Impact of pharmaceutical care on post-menopausal osteoporotic women prescribed bisphosphonates

Comprehensive interventions by pharmacists have shown to improve patient outcomes. However, in Malaysia, pharmacists’ involvement with osteoporosis patients is minimal. Therefore, the main aim of this study was to evaluate the impact of pharmaceutical care on postmenopausal osteoporotic women prescribed bisphosphonates. This study validated the instruments for evaluating the quality of life, knowledge and satisfaction of patients with osteoporosis in Malaysia. The provision of pharmaceutical care improved medication adherence, quality of life, knowledge and satisfaction of participants significantly, but not persistence to bisphosphonate and BTM outcomes. Many pharmaceutical care issues were identified but the main issue was due to the use and side effects of bisphosphonate. The provision of pharmaceutical care should be an ongoing process and the pharmaceutical care model developed could serve as a template for use by other healthcare institutions to provide more consistent pharmaceutical care services.

Researchers:

Associate Prof. Dr. Lai Siew Mei Pauline, Dr Nagammai Thiagarajan (Department of Primary Care Medicine), Prof Dr Chua Siew Siang, Chong YH (Department of Pharmacy) and Prof Dr Chan Siew Pheng,
Associate Professor Dr Shireene Vethakkan (Department of Medicine – Division of Endocrinology), Prof Low Wah Yun (Dean’s Office), Faculty of Medicine, University of Malaya.
Chew Yee Yean, Central Diagnostic Laboratory, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Prof Ian Chi Kei Wong (Centre for Paediatric Pharmacy Research, A Collaboration between the School of Pharmacy) University of London and the Institute of Child Health & Great Ormond Street Hospital for Children, University College London, United Kingdom

Publications:

1. Lai, P. S. M., S. S. Chua, S. P. Chan and W. Y. Low (2008). "The validity and reliability of the Malaysian Osteoporosis Knowledge Tool in postmenopausal women." Maturitas 60(2): 122-130.
2. Lai, P. S. M., S. S. Chua, S. P. Chan and W. Y. Low (2008). "Validation of the English version of the quality of life questionnaire of the European foundation for Osteoporosis (QUALEFFO) in Malaysia." International Journal of Rheumatic Diseases 11(4): 421-429.
3. Siow, J. Y., P. S. M. Lai, S. S. Chua and S. P. Chan (2009). "The impact of pharmacist intervention on the use of activated vitamin D in a tertiary referral hospital in Malaysia." International Journal of Pharmacy Practice 17(5): 305-311.
4. Lai, P. S. M., S. S. Chua, S. P. Chan, W. Y. Low and I. C. K. Wong (2010). "Development and validation of the Osteoporosis Patient Satisfaction Questionnaire (OPSQ)." Maturitas 65(1): 55-63.
5. Lai, P., S. Chua and S. Chan (2010). "A systematic review of interventions by healthcare professionals on community-dwelling postmenopausal women with osteoporosis." Osteoporosis international 21(10): 1637-1656.
6. Lai, P. S. M., S. S. Chua, Y. Y. Chew and S. P. Chan (2011). "Effects of pharmaceutical care on adherence and persistence to bisphosphonates in postmenopausal osteoporotic women." Journal of Clinical Pharmacy and Therapeutics 36(5): 557-567.
7. Lai, P., S. S. Chua, C. H. Tan and S. P. Chan (2012). "Validation of the diabetes, hypertension and hyperlipidemia (DHL) knowledge instrument in Malaysia." BMC Medical Research Methodology 12(1): 18.
8. Lai, P. S., S. S. Chua, Y. H. Chong and S. P. Chan (2012). "The effect of mandatory generic substitution on the safety of alendronate and patients' adherence." Current medical research and opinion 28(8): 1347-1355.
9. Lai, P. S. M., S. S. Chua and S. P. Chan (2012). "Pharmaceutical care issues encountered by post-menopausal osteoporotic women prescribed bisphosphonates." Journal of Clinical Pharmacy and Therapeutics 37: 536-543.
10. Lai, P., T. Nagammai and S. R. Vethakkan (2013). "What next? A case report of a postmenopausal osteoporotic woman losing bone mineral density after 8 years of being on bisphosphonates (submitted on 11 Jan 2013)." Malaysian Family Physician.
11. Lai, P. S. M., S. S. Chua and S. P. Chan (2013). "Impact of pharmaceutical care on knowledge, quality of life and satisfaction of postmenopausal women with osteoporosis." Int J Clin Pharm 35: 629-637.
12. Nagammai, T., M. Mohazmi, S. Liew, K. Chinna and P. Lai (2015). "Validation of the Malay version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) in Malaysia." Qual Life Res 24(8): 2031-2037.
13. Nik, J., P. S. M. Lai, C. J. Ng and L. Emmerton (2016). "A qualitative study of community pharmacists’ opinions on the provision of osteoporosis disease state management services in Malaysia." BMC Health Services Research 16(1): 1-14.

