Malaysian Pharmacists Research Articles

Factors associated with the intention of community pharmacists to report adverse drug reactions to regulatory authority in Malaysia: application of the theory of planned behaviour.

It is known that community pharmacists in Malaysia underreport adverse drug reactions (ADRs). In order to improve ADR reporting, a theory-based understanding of the factors associated with the community pharmacists' reporting behaviour is important. This study used the theory of planned behaviour (TPB) to identify the predictors of behavioural intention to report ADRs to the regulatory authority among community pharmacists in Malaysia and to assess the relative importance of the predictors. A questionnaire-based study was conducted among 188 randomly selected community pharmacists in the state of Johor, Malaysia. The questionnaire included four main TPB constructs (intention, attitude, subjective norms and perceived behavioural control) and related measures, including perceived moral obligation, past reporting behaviour and sociodemographic variables. Descriptive and hierarchical regression analyses were conducted. A total of 164 questionnaires were collected. The mean score of intention to report ADRs was 15.43 (SD = 2.99). The final model of the hierarchical regression analysis showed that attitude towards ADR reporting (P = 0.004), subjective norm (P = 0.010) and perceived moral obligation (P = 0.014) were significant predictors of intention to report ADRs. Attitude was the most significant predictor, followed by subjective norm and perceived moral obligation. Interventions targeting community pharmacists' attitude, subjective norms and perceived moral obligations towards ADR reporting, with a specific focus on attitude would likely have a positive impact on improving ADR reporting in Malaysia.

Awareness of osteoporosis risk assessment tools and screening recommendations among community pharmacists in Malaysia.

Background The incidence of osteoporosis in Malaysia is increasing due to a fast-ageing population. Because of its silent nature, various osteoporosis risk assessment tools exist to detect high-risk patients and facilitate referrals for bone mineral density measurements. As an accessible point of contact, community pharmacists would benefit from the utilization of these tools and familiarity with guideline recommendations for osteoporosis screening. Aim This study aimed to investigate the awareness of osteoporosis risk assessment tools, practice behaviour towards osteoporosis, and knowledge of guideline recommendations among community pharmacists in the Klang Valley, Malaysia. Setting Community pharmacies. Methods This study was a cross-sectional study which sampled 284 community pharmacists practicing in the Klang Valley, using a stratified sampling approach. The study was conducted using a self-administered questionnaire which was divided into three sections: demographic data, knowledge of osteoporosis risk assessment tools and guideline recommendations, and practice behaviour towards osteoporosis. Practice behaviour was assessed with 15 items using a 5-point Likert scale. Main outcome measure. Proportion of respondents aware of osteoporosis risk assessment tools and respondent knowledge on guideline recommendations for osteoporosis screening. Results A total of 284 community pharmacists participated in the study. 84.1% of the respondents were aware of at least one risk assessment tool. However, only a small proportion of pharmacists (14.9%) regularly used these tools in their practice. Respondents perceived these tools to be relevant and beneficial, but perception towards their accessibility, ease-of-use, and administration time was mixed, suggesting unfamiliarity. Respondents preferred to conduct clinical assessments based on risk factors, with respondents identifying a mean of 10.1 ± 3.4 out of 15 risk factors. However, several clinically relevant risk factors were frequently unidentified. Knowledge of guideline recommendations among respondents was low. Conclusion There is some awareness of osteoporosis risk assessment tools but use in practice remains low among community pharmacists in Malaysia. There is potential to increase the use of these tools and knowledge of recommendations for osteoporosis screening and referral among community pharmacists.

Self-perceived competence on antimicrobial stewardship among government ward pharmacists in Malaysia

