Edited by: Jean-Paul Deslypere, Proclin Therapeutic Research Pte Ltd., Singapore
Reviewed by: Sunita Nair, Capita India Pvt. Ltd., India; Domenico Criscuolo, Genovax S.r.l., Italy
*Correspondence: Chin Fen Neoh
This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The prevalence of Alzheimer's disease (AD) has increased with the fast growing of aging population, thereby posing great challenges to provision of care for AD patients. Pharmacists play a vital role in the management of AD; this includes recognizing early symptoms of AD, providing medication counseling to AD patients and their caretakers, and identifying potential adverse drug reactions. A comprehensive understanding of the disease progression, as well as the pharmacological therapy, is essential to provide effective care to AD patients. The level of knowledge about AD among the pharmacists, however, remains unknown. Hence, this study aimed to assess the knowledge on AD among the pharmacists in public hospitals and health clinics and its correlates. A clear picture of the characteristics associated with different levels of knowledge could facilitate the targeted re-training of pharmacists. The 30-item validated Alzheimer disease knowledge scale (ADKS) tool was pilot-tested and used in this cross-sectional study. All pharmacists, from nine public hospitals and seven public health clinics in the State of Selangor, Malaysia, were invited to participate in this cross-sectional survey. The ADKS score was computed and compared across demographics characteristics. A total of 445 pharmacists responded to the survey. These pharmacists had a moderate overall score in ADKS; nevertheless, high scores were recorded in the domains of treatment management and care giving. No difference in AD knowledge was found among pharmacists worked in public hospitals and health clinics, except for the domain of care giving (
More than 46 million people worldwide are living with Alzheimer's disease (AD) and the number is expected to increase to 131.5 million by 2050, with the majority are from low and middle income countries (Alzheimer's Disease International,
Management of AD patients is complex as the development of psychiatric and behavioral disturbances upon pharmacological treatment might overlap with the symptoms of cognitive decline (Feinberg and Michocki,
Inadequate knowledge in regards to AD among the healthcare professionals have been shown to be negatively impacted patient outcomes (Barrett et al.,
This cross-sectional study was conducted between September and November 2016. All pharmacists who worked in public hospitals and health clinics in Selangor, Malaysia, were invited to participate in this study. The list of the pharmacists with their email addresses was obtained from Selangor State Health Department.
A 38-item survey, which included questions on: (i) demographics of the pharmacists, (ii) validated items from Alzheimer's disease Knowledge Scale (ADKS) (Carpenter et al.,
The survey was distributed via two approaches: (i) using a web-based questionnaire, hosted by
Ethics approvals from Research Ethics Committee (REC) of Universiti Teknologi MARA (UiTM) [Reference no: 600-IRMI (5/1/6) REC/345/16] and Medical Research and Ethics Committee (MREC) [Reference no: NMRR-15-133-24229(IIR)], Ministry of Health, Malaysia, were obtained for the purpose of this study.
Descriptive data were analyzed by using Statistical Package for Social Science (SPSS) programme version 20.0 and Microsoft Excel version 2010. Descriptive statistical analysis, such as frequency, percentage, mean, and standard deviation (SD) was carried out to analyze demographic data. Descriptive statistics for all independent variables were calculated and the mean ADKS scores across different groups were compared using independent
Of the total 775 pharmacists, 445 responded to the survey, giving a response rate of 57.4%. There was almost an equal participation of pharmacists from the public hospital and health clinics (Table
Demographic characteristics and their relationship to AD knowledge (
Male | 74 (16.6) | 19.23 (4.17) | 1.054 | 443 | 0.225 |
Female | 371 (83.4) | 18.67 (3.52) | |||
Bachelor degree | 414 (92.8) | 18.83 (3.66) | 0.2 | 443 | 0.655 |
Master degree | 31 (7.0) | 17.90 (3.36) | |||
Health clinic | 225 (50.6) | 19.05 (3.69) | 0.142 | 443 | 0.095 |
Hospital | 220 (49.4) | 18.47 (3.56) | |||
<30 | 335 (75.3) | 19.03 (3.69) | 3.43 | 2,442 | 0.009 |
31–40 | 106 (23.8) | 17.99 (3.44) | |||
41–50 | 4 (0.9) | 18.06 (1.03) | |||
Malay | 238 (53.5) | 19.21 (3.86) | 2.82 | 3,441 | 0.039 |
Chinese | 158 (35.5) | 18.13 (3.24) | |||
Indian | 46 (10.3) | 18.72 (3.64) | |||
Others | 3 (0.7) | 18.33 (0.58) | |||
<3 | 174 (39.1) | 18.73 (3.68) | 0.172 | 4,440 | 0.953 |
4–7 | 188 (42.2) | 18.80 (3.61) | |||
8–11 | 70 (15.7) | 18.65 (3.58) | |||
12–14 | 10 (2.2) | 19.00 (6.16) | |||
>15 | 3 (0.7) | 18.76 (3.64) | |||
Outpatient pharmacy | 254 (57.1) | 19.21 (3.76) | 2.299 | 9,435 | 0.016 |
Store | 47 (10.6) | 17.55 (2.67) | |||
Clinical pharmacy | 54 (12.1) | 17.81 (3.11) | |||
Drug information services | 23 (5.2) | 17.91 (3.78) | |||
Total parenteral nutrition | 7 (1.6) | 21.14 (4.05) | |||
Others | 60 (13.4) | 17.16 (3.05) |
The mean (SD) total ADKS score for health clinics pharmacists was 19.05 (3.69), with 63.5% correct answers, whereas hospital pharmacists' score was 18.47 (3.56), with 62.5% correctness (Table
As shown in Table
ADKS content domain scores between public hospitals and health clinics pharmacists.
