for further improvement of the project included improving the technology system, expanding the coverage to other health benefit schemes, and training related personnel to provide quality services. Future research should focus on long-term evaluation and improving the pharmacy management system. The data from this study can be used to improve public health policies and promote the expansion of the role of pharmacists in Thai health system. Conclusion: The provision of minor ailment care services in pharmacies under the National Health Security System promotes pharmacists to provide services according to professional standards. This is regarded as an improvement in pharmacy services, and value addition for community pharmacists and pharmacy profession, leading to the benefit of public and society. Therefore, there should be continuous support from the government for this project to ensure sustainability for this service.

Factors Associated with Failure of Non-pharmacological Treatment in Smoking Cessation

2025-02-20T14:34:22+07:00

Objective: To identify factors contributing to the failure of non-pharmacological treatment in smoking cessation. Methods: This prognostic factor research collected retrospective cohort data from the medical records of patients who received treatment at the Fahsai Clinic, Rangsit University, from June 18, 2014, to November 16, 2023. The inclusion criteria were: 1) aged 18 years or older, 2) being current smokers seeking treatment to reduce or quit smoking, and 3) treated with non-pharmacological methods. The study outcome was treatment failure, assessed after completing 6 months of therapy through a phone interview. The factors studied included: 1) general information, such as gender, health issues, having spouses, partners or children, use of alcohol or drugs, and 2) smoking behavior, such as accumulated cigarette consumption, severity of nicotine dependence as assessed using the Heaviness of Smoking Index, and readiness to quit smoking based on the Transtheoretical Model. Multivariable logistic regression was used for association analysis. Results: The sample consisted of 316 individuals, with 81.33% treatment failure rate. The majority were male (88.61%), with a median age of 21 years and interquartile range of 19-31 years, and having mild and moderate levels of nicotine dependence (47.83 and 44.82, respectively). Factors associated with treatment failure included: 1) severe nicotine dependence (OR: 15.13; 95% CI 1.36-168.62), 2) having readiness to quit in the contemplation stage (OR: 8.49; 95% CI 2.85-25.25), and 3) being female (OR: 3.90; 95% CI 1.14-13.35). Conclusion: Factors associated with treatment failure in non-pharmacological smoking cessation include severe nicotine dependence, having readiness to quit in the contemplation stage, and being female. Patients with these factors should receive pharmacological intervention for smoking cessation from the start of therapy.

A survey of Storage Temperature of In-use Human Insulins at Patients’ Homes and Analysis of Their Stabilities under the Simulated Highest Temperature Identified in the Patients’ Home

2025-02-02T14:19:03+07:00

Objectives: To obtain patients’ household storage temperature of in-use human insulins, and to determine stability of human insulins under the simulated highest home storage temperature. Methods: Out-patients with diabetes (N = 47) who received either regular insulin (RI), isophane (NPH) or premixed RI/NPH insulins, used with a self-assembly pen were given a temperature logger to track storage temperature of in-use insulins for a consecutive 5-7 days. The highest and lowest storage temperatures were identified. Times per day the temperature being outside the recommended storage ranges were reported. Determination of the stability followed the analysis in the United State Pharmacopoeia (42^nd ed.). Three batches of each insulin above were stored in temperature controlled cabinet under the isothermal highest home storage temperature identified previously. The assay for insulin content was performed at a weekly interval for 4 weeks, and was reported as percentage label amount, of which 95-105% was considered as passed. Physical changes were also observed. Results: Of the patients keeping insulin in a refrigerator (n = 22), 18 had temperatures outside the recommended 2 to 8^๐C range, with the average times amounted to 8 hours 30 minutes per day. The temperature was above 30^๐C for all patients reporting keeping insulin at room temperature, with the average times corresponding to 7 hours 57 minutes per day. The highest storage temperature identified was 43.6 ^๐C. At the simulated isothermal 42±2^๐C, RI, NPH, and premixed RI/NPH insulins had insulin contents in the 95-105% range up to 2, 3, and 4 weeks, respectively. No significant physical changes were observed except an increase in viscosity of NPH and the premixed. Conclusions: Home storage temperatures of insulins were mostly out of the recommended ranges for about one-third of times in a day. Under isothermal temperature of 42±2 ^°C, RI, NPH, and RI/NPH insulins retained their acceptable potency at 2, 3, and 4 week, respectively.

