Involvement of Sudanese community pharmacists in public health activities

Public Health Interventions Delivered by Pharmacy Professionals in Low- and Middle-Income Countries in Africa: A Systematic Scoping Review

Pharmacists and their teams play an important role in providing public health services, however little is known about their level of contribution and the strength of evidence in Africa's Low- and Middle-Income Countries (LMICs). The purpose of this scoping review was to explore and map the available evidence on pharmacy professional-delivered public health interventions in Africa's LMICs. Six electronic databases (Medline, Embase, International Pharmaceutical Abstract, PsycInfo, Maternity and Infant Care, and Cochrane database), relevant grey literature sources, key journals focused on African health issues, and libraries of relevant organizations were searched between January 2010 and December 2020. Studies were included if they reported public health interventions delivered by pharmacy professionals (pharmacists or pharmacy technicians) or their teams. The quality of the individual studies was assessed using an adapted grading system. Thirty-nine studies were included in this review. Pharmacy professionals delivered a wide range of public health interventions, with the most common themes being noncommunicable diseases, infectious diseases, sexual and reproductive health, antimicrobial resistance, and other health conditions, e.g., dental health, unused drugs or waste, minor ailments. The majority of the studies were classified as low-quality evidence. They were predominantly feasibility and acceptability studies conducted in a narrow study area, in a small number of LMICs in Africa, resulting in little evidence of service effectiveness, issues of broad generalizability of the findings, and sustainability. The major constraints to service provision were identified as a lack of training, public recognition, and supporting policies. Pharmacy professionals and their teams across LMICs in Africa have attempted to expand their practice in public health. However, the pace of the expansion has been slow and lacks strong evidence for its generalizability and sustainability. Future research is needed to improve the quality of evidence, which will subsequently serve as a foundation for policy reform, allowing pharmacy professionals to make significant contributions to the public health initiatives in the region.

Attitudes, perceptions, and barriers of community pharmacists in Rwanda towards health promotion: a cross sectional study

Background

The practice of Pharmacists has changed worldwide over the past years. Today, health promotion is better known as an important part of modern pharmacy practice. Involving Community Pharmacists in health promotion is thus considered a valuable option in addressing public health issues. However, the literature on this practice remains unsubstantiated in African countries. In Rwanda, Community Pharmacists are believed to be solely involved in dispensing and very little has been studied about their role in health promotion. Thus, this study aimed to evaluate attitudes, perceptions, and barriers of Community Pharmacists in Rwanda towards their involvement in health promotion.

Methods

A cross-sectional study was conducted among 236 licensed Community Pharmacists in Rwanda from 23rd January to 23rd June, 2021. A list of all respondents was obtained from Rwanda Food and Drugs Authority. All participants were randomly enrolled. Each community pharmacy was represented by one Pharmacist. We collected data from community pharmacy settings using a self-administered questionnaire made of close and open-ended questions. Statistical analyses were performed using Statistical Packages for Social Sciences (SPSS) version 25.

Results

Of the 236 respondents, (n = 149, 63.1%) were male and (n = 87,37%) were female. The average age was 38.1 years (SD = 4.3). More than half confirmed that professional curriculum is adequate for offering health promotion services (n = 152, 64.4%).Majority responded that health promotion is part of their responsibility, and they are willing to provide health promotion services (n = 233,98.7%).The statement that “Pharmacists should not be involved in public health activities “was opposed by many (n=174,73.7%).The most sought-after service provided was education to drug misuse (n=211, 89.4%).Three major barriers to provision of health promotion were: lack of coordination with other healthcare professionals(n=106,69%),structure of healthcare system (n=157,67%),and lack of equipment (n=144,61%).Most Pharmacists disagreed with the statement that “patients are not interested in getting health promotion services”(n = 134,57%).

Conclusion

Though Community Pharmacists faced several challenges that hindered their participation in health promotion, they had positive attitudes towards promoting public health messages. There are several barriers like lack of structure to provide health promotion services that need to be addressed to boost more active participation of Pharmacists in health promotion.

