Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians.

OBJECTIVES: To implement an osteoporosis screening and referral program in community pharmacies and evaluate the use of the Osteoporosis Self-Assessment Tool for Asians (OSTA) as the screening instrument. DESIGN: Uncontrolled study. SETTING: Three community pharmacies in Bangkok, Thailand. PATIENTS: 51 women aged 50 years or older without prior diagnosis of osteoporosis; three community pharmacists; six hospital-based physicians. INTERVENTION: OSTA assessment by community pharmacists of the risks of osteoporosis in patients; counseling of patients about diet and exercise; referral of patients at high risk (OSTA index value less than -4) to hospitals where pharmacists had made arrangements in advance; and assessment of satisfaction and opinions of participating patients and physicians. RESULTS: Of the 51 patients, 32 (62.7%) were categorized as low risk (OSTA index value > -1) and 19 (37.3%) as intermediate risk (OSTA index value range, -4 to -1). The majority of patients (97%) were satisfied with the program and the knowledge gained. Even though no high-risk patients were identified and referred for medical care, all six participating physicians agreed with having risk assessment service in community pharmacies and the prearranged referral system, and five of six physicians believed that OSTA results were valuable in the management of osteoporosis. CONCLUSION: Community pharmacy-based osteoporosis risk assessment services using OSTA were well accepted by the patients and participating physicians. Public health benefits may result from the provision of osteoporosis risk screening services in community pharmacies in Thailand and other Asian countries.     

A National Survey of Training and Smoking Cessation Services Provided in Community Pharmacies in Thailand

Over the past few years, several training programs have been run in support of smoking cessation services within community pharmacy circles in Thailand. These have included a comprehensive training program offered by the Thai Pharmacy Network for Tobacco Control (TPNTC) and brief training programs run by other agencies. This study provides an estimate of the scale of smoking cessation activities among Thai pharmacies, and examines the impact of both the brief and comprehensive training programs on the provision of smoking cessation services. A self-administered questionnaire was mailed to 3,600 Thai community pharmacists. A total of 1,001 questionnaires were returned (response rate: 27.8%). Smoking cessation services were provided by 71.1% of the respondents, and 47.4% of such services gave only brief advice. Comprehensive services (defined by the 5A’s: ask, advise, assess, assist, and arrange follow-up) accounted for 15.3% of the respondents. Only 293 pharmacists (29.6%) said they had received cessation training; 62.5% of whom had received such training from TPNTC. The receipt of brief and comprehensive training was associated with a higher rate of the provision of brief advice, when compared with no training, showing adjusted odds ratios (ORs) of 2.93 (95% CI, 1.66–5.18) and 5.93 (95% CI, 3.18–10.17) respectively, while evidence of differences between these training programs was not observed, having an adjusted OR of 1.94 (95% CI, .89–4.21). TPNTC trained pharmacists were 4.98 times (95% CI, 2.24–11.05) more likely than those who received other brief training to provided the 5A’s cessation services. All types of training program help to promote the provision of brief counseling by pharmacists. Comprehensive training is associated with the increased provision of both 4A’s and 5A’s cessation services.     

Registry based analysis of cost-of-illness study among stage C heart failure patients at Hospital Queen Elizabeth II,Sabah, Malaysia

Background

Numerous cost-of-illness studies of heart failure (HF) have been published in developed countries, but such knowledge is lacking in Malaysia. To fill the gap, this study estimated the cost of HF in Hospital Queen Elizabeth II (HQEII).

Outcomes-based Risk-sharing Schemes: Is There a Potential Role in the Asia-Pacific Markets?

ObjectivesTo provide a commentary on outcomes-based risk-sharing schemes in Europe and the US, and to assess characteristics of such schemes and whether they have a potential role in the Asia-Pacific markets. This commentary also examines current experience in the Asia-Pacific markets and considers criteria for such agreements as they might relate to the different health care environments.SummaryFuture opportunities for patient access schemes, and specifically, a role for outcomes-based risk-sharing schemes, exist in the Asia-Pacific markets. Four types of agreements across the Asia-Pacific markets were identified that are not purely outcomes-based or risk-sharing, but cover innovative high-cost medicines, areas of high unmet need, areas affecting small patient populations, and medicines where the evidence is uncertain. Key factors for consideration are the public environment and the general acceptance of such agreements; the level of available resources that impact the health care priorities in each market and the public demand for access to medicines and to innovation. The ability to undertake such agreements appears to depend significantly on the degree of centralized decision-making and the dominance of a “single payer” for negotiation; the ability to manage data – both to undertake health technology assessments and to have systems/infrastructure to collect data and demonstrate outcomes; the nature of local health care structures and the capabilities to implement schemes where the financing is linked to outcomes. Caution was shared across markets with a trend to “watch and wait” while evidence emerges elsewhere.     

Efficacy and Safety of Cissus quadrangularis L. in Clinical Use: A Systematic Review and Meta‐analysis of Randomized Controlled Trials

Cissus quadrangularis L. (Cissus) is a medicinal plant commonly used for centuries for various conditions, but lacks critical appraisal of its clinical effects. This study aimed to determine the efficacy and safety of Cissus in all conditions. Publications from 12 electronic databases were searched from inception through November 2016. A total of nine studies with 1108 patients were included. Each outcome was pooled using a random effects model. Effects of Cissus on hemorrhoid symptoms were not different from any comparators but had significant effects on bone pain. Effects of Cissus combination products on body weight reduction, low‐density lipoprotein, triglyceride, total cholesterol, and fasting blood sugar were superior to placebo, with weighted mean difference of ?5.19 kg (?8.82, ?1.55), ?14.43 mg/dl (?20.06, ?8.80), ?37.50 mg/dl (?48.71, ?26.29), ?50.50 mg/dl (?70.97, ?30.04), and ?10.39 mg/dl (?14.60, ?6.18), respectively. No serious adverse effects were reported. Quality of evidence based on Grades of Recommendations Assessment Development and Evaluation (GRADE) indicated low (bone fractures) to high quality (hemorrhoids, body weight reduction).In conclusion, Cissus had benefit for bone fractures, but not for hemorrhoids. For obesity/overweight, only combination products are pooled and show benefit. However, high‐quality studies remain needed. Copyright © 2017 John Wiley & Sons, Ltd.