Improving Medication Adherence in Patients with Type 2 Diabetes Mellitus through Home Visits by Pharmacists in Sri Sut Tho Primary Care Unit at Bandung Crown Prince Hospital

2025-02-21T08:50:00+07:00

Objective: To study the improving of medication adherence (MA) in type 2 diabetic patients through home visits by pharmacists of Sri Sut Tho primary care unit, Bandung Crown Prince Hospital. Method: This research was a quasi-experimental study. The subjects consisted of 40 type 2 diabetic patients who used at least one oral diabetic medication and had a blood sugar level (HbA1C) more than 8%. The home visits by pharmacists consisted of 4 phases. Phase 1 was the data collection of blood sugar levels (fasting blood sugar: FBS), HbA1C, MA assessed by the Medication Adherence Scale for Thais (MAST), and pill counting, and knowledge on diabetes medications. This phase was carried out during weeks 1-4 of the study, Phase 2 was the development of home visiting activities during weeks 5-6. Phase 3 involved conducting at least one home visit for each patient within weeks 7-12. Phase 4 was the assessment of study outcomes including FBS, HbA1C, MA assessed by the MAST scale and pill count, and knowledge on diabetes medications after home visit. Results: Patients had a statistically significant increase in MA. The median MAST score significantly increased from 32 to 37 (total score of 40) (P<0.001). Median MA rate assessed by pill count significantly increased from 78.62% to 95.57% (P<0.001). The mean knowledge on diabetes medications significantly increased from 7.15±1.61 to 9.28±0.93 (total score of 10) (P<0.001). The median FBS decreased significantly from 172.50 mg/dl to 129.00 mg/dl (P<0.001) and the mean HbA1C decreased from 10.14±1.79 to 8.34±1.23 %(P<0.001). Conclusion: Home visits by pharmacist improved MA, knowledge on diabetes medications, and glycemic control of patients. Therefore, home visit should be applied to patients with other diseases who have problems with MA and disease control.

Action Research to Develop a Medication Management Model with the Collaboration between Health Care Professionals and Village Health Volunteers for Patients with Uncontrolled Blood Pressure: Case Study of Maelan District, Pattani

2025-02-26T08:19:55+07:00

Objective: To develop a Medication Therapy Management (MTM) model for patients with uncontrolled blood pressure in the community of Maelan District, Pattani Province, and to evaluate the outcomes of the developed MTM model. Method: This Action research consisted of four phases. Phase 1 was planning based on the information from the interview with health care professionals and focus group discussions among village health volunteers (VHVs) on an MTM service model for caring for hypertensive patients in the community. Phase 2 involved the Implementation of care based on the MTM service model for two months in sixteen patients with uncontrolled blood pressure who received four or more antihypertensive medications. Phase 3 was the evaluation of patient outcomes and evaluation of the MTM model by health care professionals and VHVs. Phase 4 was the reflection after the model implementation by health care professionals and VHVs. Results: The developed MTM model employed VHVs as a link for providing care to patients in collaboration with health care professionals. The design and planning to resolve the problems for patient care in the community led to the MTM service model appropriate for the context and problems of the area. Outcome evaluation of the model implementation revealed that nine out of sixteen patients were able to control their blood pressure. The average blood pressure of the patients decreased significantly. The patients had better health behaviors. The consumption of budu decreased by ten patients. Forgetting to take medicine decreased by five patients. Concerns about developing kidney disease from taking medicines decreased by fifteen patients. The patients were very satisfied with the MTM service with average satisfaction score at 4.58 ± 0.11 (out of five). Conclusions: The implementation of the MTM service model with the participation of VHVs to care for patients with uncontrolled blood pressure resulted in an increase in the number of patients with controlled blood pressure and a decrease in average blood pressure of the patients. It also reduces health behavior problems of patients associated with uncontrolled blood pressure

Effectiveness of Glucagon-like Peptide 1 Receptor Agonists on Body Mass Index and Waist Circumference in Patients with Obesity: A Systematic Review and Network Meta-Analysis

