Background: Distribution of product samples is a typical and traditional marketing and promotion strategy used by pharmaceutical companies. However, issues have been raised about their influence on physicians' prescribing behavior and patients' health outcomes. Objectives: This study aimed to determine the effects of the distribution of product samples on physicians' prescribing behavior and adherence to patients' treatment regimens. It also sought to provide policy recommendations on product sample distribution and the administrative order on pharmaceutical promotion. Methodology: The study involved a descriptive design. The study sites were Manila City, Cebu City, and Davao City. Data were collected using focus group discussions, key informant interviews, and surveys among patients and physicians. Content analysis was performed to analyze qualitative data, while descriptive statistics and measures of association were conducted to analyze quantitative data. Results: A total of four FGDs were conducted with one FGD for each stakeholder group, and 846 patients and 286 physicians answered the study questionnaire. About half (48.0%) of the patients received product samples; 75.8% had low medication adherence. Product sample distribution was not significantly associated with patients' adherence (p=0.150). The majority of the physicians (69.2%) received product samples. There was no significant association between product sample distribution and physicians' prescribing behavior (p=0.111). It was found, however, that the distribution of product samples was significantly associated with the other physicians' prescribing behavior (p=0.009). The issues identified included the influence of medical representatives on physicians' prescribing behavior, incapacity of the poor and marginalized population to complete their treatment regimen due to lack of supply of product samples, and mentality of patients that product samples have better quality. Conclusion This study emphasized that the regulation of product sample distribution was justifiable since this might negatively influence professional behavior affecting rational prescribing and the use of medicines. Furthermore, the distribution of product samples did not directly translate to increased patients' medication adherence. Should the distribution of samples be continuously practiced, the provision of product samples should be strictly followed, and the distribution should be regulated and monitored to prevent the occurrence of violative practices.
Medication Adherence

Background: Community pharmacists play a strategic and indispensable role as healthcare professionals with direct patient access during the COVID-19 pandemic. Nevertheless, there had been no studies that document the challenges, adaptive measures, and opportunities of community pharmacy practice in the country during such period. Objectives: This study aimed to describe the challenges encountered and adaptive measures implemented by community pharmacies, and to explore opportunities of community pharmacy practice brought about by the COVID-19 pandemic in the Philippines. Methods: The study employed a qualitative, cross-sectional study design. Convenience sampling was conducted representative of chain and independent drug stores, online and other stores with service variations, and pharmacy organizations. Recruitment was pursued until data saturation with a total of 16 participants. Interviews were transcribed and analyzed through thematic analysis using NVivo 12. The study received ethical clearance for implementation from the UP Manila Research Ethics Board. Results: Results showed there were various challenges that affected both the supply- and demand- side of pharmacy operations in the community pharmacy practice during the pandemic. Due to the adaptive role of the pharmacy profession during the pandemic, there has been an increased relevance of pharmacists in public health. Furthermore, the pandemic has exhibited the need to shift to the use of e-prescriptions. However, there are limitations to its current use, such as ensuring the validity of the prescription when presented in a pharmacy. Conclusion There are several challenges encountered by community pharmacists during the pandemic. These challenges led to several adaptive measures being implemented that also became an opportunity to emphasize the vital role community pharmacists play in the healthcare system.
COVID-19 ; pandemics

Background and Objectives: Interprofessional education (IPE) is considered by the World Health Organization “a necessary step in producing collaborative practice-ready health professionals.” In the Philippines, the ability to “work collaboratively within interprofessional and multi professional teams”, was identified by the Commission on Higher Education as one of the outcomes common to all health-related professions programs. Although steps were taken to integrate IPE in health professions education, majority of academic institutions in the country are yet to implement this. This study aimed to present the implementation of an online IPE module about the community health workforce among dental, medical and pharmacy students in a national health sciences university. Methodology: The IPE module was developed and facilitated jointly by an interprofessional team of faculty engaged with the Community Health and Development Program of the University of the Philippines Manila. A total of 48 students from the Colleges of Dentistry, Medicine and Pharmacy participated. Teaching-learning activities used in the sessions included lectures, small group discussions, interviews, case study, large group discussions, and reflections. Results: Insights gained by the participants included the complementary roles of health care workforce in the community, importance of communication and role understanding for better provision of care, the challenges that the workforce experience and their roles as future health workers in promoting collaborative practice by demonstrating respect and professional equality. Conclusion The module has shown that IPE activities may be successfully implemented through remote learning if done with proper planning and execution with the commitment of faculty facilitators.
Interprofessional Education