Background: Pharmacists are widely involved in antimicrobial stewardship (AMS), but there's a paucity of data on their competence in AMS. Hence, this study is aimed to identify self-perceived competence of ward pharmacists in AMS and their predictors. Methods and materials: A cross-sectional survey via questionnaire was conducted online (via email invitation) and by hard copies per request from May to July 2018, involving ward pharmacists from hospitals under Ministry of Health and Hospital Canselor Tunku Muhriz (HCTM). 5-point likert scales were used in 28 questions to assess self-perceived competence. These questions were adapted and modified from the Expert Professional Practice Curriculum for Pharmacists in Infections and AMS by the Royal Pharmaceutical Society. They were categorized into four constructs, namely knowledge (6 questions), confidence (8 questions), attitude (3 questions), and practice (3 questions). Different types of Likert scale option anchors were chosen based on the constructs mentioned (16). Each of the Likert-scale response carries a score, which was calculated in total to reflect the overall self-perceived competence of government ward pharmacists in this study, where higher total scores indicate higher levels of self-perceived competence in AMS. Descriptive statistics, chi-square tests and multiple linear regression were used to analyze the results of the questionnaire. Results: A total of 553 ward pharmacists from 67 hospitals responded to this survey, yielding a response rate of 72.5%. Knowledge on infections, antimicrobials and AMS system, confidence to advise on various issues relating to antimicrobial therapy and participation in clinical audit and evaluation were among the learning needs identified (median score 3.00). Meanwhile, knowledge on epidemiology of infections, off-label uses of antimicrobials, and pharmacoeconomics relating to antimicrobials had lower median scores (2.00) and thus prioritized as high learning needs. Significant predictors of self-perceived competence in AMS were gender (p < 0.001), prior specific training in infections and AMS (p < 0.001), Masters degree and above (p < 0.001), practicing in the area of infectious disease (p < 0.05), and years of working experience as a ward pharmacist (p < 0.005). Conclusion: Findings in this study suggest the necessity to establish and intensify standardized training in AMS among government ward pharmacists.

Barriers and facilitators to provision of written consumer medicines information among community pharmacists in Malaysia: a cross-sectional study

Abstract Objectives This study examined the barriers and facilitators to the provision of consumer medication information leaflets (CMIL) by community pharmacists in Malaysia and assessed the relationship between the participants' characteristics and provision of CMIL. Methods This was a cross-sectional self-administered questionnaire survey conducted among pharmacists working in randomly selected community pharmacies in the Federal Territories of Kuala Lumpur and Putrajaya, and the State of Selangor, Malaysia. Multiple response analysis was conducted to examine the barriers and facilitators. Chi-square test was used to assess the relationship between the participants' characteristics and provision of CMIL. IBM SPSS Statistics version 23 software was used for all statistical analysis. Statistical significance was set at P &amp;lt; 0.05. Key findings A total of 162 participants were involved in the study. Response rate was 77.5% (162 out of 209) and completion rate 100%. The two most frequently reported barriers to non-provision of CMIL were because the customer has taken the medicine previously (29.4%) and the customer receives all the information they need verbally (20.0%). The two most frequently reported facilitators to the provision of CMIL were because the community pharmacists felt they have a duty of care to inform the customer about their medicine (16.3%) and the customer has a right to information about their medicine (15.6%). There was a significant association between the provision of CMIL and participants educational level (P = 0.005) and awareness of CMIL (P &amp;lt; 0.001). Conclusions The key barriers to the provision of CMIL by the community pharmacists appeared to be related to attitudinal factors, while key facilitators appeared to be related to the professional obligations of the community pharmacists. Increased awareness and educational strategies would be important in improving the provision of CMIL by community pharmacists in Malaysia.

Self-perceived competence and training needs analysis on antimicrobial stewardship among government ward pharmacists in Malaysia.

BackgroundThere is a paucity of data on pharmacists’ competency and learning needs in antimicrobial stewardship (AMS).ObjectivesTo identify and prioritize learning needs based on self-perceived competence of ward pharmacists in AMS, to identify predictors of self-perceived competence, learning methods in AMS and perceived barriers to learning.MethodsA cross-sectional survey involving ward pharmacists from Hospital Canselor Tuanku Muhriz (HCTM) and hospitals under the Ministry of Health was conducted from May to July 2018.ResultsA total of 553 ward pharmacists from 67 hospitals responded to this survey (71.3% response rate). Knowledge of infections, antimicrobials and AMS systems, confidence to advise on various issues relating to antimicrobial therapy and participation in clinical audit and evaluation were among the learning needs identified (median score 3.00). Meanwhile, knowledge on the epidemiology of infections, off-label use of antimicrobials and pharmacoeconomics relating to antimicrobials had lower median scores (2.00) and were thus prioritized as high learning needs. Significant predictors of self-perceived competence in AMS were: gender (P < 0.001); prior specific training in infections and AMS (P < 0.001); postgraduate degree (P < 0.001); practising in the area of infectious disease (P < 0.05); and years of working experience as a ward pharmacist (P < 0.005). Continuing medical education, seminars, courses and workshops were the most common (78.1%) and preferred (84.6%) learning methods in AMS. Lack of appropriate training (67.8%), time (44.5%) and funding (42.5%) topped the list of barriers to learning in AMS.ConclusionsFindings in this study suggest the need to establish and intensify standardized training in AMS among government ward pharmacists.

