Family support-based intervention using a mobile application provided by pharmacists for older adults with diabetes to improve glycaemic control: a randomised controlled trial

International Journal of Clinical Pharmacy - Background Family support is crucial in the care of older patients with diabetes. However, more information is needed to evaluate the potential benefits...     

Practice and attitudes regarding the management of childhood diarrhoea among pharmacies in Thailand

Objectives To compare practice behaviour and attitudes of pharmacy personnel in the management of childhood diarrhoea between type I (requiring a pharmacist to be on duty) and type II (pharmacist not required) pharmacies, between those surveyed in 2008 and in 2001, and between new‐generation (graduation ≤10 years) and old‐generation (graduation >10 years) pharmacists. Methods The setting was 115 pharmacies in a city in the south of Thailand. The study was separated into two phases: a simulated client method to evaluate history taking, drug dispensing and advice giving among pharmacy personnel and a questionnaire to measure attitudes and factors affecting diarrhoea treatment. Key findings In the simulated client method study, questions asked and advice given by the providers (the pharmacists or non‐pharmacists responding to the simulated clients), especially in type II pharmacies, were insufficient. Only 5.2% of pharmacies correctly dispensed for a child with viral diarrhoea, using oral rehydration salts (ORS) alone. Appropriate ORS dispensing of providers was not affected by shop type, survey time or peer generation. However, 52.2% of providers inappropriately dispensed antibiotics for such illness. In the questionnaire study, 108 completed surveys were obtained (a response rate of 93.9%). The providers working in 2008 more strongly agreed that ORS was effective, safe, used by health professionals and requested by patients, relative to those in 2001 (P < 0.05). No potential factor influencing the actual ORS dispensing was identified. Nevertheless, antibiotic dispensing was affected by beliefs in producing recovery and high profit. Conclusions Practice and attitudes of pharmacy personnel were inappropriate in the management of childhood diarrhoea. Revision of the pharmacy curriculum did not result in improvement of practice as seen by the similarity of practice patterns among the 2001 and 2008 samples. Improvement of knowledge and practice behaviour among providers in pharmacies is needed.     

慢性病患者生命质量测定量表体系共性模块的分析:结构方程的应用

目的 对慢性病患者生命质量测定量表体系共性模块(QLICD-GM)的结构进行分析.方法 根据理论构想及因子分析结果提出量表结构的理论模型,用结构方程模型对其进行验证与评价.结果 整个结构模型的近似误差均方根RMSEA为0.0606,RMSEA 90% CI=(0.0569;0.0643),非范拟合指数NNFI为0.941,相对拟合指数CFI为0.947,标准化残差均方根SRMR=0.0693,以上指数显示模型拟合较好.结论 结构方程模型分析结果与因子分析及理论构想吻合,说明QLICD-GM可以分为躯体功能、心理功能和社会功能三个领域10个小方面,结构效度较好.     

Assessment of multimedia-supported intervention in Muslim diabetic patients treated with insulin

This study aimed to evaluate the effect on diabetic care of an educational DVD in Jawi, the primary spoken language of Muslims in the study area, and pharmacist intervention among Muslim patients with diabetes treated with insulin. Type 2 diabetes Muslim patients on insulin treatment and poor glycemic control (N?=?143) in one hospital in southern Thailand were recruited to participate in a 6-month-period pre- and post-intervention study. For the intervention, the pharmacist provided the patients with education using a DVD and then asked them to show how to use insulin injection. Afterward, the pharmacist would correct the techniques for patients individually. At 6 months after intervention, significant reductions in glycated hemoglobin (HbA_1c) (8.31?±?1.40 to 7.19?±?1.15 %, P?<?0.001), fasting blood glucose (FBG) (195.06?±?86.14 to 115.81?±?11.48 mg/dL, P?<?0.001), systolic blood pressure (130.62 to 126.57 mmHg, P?=?0.004), triglycerides (183.36?±?90.48 to 182.31?±?90.68 mg/dL, P?<?0.001), and total cholesterol (199.57?±?68.77 to 194.97?±?64.77 mg/dL, P?=?0.006) were detected in patients who received the intervention. Increased low-density lipoprotein cholesterol (LDL-C) level (P?=?0.028) but no significant change in high-density lipoprotein cholesterol (HDL-C) were found (P?=?0.900). Moreover, medication adherence, diabetes knowledge, and skill in using insulin injection improved at the end of the study (P?<?0.001). In conclusion, the combination of language-specific educational DVD and pharmacist intervention appears to improve the short-term outcomes of diabetes care in Muslim patients on correctional insulin therapy.     

Knowledge-based changes to health systems: the Thai experience in policy development

Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of nongovernmental organizations) were able to bridge the gap between researchers and politicians, an evidence-based political decision was made. Additionally, the media played a part in shaping the societal consensus on universal coverage.