Self-medication is a representative phenomenon in the domain of popular care, originated from perspective of medical pluralism and the pharmacy profession is said to be in the most appropriate position of health care professions to activate self-medication. As any healthcare reform impacts in a country, 2000 institutional separation between medicine and pharmacy implemented in Korea brought a lot of changes in behavior of drug use not only to physicians and pharmacists but also to consumers (patients). In this paper, the reality of self-medication since the institutional separation between medicine and pharmacy was analyzed, based on the empirical data which were collected by the Korea Institute for Health and Social Affairs in 2002. The major finding is that the domain of popular care including self-medication was significantly shrunk, while that of professional care was proportionally expanded. As a result, the following four points were strongly recommended for the purpose of promoting self-medication: i) upgrading the pharmacy education system from 4 year to 6 year level, ii) improvement of continuing education and introduction of GPP (Good Pharmacy Practice), iii) activating 'pharmacal encounter' (i.e., pharmacist-consumer relationship) and iv) promotion of socio-economic research activities and proactive participation in the international self-medication movement of pharmacists in Korea.
Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.
Background: It is recommended to use aerosolized (AS) colistin in patients undergoing mechanical ventilation therapy as an adjunctive in the latest guidelines, in spite of high nephrotoxicity and limited studies. In this study, systematic reviews and meta-analyzes were conducted to evaluate the safety and efficacy of AS colistin in patients with ventilator-associated pneumonia Methods: Two authors independently searched related literature published from Pubmed and EMBASE until July 2016 and included a study comparing adjunctive AS colistin with intravenous (IV) colistin monotherapy. The primary outcome was the clinical response rate, the secondary outcome was the overall mortality, and nephrotoxicity. The publication bias was evaluated using the Egger's test. Results: Of the total 279 articles, nine were finally included in the final analysis. There was a significant difference between the adjunctive AS colistin group and the IV colistin monotherapy group for the treatment-response rate (odds ratio (OR), 1.56; 95% CI, 1.14-2.14; p = 0.005; $I^2=36%$), although there was no significant difference in overall mortality (OR, 0.77; 95% CI, 0.57-1.04; p = 0.09; $I^2=20%$). However, there was no significant difference between the two groups in nephrotoxicity (OR, 1.13; 95% CI, 0.74-1.74; p = 0.57; $I^2=4%$). Conclusion: The addition of aerosolized colistin to IV colistin monotherapy showed better results in terms of efficacy than IV colistin monotherapy and did not show any significant difference in terms of total mortality and nephrotoxicity. Additional large-scale studies of this need to be verified.
As medicinal knowledge developed. population system has been migrating into the aged society. These aged society evokes the social problem of senile diseases. One of these. Alzheimer's Disease (AD) has been an issue. and its causative. ${\beta}$-amyloid(A${\beta}$) has also been a key target in drug development. In AD, microglial cell affects neuron cells in any way of positive and negative. (omitted)
This study investigated social relief schemes for serious adverse drug reactions in foreign countries and deduced lessons and implications for Korea to implement the scheme. A social relief scheme for serious adverse drug reactions provides reliefs for diseases and such health effects as disabilities or deaths that were caused by adverse reactions to pharmaceuticals prescribed at hospitals and clinics as well as those purchased at pharmacies notwithstanding their proper use. The US and the UK do not have specific relief schemes for adverse drug reactions but apply rules of strict liability or negligence. New Zealand and Nordic countries provide no-fault compensation schemes for health effects or injuries caused by medical treatments or medicinal products. Japan and Taiwan have operated the schemes since 1980 and 2000, respectively. In designing the scheme in Korea, we suggested that cases eligible for relief be confined to serious adverse reactions such as death or disability and then extended to diseases. It is desirable to encourage the reporting system of adverse drug reactions and quality use of medicines for the relief scheme to work efficiently.
Background: This study aimed to examine the level of knowledge, attitude, acceptance, and willingness to pay (WTP) for HPV vaccination among female parents of girls aged 12-15 years in Thailand. Materials and Methods: A cross-sectional survey was conducted in eight schools across Bangkok. Results: Of 1,200 questionnaires sent out, a total of 861 questionnaires were received. Knowledge regarding the HPV vaccine among parents was quite low. Only half of the parents knew about the link between HPV and cervical cancer while one-third of them knew that the vaccine should be administered to the children before they become sexually active. Nevertheless, vaccine acceptance was high if it was offered for free: 76.9% for the bivalent and 74.4% for the quadrivalent vaccine. The proportion of respondents who were willing to copay for the vaccine if it was not totally free was also high, ranging from 68.9% for the bivalent to 67.3% for the quadrivalent vaccine. No significant difference between bivalent and quadrivalent vaccines in terms of prevalence of acceptance and willingness to pay was found. About one-third of the participants, who were willing to copay for the vaccine if it was not offered for free, indicated that they would copay less than 500 baht (30 baht = approx US$1) for three doses of bivalent vaccine. Conclusions: Substantial effort should be made to educate parents prior to introduction of a national HPV vaccination program. In terms of acceptance, either bivalent or quadrivalent vaccines can be recommended.