Grants:

1. Vote F, UM F0700/2004A (RM5400)
2. Postgraduate research fund P0110/2006B UM (RM2000)
3. Endocrine Research Fund CIC0233 UM (RM10,000)
4. PV018/2012A (RM38,300)
5. P0057-2012B (RM 5,000)
6. PG010-2014A RM 3,200.00

Assessing the effectiveness of an interprofessional collaborative osteoporosis screening programme (ipc-osp) among postmenopausal women in primary care

Osteoporosis is usually asymptomatic in its early stages. Consequently, women who may have osteoporosis remain unidentified. This may lead to unwanted fractures. Fractures are associated with a reduction in quality of life. There is a 3-fold increased risk of death within 5 years in those who fracture. It is therefore imperative to encourage prevention and screening programmes which aid in early detection of osteoporosis. Current research suggests that many individuals with fragility fractures do not undergo appropriate screening and do not engage in preventive health behaviours. Hence, an interprofessional collaborative osteoporosis screening program was developed to screen for osteoporosis among postmenopausal osteoporosis women within a primary care setting.

Researchers

Associate Prof. Dr. Lai Siew Mei Pauline, Dr Lee Yew Kong, Dr Nagammai Thiagarajan (Department of Primary Care Medicine), and Associate Prof Dr Jeyakantha (Department of Medicine – Division of Endocrinology), Faculty of Medicine, University of Malaya.

