Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : August | Volume : 3 | Issue : 4 | Page : 1671 - 1678

Awareness, Attitude and Practices Concerning the Essential Medicines Concept among Malaysian Prescribers and Pharmacists

Ahmed H M A *, Ibrahim M I M **, Fathelrahman A I ***

*MSc Candidate, Social & Administrative Pharmacy Discipline, **PhD (Deputy Dean of Research & Postgraduate Study) Social & Administrative Pharmacy Discipline, School of Pharmaceutical Sciences , ***M.Sc. WHO Collaborating Center for Drug Information Universiti Sains Malaysia Minden, 11800 USM, Penang, (Malaysia)

Correspondence Address :
Prof. Mohamed Izham Mohamed Ibrahim, PhD
(Deputy Dean of Research & Postgraduate Study)
Discipline of Social & Administrative Pharmacy
School of Pharmaceutical Sciences
Universiti Sains Malaysia,11800 Penang, Malaysia
Telephone #: +6-04-6534149. Fax #: +6-04-6570017
E-mail : mohamedizham@yahoo.com

Essential medicines (EM) are the fundamental elements of primary health care (1). They are the medicines that satisfy the priority needs of a population in treating common health conditions (2),(3). An essential medicines program and a list of essential medicines (EML) are adopted by each country as a part of its national drug policy (4). Medicines are selected on the basis of safe, cost-effective clinical guidelines (5). EML leads to more rational prescribing, enhances the accessibility to health care and decreases the costs (i.e. increases affordability), which in turn improve the entire quality of care (5),(6). A major barrier to the implementation of the essential medicines concept (EMC) is the resistance from some health care professionals as a result of certain misconceptions (7). Some health care professionals may think that the efficacy and the quality of the essential medicines are low because they are cheap and that they may not satisfy the patient’s needs. Some may be worried about financial implications or about their clinical freedom (8). The Malaysian EML was launched on 27th January 2000, and to our knowledge, till now, the knowledge and attitudes towards the essential medicines concept
among health care professionals in Malaysia is unknown. The present work aims to measure the knowledge, attitudes and practice of the Malaysian prescribers and pharmacists with respect to essential medicines.

Material and Methods

The design of the study was cross-sectional. Data was collected during the period from September to November 2007. The eligible populations were prescribers and pharmacists who were working at the time of the study in public (government) clinics and hospitals, respectively, all over Malaysia.

The sampling procedures involved the multistage clustering technique. In the first step, ten states from west Malaysia were recruited by simple random sampling using the lottery method. Within those states, the same technique was used to select hospitals and clinics. A total of 60 hospitals and 113 health clinics were included.

A structured self-administered questionnaire was mailed to each health facility. The questionnaire sent to physicians was almost similar to that sent to pharmacists regarding the knowledge and attitudes items. The questions related to practice were different. The two questionnaires were developed in English initially, based on literature review. Face and content validations were achieved through a group of faculty lecturers and graduate students in the School of Pharmaceutical Sciences, Universiti Sains Malaysia. A pilot study was conducted among 30 pharmacists and modifications on questionnaires were performed whenever required. Covering letters were addressed to the medical officers in charge and the chief pharmacists in the recruited clinics and hospitals, respectively, asking them to distribute questionnaires to all prescribers and pharmacists in their institutions. The average numbers of prescribers in each clinic and the average number of pharmacists in each hospital were estimated to be three and ten, respectively. The numbers of questionnaires sent to each institution were based on previous estimation. A return envelope with stamps and a pen (as a token of appreciation) was sent to each respondent.

Besides demographic information, the data collected covered the knowledge, attitude and practices of prescribers and pharmacists with respect to the concept of essential medicines. The questionnaire included questions about whether Malaysia has a national essential medicines list and sources of the respondent’s information about the Malaysian national medicines lists.

Knowledge was measured by eight items, whereas, attitudes were measured by five items. Each item on knowledge was coded as a dummy variable (i.e. yes=1 and no=0) and total scores were computed for each respondent. Items on attitude were scored on a summated 5-point likert-scale: strongly disagree, disagree, neutral, agree, and strongly agree. Higher scores represented higher knowledge and more positive attitudes towards essential medicines. The questionnaire included two questions on practice. The two items were scored on a summated 5-point likert-scale: never, sometimes, about half time, usually, and always. Higher scores represented better practices with respect to essential medicines.

Data was analyzed using the Statistical Package for Social Sciences (SPSSÂź) Version 13.0 and MicrosoftÂź Office Excel. Descriptive statistics such as median, frequency and percentage were used whenever applicable. Data distribution around the mean was assessed using the Kolmogorov-Smirnov test. Mann-Whitney U, Kruskal-Wallis, Chi Square and Spearman rank-order correlation statistics were used for comparative and correlation analyses whenever applicable. P-values < 0.05 were considered to be statistically significant.

Response rates were calculated according to the number of pharmacies and clinics which responded out of the total number surveyed (60 hospitals and 113 health clinics), regardless of the number of subjects who filled the questionnaires in each health facility.