Stakeholders' Acceptability of Pharmacist-Led Screening in Community Pharmacies: A Systematic Review

INTRODUCTION

Community pharmacists are among the most accessible healthcare providers. Community pharmacist-led screening may facilitate the early detection of illnesses/medical risk factors, optimizing health outcomes. However, it is important to assess the acceptability of screening services to ensure uptake by key stakeholders. The aim of this review was to explore the acceptability of community pharmacist-led screening by all stakeholders (i.e., patients, pharmacists, and other healthcare professionals) and identify the methods used to evaluate the acceptability of screening.

METHODS

A systematic search was conducted in Embase, MEDLINE, International Pharmaceutical Abstracts, and Scopus in April 2020 since inception. Studies that explored the acceptability of pharmacist-led screening for any risk factor/medical condition(s) within community pharmacies were included.

RESULTS

A total of 44 studies met the inclusion criteria. A total of 17 studies identified community pharmacies as appropriate screening locations. Seven studies reported that patients were comfortable with participating in pharmacist-led screening. Eight studies explored acceptability from the perspective of medical practitioners and other healthcare professionals, with 6 reporting high recommendation acceptance rates and/or acceptability of pharmacist-led screening. Barriers to pharmacist-led screening included time and privacy constraints, whereas adequate remuneration was considered an important enabler.

DISCUSSION

Community pharmacist-led screening appears to be acceptable to patients, pharmacists, and other healthcare professionals. However, no uniform psychometrically sound measure of acceptability was used consistently across studies, rendering comparisons difficult and showing the need for future research exploring the psychometric properties of acceptability measures. Findings, including barriers and enablers to pharmacist-led screening, are important to consider when providing screening services in community pharmacies.

Instruments to assess the role of the clinical pharmacist: a systematic review

BACKGROUND

The clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge regarding the instruments that evaluate the different activities of the clinical pharmacist, as well as the evaluation of the psychometric properties of these instruments, is necessary.

METHODS

A literature search was performed in the PubMed and Scopus electronic databases without time and language restrictions. For the search strategy, the "pharmaceutical services," "validity studies," and "professional performance" domains were used. To assess the quality of the instruments, the five sources of validity evidence of contemporary psychometry were used, and the Joanna Briggs Institute's standardized instrument was used to assess the methodological quality of the studies. After screening 4096 articles, 32 studies were selected.

RESULTS

A total of 32 studies were included, and 32 instruments were identified to be used by pharmacists acting in various pharmaceutical practice scenarios. It was found that the available instruments were developed or adapted from others, with variation in the methods, constructs, dimensions, and domains, as well as the psychometric properties. Most of the instruments addressed community pharmacies, and evidence of content validity and internal structure was found most frequently. A standardized and validated instrument that comprehensively assessed the performance of the clinical pharmacist, addressing clinical activities, was not identified for all practice environments.

CONCLUSIONS

Without standardized and validated instruments specifics to assess the performance of the clinical pharmacist, it is hard to establish the main clinical activities performed by pharmacists in their pharmaceutical practice environments and to propose training actions to improve professional practice. Despite the large number of instruments available and considered validated by the authors, it is questioned to what extent the validity indicators presented in the different studies really show the validation status.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD 42018099912.

Knowledge, attitude, perceived barriers, and practices among pharmacists regarding risk assessment of cardiovascular disease: a cross-sectional study in Yemen

BACKGROUND

Risk evaluation of atherosclerotic cardiovascular diseases can guide the decision-making on various preventive measures, such as initiating or deferring statin therapy. Pharmacists can play an active part in the risk evaluation and primary prevention of atherosclerotic cardiovascular diseases. Thus, our study aimed to assess the pharmacists' knowledge, attitude, perceived barriers, and practices regarding risk assessment of atherosclerotic cardiovascular disease.

MATERIALS AND METHODS

A cross-sectional study was conducted among 500 pharmacists using a structured validated questionnaire between November 2020 and February 2021. The Mann-Whitney and Kruskal-Wallis tests were used to analyze the data.