The COVID-19 pandemic created the urgent need to use online and virtual platforms to facilitate development of skills and competencies as part of remote learning of students. MyDispense®, a learning management system developed by Monash University in Australia, is a practice-based online tool utilized by the University of the Philippines College of Pharmacy to teach dispensing skills in Dispensing and Incompatibilities courses (Phar 154 and Pharm 133). This commentary describes how MyDispense® was used as an online retail pharmacy simulation through the SEIPS (Systems Engineering Initiative for Patient Safety) model, with discussion on how the person, tasks, organization, tools and technology, and virtual environment work within the teaching and learning process in dispensing. The application of MyDispense® as a learning platform both in remote and traditional teaching can be further explored to maximize its features and utility.
COVID-19

The COVID-19 pandemic created the urgent need to use online and virtual platforms to facilitate development of skills and competencies as part of remote learning of students. MyDispense®, a learning management system developed by Monash University in Australia, is a practice-based online tool utilized by the University of the Philippines College of Pharmacy to teach dispensing skills in Dispensing and Incompatibilities courses (Phar 154 and Pharm 133). This commentary describes how MyDispense® was used as an online retail pharmacy simulation through the SEIPS (Systems Engineering Initiative for Patient Safety) model, with discussion on how the person, tasks, organization, tools and technology, and virtual environment work within the teaching and learning process in dispensing. The application of MyDispense® as a learning platform both in remote and traditional teaching can be further explored to maximize its features and utility.
Remote learning

OBJECTIVES

To assess the clients’ perceptions of the UP College of Pharmacy (UPCP) Telepharmacy Service on their knowledge, decision-making, and medication safety.

The study employed a cross-sectional design administered through guided voice-call interviews using an online survey questionnaire as the data collection instrument. The inclusion criteria of the study were as follows: (1) must be at least 18 years old, (2) with no cognitive impairment, (3) must have sent a medication-related query in the UPCP Telepharmacy Service between October 2020 and July 2022, and (4) must be contacted through voice call platforms.

A total of 72 respondents participated in the study. Majority were from 30 to 59-year-old age category (51.39%), females (72.22%), from Region IV-A (36.11%), college graduates (44.44%), and with average monthly income of below PhP 11,000 (47.22%). Overall, clients reported very positive perceptions on the drug information advice received (X̅4.510) and were very satisfied with the service (X̅ 4.625). They perceived that the advice influenced their decision-making about their medications (X̅ 4.514) and increased their understanding of medication safety (X̅ 4.522). Multiple regression analysis revealed that clients’ perception on drug information advice is positively associated with perceived effect on decision-making (r = 0.5033; p = 0.000) and medication safety (r = 0.4320; p = 0.004).

The pharmacist-led drug information service, such as the UPCP Telepharmacy Service, is a helpful program to provide accurate and reliable medication information to clients who need them amidst the increasing accessibility of medical information on the internet. It can help improve knowledge of patients about appropriate use of medicines, drug interactions, and adverse drug reactions that will enable them to make informed decisions regarding their medications, identify the need to consult with healthcare providers, and ultimately ensure medication safety.

Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem. Objectives: This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices. Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation. Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage. Conclusion Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.
Human ; access to medicines ; health services accessibility ; affordability ; costs and cost analysis

BACKGROUND AND OBJECTIVES

Pharmacists are in a unique position to provide important medication information, prevent errors, and help improve patient outcomes. Patient medication counseling (PMC) is integral in medication therapy management of pharmacists. Students perceive PMC as an important step in ensuring the most appropriate pharmacotherapy for the patients and as an essential component of drug management. The objective of the study is to describe the students’ perceptions on a university-led patient medication counseling program implemented in a patient medication counseling course.