Publications

1. Toh, L. S., P. S. M. Lai, K. T. Wong, B. Y. Low and C. Anderson (2013). "Development and validation of the satisfaction questionnaire for osteoporosis prevention (SQOP) in Malaysia." Osteoporosis international 24(suppl 1): S155.
2. Toh, L. S., P. S. M. Lai, K. T. Wong, B. Y. Low, S. Othman and C. Anderson (2013). "Is there a role for the pharmacist in an osteoporosis screening and prevention program? A qualitative study on Malaysian pharmacists' views." IJPP 21(suppl 1): 41.
3. Toh, L. S., P. S. M. Lai, D. B. C. Wu, K. T. Wong, B. Y. Low, A. T. B. Tan and C. Anderson (2014). "The development and validation of the Satisfaction Questionnaire for Osteoporosis Prevention (SQOP) in Malaysia." Patient Preference and Adherence 8 1365–1381.
4. Toh, L. S., P. S. M. Lai, K. T. Wong, B. Y. Low and C. Anderson (2014). "Interprofessional Collaboration - Can Malaysian Pharmacists Expand their Non-dispensing Role in Osteoporosis Screening and Prevention?" Research in Social and Administrative Pharmacy 10(5): e29.
5. Toh, L. S., P. S. Lai, D. B. Wu, K. T. Wong, B. Y. Low and C. Anderson (2015). "The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia." Plos One 10(5): e0124553.
6. Toh, L. S., P. S. Lai, S. Othman, K. T. Wong, B. Y. Low and C. Anderson (2016). "An analysis of inter-professional collaboration in osteoporosis screening at a primary care level using the D'Amour model." Res Social Adm Pharm S1551-7411(16)30481-8. doi: 10.1016/j.sapharm.2016.10.004.
7. Toh, L. S., P. S. M. Lai, S. Othman, A. Shah, C. P. L. Dang, B. Y. Low, K. T. Wong and C. Anderson (2018). "Exploring the current and future role of the pharmacists in osteoporosis screening and management in Malaysia." Int J Clin Pharm 40(2): 450-457.
8. Toh, L. S., P. S. M. Lai, D. B. Wu, B. G. Bell, C. P. L. Dang, B. Y. Low, K. T. Wong, G. Guglielmi and C. Anderson (2019). "A comparison of 6 osteoporosis risk assessment tools among postmenopausal women in Kuala Lumpur, Malaysia." Osteoporos Sarcopenia 5(3): 87-93.
9. Toh, L. S., P. S. M. Lai, B. Y. Low, K. T. Wong and C. Anderson (2020). "Feasibility of an interprofessional collaborative osteoporosis screening programme in Malaysia." Int J Clin Pharm 42(1): 11-17
10. Sandhu, A. K., L. S. Toh, Y. K. Lee, A. T. B. Tan, J. Ratnasingam, N. Thiagarajan and P. S. M. Lai (2021). "Cross-Cultural Adaptation and Validation of the Malay Satisfaction Questionnaire for Osteoporosis Prevention in Malaysia." Patient Prefer Adherence 15: 1383-1395.

Grants

1. MOSTI 06-02-12-SF0183 RM 80,530 for entire project
2. UMRG RM 62,467.00

Prevalence and risk factors of reduced bone mineral density in HIV infected individuals

The commencement of antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected individuals has decreased HIV-related complications and improved survival. However, studies have shown that there is a higher prevalence of osteopenia/osteoporosis [reduced bone mineral density (BMD)] in HIV-infected individuals. The causes of low BMD in HIV-infected individuals are multifactorial due to a complex interaction between HIV infection, traditional osteoporosis risk factors and exposure to specific antiretroviral therapy (ART). To date, there is a paucity of local data on low BMD in HIV-infected individuals in Malaysia. It is important to determine the local prevalence of low BMD and its associated risk factors so that clinicians can develop specific screening strategies and implement management algorithms targeted specifically for people living with HIV in Malaysia. Therefore, our study aimed to determine the prevalence of low BMD in HIV-infected versus HIV-uninfected individuals in Malaysia; and its associated risk factors. Our study found that the prevalence of reduced BMD, vitamin D deficiency and the 10-year probability of sustaining a hip fracture were higher in HIV-infected compared to HIV-uninfected individuals. Lower body mass index (BMI), reduced physical activity and older age were found to be associated with reduced BMD in HIV-infected individuals.

Researchers

Associate Prof. Dr Lai Siew Mei Pauline (Department of Primary Care Medicine), Prof Dr Sasheela A/P Sri La Sri Ponnampanavalar (Department of Medicine), Associate Prof. Dr Alexander Tan Tong Boon (Department of Medicine), Faculty of Medicine, University of Malaya.

Publication

1. Goh, S. S. L., P. S. M. Lai, A. T. B. Tan and S. Ponnampalavanar (2018). "Reduced bone mineral density in human immunodeficiency virus-infected individuals: a meta-analysis of its prevalence and risk factors." Osteoporosis International 29(3): 595-613.

