/library/oar/handle/123456789/32808 2026-06-14T06:49:33Z /library/oar/handle/123456789/33230 Title: Development of protocols for continuing professional development in pharmacy Abstract: It has been established that Continuous Professional Development (CPD) is a process which most professionals need to follow to update skills required within the procession they represent. Pharmacists are no exception and the aim of this study was to develop and evaluate CPD record sheets for use by local community pharmacists. These sheets were finalised after a total of 101 cases were managed in a community pharmacy with the help of protocols on allergic skin, nose and eye disease which had been designed in a previous local study. Such protocols outline plans for management of allergic disease symptoms however they were considered to be too long for practical use by pharmacists. Hence before using them to manage cases tor this study the protocols were abridged and later evaluated through a panel of experts consisting of medical and non-medical professionals. Fieldwork entailed documentation of pharmacist intervention when responding to 101 cases of allergic skin, nose and eye conditions identifying compliance with protocols and areas requiring corrective actions. After the first 26 cases were collected, draft CPD record sheets were designed using detailed documentation regarding management of such cases. Such sheets were later used to document the management of the remaining 75 cases collected. Hence the practicality of the sheets was tested and necessary amendments were applied after all cases were collected. Pharmacist intervention was graded according to a pre-established scoring system and guides obtained were also recorded on the CPD record sheets. Difficulties encountered by the pharmacist were outlined on the CPD record sheets together with the respective CPD plan/s chosen. Out of a total of 101 cases collected difficulties were encountered in 37 occasions. Cases with difficulties included 18 skin cases, 12 nose cases and 7 eye cases. Neither of the actions planned by the pharmacist took more than a month to be performed and some actions were performed either on the same day the difficulty was encountered or the day after. Most actions were performed within a week of the difficulty encountered. All planned actions performed were completed within the established time schedule except one. Also all the actions chosen satisfied the difficulty encountered except two and in both these cases the pharmacist felt that further research would in fact solve the deficiency encountered. This was also recorded on the CPO record sheet. The most popular CPD action plan chosen was research involving related articles on published or online pharmaceutical/medical profession related publications. At the end of the study, an exercise was performed to determine whether CPO actions had any effect on similar cases which presented at the pharmacy after the CPD action was carried out. Analysis of a number of nose and skin cases was carried out since the number of eye cases was too small to offer enough data. Although, a number of similar cases could be identified for nose and skin protocols. no definite results on the impact of CPO actions regarding patient satisfaction could be drawn up since the number of cases collected was still too small for such an analysis. However, as regards confidence in the treatment of cases, it was noticed that the investigator was in fact much more at ease when treating similar cases to those which required a CPO action before. Also the pharmacist took less time to treat such eases and could answer questions poised by patients more fluently. When the need to discuss such cases with professionals of the expert panel arose, the pharmacist would contribute more and understand better the experience and personal opinion offered by the professional. Description: M.PHIL. 2009-01-01T00:00:00Z /library/oar/handle/123456789/32817 Title: Cost-effectiveness of drugs which suppress the rheumatic disease process Abstract: Rheumatoid arthritis is a chronic, progressive, debilitating, inflammatory disease affecting predominantly the synovial joints of the body. If left unchecked it causes considerable pain, deformity and disability which in turn result in impairment of the psychological and social functioning of the patient. All this imposes an economic burden on the patient as well as on the state. Prior to the 1990s the treatment of rheumatoid arthritis consisted of disease-modifying antirheumatic drugs (DMARDs), steroids and analgesics which are not so expensive and did not contribute a large percentage to the overall cost of treating rheumatoid arthritis. More recently tumour necrosis factor (TNF) inhibitors have been added to the armamentarium of treatment of rheumatoid arthritis. These agents are considerably more expensive than what was available before so this study was undertaken to explore their cost effectiveness ratio. Ten patients who satisfied the American College of Rheumatology (ACR) criteria for a diagnosis of rheumatoid arthritis and who, during the study period, still experienced active joint disease despite full doses of traditional disease-modifying antirheumatic drugs, were commenced on tumour necrosis factor inhibitor therapy and formed the basis of this study. In view of the expense of this treatment it was important to demonstrate a beneficial effect both from the physician's perspective as well as from the patient's. Outcome measures were selected to cover both these aspects and consisted of the disease activity score (DAS28) as a predominantly objective marker of disease activity as well as the Health Assessment Questionnaire (HAQ) and the Short Form -36 (SF36) as subjective markers of functional disability. Statistically significant improvements in all these outcome measures were noted as early as 6 months after the start of tumour necrosis factor inhibitor blocker therapy and this was sustained at the end of 1 year. A statistically significant correlation was also noted between the outcome measures DAS28 and HAQ over time. The pharmacoeconomic analysis was based on calculating the incremental cost effectiveness ratio (lCER) per unit of improvement in the Health Assessment Questionnaire score and per unit of improvement in the disease activity score (DAS28). An incremental cost effectiveness ratio of € 9,523 / unit of Health Assessment Questionnaire and of € 4,427 / unit of DAS28 was obtained taking into consideration direct costs. If indirect costs were to be included in the equation, a more favourable incremental cost effectiveness ratio was obtained: € 3,037 / unit of Health Assessment Questionnaire and of € 1275/ unit ofDAS28 when calculated from the Government's perspective and € 77 / unit of Health Assessment Questionnaire and of € 32 / unit of disease activity score (DAS28) when calculated from the patient's perspective. How cost-effective the tumour necrosis factor inhibitors are will ultimately depend on how much the health care system is prepared to spend to achieve the significant improvement in the outcome measures observed in this study bearing in mind that this improvement may well translate into economic benefits due to reduced loss of work productivity and possibly a reduced need for institutional care. These benefits may offset a significant part of the increased expense of the tumour necrosis factor inhibitors. Description: M.PHIL. 2009-01-01T00:00:00Z