RESULTS

A total of 456 pharmacists completed the questionnaire out of 500 distributed (91.2% response rate). Over 60% of participants responded with never or rarely for two out of five cardiovascular diseases (CVD) prevention practices. The lowest pharmacist-patient counseling practices were for side effects of statin medication (14.5%) and reviewing the patient's medications to avoid potential statin-drug interactions (31.8%). Participants had a high positive attitude (median = 34 out of 40). The three major barriers for risk assessment were the lack of support (74.8%), the lack of resources (70.6%), and inadequate training (48.7%). Interestingly, having ≤75 customers a day, community pharmacies, PharmD degree, age ≥30 years, and experience ≥6 years were significantly associated (p < .05) with higher CVD prevention activities and counseling practices.

CONCLUSION

Pharmacists have a high positive attitude toward CVD risk assessment. However, they had insufficient knowledge and only provided limited activities and counseling services for CVD prevention and statin therapy. Participants perceived several barriers to CVD risk assessment services in pharmacies. Therefore, it is necessary to remove these impediments for pharmacists to be more involved in CVD risk assessment and prevention. Also, continuing medical education and adequate training for pharmacists are required.

Involvement of community pharmacists in public health services in Asir Region, Saudi Arabia: A cross-sectional study

BACKGROUND

Community pharmacists are one of the most accessible healthcare practitioners worldwide and their services are used by a large proportion of the population. Expanding the roles of community pharmacists could contribute to reducing pressure on general health practice and other areas of the health services. This research aimed to evaluate the contribution of community pharmacists in the provision of public health services and to investigate the perceived barriers for the provision of these services in Saudi Arabia.

MATERIALS AND METHODS

This study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study took place in Asir region, Saudi Arabia, between September 2019 and February 2020. A convenience sampling strategy was used to select and recruit the study participants. The questionnaire was adapted from previous research and involved three sections: demographics, involvement in public health services and barriers for practising public health roles.

RESULTS

The total number of respondents was 193. The proportion of respondents who reported that they were "very involved" or "involved" in each service was 61.7% for weight management, 60.6% for sexual health, 57.5% for healthy eating, 53.4% for physical activity promotion, 51.3% for dental health, 46.1% for smoking cessation, 39.4% for screening for diabetes, 35.7% for screening for hypertension, 31.1% for alcohol dependence and drug misuse counselling, 30.6% for screening for dyslipidaemia, and 21.8% for vaccination and immunisation. Most of the barriers in the current research were rated as having low relevance to the provision of public health services.

CONCLUSION

Findings in the current research suggest that community pharmacists in Asir region have varying levels of involvement in public health roles. Further research needs to be undertaken to understand the barriers to the provision of public health services and what strategies would be beneficial for enhancing the public health role of community pharmacists in Saudi Arabia.

How do Polish pharmacy staff evaluate own qualifications, competences, relevance, motivation, effectiveness in health promotion?

Health promotion programmes are complex and need to engage all health care specialists, including pharmacists. Pharmacies are considered as a potentially ideal place for health promotion and education. To evaluate own qualifications, competences, relevance, motivation and effectiveness of Polish pharmacy staff with regard to health-related information provided to patients, which contributes to health promotion. 308 pharmacy staff from Lublin (Poland) were surveyed with a questionnaire prepared by the researchers and piloted previously. It consisted of 5 domains: qualifications, competences, relevance, motivation, and effectiveness of health promotion. Items in each domain were scored by respondents in 1 − 10 scale where 1 is ‘very low’ and 10 is ‘very high’. Pharmacy staff rated the relevance of health promotion the highest, while the lowest—own competences and effectiveness in health promotion. Female pharmacy staff assessed the relevance of health promotion significantly higher than males (7.1 vs. 6.1, p = 0.005). Higher self-assessments of qualifications, competences, relevance, motivation and effectiveness in health promotion were provided by: the youngest pharmacy staff, those with a short period of employment, and pharmacy staff working in pharmacies employing up to 3 persons. Qualification and competences in health promotion were assessed higher by pharmacy technicians and masters of pharmacy with post-graduate studies or professional specialization, or Ph.D. than by masters of pharmacy. Relevance and effectiveness in health promotion were evaluated higher by pharmacy staff in pharmacies serving more than 100 customers daily. There is a need to improve qualifications, competences, relevance, motivation and effectiveness in health promotion conducted by Polish pharmacy staff.