Life impact | 3 | 1.58 (0.77) | 52.7 | 1.58 (0.53) | 1.57 (0.05) | 0.898 |
Risk factors | 6 | 3.59 (1.22) | 59.8 | 3.64 (0.08) | 3.53 (0.82) | 0.356 |
Symptoms | 4 | 1.84 (1.05) | 46.2 | 1.92 (0.07) | 1.77 (0.07) | 0.131 |
Treatment management | 4 | 3.05 (0.81) | 76.4 | 3.06 (0.05) | 3.04 (0.05) | 0.829 |
Assessment | 4 | 2.67 (0.91) | 66.8 | 2.67 (0.06) | 2.66 (0.58) | 0.932 |
Care giving | 5 | 3.60 (1.07) | 72.1 | 3.71 (0.06) | 3.49 (0.07) | 0.033 |
Course of disease | 4 | 2.41 (1.00) | 48.3 | 2.44 (0.66) | 2.38 (0.068) | 0.437 |
Findings from multiple linear regression analysis (Table
Regression model predicting knowledge of AD among pharmacists.
Health clinic | – | – | – | – |
Hospital | −0.54(−1.220, 0.135) | 0.116 | ||
Male | – | – | ||
Female | −0.56(1.473, 0.347) | 0.225 | ||
Bachelor degree | – | – | ||
Master degree | −0.93(−2.261, 0.401) | 0.170 | ||
<30 | 1.035 (0.285, 1.811) | 0.009 |
0.83 (0.059, 1.600) | 0.018 |
31−40 | – | |||
41−50 | 0.75 (−2.87, 4.371) | 0.684 | ||
Chinese | – | – | ||
Malay | 1.078 (0.348, 1.809) | 0.004 |
0.89 (0.219, 0.557) | 0.009 |
India | 0.598 (−0.602, 1.78) | 0.331 | ||
Others | 0.206 (−3.939, 4.351) | 0.922 |
The role of pharmacists in management of AD is increasingly recognized, which includes recognizing early symptoms of AD, referring AD patients to seek for timely diagnosis and treatment, identifying potential ADRs of pharmacological treatment, and educating and providing counseling to the AD patients and caregivers. For example, findings from a study on multi-disciplinary dementia care services conducted in Germany revealed that pharmacists are adapt in identifying problems related to drug administration, adherence, and drug interaction among patients with dementia (Wucherer et al.,
This study, the first in Asia region, assessed the level of AD knowledge among the pharmacists in public hospitals and health clinics by using ADKS. This study revealed that the pharmacists from both public hospitals and health clinics in the state of Selangor had moderate knowledge on AD. It is unknown whether the current scores are on par with the regional and international counterparts as no similar study was conducted except one involving community pharmacists at Maltese Islands (Zerafa and Scerri,
It is interesting to note that pharmacists with a master education did not score better than the bachelor holders. It is unfortunately that the survey did not elicit the specialty of the master holders, and therefore, it is unclear whether AD was part of the learning focus during the master training. Of note, there was no difference in the mean ADKS score between the hospital pharmacists and health clinics pharmacists except in one domain (i.e., care giving). The score for the care giving domain was higher among the pharmacists in public hospitals compared to those worked in the health clinics. This could be due to the fact that hospital pharmacists have more encounters with AD patients or caregivers in the geriatric clinics or wards. The pharmacists scored lowest in domains such as symptom and course of disease. Indeed, these two domains have more medically-oriented questions, which may not be the primary focus of their job scopes, for example, the stages of cognitive impairment in people with AD and the lifespan of people with AD generally can survive.
There was a positive correlation between ADKS score and self-rated AD knowledge using a 11-point scale (
In the current study, the age group (i.e., age <30) was found to be a significant independent predictor of higher ADKS score. This is consistent with an Australian study that surveyed the nursing, medical, support, and allied health staff, which revealed that age bracket of <30 years old scored 1.0 point ADKS higher than other age groups (Smyth et al.,
Malay pharmacists had a significantly higher ADKS score and were an independent predictor associated with higher ADKS score in the current study. This interesting finding could be related to their exposure and personal experience in handling AD among their family members due to the greater prevalence of AD among in Malay ethnicity (Kua and Ko,
There are several limitations in this study. Some respondents may have referred to any resources while answering this questionnaire. In addition, the current study did not evaluate the previous training and personal experience on AD (e.g., family member with AD), which could have an impact on the ADKS score. Furthermore, this study was conducted at only one region in Malaysia (i.e., Selangor), and thus, the findings from this study cannot be generalized to all pharmacists in Malaysia.
In the present study, the majority of the pharmacists have moderate ADKS score. No difference in AD knowledge was noted among the pharmacists working in public hospitals and health clinics except in the care giving domain. AD-specific education training would have benefited these pharmacists in providing better care to AD patients.
THMN assisted in data collection, data analysis/interpretation and write-up. CFN assisted in concept/design, critical revision and approval of the article. YHH, SMJ, MFO, and LCM assisted in critical revision and approval of the article.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author would like to thank all pharmacists who responded to this study and Prof. Brian D. Carpenter for his permission and assistance in using ADKS tool in this study. Also, the authors would like to thank the Director General of Health Malaysia for his permission to publish this article. The current study is partly funded by UiTM internal grants [600-IRMI/MYRA 5/3/BESTARI (015/2017) and 600-IRMI/DANA 5/3/ARAS (0022/2016)].