Background: The current educational goals and missions of pharmacy schools in Korea were analyzed to examine the current orientation and future direction of pharmaceutical education. Methods: Educational mission statements were obtained from the homepages of 35 pharmacy schools and subjected to convert into codes. Themes and categories were induced using qualitative content-analysis from the codes and compared according to location of school (capital area versus province), public versus private, and date of initial enrollment (before versus in 2011). The themes and categories were compared with "the eight-star pharmacist" suggested by World Health Organization (WHO) and International Pharmaceutical Federation (FIP). Results: Twelve themes, 44 categories, and 496 codes were identified. Themes included pharmaceutical expertise, professionalism, contribution to society, basic educational ideology, sphere of activity, leadership, research, dealing with future change, problem-solving ability, self-management and development, cooperation, and respect for life. Mission statements of schools that initially enrolled in 2011 cited humankind level contribution (p=0.011), patient-centered care (p=0.026), and globalization (p=0.018) more frequently than those enrolled before 2011. Most schools mentioned about care-giver, researcher, and decision-maker which were stated in "the eight-star pharmacist". Conclusion: To meet the growing social requirements of a pharmacist's roles, wide-ranging active discussion on establishing educational goals should be made.
Background: The pharmacy education system in South Korea has changed from four-year degree program to two-year pre-pharmacy program plus four-year professional degree program (a total of six years) since 2009. Objectives: The purpose of this study is to assess final year student's satisfaction on this new pharmacy education system and to explore factors related to student satisfaction. Methods: A paper-and-pencil survey instrument was administered to all final year pharmacy students at four universities located in South Korea during September of 2014. The self-administered questionnaire contained 39 items. In part 1, the quality of education with regards to school utilities, education system, human resources, and communication domains were measured. In part 2, overall satisfactions with the new education system were asked to students. Responses were recorded on a seven point Likert scale. Results: A total of 207 students were participated in this study. Students showed low satisfaction on school utilities and standardization of education while they displayed high level of satisfaction on the quality of the faculty members and preceptors at clerkship sites. Factor analysis showed that education service was the most significant factor that affects students' satisfaction followed by facilities, standardized education, communication, administration, pharmacy practice (p<0.05). Conclusion: The qualification of faculty and preceptors ranked number one in students' satisfaction and it was the most significant factor. School facilities were found to be the second most significant factor in students' satisfaction while students displayed poor satisfaction. The study results might need to be reflected in future education planning to improve students' satisfaction.
Background: Currently establishment of public pharmaceutical companies became an issue for securing stable supply of national essential drugs in order to respond appropriately to national public health crisis. Pharmacy students as future pharmacists need to be interested in drug related issues under the discussion in our society. This study aimed to investigate perceptions of pharmacy students on the national drug supply strategy through public pharmaceutical companies. Methods: A 20-items questionnaire designed for this study was used. Pharmacy students nationwide were enrolled in July 2017. They responded to questions through on-line survey program. Data were analyzed descriptively. Results: 160 students from 26 pharmacy schools participated. 5th and 6th grade students accounted for two-thirds, and one third aspired future jobs in pharmaceutical industry. Among responders, 71.3% was unaware of current national essential drugs, 52.5% did not know the Rare and Essential Drug Center, and 91.9% was unaware of the legislation on the supply and management of essential drugs. 82.5% favored the establishment of public pharmaceutical companies. 80.6% agreed that government should intervene in pharmaceutical market for ensuring drug accessibilities, 73.8% agreed that public pharmaceutical companies make possible to reach a goal of stable supply of pharmaceuticals, and 85.1% agreed that active compulsory license by public pharmaceutical companies is necessary. Conclusion: We found that pharmacy students recognized the need for governmental control to achieve social values of pharmaceuticals. More attention and participation of the pharmacy students as well as pharmacists in the process of national debate on public pharmaceutical companies are expected.
The aim of this study was to examine the current turnover status of hospital pharmacists and to analyze the factors which affected the turnover of them after the separation of prescribing and dispensing practice. We surveyed 19 managers of hospital pharmacies and 154 hospital pharmacists. Results are as follows. Pharmacist manpower of hospital pharmacies was only $63.99\%$ in tertiary hospitals and $76.78\%$ in general hospitals respectively of the number of pharmacists before the separation of prescription and dispensing practice. The ratio of those who left hospital pharmacies during the period of January 2000 and October 2001 was $80.23\%$ for tertiary hospitals, and $100.84\%$ for general hospitals. Decrease in the number of pharmacists brought the increase of work load and night duty. Major factors which affected the turnover of hospital pharmacists were found as following: income gap between hospital pharmacists and community pharmacists, increasing workload especially at night and on holidays, infrequent chance for the promotion, and low chance to provide clinical pharmacy services after the separation of prescribing and dispensing practice. Adequate manpower is the basic factor for providing hospital pharmacy services and improving clinical pharmacy services. The study suggested that proper number of hospital pharmacists is to be ensured through strengthening the legal requirement for the hospital pharmacists and improving health insurance reimbursement rate for the pharmaceutical services at hospital.
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