2025-04-01T14:17:28+07:00

Objective: To evaluate the efficacy of glucagon-like peptide 1 receptor agonists (glucagon-like peptide 1 receptor agonists หรือ GLP-1 receptor agonists) in reducing body mass index (BMI) and waist circumference. Methods: This study was a systematic review and network meta-analysis of randomized controlled trials involving individuals with obesity or overweight, with or without type 2 diabetes, who were treated with GLP-1 receptor agonists. The primary outcomes were BMI and waist circumference. Results: Overall, GLP-1 receptor agonists significantly reduced BMI and waist circumference compared to placebo. Tirzepatide demonstrated the greatest reduction in BMI over 24 to 52 weeks (mean difference [MD] -3.58; 95% Confidence Interval [CI]: -4.68 to -2.47), followed by subcutaneous and oral semaglutide. For treatment durations longer than 52 weeks, oral semaglutide achieved the most substantial BMI reduction (MD -4.70; 95% CI: -6.72 to -2.68). Regarding the reduction of waist circumference, tirzepatide, subcutaneous semaglutide, and oral semaglutide showed the greatest reductions. Subcutaneous semaglutide led to the largest reduction at 12–24 weeks, decreasing waist circumference by 9.3 cm (95% CI: -14.61 to -3.99), while tirzepatide achieved the most significant reduction beyond 24 weeks, with a decrease of 12.74 cm (95% CI: -16.57 to -8.90) for treatment durations exceeding 52 weeks. These findings corresponded with reductions in body weight and BMI. Conclusion: GLP-1 receptor agonists, particularly tirzepatide and semaglutide, are highly effective in reducing BMI and waist circumference in individuals with or without type 2 diabetes. These results offer valuable insights to guide pharmacological treatment choices for weight management.

Rate of Rational Use of Antibiotics at Saweangha Hospital in Ang Thong Province

2025-02-28T14:31:41+07:00

Objective: To study the rate of antibiotic use and evaluate the appropriateness of antibiotic use in acute upper respiratory tract infections and bronchitis, acute diarrhea, and fresh traumatic wounds. Methods: This retrospective descriptive study collected data from medical records of outpatients with acute upper respiratory tract infections and bronchitis, acute diarrhea, and fresh traumatic wounds who received care from Saweangha Hospital in Ang Thong Province between January 2022 and December 2024. A total of 19,773 patients passed the inclusion criteria. The study selected a sample of 7,912 people to study rate of drug use and the appropriateness of antibiotic use according to the guidelines for rational antibiotic use. Results: The total number of patients in the study was 7,912. Among 4,834 patients with upper respiratory tract infections and acute bronchitis, 4,366 (90.3%) were given antibiotics rationally. Among 1,616 patients with acute diarrhea, 1,336 (82.7%) were given antibiotics rationally. Among 1,462 patients with fresh traumatic wounds from accidents during the year, 1,185 (81.1%) were given antibiotics rationally. When assessing the drug use according to the rational use criteria, there were 631 patients (7.98%) who did not receive antibiotics but met the criteria to receive the drug. There were 394 patients (4.98%) who did not meet the criteria to receive antibiotics but received the medication. Conclusion: The rate of antibiotic use in the 3 disease groups studied passed the standard criteria. However, when assessing the appropriateness of drug use in detail, it was found that drugs were still being used irrationally. Therefore, there should be an assessment of the appropriateness of drug use in order to reduce unnecessary antibiotic use.

Development of Learning Games on "Knowledge of Health Products" : A Case Study of Middle School Students at Thawaranukul School

2025-03-03T13:37:24+07:00

Objective: To develop learning platform on health product knowledge based on computer games for junior high school students at Thawaranukul School and to compare the learning outcomes by using such method compared with those based on lecture. Method: The study was divided into 4 phases. Phase 1 was the development of a computer game for learning on “Health Product Knowledge” as a web application. Phase 2 was the evaluation and verification of the quality of the content and media design of the game by experts, and the verification of the validity of the measuring scale for satisfaction towards learning activities. Phase 3 was the development of a 4-choice health product knowledge test and testing for the difficulty, discrimination power, and reliability (KR-20). Phase 4 was the measurement of learning outcomes on health product knowledge after games based learning. The subjects were junior high school students of Thawaranukul School who were randomly divided into an experimental and a control group, 30 students per group. The experimental group learned by using computer games and the control group learned by attending lecture. The evaluation of outcomes was conducted using a health product knowledge test and a satisfaction survey on learning activities. Results: The developed computer game had content in line with the guidelines of the Oryornoi manual. The content quality assessment by experts scored an average of 4.86 ± 0.26 (out of 5) and had a media design assessment score of more than 4 points (out of 5) in all 5 assessed areas. The experimental group had a post-learning achievement (15.7 ± 1.34) significantly higher than the control group (14.4 ± 1.97) (P<0.05). Overall, the students in experimental group were very satisfied with learning through games (4.63 ± 0.11). Conclusion: Learning health product knowledge through computer games resulted in a higher achievement in students than learning through lectures. They also had the highest level of satisfaction with learning through games. Learning through games is, therefore, another alternative in providing knowledge to the youth in present era that emphasizes the use of information technology.