Challenges to clinical pharmacy practice in Nigerian hospitals: a qualitative exploration of stakeholders' views

The role of pharmacists in eliminating counterfeit medicines in Nigeria

Introduction

Over the years, counterfeit pharmaceuticals have posed immense concerns for global health and patient safety. This menace encompasses various classes of medications. Given the criticality of pharmacists' interventions in drug distribution and supply, this study aimed at exploring their role in the prevention and control of counterfeit pharmaceutical products in Nigeria.

Methods

A cross-sectional study was undertaken, using questionnaires to collect data from pharmacists across various sectors of pharmacy practice in Nigeria. Face and content validity was undertaken on the study tool prior to data collection. Ethical approval was obtained from the National Institute for Pharmaceutical Research and Development Health Research Ethics Committee, and confidentiality was strictly maintained during data collection process. Data were analyzed using Statistical Package for Social Sciences. Descriptive statistical analysis was undertaken and chi square was used to determine association between socio-demographic characteristics and variables.

Results

The responses comprised 205 (52.6%) female and 185 (47.4%) male participants. Almost all the participants (98.4%) agreed that strict enforcement of drug laws can contribute to adequate control of counterfeit medicines in Nigeria, and majority of the study sample (64.7%) indicated that the poor implementation of these laws was a major factor influencing the preponderance of counterfeit medicines in the country. Two-thirds (63.5%) of the participants supported the need for pharmacists to provide adequate education to patients on strategies to identify counterfeit medicines, and a similar proportion (68.0%) were of the opinion that it was the responsibility of pharmacists to ensure that drugs are purchased from credible sources.

Conclusion

Findings from this study, in addition to confirming pharmacists' instrumentality in the fight against counterfeit medicines, identified certain context specific factors that can strengthen the regulation, policy and the entire healthcare system. Government and relevant stakeholders can therefore begin to articulate strategic reforms for contextual policy intervention that address medicines' counterfeiting, whilst prioritising pharmacists' role in other critical areas in the healthcare system.

Barriers and facilitators of integration of pharmacists in the provision of clinical pharmacy services in Tanzania

BACKGROUND

Collaboration between medical doctors and nurses in the provision of healthcare services has been there for decades. The concept of clinical pharmacy services as a main goal for pharmacy practice is relatively new and is yielding more positive results for healthcare providers (HCPs), patients, and the health system. This study assessed barriers and facilitators toward the integration of pharmacists in the provision of CPS in Tanzania.

METHODS

A qualitative study was conducted in five tertiary hospitals representing Tanzania mainland. Ten (10) focus group discussions (FGDs) with 83 HCPs and 14 in-depth interviews (IDIs) with hospital administrators in referral hospitals were conducted between August and September 2021. The experienced qualitative researchers moderated the IDIs and FGDs, and all discussions were audio-recorded. Finally, the audios were transcribed verbatim, and analysis was done using a thematic approach.

RESULTS

Limited skills, lack of confidence, poor communication, inferiority, and superiority behaviors among HCPs were among the mentioned barriers. Shortage of pharmacists, lack of in-job training, standard operating procedures (SOPs), and guidelines were also mentioned. The study noted the high acceptability of CPS by other HCPs, the positive perception of pharmacists, and the recognition of CPS by the Tanzania Pharmacy Act and regulation.

CONCLUSION

The facilitators and barriers to the integration of pharmacists in the provision of CPS lie at the individual, health facility, and health system levels. Therefore, the study recommends in-job pharmacists training, fostering teamwork among HCPs, and development of CPS SoPs, and guidelines.

Clinical pharmacists' perceptions of the barriers and facilitators to the implementation of paediatric clinical pharmacy services in Hong Kong

OBJECTIVES

To identify barriers and facilitators that influenced the implementation of paediatric clinical pharmacy service (CPS) in Hong Kong's public hospitals from clinical pharmacists' perspective.