Grants

1. University of Malaya High Impact Research Grants for Malaysian Elderly Longitudinal Research group, MELOR (UM0000099/HIR.C3)
2. University of Malaya High Impact Research Grants for Malaysian Elders Longitudinal Research (MELoR) - Health & Wellbeing: HIV & Aging (MHIVA) (H-20001-00-E000091)
3. Postgraduate Research Grant (PG197-2015B) RM3,950.00

Deprescribing medications in older persons in primary care setting

Deprescribing (defined as “the process of withdrawal of an inappropriate medication, supervised by a health care professional”) is used to improve patient outcomes and decrease the risks associated with polypharmacy in older persons. Stopping unnecessary medications is an essential part of good prescribing practice. However, the process of deprescribing is complex and requires careful clinical consideration, with a need to balance between the benefits of treatment and its harm. To date, there are limited studies related to deprescribing medications in older persons in primary care setting in Malaysia.

Researchers

Associate Prof. Dr. Lai Siew Mei Pauline, Dr. Siti Nurkamilla binti Ramdzan (Department of Primary Care Medicine), Associate Prof Dr Tan Kit Mun (Department of Medicine), Faculty of Medicine, University of Malaya.
Dr Renukha Sellappans (Taylors University, Malaysia)

Publications

1. Lai, P. S. M., W. W. Chung, L. S. Toh and S. Othman (2018). "Development and validation of an Ambulatory Care Patient Satisfaction Questionnaire to assess pharmacy services in Malaysia." Int J Clin Pharm 40: 1309-1316.
2. "Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study." BMJ Open 5(8).
3. Sellappans, R., C. Ng and P. Lai (2015). "Validation of the Physician–Pharmacist Collaborative Index for physicians in Malaysia." International Journal of Clinical Pharmacy 37(6): 1242-1249.
4. Sellappans, R., C. J. Ng and P. S. M. Lai (2014). "What are the medication experiences of older people with chronic diseases? A qualitative study (won oral merit award)." Malaysian Family Physician 9(suppl 1): 34.
5. Goh, S. S. L., P. S. M. Lai, S. M. Liew, K. M. Tan, W. W. Chung and S. S. Chua (2020). "Development of a PATIENT-Medication Adherence Instrument (P-MAI) and a HEALTHCARE PROFESSIONAL-Medication Adherence Instrument (H-MAI) using the nominal group technique." PLoS One 15(11): e0242051.
6. Chua, S. S., P. S. M. Lai, C. H. Tan, S. P. Chan, W. W. Chung and D. E. Morisky (2013). "The development and validation of the Malaysian Medication Adherence Scale (MALMAS) among patients with type 2 diabetes in Malaysia." International Journal of Pharmacy and Pharmaceutical Sciences 5(3): 790-794.
7. Chung, W. W., S. S. Chua, P. S. Lai and D. E. Morisky (2015). "The Malaysian Medication Adherence Scale (MALMAS): Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia." Plos One 10(4): e0124275.
8. Lai, P. S. M., R. Sellappans and S. S. Chua (2020). "Reliability and Validity of the M-MALMAS Instrument to Assess Medication Adherence in Malay-Speaking Patients with Type 2 Diabetes." Pharmaceutical Medicine 34(3): 201-207.

Grants 

1. University Malaya Research Grant (RP048A-17HTM) RM 87,410.00
2. UMRG RM 83,500.00

Antibiotic stewardship

Antimicrobial resistance is a normal evolutionary process for microorganisms to ensure their own survival.  Thus, the development of antimicrobial resistance is inevitable. Use of antibiotics will exert selection pressure for the overgrowth of the mutated strain of bacteria. These mutated strains  are likely to be more resistant to antibiotics than the non-mutated strain in order to increase the microorganisms’ chance of survival. The beneficial effects of antibiotic stewardship programs in reducing antibiotic consumption and cost have been well-documented, although more studies of better quality are still needed to confirm its impact on clinical and microbiological outcomes