Results

A total of 186 prescribers from 65 clinics and 277 pharmacists from 44 hospitals completed the survey instrument with valid response rates of 57.5% and 73.3% for prescribers and pharmacists, respectively. The demographic characteristics of the participants are shown in (Table/Fig 1).

64.5% and 63.5% of the responded prescribers and pharmacists, respectively, knew that Malaysia has an essential medicines list. The percentages of correct answers for knowledge questions varied extremely, ranging from 37.1% (the Essential Medicines Concept concerned with medicines therapeutic efficacy) to 72.0% (generic medicines have the same quality as brand medicines), and from 57.8% (the Essential Medicines Concept concerned with medicines therapeutic efficacy) to 74.7% (medicine availability is one of Essential Medicines Concept parameters and generic medicines are more affordable than brand medicines) among prescribers and pharmacists, respectively (Table/Fig 2). Significant differences between the two groups were found for both the knowledge and attitudes items (Table/Fig 2). Knowledge sources were mainly internet and printed media (newspaper and magazine) for prescribers, and the internet and university curriculum for pharmacists.

When the measurement of items was used to compute scale variables (score systems on knowledge, attitudes and practice), some differences and similarities were found between prescribers and pharmacists. For both prescribers and pharmacists, the median score on knowledge was 5, with a minimum score of zero and a maximum score of 8. Both prescribers and pharmacists showed moderate positive attitudes towards essential medicines. The median score of the prescribers on attitude items was 17, with a minimum score of 9 and a maximum score of 25. The median score of the pharmacists on attitude items was 18, with a minimum score of 10 and maximum score of 25. The scores of the prescribers on practice (median= 8) were better than that of the pharmacists (median= 6).

The scores on knowledge, attitudes and practice were compared by respondent categories and demographic characteristics (Table/Fig 3).Female prescribers showed a significantly higher median attitude score than their male counterparts. Among both prescribers and pharmacists, Indians showed the best attitude scores, followed by their Chinese and Malay counterparts. On the other hand, Malay pharmacists scored the highest scores on practice items as compared to other ethnic groups. Both the specialists and the medical officers showed significantly higher attitude median scores than the other prescriber’s categories.

Correlations between scores on knowledge, attitudes and practice with the continuous variables of age and years of experience are presented in (Table/Fig 4). Among pharmacists, there were significant correlations between the two variables “age” and “years of experience” and between each of knowledge and practice scores. Among prescribers, there was only one significant correlation between years of experience and knowledge scores. All of the previous significant correlations were weak (correlation coefficients < 0.2) and positive (i.e. scores increased according to the increase in age and years of experience).

Correlations between the scores on positive attitudes and negative attitudes with the continuous variables of age and years of experience are presented in (Table/Fig 5). Among pharmacists, there were significant correlations between the two variables “age” and ‘positive attitude’ and between “years of experience” and ‘negative attitude’. Among prescribers, there was a significant correlation between “age” and “years of experience” and each of the positive attitude scores. All of the previous significant correlations were weak (correlation coefficients < 0.2).

Discussion

The essential medicines concept offers cost-effective solutions to many health problems among populations (9). The lack of knowledge among prescribers and pharmacists about the concept acts as a major barrier for their attitudes and practice. This affects the implementation of the concept in the field as well as the implementation of the national drug policy, since “essential medicines” is a cornerstone for the national drug policy (10).

In our findings, the levels of knowledge of the prescribers and pharmacists were less than satisfactory. Their responses to knowledge items indicated misunderstandings about EM. This is supported by the WHO report that focused on the misconceptions of the Western Pacific Region’s health professionals to EM. The report mentioned that health professionals thought that the essential medicines had low therapeutic efficacy (8). However, in contrast to the WHO report, our prescribers think positively about the quality of the generic medicines. Generally, the level of knowledge of the pharmacists seemed to be better than that of the prescribers. This may be explained by the fact that the main source of knowledge for the pharmacists was the university curricula. The difference between our two study groups in the affordability-related knowledge-items may be due to the fact that pharmacists are more aware about the cost-effective alternatives of medicines (11).

The theory of reasoned action states that people intend to conduct a behaviour such as considering essential medicines while prescribing and dispensing, only when they evaluate it positively (12). Almost half of the respondents expressed negative attitudes towards EMC. On the other hand, greater proportions of them showed positive attitudes. These contrasted findings can be explained by a model of dual attitudes in which people can simultaneously hold two different attitudes toward the same thing, one implicit and the other explicit (13). Compared to the prescribers, pharmacists showed a higher tendency towards positive attitudes as well as negative ones. Negative attitudes appear clearly through the thoughts of the respondents that their clinical freedom is restricted by following the essential medicines list, limitations of the innovation in the pharmaceutical industry and that EML is useful mainly for developing countries. In the same context, a survey on truth about the hospital formulary reported that 67% of the respondents believe that the formulary interferes with their clinical freedom (14). A survey in Nigeria about the acceptability of the essential medicines list (15) mentioned the same thing.