Risk Minimization Measures in Off-Label Drug Use: A Survey of Community Pharmacists in Malaysia.

While off-label drug use is common and sometimes necessary, it also presents considerable risks. Therefore, measures intended to prevent or reduce the potential exposure to off-label risks have been recommended. However, little is known about community pharmacists' beliefs regarding these measures in Malaysia. This study examined community pharmacists' beliefs towards risk minimization measures in off-label drug use in Malaysia and assessed the relationship between perceived risk of off-label drug use and beliefs towards risk minimization measures. A cross-sectional survey was conducted among 154 pharmacists practicing in randomly selected community pharmacies in Kuala Lumpur and the State of Selangor, Malaysia. The majority agreed or strongly agreed that adverse drug events from the off-label drug should be reported to the regulatory authority (90.9%) and the off-label drug should only be used when the benefit outweighs potential risks (88.3%). Less than half (48.1%) agreed or strongly agreed that written informed consent should be obtained before dispensing off-label drugs and a majority (63.7%) agreed or strongly agreed that the informed consent process will be burdensome to healthcare professionals. Beliefs towards risk minimization measures were significantly associated with perceived risk of off-label drug use regarding efficacy (p = 0. 033), safety (p = 0.001), adverse drug rection (p = 0.001) and medication errors (p = 0.002). The community pharmacists have positive beliefs towards most of the risk minimization measures. However, beliefs towards written informed consent requirements are not encouraging. Enhancing risk perception may help influence positive beliefs towards risk minimization measures.

Community pharmacists' perceptions, attitudes and barriers towards pharmacist-led minor ailment services in Malaysia.

Background Community pharmacists are increasingly recognized to have an important role in providing a convenient and accessible alternative support for patients with minor ailments. In view of the abilities of community pharmacists in managing minor ailments, some countries have started the pharmacy-based minor ailment schemes that offers public access to treatment and advice of minor ailments from their local pharmacist. Nevertheless, there is limited study in Malaysia that explore the current practice of community pharmacists in managing minor ailment. Objective This study aims to evaluate community pharmacists' perceptions, attitudes and barriers of pharmacist-led minor ailment services. Setting Community pharmacists inMalaysia. Methods A cross-sectional survey among community pharmacists practicing in Malaysia was conducted between December 2017 until March 2018. The self-administered survey was distributed online via email, Facebook and WhatsApp's group. Main outcome measure Community pharmacists' perceptions, attitude and barriers towards minor-ailment service in community pharmacy settings. Results A total of 305 community pharmacists had completed the survey. The majority of community pharmacists in Malaysia had positive perceptions and attitudes towards pharmacist-led minor ailment services. The most common perceived barriers were lack of patient's medical information, absence of dispensing separation and lack of support from other healthcare professionals. Ethnicity, position and years of working experience were found to have significant associations with community pharmacists' score of attitudes and barriers related to minor ailment treatment in community pharmacy settings. Conclusion Community pharmacists in Malaysia have positive perceptions and attitudes over benefits of minor ailment services to public, however the barriers towards the service must be overcome to ensure service is sustainable for public's benefits.

Patient-centred care in the context of pharmacy consultations: A qualitative study with patients and pharmacists in Malaysia.

