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Volume 1, Issue 1 November 2013

Medication Therapy Adherence Clinic (MTAC)

In addition to monitoring patients' compliance with medicine usage, a number of Medication Therapy Adherence Clinics (MTAC) operated by pharmacists has been established. The objective of this service is to improve patient adherence to medications. MTAC was started in 2004 and has grown exponentially. This service stress on the importance of patient adherence to medications and this will lead to reduction on the complications of the illness. This service also involves collaboration between pharmacists and medical officers in providing pharmaceutical care to patients. MTAC pharmacists carry out the monitoring of drug therapy and providing information to patients to improve their understanding about treatment pharmacotherapy and provide motivation so that patients have a positive perception about the disease and treatment received. This service also includes clinical consultations, and alteration of the dose of some drugs such as insulin and warfarin.
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Contraception For Special Groups

DEFINITION Contraception: Intentional prevention of conception or impregnation through the use of various devices, agents, drugs, sexual practices, or surgical procedures. Special groups: adolescent, post partum and lactating (breastfeeding) women, women with medical conditions or risk factors, older women.

Inside this issue:

Medication Therapy Adherence Clinic (MTAC) Contraception For Special Groups Middle East Respiratory Syndrome (MERS-COV) Pharmacy department staff movement Pharmacy humor 2 4 6 8 9

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Role of Pharmacist in Medication Adherence


medication dispensing is the best-

known function of the pharmacist, pharmaciststhrough counseling, medication therapy management (MTM), disease -state management , and other meanscan play a pivotal role in patient care. There are opportunities in every type of pharmacy practice to improve patients adherence and therapeutic outcomes, and pharmacists must embrace and act on them. Many factors dictate a patients medication adherence, and each patient is unique. The pharmacist must approach each patient individually to determine the level of adherence and what barriers may exist that are preventing the patient from taking his or her medication appropriately. Education, while helpful, is usually not enough to persuade the patient to comply with the physicians drug orders. Information must be presented in clear, easy-to-understand language, and the patient must understand not only the benefits of adherence, but the repercussions of non-adherence. Also, positive reinforcement goes a long way; patients who feel empowered and cared for are more apt to play an active role in their treatment. Dosing simplification and minimization of

adverse effects are extremely successful strategies for improving adherence. When filling a prescription, the pharmacist should do a quick review to see whether the dosing schedule is as simple as possible. The pharmacist should inquire frequently about any adverse effects the patient is experiencing and then consult the physician regarding suggested alternatives. Preparing a dosing card containing only the most essential elements of the patients medications can be highly beneficial. Including the name of the pill, an image (if possible), the condition it is for, and time of day taken can be extremely helpful for patients who take many medications or who have cognitive barriers. Reminder calls, texts, or e-mails are helpful for many patients, especially those with busy lifestyles. Automatic refills are a useful strategy. Small details, like splitting a patients pills when necessary and providing easy-off caps, can be beneficial. Whatever the barriers to adherence may be, the only way to assess them is to talk to the patient. The pharmacist needs to be diligent about including the patient in the treatment experience. The more trust the patient has in the pharmacist, the more he or she will open up and disclose any apprehensions or difficulties about taking his or her medication. Only then can the pharmacist play an integral role in improving a patients adherence.
Among the types of MTAC offered are:

List of MTAC Clinic Available In Government Health Care

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Future Changes Warranted


patients, further study of the effects of pharmacist communication, and updating pharmacy education curriculum are changes that can facilitate effective pharmacistpatient communication in the future. Several organizations emphasize the need to educate the public about the expanding role of pharmacists. Pharmacists surveyed for the Boehringer Ingelheim study noted the need to re-educate the public about the services pharmacies are providing, and to change their view of pharmacy from a pill dispensary to a source of medication information. And a 2006 policy brief from the Center for Health Improvement, based on surveys and studies of California pharmacists, stresses the need to educate patients about the changing practice of pharmacy so that patients will learn to rely on pharmacists for medication and health information. More data and documentation, as well as

updating pharmacy curriculum, can also provide pharmacists with information that will help them move communication and education efforts forward. Many organizations and researchers call for more studies to document evidence that pharmacist intervention does decrease rate of errors, and increase medication adherence. NCPIE calls on the federal government to begin collecting information on medication management and adherence intervention best practices. NCPIE also suggests that colleges of pharmacy and continuing education programs adopt curriculum on patient adherence management, train faculty apropriately, and include patient adherence management as a graduation competency.

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Classification Of Contraception
Classification Oral Hormonal Combined OCP Progestrogen only pill (POP) Non Oral Progestrogen IM depo Depo Provera Progestrogen implant Implanon Levonorgestrel IUCD Copper IUCD Barrier methods Spermicide Lactational amenorrhoea Sterilisation Non Hormonal -


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Available Oral Contraceptive Agents (OCP) in MOH Facilities

Brand Loette Nordette Rigevidon Marvelon Mercilon Noriday Escapelle Progestin 100mcg Levonorgestrel 150mcg Levonorgestrel 150mcg Levonorgestrel 150mcg Desogestrel 150mcg Desogestrel 350mcg Norethisterone 1.5mg Levonorgestrel Estrogen 20mcg Ethinyl Estradiol 30mcg Ethinyl Estradiol 30mcg Ethinyl Estradiol 30mcg Ethinyl Estradiol 20mcg Ethinyl Estradiol -

Different Contraception Methods for Different Groups

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Role of Pharmacist
1. Make sure patient receive both verbal and written instructions on the chosen method of contraception. 2.Advice on dosage and administration (missed dose).

