BACKGROUND AND OBJECTIVE

Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4th class municipality.

This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD— the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases—it is also common to have household members taking medicines for two to three NCDs.

This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.

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.

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.

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 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.

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.

BACKGROUND

Drug use and abuse is a public health issue that has come into focus in the Philippines in the past years. Excluding the years of the COVID-19 pandemic, there has been a yearly increase in the number of admissions to treatment and rehabilitation centers. The census in the University of the Philippines-Philippine General Hospital (UP-PGH) National Poison Management and Control Center (NPMCC) shows a parallel increase in drug-positive patients consulting in the emergency room (ER).

The objective of this study was to describe the demographic, clinical, and drug use profiles of substance users admitted to the UP-PGH and referred to the NPMCC for drug testing.

This is a cross-sectional study where participants included patients aged 10 years and above who were referred to the NPMCC for drug testing within three days of the ER consult. Once consent or assent from children was obtained, patients were interviewed and examined. Urine samples were collected for drug screening using drugs of abuse screening test kits. A split sample was sent to the UP Drugs of Abuse Research Laboratory (UP DARL) for analysis using the liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). The data was encoded in the REDcap platform. The results were analyzed and summarized using descriptive statistics.

Three hundred eighty-four (384) individuals participated in the study and submitted urine samples for testing from 1 January 2019 to 28 February 2020. One hundred thirty-four (134) samples were positive for substances of abuse detected by drug screening test kits for methamphetamine (MAP), delta-9-tetrahydrocannabinol (THC), cocaine, 3,4-methylenedioxymethamphetamine (MDMA), benzodiazepines, and opioids, and by LC-QTOF/ MS analysis. Majority of the patients were males with an average age of 34.54 ± 1.16 years old. Many complained of neurobehavioral changes necessitating consultation at the hospital emergency room. The neurologic and cardiovascular systems were frequently affected. By using the drugs of abuse test kit, methamphetamine was the most common substance of abuse detected and was seen in 40.3% of the samples. Amphetamine type stimulants were the most common group of drugs identified by LC-QTOF/ MS analysis and was seen in 103 instances. New psychoactive substances detected more frequently than others include paramethoxymethamphetamine (PMMA), 3,4- methylenedioxy methamphetamine (MDMA) and 3,4- methylenedioxyamphetamine (MDA). A few cathinones like butylone and cathinone were also detected.

Methamphetamine was the most common substance of abuse detected in urine samples of the participants. New psychoactive substances were also detected in urine samples when LC-QTOF/MS analysis was utilized. Most persons who use drugs are unemployed young- to mid-adult males. The participants often had neurobehavioral and cardiovascular signs and symptoms.

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.

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.

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.

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.

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.

BACKGROUND AND OBJECTIVE

Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4th class municipality.

This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD— the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases—it is also common to have household members taking medicines for two to three NCDs.

This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.

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

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