Patient-centred care (PCC) has been increasingly recognized as the standard in current health care, especially when it comes to health communication between patients and health care professionals. The evidence suggests that PCC could potentially improve medication-related outcomes such as medication adherence, disease self-management, and patient-provider relationships. Pharmacists are strategically positioned in the health care system to provide medication management to patients. However, there is a paucity of research regarding PCC in pharmacist-patient consultations. This study aimed to explore the views and experiences of pharmacists and patients on the important aspects of a PCC consultation. A semistructured interview study was conducted among 17 patients and 18 pharmacists in three tertiary hospitals in Malaysia. All interviews were audiotaped and transcribed verbatim. Themes were developed using a constant comparison approach and thematic analysis. Five main themes emerged from the data, namely, achieving mutual understanding, recognizing individuality, communication style, information giving, and medication decision making. For both pharmacists and patients, a PCC consultation should promote mutual understanding and non-judgmental discussions. Communication was an important element to bridge the gap between patients' and pharmacists' expectations. Patients emphasized the importance of emotional aspects of the consultation, while pharmacists emphasized the importance of evidence-based information to support patient engagement and information needs. Comparison of pharmacists' and patients' views provided insight towards important aspects of PCC in pharmacist-patient consultations. It was suggested that PCC is not a one-sided approach but rather a patient-provider collaboration to optimize the consultation. Further research can be done to improve the integration of PCC in the local health care context, including pharmacist consultations.

Perception of Community Pharmacists in Malaysia About Mental Healthcare and Barriers to Providing Pharmaceutical Care Services to Patients with Mental Disorders

The aim of this study was to assess community pharmacists’ (CPs) perceptions toward mental healthcare, and the barriers faced in providing pharmaceutical care (PC) services to these patients. A 40-item survey was posted to CPs. Ninety-six pharmacists participated. The majority (84.2%) agreed there is a role for CPs to play in mental health care, while approximately 60% agreed it is their responsibility to provide PC to these patients. The biggest barrier to providing this service is the lack of knowledge, cited by close to 50% of respondents. This corresponds with the revelation that close to 60% believe that they have a poor or fair understanding of mental disorders. About 30% of respondents said they do not stock psychotropic drugs at all, mainly due to medico-legal reasons, and low prescription requests. Our findings highlight the need for more training of CPs in managing patients with mental disorders.

Malaysian Pharmacists’ Involvement in Pharmaceutical Care: A Narrative Review

Malaysian Pharmacists’ Involvement in Pharmaceutical Care: A Narrative Review

Malaysian Pharmacists’ Involvement in Pharmaceutical Care: A Narrative Review

Malaysian Pharmacists’ Involvement in Pharmaceutical Care: A Narrative Review

Travel health-related activities and services provided by community pharmacies in Selangor, Malaysia: A cross-sectional analysis.

Millions of tourists visit Malaysia annually while a large number of Malaysians travel overseas. Taking care of travellers' healthcare needs is important aspect of the healthcare system. Community pharmacies are ideally positioned to provide travel health-related services. However, studies are lacking in this area. Therefore, this study aims to explore the nature and type of travel health-related services provided by Malaysian community pharmacies. A survey was carried out at 135 community pharmacies in nine districts of Selangor, Malaysia, from November 2017 to February 2018, using a self-administered standardized questionnaire. The majority (n = 95, 85%) of community pharmacies reported to have provided services to both international travellers and outbound Malaysian travellers. The common healthcare services provided to international travellers were monitoring of chronic diseases including hypertension and diabetes, and advice on minor ailments, supplements and medical devices. The key health services provided to outbound Malaysian travellers were advice on vaccination requirements, better management of chronic diseases and necessary medications to manage illness during travel. Most of the respondents supported the provision of travel health-related services through the community pharmacies. The study findings showed that Malaysian community pharmacies provided several travel health-related services to both international and Malaysian outbound travellers. Pharmacists in Malaysia are ideally positioned to have an increased role in travel medicine. They have the training to advise on complex medication issues especially with regard to interactions and polypharmacy. However, further training and courses should be provided that are tailored specifically for the needs of this professional group.

A training program incorporating a diabetes tool to facilitate delivery of quality diabetes care by community pharmacists in Malaysia and Australia.