Pharmacy Practice in High-Volume Community Settings: Barriers and Ethical Responsibilities

Pharmaceutical care describes a philosophy and practice paradigm that calls upon pharmacists to work with other healthcare professionals and patients to achieve optimal health outcomes. Among the most accessible health professionals, pharmacists have responsibilities to individual patients and to public health, and this has been especially evident during the COVID-19 pandemic. Pharmacists in high-volume community settings provide a growing number of clinical services (i.e., immunizations and point-of-care testing), but according to job satisfaction and workplace survey data, demands related to filling prescriptions, insufficient staffing, and working conditions are often not optimal for these enhanced responsibilities and lead to job dissatisfaction. Professional codes of ethics require a high level of practice that is currently difficult to maintain due to a number of related barriers. In this paper, we summarize recent changes to the scope of practice of pharmacists, cite ethical responsibilities from the American Pharmacists Association Code of Ethics, review data and comments from workplace surveys, and make a call for change. Corporate managers, state boards of pharmacy, and professional organizations have a shared responsibility to work with community pharmacists in all settings to find solutions that ensure optimal and ethical patient care. Attention to these areas will enhance patient care and increase job satisfaction.

Community pharmacists' knowledge and practice regarding malaria and its treatment in Sudan: a cross-sectional survey

Background Malaria is one of the main causes of death in Sudan with high prevalence among males, children under five-year and pregnant women. In 2016 near 13% of hospital admissions in Sudan were due to malaria. Community pharmacist dispensing of antimalarial drugs without prescription and malaria self-treatment may lead to the development of drugs resistance and delay disease control. Objective To assess the knowledge and practice of community pharmacists regarding malaria and its treatment. Setting Community pharmacies in Khartoum State, Sudan. Method A cross-sectional survey was carried using a structured pre-tested self-administered questionnaire for the pharmacists in charge of 320 randomly selected community pharmacies. Main outcome measures The community pharmacists'knowledge and practices regarding malaria and antimalarials dispensing. Results A total of 293 pharmacists participated in the study giving a response rate of 91.5%. About 92.2% of the respondents were from the age of 20-39 years and 63.8% had less than 5 years of experience. Community pharmacists showed inadequate knowledge regarding malaria and its treatment. In addition to that, they were dispensing antimalarials without prescriptions. The community pharmacists reported many barriers to their effective contribution in malaria prevention and treatment such as lack of knowledge, lack of time and lack of training. Conclusion Inadequate knowledge and irrational antimalarials dispensing practices were reported among the community pharmacists in Khartoum State. Although training was a significant predictor of pharmacists' knowledge regarding malaria and its treatment, health authorities were not providing regular training for the practicing pharmacists.