The study employs a qualitative study design with a total population sampling of forty-two (42) Clin Pharm 176 BS Pharmacy students in a College of Pharmacy. A self-evaluation adapted from the United States Pharmacopeia medication counseling behavior guidelines (USP-MCBG) scale was performed which has with four components: needs assessment, precautions and warnings, management of the treatment, and communication. A synthesis session was conducted utilizing a semi-structured questionnaire. The data was analyzed using measures of central tendency and thematic analysis.

Forty-two (42) students answered the USP-MCBG scale and participated in the synthesis session. Participants rated highest in communication (88.81±8.78) and lowest in treatment management (79.49±12.90) which suggests that the students were better equipped in displaying effective nonverbal behaviors and using appropriate language but were least confident in developing and managing treatment plans. There were five main domains on how the students evaluated the course and the PMC program which include pre-counseling session requirements, challenges in patient interaction, interprofessional collaboration, professional outlook, and program recommendations.

A university-led PMC program is effective in providing training for student pharmacists to identify and provide recommendations on medication therapy problems, and to practice interprofessional collaboration. It is recommended to continue the student training in the PMC program and to integrate this in the student internship program to evaluate the skills development of students during their clinical rotations.

Background: Based on the 2017-2020 annual report of the Department of Health-Antimicrobial Resistance Surveillance Program, significant resistance patterns have been observed for common disease-causing pathogens. In the hospital setting, antimicrobial stewardship programs have been implemented to optimize the use of antimicrobials. Drug utilization review studies provide essential feedback to improve prescribing and use of medications. Objectives: This study aimed to review drug utilization of monitored parenteral antimicrobials among patients admitted from January to December 2019. Methods: The study employed a retrospective, cross-sectional, descriptive research design. A retrospective chart review of drugs administered to patients was conducted. : Results. A total of 821 patients charts met the inclusion criteria. The patients’ ages ranged from 18 to 98 years old and 52% were females. General Internal Medicine practitioners (28%) were the top prescribers of monitored parenteral antimicrobials primarily for the management of moderate-risk community-acquired pneumonia (39%). They were mostly indicated for empirical treatment of infections (94%) and were given for an average of 5.73 days. Only 58% of the total cases had orders for culture and sensitivity testing. Of which, principally 47% had colony cultures. Blood (29%) and sputum (27%) were the most common specimens taken for culture and sensitivity testing. The microorganisms often isolated were Escherichia coli (19%), Klebsiella pneumoniae (18%), and Staphylococcus aureus (9%). In addition, extended-spectrum beta lactamase-producing gram-negative pathogens (4%) and methicillin-resistant S. aureus (1%) were also isolated. All the microorganisms isolated showed most resistance to ampicillin (81%) and most susceptibility to colistin (100%). There were drug therapy-related problems encountered. There was one case of an adverse drug reaction (0.1%) and two cases of contraindications (0.2%). Therapeutic duplication was also observed in 5% of the cases. Moreover, 39% had instances of drug-drug interactions.Piperacillin-tazobactam had the highest consumption (79.50 defined daily doses/1,000-patient days) among the monitored parenteral antimicrobials. Some prescriptions were deemed inappropriate upon evaluation. 12% of cases were inappropriate based on the justification indicator. As for the critical indicators, duration of therapy (78%) was the main reason. Only four components of the DUE criteria indicators have met or exceeded the established threshold level.The cost analysis indicated that the total actual cost of therapy with the monitored parenteral antimicrobials amounted to ₱17,645,601.73. Considering Department of Health National Antibiotic Guidelines recommenda-tions, ideal total cost of treatment was ₱14,917,214.29. Potential cumulative cost savings of ₱2,728,387.44 could have been achieved for patients admitted last 2019. Conclusion Consumption of piperacillin-tazobactam was relatively high as compared to the other monitored parenteral antimicrobials covered in this study. Physicians at the study site seldom prescribe monitored parenteral antimicrobials as recommended by the National Antibiotic Guidelines. This is evidenced in the incidence of inappropriate therapy regimens, with inapt duration of therapy as the leading explanation.From the patient’s perspective, the main economic implication was on the direct medical costs, particularly the increased cost of the actual antimicrobial therapy prescribed to manage various infections. Adherence of physicians to the established guidelines and selection of the most cost-effective therapy could have resulted in considerable cost savings.
Drug Utilization Review ; Antimicrobial Stewardship