Objectives:To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM) incorporating a diabetes tool, the Simpler™ tool. Subsequently pharmacists’ experience utilising the tool to deliver structured, consistent, evidence-based T2DM care was explored.Methods:Full-time non-credentialed diabetes pharmacists providing diabetes medication management services in community settings were purposively recruited. Participants had either face-to-face or online training on diabetes management using the tool which took about two hours and 20 minutes to complete. Their diabetes management knowledge was assessed pre- and post-training using quantitative methodology. They were then required to apply the tool in daily practice for one month. Feedback on both the training sessions and tool utilisation were obtained through semi-structured interviews and analysed using a qualitative approach.Results:Twelve pharmacists participated: Six from Australia and six from Malaysia. Before attending the training session, their median test score was 6.5/27, IQR 1.4 (1st marker) and 5.3/27, IQR 2.0 (2nd marker). After training, the scores doubled to 14.3/27, IQR 4.5 (1st marker) and 11.3/27, IQR 3.1 (2nd marker), showing significant improvements (p=0.002). Interview data identified perceived effectiveness factor through use of the tool. Participants found the content relevant, structured, concise and easy to understand; enabled comprehensive medication reviews; focused on achieving glycaemic improvement; facilitated documentation processes and pharmacists’ role in T2DM management; and as a specific aid for diabetes management. Barriers included lack of accessibility to patients’ laboratory data in Australia.Conclusions:The targeted training improved pharmacists’ knowledge on diabetes management and supported the Simpler™ tool use in practice as a structured and beneficial method to deliver evidence-based T2DM care.

Awareness of Beers Criteria and knowledge of potentially inappropriate medications among community pharmacists in the Klang Valley, Malaysia

Potentially inappropriate medications (PIMs) in older adults are detrimental to both clinical outcomes and health care costs, with their prominence set to increase in tandem with a fast-growing ageing population. Beers Criteria is one of the most commonly used guidelines that lists specific PIMs. Community pharmacists would therefore benefit from knowledge of Beers Criteria in detecting PIMs in primary care. This study therefore investigates the awareness of Beers Criteria and knowledge of PIMs among community pharmacists in the Klang Valley, Malaysia. The study was conducted using a self-administered questionnaire. Knowledge of PIMs was assessed using 10 clinical vignettes based on the 2015 Beers Criteria. Practice behaviour towards older customers was assessed using 10 items with a 5-point Likert scale. Descriptive and inferential statistics were used to analyse the data. A total of 277 community pharmacists participated in the study. Only 27.1% of the pharmacists were aware of Beers Criteria, and of these, only 37.3% were aware of the latest 2015 update. The respondents demonstrated moderate knowledge of PIMs with a mean total score of 5.46±1.89 out of a maximum of 10. Pharmacists who were aware of Beers Criteria had significantly higher scores (6.31 vs 5.14, P<.001). Only a small proportion of pharmacists (17.0%) regularly used Beers Criteria in practice. However, most pharmacists reported good practices when dealing with older customers in terms of asking relevant questions, considering age, referring to other resources, and regularly updating their knowledge through continuous professional development. Awareness of Beers Criteria remains low among community pharmacists in Malaysia. Pharmacists who are aware of Beers Criteria have improved knowledge regarding PIMs in the older adults. There is a need to increase the awareness and use of Beers Criteria among community pharmacists.

Pharmacists’ attitude, self‐reported knowledge and practice of dosage adjustment among chronic kidney disease patients in Malaysia

AbstractDrug‐related issues, such as inappropriate drug dosing, are pervasive patient issues that are particularly common among chronic kidney disease (CKD) patients. Pharmacists have the expertise to play an important role in avoiding such problems. The aim of the present study was to explore pharmacists’ self‐perceived knowledge, attitude and practice towards dosage adjustment among CKD patients. A cross‐sectional, Web‐based, self‐administered survey was conducted among 1594 registered pharmacists in Malaysia. Participants were surveyed regarding their perceived knowledge, attitude and implementation of drug dosage adjustment based on renal function among CKD patients in their practice. The study was completed by 234 pharmacists (14.7%). More than four‐fifths of respondents (n = 199) reported that they are practicing dosage adjustment. The median self‐perceived knowledge score was 27.0 (of a total of 45). Pharmacists younger than 29 years of age and those practicing in hospitals had higher knowledge of drug dosage adjustments. Female pharmacists were more likely to express interest in being involved in the identification, monitoring and resolution of drug therapy problems for CKD patients (p = 0.02). The two most common obstacles reported by pharmacists who did not practice dosage adjustment were a lack of information regarding a patient's renal function status (76%) and medical history (74%). Further training should be given to pharmacists to improve knowledge and awareness. An alert card could be implemented to record a patient's renal function to improve communication between hospitals and primary care settings.