3. Educate patient on possible side effects, ways to identify and manage to improve compliance.

4.Advise for annual blood pressure monitoring & clinical problems possibly relating to the CHC (e.g., breakthrough bleeding, amenorrhea, weight gain, and acne).

Reference 1. 2. 3. Combined Oral Contraceptives, http://www.moh.gov.bh/PDF/MCHnewsLetter/English-OCP.pdf Contraception and Lactation, Joyce King , J Midwifery Womens Health. 2007;52(6):614-620. The Efficacy of Intrauterine Devices for Emergency Contraception, Kelly Cleland, Haoping Zhu, Norman Goldstuck, Linan Cheng, James Trussel Hum Reprod. 2012;27(7):1994-2000.


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Middle East Respiratory Syndrome Coronavirus (MERS-COV)

What is the novel coronavirus (MERS-CoV)? Coronaviruses are a large family of viruses that cause illness in humans and animals. In people, coronaviruses can cause illnesses ranging in severity from the common cold to Severe Acute Respiratory Syndrome (SARS). The novel coronavirus, first detected in April 2012, is a new strain of coronavirus that has not been seen in humans before. This new coronavirus is now known as Middle East Respiratory Syndrome Coronavirus (MERS-CoV). It was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses in May 2013. Where are MERS-CoV infections occurring? Nine countries have now reported cases of human infection with MERS-CoV. Cases have been reported in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates (UAE) and the United Kingdom. All cases have had some connection (whether direct or indirect) with the Middle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in people who had not been to the Middle East but who had been in close contact with laboratory-confirmed or probable cases. How widespread is MERS-CoV? How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia. WHO will continue to share information as it becomes available. How do people become infected with this virus? We do not yet know how people become infected with this virus. Investigations are underway to determine the source of the virus, the types of exposure that lead to infection, the mode of transmission and the clinical pattern and course of disease. Can the virus be transmitted from person to person? Yes. We have now seen multiple clusters of cases in which human-to-human transmission is either strongly suspected or confirmed. These have all occurred either in a health care facility or among close family members. However, the mechanism by which transmission occurred in all of these cases, whether respiratory (e.g. coughing, sneezing) or direct physical contact or contamination of the environment by the patient, is unknown. Thus far, no sustained community transmission has been observed. Is there a vaccine for MERS-CoV? No vaccine is currently available. Does treatment exist for MERS-CoV? There is no specific treatment for disease caused by MERSCoV. Treatment should be based on the patients symptoms.
Page 6 P H A R M A CY B U L L E T I N

Are health workers at risk from MERS-CoV? Yes. Transmission has occurred in health care facilities, including spread from patients to health care providers. WHO recommends that health care workers consistently apply appropriate infection prevention and control measures. Infection control measures & how to implement Standard precautions hand hygiene and use of personal protective equipment (PPE) to avoid direct contact with patients blood, body fluids, secretions (including respiratory secretions) and non -intact skin when providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), use eye protection, because sprays of secretions may occur prevention of needle-stick or sharps injury safe waste management cleaning and disinfection of equipment Apply routinely in all health-care settings for all patients. Droplet precautions Use a medical mask if working within 1 m of the patient Place patients in single rooms, or group together those with the same etiological diagnosis. If an etiological diagnosis is not possible, group patients with similar clinical diagnosis and based on epidemiological risk factors, with a spatial separation of at least 1 m. Limit patient movement and ensure that patients wear medical masks when outside their rooms. Airborne precautions Ensure that healthcare workers performing aerosol generating procedures use PPE, including gloves, long-sleeved gowns, eye protection and particulate respirators (N95 or equivalent). Whenever possible, use adequately ventilated single rooms when performing aerosol-generating procedures. Is MERS-CoV like SARS? SARS is a coronavirus that was identified in 2003 and is distantly related to MERS-CoV. However, although both viruses are capable of causing severe disease, current information indicates that they have key differences. Most importantly, MERS-CoV does not appear to transmit easily between people whereas the SARS virus was much more transmissible. Are there any travel or trade restrictions related to this new virus? No. WHO does not recommend any travel or trade restrictions with respect to MERS-CoV. WHO will continue to review all recommendations as more information becomes available.
Reference: Source: http://www.who.int/csr/disease/coronavirus_infections/en/index.html (as of 17 July 2013).Information will be updated from time to time based on the WHO website.
VOLUME 1, ISSUE 1 Page 7

Pharmacy Department Staff Movement

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Humor of the Day...

A doctor is to give a speech at the local AMA dinner. He jots down notes for his speech. Unfortunately, when he stands in front of his colleagues later that night, he finds that he can't read his notes. So he asks, "Is there a pharmacist in the house?"

A customer gets a topical cream. Pharmacist : Apply locally two times a day. Customer : I can't apply locally, I'm going overseas."


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Authors Nur Shuhada Shamsuri Siti Najlaa Izzatie Mohammed Marzhuki Normala Harom Muhammad Azwann bin Ambak

CONTACT US Address: Pharmacy Department Hospital Jeli, 17600 Jeli, Kelantan. Tel: 09-9443300 Fax:09-9440014 Outpatient/Inpatient Ext: 3335/3336/3338 Store Ext: 3313/3316