METHODS

A qualitative study based on semi-structured interviews of clinical pharmacists who practiced in paediatrics in public hospitals in Hong Kong. Interview schedule was designed based on determined themes identified in previous research and pilot testing was performed. The coding process was performed by two researchers with the resulting topics organised by thematic analysis. Consensus was reached amongst the researchers for the identification of themes that emerged during the interviews. The Consolidated Criteria for Reporting Qualitative Research guideline was followed to ensure the complete and transparent reporting of this research. Ethical approval for this study was obtained from the research ethics committee of the relevant institutions.

KEY FINDINGS

Of the 32 clinical pharmacists from across the study sites, 12 were interviewed. Five barriers and three facilitators were identified as main themes. The barriers that were identified which hindered service implementation include the service penetration into the healthcare system, practice environment constraints, lack of affirmation from the administrative stakeholders, governance of the profession and partnership with universities. The facilitators that were identified which enabled service implementation include other healthcare professionals' trust and confidence in the service, the support from the pharmacy management team and clinical pharmacists' self-efficacy.

CONCLUSIONS

Clinical pharmacists interviewed reported that the successful implementation of CPS in paediatrics in public hospitals in Hong Kong is an area of continued development with several key barriers identified.

Implementing clinical pharmacy activities in hospital setting in Vietnam: current status from a national survey

Background

Clinical pharmacy activities have evolved over the past decades contributing to all stages of the patient care process, especially in the hospital setting. However, these practice roles may differ to a significant extent depending on the healthcare policy of countries. In Vietnam, the magnitude of adopting clinical pharmacy activities in hospital settings throughout the country is still unknown since these activities have been implemented. This study aimed to ascertain the current status of clinical pharmacy activities performed within the Vietnamese hospital setting.

Methods

A nation-wide survey was conducted from December 2017 to January 2018. Two online questionnaires, one for the Heads of Pharmacy Department and one for clinical pharmacists, were designed based on the national legal regulations about implementing clinical pharmacy activities in the hospital setting. These questionnaires were sent to all hospitals and healthcare facilities with a department of pharmacy.

Results

A total of 560 Heads of Pharmacy and 574 clinical pharmacists participated in the study, representing a response rate of 41.2%. Among the participating hospitals, non-patient specific activities were implemented widely across all hospital classes, with pharmacovigilance, medication information, and standard operating procedures development implemented in ≥88% of all hospitals. In contrast, there was a significant variation in the level of implementation of patient-specific activities among hospital classes. With activities such as medication counselling, monitoring of adverse drug reactions, and obtaining patient’s medication histories provided at a considerably lower level in between 49 and 57% of hospitals.

Conclusion

Clinical pharmacy activities have been initiated in most of the surveyed hospitals. In general, clinical pharmacy is more established in higher-class hospitals in Vietnam. However, the current implementation status is focused on non-patient-specific activities, while patient-oriented activities remained insufficiently established.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08242-5.

Participation of pharmacy technicians in clinical and patient-centered care practices: A state-wide survey in Nigeria

BACKGROUND

Identifying the involvement of pharmacy technicians (PTs) in nonclinical and clinical duties will provide insight for improved pharmaceutical services.

OBJECTIVES

This study assessed the involvement of PTs in nonclinical tasks, patient-centered services, and more specialized patient care services and the difference in practice between hospital and community PTs.

METHODS

A cross-sectional survey was conducted using a 5-point Likert scale, and an analysis of data was performed using IBM SPSS version 21.0 (IBM). Descriptive statistics was done, and P ≤ 0.05 was considered statistically significant. The study was conducted in community and hospital pharmacies in Ogun State, Nigeria, among 100 PTs. Outcome measures were the involvement of PTs in clinical roles and other pharmaceutical care practices.