Researchers

University of Malaya Medical Centre (UMMC):
Prof. Dr. Adeeba Kamarulzaman (Infectious Diseases Consultant)
Assoc. Prof. Dr. Pauline Siew Mei Lai (Primary Care Medicine)
Assoc. Prof. Dr. Sharifah Faridah Syed Omar (Infectious Diseases Consultant)
Dr. Wong Pui Li (Infectious Diseases Physician)
Dr. Anjanna Kukreja (Infectious Diseases)
Dr. Bushra Megat Johari (Infectious Diseases)
Dr. Ong Hang Cheng (Infectious Diseases)
Tan Ching Hooi (Clinical Pharmacist)
And collaborators from Hospital Canselor Tuanku Muhriz (HCTM) (formerly known as UKMMC) and National Centre for Antimicrobial Stewardship (NCAS), Melbourne, Australia

Publications

1. Lim, M. K., P. S. Lai, S. S. Ponnampalavanar, S. F. Syed Omar, N. A. Taib, M. Y. Yusof, C. M. Italiano, D. C. Kong and A. Kamarulzaman (2015). "Antibiotics in surgical wards: use or misuse? A newly industrialized country's perspective." J Infect Dev Ctries 9(11): 1264-1271.
2. Jamaluddin, N. A. H., P. Periyasamy, C. L. Lau, S. Ponnampalavanar, P. S. M. Lai, R. Ramli, T. L. Tan, N. Kori, M. K. Yin, N. J. Azman, R. James, K. Thursky and I. Naina-Mohamed (2021). "Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital." Antibiotics (Basel, Switzerland) 10(5): 531.

Grants

1. UMRG 2/2012 RM 40,900.00
2. Pfizer USD$128,262.20  

Safe disposal of unused medicines

Ideally, unused medications should be returned to authorized collectors for proper disposal to reduce releasing unwanted active pharmaceutical ingredients into the environment. More than 50% of Malaysian patients disposed of unused medications by throwing them away with normal garbage or by burning them. Another study found that 93% of university students in Malaysia were not aware of the “Return Your Medicines Program” and had flushed unused medications down the toilet or sink.8 Disposal of unused medications as household garbage (which ends up in a landfill) or flushing them down the toilet or sink (where they end up in the sewerage system) may contaminate soil or surface water. Management of active pharmaceutical ingredients in the environment is both challenging and potentially costly.

Researchers

Associate Prof. Dr. Lai Siew Mei Pauline (Department of Primary Care Medicine), Prof Debra Sim Si Mui (Department of Pharmacology) and Assoc Prof Dr Tan Kit Mun (Department of Medicine), Faculty of Medicine, University of Malaya.
Mary Lee Hong Gee (Faculty of Pharmacy), University of Malaya
Wong Yin Yen, Nur Azirida (Department of Pharmacy) University Malaya Medical Center

Publications

1. Lee, H. G., S. M. Sim, K. M. Tan, P. S. M. Lai, Y. Y. Wong and C. Z. Sulaiman (2020). Safe disposal of unused medications (the way forward), sustaining and keeping it going. University of Malaya, University Press: 42-44.
2. Lai, P. S. M., K. M. Tan, H. G. Lee, Y. Y. Wong, N. A. Azhari Wasi and S. M. Sim (2021). "Effectiveness of an intervention to increase the knowledge, attitude, and practice regarding the return and disposal of unused medications." Malays Fam Physician 16(1): 56-63.
3. Sim, S. M., P. S. M. Lai, K. M. Tan, H. G. Lee and C. Z. Sulaiman (2018). "Development and Validation of the Return and Disposal of Unused Medications Questionnaire (ReDiUM) in Malaysia." Asia Pac J Public Health 30(8): 737-749.
4. Sim, S. M., P. S. M. Lai, K. M. Tan, H. G. Lee, C. Z. Sulaiman and Y. Y. Wong (2018). Safe disposal of unused medications - working towards a  green pharmacy in University of Malaya Medical Centre. UM Living Lab. S. Yusoff. Kuala Lumpur, University of Malaya press. 1: 58-70.