Job satisfaction and stress levels among community pharmacists in Malaysia

AbstractBackgroundCommunity pharmacists have an important role in ensuring safe and effective use of medicines. However, poor job satisfaction and high stress levels may negatively affect job performance.AimThis study evaluated job satisfaction and job stress levels, and associated factors, among community pharmacists in Klang Valley, Malaysia.MethodsA cross‐sectional survey was conducted to assess job satisfaction and stress among community pharmacists. A sample of 286 respondents was selected using stratified‐random clustered sampling. Levels of and factors affecting job satisfaction and stress, as reported by community pharmacists, were analysed.ResultsThere was a moderate level of job satisfaction among pharmacists (mean (±SD) score 3.39 ± 0.42; range 1–5). Job characteristics that provided the highest satisfaction were work environment and interpersonal relationships with coworkers. Stress levels among pharmacists were below the scale mid‐point (mean (±SD) score 1.86 ± 0.44; range 1–4). Responsibility for patient care was perceived to contribute most to job stress. Ethnicity (p = 0.026) and average number of prescriptions filled daily (p = 0.016) significantly affected job satisfaction, whereas job stress was significantly affected by age (p &lt; 0.001), years of experience (p = 0.003) and number of working hours/week (p = 0.003).ConclusionsThis study demonstrates the effects of various demographic and job‐related variables on community pharmacists’ job satisfaction and stress. Further research is required to gain a better understanding of factors affecting job satisfaction and stress among pharmacists across Malaysia, and their effects on professional practice and patient care.

Pharmacists’ roles in nursing homes in Malaysia

The Malaysian population is aging, and it is estimated that, by 2020, 3.3 million people will be aged ≥60 years.1 The consequent increase in chronic diseases means increased demand for health services, the use of medicines and the coordination of care for older people. Although medications increase survival and improve quality of life, medication errors can occur.2, 3 Medication-related harm is an ongoing, significant issue in all sectors of health care. Studies have shown that nursing home residents experience adverse events due to inappropriate prescribing practices and inadequate monitoring.4 Pharmacists’ involvement in nursing homes has the potential to minimise medication-related problems and prevent potential medication-related harm and hospitalisations. Studies showed that one-half of nursing home residents are exposed to adverse drug events, duplication of therapy and drug interactions.5 We conducted an exploratory study to examine pharmacists’ attitudes towards the care of older people and their views on the role of pharmacists in Malaysian nursing homes. The study was a prospective, cross-sectional survey conducted from September to October 2015 with pharmacists in Malaysia. The study was approved by the Monash University Human Research Ethics Committee (CF15/791-2015000358). In all, 41 pharmacists responded to the survey. Most (73%) were 20–29 years of age and female (71%), and 77% indicated that they had never had any interactions with nursing home staff relating to pharmacist activities. Many (85%) agreed that pharmacists should have a more active role in nursing homes, whereas 60% agreed that it was an area of health care they would like to practice in. Many (81%) agreed with the statement ‘I tend to pay more attention and have more sympathy for the elderly than younger patients’, and 42% agreed that ‘most older people are pleasant to be with’, whereas 47% responded neutrally to the latter statement (Table 1). With regard to proposed roles for pharmacists in nursing homes, respondents agreed that pharmacists should dispense medications (89%), provide advice on methods of administering medicines (97%), provide advice to prescribers regarding the selection of drug therapy (97%), provide drug information and education directly to patients and nursing home staff (100%), identify patient medication issues and adverse drug reactions that are not being recognised (100%) and undertake medication reviews (100%). Pharmacists, through their training and skills, are ideally placed to perform a medication review and identify medication-related problems. The results of the current survey suggest that most pharmacists believe that better utilisation of their skill-set would be of significant benefit to nursing home residents and their providers. Indeed, many expressed enthusiasm for extending their roles to include the provision of services in nursing homes. A Malaysian study suggested that management of the quality use of medicines (QUM) in nursing homes is inadequate, with an average of 6.1 medication-related problems for every resident.7 The provision of pharmacist services could help reduce excessive medication usage, improve quality of care and decrease costs of medication use and wastage. Pharmacists could also be involved in medicines policy development and education for nurses and physicians. However, before these initiatives can be effectively implemented, it is important that pharmacists in Malaysia undertake further training on geriatric therapeutics and medication reviews. This study highlights a potential new role for appropriately trained pharmacists within the healthcare system to improve medication use in the nursing home setting. No funding was received for this study. The authors declare that they have no conflicts of interest. All authors contributed to the study concept and design, data collection, analysis, interpretation of data and preparation of manuscript.

