Wei Chern Ang

Pharmacy Department, Hospital Tuanku Fauziah, Ministry of Health., Jalan Tun Abdul Razak, 01000 Kangar, Perlis, Malaysia.

Clinical Research Centre, Ministry of Health Malaysia, Hospital Tuanku Fauziah, Ministry of Health. Jalan Tun Abdul Razak, 01000 Kangar, Perlis, Malaysia

*Correspondence: wei.ang.1990@gmail.com

Qualitative Analysis on Interprofessional Collaboration in the Management of Paediatric Bronchial Asthma: Challenges and Suggestions for Improvement

Abstract / Full Text / Download PDF

Abstract

Introduction: Multi-disciplinary healthcare providers need to move beyond task-based responsibility towards a more collaborative approach. Chronic childhood diseases such as bronchial asthma demands effective multidisciplinary team collaboration to improve patient care. Objective: We aimed to examine the interprofessional collaboration between physicians and pharmacists in the management of paediatric bronchial asthm, to explore the views and experiences of both pharmacists and physicians on the important aspects of Paediatric Respiratory Medication Therapy Adherence Clinic (PRMTAC) and patient-centeredness, and to identify barriers against interprofessional shared decision-making in the management of paediatrics bronchial asthma. Method: The study involved a face-to-face interview involving paediatric medical officers and pharmacists involved with PRMTAC. The semi-structured interview included four pharmacists and three paediatric resident physicians from Hospital Tuanku Fauziah, Perlis, Malaysia. A full audio recording was used for detailed data retrieval and verbatim transcription. The session was deemed completed once all the probed questions had reached a thematic conclusion. Result and Discussion: Three main themes emerged: (I) The relevance and necessity of PRMTAC service to complement paediatric outpatient bronchial asthma management, (II) the lack of communication between pharmacist-physician in outpatient bronchial asthma management, and (III) recommendations for a combined clinic in the management of outpatient paediatric bronchial asthma. PRMTAC services were rated as highly relevant in the management of outpatient bronchial asthma among all study respondents, irrespective of profession. The detailed assessment of medication compliance and technical demonstration provided by PRMTAC services were deemed fundamental in holistic patient care. The current clinical scenario demonstrates that the pharmacist and paediatric medical team work independently and in parallel, rather than collaboratively. Such workflow challenges in-tandem decision-making with regards to patient-focused medication. The lack of interaction also impedes sharing of ideas and new knowledge that could benefit both parties in relation to the management of outpatient bronchial asthma. A combined clinic was unanimously suggested to remedy this. Conclusion: Proper planning with regard to allocation of support systems and mobilisation of human resources needs to be instituted to realise the implementation of a nationwide combined clinic in the management of paediatric bronchial asthma.

Utilisation of Third-Generation Cephalosporins and the Occurrence of ESBL Microorganisms in a Malaysian General Hospital

Abstract / Full Text / Download PDF

Abstract

Introduction: Bacteria had undergone an evolution since the introduction of antibiotics as a way of adaptation. The recent increase in cases of extended-spectrum beta-lactamases (ESBLs) and broad-spectrum antibiotics usage worldwide are of great concern. Objective: This study aims to establish the relationship between third-generation cephalosporin antibiotics usage and the occurrence of ESBL microorganisms in a state hospital in Malaysia. Method: A cross-sectional study utilising data from January 2014 to June 2017 for six-monthly uses of cefoperazone, cefotaxime, ceftazidime, ceftriaxone was expressed in defined daily dose (DDD) per 100 bed-days, while 6-monthly positive cultures of ESBL-producing Escherichia coli, Klebsiella pneumoniae were expressed as the frequency of infection and coloniser cases. Individual trends of antibiotics use-positive culture ESBL over time were analysed descriptively and by linear regression. Result: None of the third-generation cephalosporin use shows a significant trend over time. The most prescribed third-generation cephalosporin was ceftriaxone. The emergence of ESBL E. coli showed a significant reducing trend over time (r2 = 0.931, p < 0.001). No significant correlation was found between antibiotic use and the emergence of ESBL organisms. Conclusion: Our study found no significant correlation between third-generation cephalosporin use and the emergence of ESBL organisms in our setting. The association between third-generation cephalosporin use and ESBL emergence should not be considered universal, as the selection pressure of third-generation cephalosporin might be affected by other factors specific to the institution. The reducing trend of E. coli emergence may be due to the antimicrobial stewardship programme already in place. Additionally, ESBL-producing organisms may appear susceptible to third-generation cephalosporins in our laboratory yet be functionally resistant in vivo.