Self-assessment of Polish pharmacy staff's readiness to promote health

Background Nowadays, pharmacists are expected to focus not only on dispensing medicines but also on the wellness of the patient. In some developed countries a pharmacist is clearly defined as a health care professional that can make a contribution to improving the general health of the population. Objective To assess the readiness of Polish pharmacy staff to engage in health promotion and educational activities. Setting Community pharmacies in Poland. Method The study group consisted of 308 pharmacy staff (248 pharmacists and 60 pharmacy technicians) employed in Polish pharmacies. The survey questionnaire referred to three domains: systemic solutions for health promotion, readiness of pharmacy staff as a professional group to promote health, personal readiness to promote health. Responses about pharmacy staff’s readiness to promote health were scored using a 10-point scale. Scale reliability for all items (overall readiness), and for items within the three domains separately, were tested using Cronbach’s α and average inter-correlation coefficient among the items. Main outcome measure Pharmacy staff’s readiness to promote health (the questionnaire containing 32 items). Results The overall readiness of pharmacy staff to promote health was rather low (average of 4.6 ± 1.5 in 1–10 scale). The highest scores were obtained for pharmacy staff’s personal readiness to promote health (average of 5.5 ± 1.8) which was neutral on the scale. The lowest scores were obtained for systemic solutions for health promotion (average of 3.6 ± 1.4). Readiness of pharmacy staff as a professional group was ranked in the middle (average 4.8 ± 1.8). Surveyed pharmacy staff rated their readiness to promote health in the work environment significantly higher than promoting health in the local community. Female and younger pharmacy staff as well as those with job seniority of less than 5 years, or pharmacy technicians assessed their readiness to promote health significantly higher than others. Readiness to promote health was higher among pharmacy staff working in pharmacies employing up to 3 staff members and at pharmacies with over 200 customers daily. Conclusions The overall readiness of pharmacy staff to promote health was low, especially in the domain of systemic solutions in health promotion.

Attitudes and practices of community pharmacists and barriers to their participation in public health activities in Yemen: mind the gap

BACKGROUND

Patients in Yemen commonly visit community pharmacies to obtain consultation or treatment for common ailments. Community pharmacists have an opportunity to optimize medication use and improve patient outcomes. This study aimed to evaluate the attitudes and practices of community pharmacists regarding their participation in public health activities and barriers to their participation in these activities.

METHODS

This cross-sectional study was carried out among community pharmacists working in pharmacies located in urban areas of the Aden governorate of Yemen from March to June 2017 using a self-administered questionnaire. We selected pharmacies from a line list using proportional sampling according to the number of pharmacies in the urban areas of each district. The questionnaire contained four sections: demographic characteristics, attitudes, practices, and barriers encountered. Data were analyzed descriptively, and the Chi-square test was used for analyzing the association of variables (alpha = 0.05).

RESULTS

The questionnaire was distributed to 200 community pharmacists working in community pharmacies. Of the 200 respondents, 62% (n = 124) were male. Overall, the mean age (sd) was 30.0 years (8.6) with the number of years of work experience between 2 and 9.9 years (n = 158, 79%). On average, 62.3% of the pharmacists had a positive attitude toward participation in public health activities. Providing education to stop tobacco chewing, smoking, alcohol drinking and improve oral hygiene was an important activity of the community pharmacists. Blood pressure measurements (86%, n = 172) and glucose tests (45%, n = 90) were commonly conducted for clients. Lack of time (71%, n = 142) and lack of teamwork (70%, n = 140) were mentioned as common barriers to participation in public health activities.

CONCLUSIONS

Community pharmacists had a positive attitude toward public health activities. Health education and routine health tests were important practices of the community pharmacists. Barriers need to be overcome to enable more active participation by community pharmacists in public health activities by consulting with all stakeholders, assessing the situation, considering alternatives and taking action.

Barriers to promote cardiovascular health in community pharmacies: a systematic review

Community pharmacists play an important role in the provision of health promotion services, and community pharmacies are considered as a potentially ideal site for cardiovascular health promotion. Information based on a systematic review of barriers to promoting cardiovascular health in community pharmacy is currently lacking. We have sought to identify the most important barriers to cardiovascular health promotion in the community pharmacy. We have systematically searched PubMed and International Pharmaceutical Abstracts for a period of 15 years from 1 April 1998 to 1 April 2013, contacted subject experts and hand-searched bibliographies. We have included peer-reviewed articles, with English abstracts in the analysis, if they reported community pharmacists' perceptions of the barriers to cardiovascular health promotion activities in a community pharmacy setting. Two reviewers have independently extracted study characteristics and data. We identified 24 studies that satisfy the eligibility criteria. The main barriers to cardiovascular health promotion in the community pharmacy included pharmacist-related factors; practice site factors; financial factors; legal factors; and patient-related factors. This review will help to provide reliable evidence for health promotion practitioners of the barriers to promoting cardiovascular health in the community pharmacy setting. This knowledge is valuable for the improvement of cardiovascular health promotion in this setting and guiding future research.