RESULTS

A total of 73 (73.0%) participated in the study, 45 (61.6%) and 28 (38.4%) practiced in hospital and community pharmacies, respectively. From the 11 listed nonclinical activities, only stocking of medications 61 (83.6%) and processing clients' or patient's charges 48 (65.8%) were often or very often performed. More than half of the participants often performed each of all 7 listed patient-centered activities, particularly empathy and confidentiality 62 (84.9%), providing information and referrals to patients or clients 56 (76.7%), and identifying patients or clients for counseling 51 (69.9%), respectively. No statistically significant difference was observed between the practice areas (P > 0.05). Only 2 of the 11 listed specialized clinical activities were performed by more than half of the respondents: screening prescriptions for completeness and authenticity 43 (58.9%) and alerting the pharmacist of drug therapy problems 46 (63.0%). Differences in the practice of specialized tasks was statistically significant for consultations (P = 0.002) and resolution of clinical conflict (P = 0.040) between the practice areas.

CONCLUSION

Study participants were less frequently involved in nonclinical activities but often involved in clinical activities. They also participated in specialized clinical tasks at lesser frequencies. Differences were observed between the practice areas in performance of nonclinical and specialized activities. Strategies to fill in the observed gaps should be explored for improved practice.

Pharmacy graduates' perceptions of competency, integration, and social accountability in the undergraduate curriculum of pharmacy schools in Nigeria

INTRODUCTION

An integrated, competency-based curriculum that fosters social accountability including cultural sensitivity among graduates is an educational strategy towards producing practice-ready professionals. This study aimed to evaluate pharmacy graduates' perceptions of competency, integration, and social accountability in the undergraduate curriculum of Nigerian schools of pharmacy.

METHODS

A cross-sectional online survey consisting of a 42-item questionnaire was administered to 467 purposively selected pharmacy graduates who completed their undergraduate training between January 2012 and February 2020 from 20 accredited Nigerian pharmacy schools. Mann-Whitney U test was used to determine the differences in the participants' responses on a Likert scale.

RESULTS

Of 467 participants, 54.4% felt that the Nigerian undergraduate pharmacy curriculum was not adequate in content, while 54.2% felt the courses in the curriculum were not well integrated to facilitate easy learning by students. About half (50.6%) strongly agreed or agreed that "the basic pharmacy courses are well synchronized with the clinical components" but 28.9% strongly disagreed or disagreed. The majority (88%), with no significant difference between gender (z = -1.615, P = .11), strongly agreed or agreed that they apply knowledge of clients' culture and disparity to deliver pharmaceutical services.

CONCLUSIONS

Marginally above half of the graduates perceived the Nigerian undergraduate pharmacy curriculum to be deficient in course content. There is evidence of limited integration and social accountability in the curriculum. Cultural sensitivity appears to be a component of the curriculum but this needs to be properly structured. The pedagogy strategy for learning cultural sensitivity should be further interrogated.

Advanced pharmacist practice: where is the United Kingdom in pursuit of this 'Brave New World'?

Pharmacy has developed many novel patient-facing roles across the globe, typically delivered through the lens of pharmaceutical care. The macro-level implementation of such interventions is, however, fraught with difficulty. At an individual-level, psychological barriers of pharmacists and their ability to deliver autonomous complex clinical care are key considerations. As the United Kingdom imminently plans to launch a new advanced pharmacist practice curriculum and credentialing process to support advanced skills development, this commentary discusses where progress to date has taken us and what other developmental, environmental and cultural changes are needed to support this. The commentary also challenges some of pharmacy's historic dogma, discusses a requirement for teaching to transcend simplistic concepts of medicines-harm, considers the need for the standardisation of clinical skills and discusses the necessity of formal advanced practice programmes and preceptorship models. It finally proposes the concept of Advanced Pharmacist Practitioners as the ultimate future vision of autonomous practice and the need for Government Policy to support their creation.

