A QUALITATIVE STUDY EXPLORING PERCEPTION AND ATTITUDES
OF COMMUNITY PHARMACISTS ABOUT EXTENDED PHARMACY
SERVICES IN LAHORE, PAKISTAN
*Furqan Khurshid Hashmi1, Mohamed Azmi Hassali1, Fahad Saleem2, Zahir-ud-Din Babar3
1Discipline
of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, 11800, Universiti Sains Malaysia, Penang, Malaysia.
2Department of Pharmacy, University of Baluchistan, Quetta, Pakistan
3Lahore School of Pharmacy, Lahore Medical and Dental College, Lahore, Pakistan
* Corresponding author: [email protected]
ABSTRACT
Objective: The present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about extended pharmacy services (EPS) and their
readiness and acceptance to practice change in the city of Lahore, Pakistan.
Methodology: A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore,
Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analysed for thematic contents by the standard content analysis
framework.
Results: Thematic content analysis (TCA) yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of
EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. They CPs were ready to accept practice
change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary
structures were reported as barriers towards the provision of EPS at the practice settings.
Conclusion: The findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward
practice change provided to the support and facilitation of health and community based agencies in Pakistan.
SIGNIFICANCE OF STUDY DESIGN
INTRODUCTION
Extended pharmacy services (EPS) are referred to
those services which are other than traditional
services offered by the pharmacists such as
dispensing
and
providing
consultations
on
prescription and over-the-counter (OTC) medications,
but include new series of services as medication
therapy management (MTM), home medication
reviews (HMRs) involving comprehensive medication
reviews to look for medication-related problems
(MRPs) and all aspects of chronic disease
management (CDM) which may include include
screening, patient education, disease monitoring and
communication with the primary healthcare team
[1,2]. EPS requires additional or special skills,
knowledge by community pharmacists and require
facilities provided to people with special needs The
concept of EPS in Pakistan is a notion still naïve to
the community pharmacists and public. [3].
The pharmacists are underutilized as they are not
considered as healthcare professionals in Pakistan.
QUALITATIVE DESIGN
Hence, their role is neither identified nor recognized in
the health system in Pakistan [4]. Generally, in the study
setting majority of community pharmacists are unaware
of the concept of EPS.
Therefore, this quantitative study was conducted to
explore the perception and attitudes of community
pharmacists about their extended roles in the community
pharmacies in Lahore, Pakistan.
Table 1: Demographic characteristics of study respondents
(n=12)
Based on extensive literature review and prevailing practices in Pakistan,
semi-structured interview guide was developed
Validation of interview guide
Piloted on two community pharmacists
Respondents and inclusion criteria
Registered community pharmacists with provincial pharmacy council,
working full time in chain and independent pharmacies
Conduct of interview
Consented respondents were interviewed for about 30-40 minutes
All interviews were audio-recorded until saturation was reached at 10th
respondent
Characteristics
Frequency
Transcribed verbatim
SIGNIFICANCE
For under discovered research
areas, qualitative methods fill
gaps that are left unexposed by
survey based research
8
1
3
12
0
5
2
5
8
1
3
5
6
1
2
10
No
Themes
1
Familiarity with the extended pharmacy services (EPS)
2
Current system of practice and EPS in community pharmacies
in Lahore
3
training needed to provide EPS
4
Acceptance of EPS
5
Barriers towards adoption of EPS
Thematic content analysis (TCA)
Theme 1: Familiarity with the extended pharmacy services
(EPS):
“No I don’t have any idea about extended pharmacy service”(CP4)
Age (years)
20-30
31-40
>40
Gender
Male
Female
Educational status
B. Pharmacy
Pharm. D
Master
Experience (years)
1-5
6-10
>10
Status in pharmacy
Employee
Manager
Proprietor
Prescriptions filled/day
1-20
>20
Table 2: Themes identified after thematic content analysis
Data analysis
COVERAGE
Generates a wide range of
ideas and opinions that
individuals carry about issues,
as well as divulge viewpoint
differences among groups
RESULTS
METHODOLOGY
Instrument development
The design is flexible and
consents to an in-depth
exploration of respondents’
attitudes, experiences and
intentions
“The role of pharmacists beyond the typical dispensing services is
known as the extended pharmacy services and health care
services, I conduct MTM service on my own” (CP1)
Theme 2: Current system of practice and EPS in community
pharmacies in Lahore
“Community pharmacy practice is typically selling of medicines in
Pakistan it is not well defined and far from the concept of EPS”
(CP8)
Theme 3: training needed to provide EPS
“Continuous education programs for community pharmacists are
necessary and should be conducted on regular basis by the
pharmacy council” (CP6)
Theme 4: Acceptance of EPS
“Yes extended pharmacy services are necessary in Pakistan”
(CP9)
Theme 5: Barriers towards adoption of EPS
“There are barriers as patient has not much confidence in
pharmacist ..... our healthcare system is dominated by
doctors……only small percentage of patients accepts the
pharmacist’s intervention. Another major barrier is the timing or the
patients are always in hurry, it’s just a shop of medicines for them”
(CP6)
DISCUSSION
As far as community pharmacy services and practices are concerned, EPS is a new concept in Pakistan. The present study reported poor familiarity of CPs towards EPS in
Pakistan and suggested multiple factors that must be addressed to bring practice change at community pharmacies in Pakistan. however, majority of the respondents were
unaware of EPS. This warrants insufficient exposure of pharmacists during their undergraduate studies as pharmacy curriculum in Pakistan follows traditional classroom teaching
methodology. In addition to the lack of exposure, practicing pharmacists in Pakistan often fail to update their skills and knowledge as per trends and innovations being used and
introduced around the globe [5]. Therefore, in order to maximize the utilization of CPs at the community level, a set of unique structured strategies and health system reforms are
required to be introduced to enhance the knowledge and working capacity of CPs in Pakistan [6]. These strategies must aim to introduce trainings for CPs that can help in
increasing the confidence in providing EPS to the population.
REFERENCES
CONCLUSION
1.
This study showed lack of awareness of majority of CPs about the EPS and
pharmaceutical care in community pharmacies in Lahore, Pakistan. However the
CPs showed a good attitude toward practice change provided the government plays
its role to remove the barriers for the implementation of EPS in community
pharmacies and ultimate benefit of the public for primary care issues.
2.
3.
4.
5.
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