A practical approach toward teaching ethics to community pharmacists.

Background Pharmacists as highly qualified professionals face ethical dilemmas and conflicts in their daily practice. These issues manifest themselves in the daily practice of pharmacists, which require pharmacists to have the competencies to manage these dilemmas but there is limited formal training in ethical decision making during undergraduate pharmacy education. Objective To describe the implementation and evaluation of a methodological approach to managing ethical dilemma workshop for community pharmacists in Malaysia. Setting Community pharmacists in Klang Valley, Malaysia. Method During the workshop, pharmacists were provided insights into how they could use and apply a methodological approach towards managing a dilemma, followed by a case study and panel discussion. All participants were invited to complete a pre- and post-workshop questionnaire Main outcome measure Number and proportion of respondents answering questions related to practice of ethics and workshop effectiveness Results A total of 37 participants attended the workshop. Most of the participants reported that they had no formal training in professional ethics and often used their own approach to solve an ethical issue. Some of the most common issues mentioned include changing medication to generic. More than three quarter of participants agreed and strongly agreed the content was relevant to their job and they will be able to use what they learned in the program. Conclusion The evidence suggests that a module in ethical decision making should be introduced to community pharmacists in Malaysia. This module can be easily adapted for use in other countries and will help ensure that pharmacist can make a good professional judgement and deliver the deeds of beneficence to all their patients.

Exploring the current and future role of the pharmacists in osteoporosis screening and management in Malaysia.

Background Several studies have found that pharmacists can assist in screening and prevention of osteoporosis by referring patients for bone mineral density scans and counselling on lifestyle changes. In Malaysia, screening osteoporosis in all elderly women is not mandatory due to its cost. One approach to address this gap is to develop a pharmacist-led osteoporosis screening and prevention program. However, there is a paucity of data on the perspectives of Malaysian pharmacists in this area. Objective To explore the perspective of stakeholders (policy makers, doctors, pharmacists, nurses and patients) towards the role of pharmacists in osteoporosis screening and management. Setting A primary care clinic located within a teaching hospital in Kuala Lumpur, Malaysia. Method Patients (n=20), nurses (n=10), pharmacists (n=11), doctors (n=10) and policy makers (n=5) were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis. Main outcome measure Perspective of stakeholders on the current and future role of pharmacists. Results All participants perceived pharmacists to be suppliers of medication, although there was some recognition of roles in providing medication advice. Nonetheless, these stakeholders were eager for pharmacists to expand their non-dispensing roles towards counselling, creating awareness and screening of osteoporosis. Interviewed pharmacists referred to their current role as 'robotic dispensers' and unanimously agreed to spread out to osteoporosis management role. Conclusion Under stakeholders there is a willingness to expand the role of pharmacists in Malaysia to non-dispensing roles, particularly in osteoporosis screening and management.

Train-the-trainer program on cardiovascular health for community pharmacists in Malaysia.

Background Studies have highlighted the benefits of having community pharmacists to deliver cardiovascular screening to patients. However, only few of such trainings are provided in Malaysia. Objective To describe the implementation and evaluation of a cardiovascular train-the-trainer program for community pharmacists. Method Community pharmacists' attended a 5h train-the-trainer program. A pre and post-training survey was administered to participants who attended the workshop to determine their requirements for education and effectiveness of the training provided. Results Forty community pharmacists participated and were trained with 35 of them completing both the pre and post training assessment. Participants self-reported confidence, knowledge and ability to conduct a workshop on cardiovascular health increased between 0.22 and 0.75 points post-training (p<0.05). The program was rated as very good or excellent by 55% of participants. Eight participants implemented the program at 6months follow-up within their own pharmacy organisations to further train another 114 participants on cardiovascular health. Conclusion Participation in a train-the-trainer program significantly increases community pharmacists' perceived ability and confidence in conducting a cardiovascular health workshop.