Benefits and tensions in delivering public health in community pharmacies – a qualitative study of healthy living pharmacy staff champions

Objective

Healthy Living Pharmacies (HLP) were introduced in the United Kingdom (UK) in a further attempt to deliver public health benefits in community pharmacy settings. Central to the initiative are staff trained as Healthy Living Champions (HLC) and this study sought to explore HLC perceptions of positive and negative aspect of their work and the wider scheme.

Methods

A qualitative study was undertaken with a purposive sample of HLCs working in pathfinder HCPs in the Sheffield area in 2014. Participants were recruited by email to either a focus group (n = 7) held at a training event or later semi-structured one-to-one interviews in pharmacies (n = 6). Four stages of interpretative phenomenological analysis were used to code and identify themes.

Key findings

Four main themes emerged relating to the positive workforce development impact HLPs had upon HLCs themselves and on perceived customer and patient engagement and benefits. Tensions were identified with existing commercial business demands and negative views overall of the pharmacy setting with a perceived lack of not only integration with other services but also awareness among the public and health care staff. HLCs felt empowered and more confident in initiating conversation about health issues with patients, but identified barriers relating to workload, a lack of time to perform their role, isolation, tensions with non-HLC staff and logistical barriers such as poor Internet access.

Conclusions

Delivering public health activities through the HLC role in UK pharmacies is associated with several perceived benefits for different stakeholders, but may be threatened by well recognised barriers in UK pharmacies related to the commercial setting.

Competency-based pharmacy education in the Eastern Mediterranean Region-A scoping review

BACKGROUND

The International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) was developed as a mapping tool to provide guidance for foundation level pharmacy practice and professional development. The Eastern Mediterranean Region (EMR) with a deep rooted pharmacy history is yet to adopt an explicit competency framework.

OBJECTIVE

To review the literature for evidence of competency-based pharmacy education in the EMR, including pharmacists' and pharmacy students' perceptions of knowledge and skills acquired during training at undergraduate, post-graduate, and life-long learning levels.

METHODS

Six electronic databases were searched for articles published between 1990 and 2014. Titles and abstracts were screened according to the inclusion criteria. Full articles identified for inclusion were assessed and mapped to a relevant domain of the GbCF.

RESULTS

Totally, 57 studies met the inclusion criteria. The majority of studies portrayed pharmacists' and pharmacy students' opinions regarding educational aspects of their experiences. Participants generally cited the need for more practice-based training, modernization of curriculum, continuing pharmacist education and greater involvement in public health promotion, and research to strengthen professional competency. Interventional studies-enhanced knowledge and skills after training was provided to pharmacists and pharmacy students. No studies pertaining to the organization and management domain of the GbCF were found.

CONCLUSION

Despite paucity of studies that specifically investigated aspects of competency-based pharmacy education in the EMR, results provided impressions of what participants perceived as beneficial, or lacking in their education to attain certain competencies. Results point toward the need to implement a competency framework specific to the EMR.

Engaging Nigerian community pharmacists in public health programs: assessment of their knowledge, attitude and practice in Enugu metropolis

OBJECTIVES

The Nigerian health sector battles with control of infectious diseases and emerging non-communicable diseases. Number of healthcare personnel involved in public health programs need to be boosted to contain the health challenges of the country. Therefore, it is important to assess whether community pharmacists in Nigeria could be engaged in the promotion and delivery of various public health interventions. This study aimed to assess level of knowledge, attitude and practice of public health by community pharmacists.

METHODS

The cross sectional survey was carried out in Enugu metropolis. Questionnaire items were developed from expert literature. Percentage satisfactory knowledge and practice were obtained by determining the percentage of community pharmacists that were able to list more than 2 activities or that stated the correct answer. Attitude score represents the average score on the 5 point Likert scale for each item. Chi square and Fisher's exact test were used to test for statistically significant difference in knowledge, attitude and practice of public health between different groups of community pharmacists.