Our findings indicated inappropriate practices when dealing with EM. The prescription of EM to patients in our setting is lower than that reported by a study conducted in Nepal (16). Nevertheless, the authors recommended an education program for prescribers to increase rational prescribing according to the list of EM (17). Efforts are needed to strengthen the practice, and to consider EM in prescribing and dispensing activities. The prescribing and the dispensing according to EMC are important factors in the rational use of medicines (18), (19).

The relationship between demographic characteristics and the knowledge and attitudes is the most obvious feature. This might be explained by following specific guidelines or by using the same sources of knowledge by most groups, whereas, attitude is an aspect related to individuals. Our findings indicate that the attitude towards EMC among Indian pharmacists and prescribers were the best among different ethnic groups. Nevertheless, Indian pharmacists had the least practice scores and Malay pharmacists had the highest. These differences in ethnicity responses may be due to the fact that some minority groups have cultural norms, behaviour and beliefs that contradict other practitioner’s groups (20).

Our findings showed that younger practitioners held better attitudes towards EMC (i.e. attitude scores were negatively associated with age) while the older practitioners practiced better. It may be that the practice of the practitioners was enhanced as long as their experiences increased. On the other hand, newer issues in practice seemed to be more appealing to the younger and were expressed more positively in their attitudes as compared to those who were older. This was supported by the attitude of the practitioners towards complementary and alternative medicines (relatively new topic as essential medicines), which was found to be negatively associated with age (2),(20).

Our study showed that prescribers and pharmacists in Malaysia held positive attitudes towards EM. However, appropriate knowledge and good practices were not satisfactory. More efforts are needed by stakeholders to elevate awareness about the EMC, in order to fill the gap between the theory of essential medicines and the actual implementation of the concept in the field. The government should develop guidelines to consider essential drugs while prescribing and dispensing medications. As implementing the EMC in the field is a national responsibility, health care professionals should use essential drugs as a matter of priority. Differences in the attitudes between the genders and ethnic groups should be further studied. Also, differences in the attitudes and practice between higher degrees also need to be considered. In addition, private sector health professionals should be investigated because our study focused only on health professionals in the public sector.

Key Message

1. Essential medicines are the fundamental elements of primary health care, especially in developing nations.
2. Essential medicines satisfy the priority needs of a population in treating common health conditions.
3. Malaysian prescribers and pharmacists have somewhat positive attitudes but still lack appropriate knowledge and good practices with respect to essential medicines.
4. Efforts are warranted in Malaysia to focus on the increasing awareness of health professionals on the essential medicines concept.
5. An undergraduate curriculum and continuing medical/pharmacy education programs should be the priority and focus to increase awareness and knowledge on the essential medicines concept.

Acknowledgement

The authors would like to thank the management of all public hospitals and clinics who have approved the request to conduct this study in their institutions. They would also like to acknowledge all the prescribers and pharmacists who have participated in the study.

References

1.
. Quick JD. Essential medicines twenty-five years on: closing the access gap. Health Policy and Planning. 2003; 18: 1-3.
2.
. World Health Organization (2004) WHO Policy Perspectives on Medicines-Equitable access to essential medicines: a framework for collective action. [Online]. [Accessed19th September 2006]. Available from World Wide Web: http://whqlibdoc.who.int/hq/2004/WHO_EDM_2004.4.pdf. Geneva.
3.
. Chirac P. Translating the essential drugs concept into the context of the year 2000. Trans R Soc Trop Med Hyg. 2003; 97:10-2.
4.
. Ratanawijitrasin S, Soumerai, S. B. Weerasuriya, K. Do national medicinal drug policies and essential drug programs improve drug use? a review of experiences in developing countries. Soc Sci Med. 2001; 53:831-44.
5.
. World Health Organization. How to develop and implement a national drug policy. 2nd ed. Geneva: WHO; 2001.
6.
. Reidenberg MM, Walley T. The pros and cons of essential medicines for rich countries. BMJ. 2004; 329:1172.
7.
. Kanji N, Hardon A. What Has Been Achieved and Where are we now? In: Kanji N, Hardon, A., Harnmeijer, J. W., Mamdani, M. , Walt, G., editor. Drugs Policy in Developing Countries. London: Zed Books Ltd; 1992 p. pp. 91-109.
8.
. World Health Organization (2005) Regional Strategy for Improving Access to Essential Medicines in Western Pacific Region 2005-2010. ISBN 92 9061 185 5. Manila.
9.
. Quick JD, Hogerzeil HV., Velasquez G , Rago L. Twenty-five years of essential medicines. Bull World Health Organ. 2002; 80:913-4.
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. World Health Organization. Access to essential medicines. WHO Drug Information. 2007; 21:267-9.
11.
. Babar ZU. Pakistan's National University of Pharmaceutical Sciences. Am J Pharm Educ. 2006; 70:123.
12.
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