Grants

1. UM Living lab RM63,692.00
2. UM Living Lab RM163,892.00

Improving outcomes in patients with end stage renal disease

Medication adherence, medication burden, drug-related problems and quality of life in patients with end stage renal disease in Malaysia

The prevalence of patients with end stage renal disease (ESRD) is increasing worldwide. In Malaysia, several studies have assessed the health-related quality of life (HRQOL) and medication adherence of patients with ESRD. However, there is a paucity of data regarding the medication burden and drug-related problems (DRPs) encountered by these patients. Therefore, the aim of this study was to determine the medication adherence, medication burden, DRPs, and quality of life (QOL) of patients with ESRD on hemodialysis (HD).

Prevalence, microbial etiology and risk factors associated with healthcare associated infections (hcais) and their impact on treatment outcomes and survival among end stage renal disease (esrd) patients on renal replacement therapy (rrt)

End stage renal disease (ESRD) patients on renal replacement therapy (RRT) have an increased risk of morbidity and mortality due to healthcare associated infections (HCAIs). Several factors, such as chronic uremia, various comorbid conditions, anemia due to renal failure and malnutrition, potentially predispose these patients to infections by contributing directly to an immunocompromised state. Moreover, these infections contribute directly to poor survival and antibiotic treatment failure among ESRD patients, and according to World Health Organization (WHO), this has now become a global health crisis.

Sleep disturbance among Malaysian patients with end-stage renal disease with pruritus

Chronic kidney disease-associated pruritus (CKD-aP) is a well-recognized, frequent and compromising complication among patients on hemodialysis. Despite advancement in basic medical sciences, CKD-aP is still a major complication and a challenge for both physicians and patients to manage. The aim of this study was to estimate theprevalence of CKD-aP among hemodialysis patients in Malaysia, to determine the impact of CKD-aP on sleep quality and any factors associated with CKD-aP.

Researchers:

Associate Prof. Dr. Lai Siew Mei Pauline (Department of Primary Care Medicine), and Assoc Prof Dr Lim Soo Kun (Department of Medicine), Faculty of Medicine, University of Malaya.
Dr Raja Ahsan Aftab (Taylors University, Malaysia)
Dr Inayat Ur Rehman, Abdul Wali Khan University Mardan, Pakistan
Dr Tahir Mehmood Khan, Director, Institute of Pharmaceutical Science, University of Veterinary and Animal

Publications

1. Rehman, I. U., D. B. C. Wu, P. S. M. Lai, U. D. Palanisamy, S. K. Lim and T. M. Khan (2017). "Translation of the 5D Itching Scale from English to Malay, and Its Validation among Patients with Chronic Kidney Disease in Malaysia." Frontiers in Medicine 4(189).
2. Rehman, I. U., P. S. M. Lai, S. K. Lim, L. H. Lee and T. M. Khan (2019). "Sleep disturbance among Malaysian patients with end-stage renal disease with pruritus." BMC Nephrol 20(1): 102
3. Goh, K. K. K., P. S. M. Lai and S. K. Lim (2019). "Cross cultural adaptation and validation of the Malay Kidney Disease Quality of Life (KDQOL-36)." BMC Nephrol 20(1): 226.
4. Rehman, I. U., P. S. Lai, L. S. Kun, L. H. Lee, K. G. Chan and T. M. Khan (2020). "Chronic Kidney Disease-Associated Pruritus and Quality of Life in Malaysian Patients Undergoing Hemodialysis." Ther Apher Dial 24(1): 17-25.
5. Abbasi, S. H., R. A. Aftab, P. S. M. Lai, S. K. Lim and R. N. Zainol Abidin (2021). "Impact of Healthcare Associated Infections on Survival and Treatment Outcomes Among End Stage Renal Disease Patients on Renal Replacement Therapy." Frontiers in Pharmacology 12(2039).

Grant

1. UMRG RM 84,942.00