RESULTS

Forty pharmacists participated in the survey. About one third of the participants had satisfactory knowledge of public health. With the exception of one item in attitude assessment, average item score ranged from 'agreed' to 'strongly agreed'. Study participants scored below satisfactory on practice of public health. Knowledge, attitude and practice of public health were not influenced by years of practice, qualification and prior public health experience. Reported barriers to the practice of public health include inadequate funds, lack of time, lack of space, cooperation of clients, inadequate staff, government regulation, insufficient knowledge, and remuneration.

CONCLUSIONS

Level of knowledge and practice of public health by community pharmacists were not satisfactory although they had a positive attitude towards practice of public health. The findings highlight the importance of educational interventions targeted towards practicing community pharmacists to improve their knowledge level on public health issues. Providing incentives for public health services rendered could increase community pharmacists' engagement in public health activities.

Sudanese community pharmacy practice and its readiness for change to patient care

OBJECTIVES

This study aims to describe the current state of Sudanese community pharmacy practice and explore the capacity of existing community pharmacies to foster the change to pharmaceutical care (PC) and to assess attitude and knowledge of community pharmacists regarding PC and identify barriers.

METHODS

A structured, self-administered, piloted questionnaire was distributed to the pharmacists in charge of 274, randomly selected, community pharmacies in Khartoum state. The questionnaire included six domains: demographic characteristics, organizational structure of community pharmacies, current activities of community pharmacists, their attitudes and knowledge regarding PC, and potential barriers. Attitude responses were measured by a 5-point Likert scale.

KEY FINDINGS

Response rate was 67%. Community pharmacies are short on some tools that are deemed necessary for PC implementation, e.g. consultation areas. Community pharmacists provide mainly product-focused services with no or little PC activities. However, there is a highly positive attitude among the majority of respondents towards practice change to include PC (mean positive score ± standard deviation = 4.39 ± 0.73, frequency (%) = 89%). Many barriers to implementation of PC were identified, e.g. pharmacists' clinical knowledge and lack of understanding of pharmacist's new role.

CONCLUSION

Sudanese community pharmacists favour practice change to include PC. Successful implementation of PC requires substantial organizational and structural changes in community pharmacies, including provision of clinical knowledge, strengthening of clinical training and new practice standards. This change in practice could benefit from involvement of academia, governmental bodies and professional organizations working together for the pharmacy profession.

The role of Sudanese community pharmacists in patients' self-care

OBJECTIVES

To describe the current and potential roles of Sudanese community pharmacists in responding to symptoms (RTS) and chronic diseases management (CDM) and identify perceived barriers.

SETTINGS

Community pharmacies in Khartoum State.

METHOD

A structured, self-administered, piloted questionnaire was conducted of pharmacists in charge of 274, randomly selected, community pharmacies. Close ended questions and a 5-point Likert-type scale were used to measure responses.

MAIN OUTCOME MEASURE

Respondents' demographics, their current activities, attitude and involvement in RTS and CDM and potential barriers. Response rate was 67 %. The majority of respondents (>90 %) reported that they are involved in RTS activities but have negative views regarding practice standards. They lack specific lists of minor conditions and their treatment (87.4 %), recorded counseling procedure (84.7 %), and referral forms (85.8 %). Almost all community pharmacists see an important role for them in CDM (4.54 ± 0.74, 95.3 %) and accept team work with other health care providers (4.46 ± 0.74, 87.5 %). Lack of proper knowledge and training, time, space, patients' acceptance and official recognition of pharmacists' new role, were some of the identified barriers.

CONCLUSION

Sudanese community pharmacists provide RTS and CDM services; however, clinical knowledge and training and well defined national practice standards needs were identified. The current product-focused activities need to be refined to include more patient-focused services. For Improved patients' self-care services, a number of obstacles identified by surveyed pharmacists need to resolved. This requires collaboration of different parties including academics, governmental bodies and professional organizations.