A profession in danger: Stakeholders' perspectives on supporting the pharmacy profession in Lebanon

Background

Lebanon boosts one of the highest pharmacists to population ratios globally (20.3/10,000). Yet, workforce analysis elicited serious concerns with the distribution, practice environments and regulation of Lebanese pharmacists. Recent workforce data shows that the profession has been majorly destabilized with hundreds of pharmacists closing their pharmacies or losing their employment. Proper planning for the future of the pharmacy profession in Lebanon necessitates a deeper understanding of the current challenges and the necessary policy and practice recommendations. The aim of this study is to examine stakeholders’ perspectives on the current pharmacist workforce challenges and the necessary measures to support the profession.

Methods

The research team carried out a series of semi-structured interviews with twenty-one key stakeholders within the pharmacy profession in Lebanon. We categorized stakeholders according to their experience as policy makers, practitioners, academicians, and media experts. The interview guide included questions about workforce trends, labor market challenges and recommendations for improvement. Interviews were transcribed and analyzed thematically.

Results

Four major themes emerged from this study: the oversupply of pharmacists in Lebanon, the demand supply imbalance, poor regulation of the pharmacy practice, and the difficult practice environment. There was a consensus among interviewees that the oversupply of pharmacists is due to the poor workforce planning and weak regulatory framework, combined with the easy integration of foreign-trained pharmacists into the labor market. The lack of coordination between the educational and practice sectors is further widening the demand-supply gap. Interviewees further revealed that the regulatory policies on pharmacy practice were outdated and/or weakly enforced which increases the risk of unethical practices and erodes the image of pharmacists in the society. With respect to the practice environment, there is an ongoing struggle by Lebanese pharmacists to maintain profitability and exercise their full scope of practice.

Conclusion

The poor pharmacy workforce planning and regulation is significantly weakening the pharmacy profession in Lebanon. A concerted effort between the various stakeholders is necessary to enhance workforce planning, regulate supply, optimize the integration of pharmacists into work sectors of need, and improve the financial and professional wellbeing of pharmacists in Lebanon.

Applicability of American College of Clinical Pharmacy (ACCP) competencies to clinical pharmacy practice in Egypt

Background

The American College of Clinical Pharmacy (ACCP) prepared clinical pharmacist competencies that have specific recommendations. Recently, many efforts to advance clinical pharmacy services in Egypt exist. The literature revealed that no country has assessed the extent of applicability of ACCP competencies in its current pharmacy practice setting. Egyptian pharmacists can provide feedback about applicability of such competencies in clinical pharmacy settings in Egypt.

Objective

The objective of this study was to investigate the extent to which ACCP competencies were implemented by Egyptian clinical pharmacists and therefore evaluate development of clinical pharmacy practice in Egypt. The study also investigated factors affecting the applicability of such competencies in the current clinical pharmacy practice setting in Egypt.

Methods

Four hundred and ninety-five randomly selected clinical pharmacists from several hospitals were invited to participate in a cross sectional survey using a self-administered validated questionnaire composed of 31 questions classified into six domains. This questionnaire was designed to determine the pharmacists' perception about applicability of ACCP competencies to clinical pharmacy practice in Egypt.

Results

The response rate was 64% as 317 out of 495 pharmacists completed the questionnaire. These pharmacists were categorized according to age; gender; qualifications; years of previous work experience, years since BSc. and type of hospitals they are currently working at. Analysis of data revealed the professionalism domain to have the highest percentage of acceptance among pharmacists, while the system-based care & population health domain had the lowest percentage of acceptance. Results also showed that qualifications of participants did not affect their response in three domains; "Direct Patient Care", "Systems-based Care & Population Health" and "Continuing Professional Development" (p=0.082, 0.081, 0.060), respectively. Nevertheless, qualifications of participants did affect their response in the other three domains; "Pharmacotherapy Knowledge", "Communication" and "Professionalism" (p<0.05). The age of pharmacists, gender, years of previous work experience, and graduation year did not affect their responses in all six domains. The type of hospital they are currently working at, though, affected their responses where, there was a highly statistically significant increase of the mean score of all domains among participants working at the NGOs/private hospitals compared to governmental hospitals (p<0.001).

Conclusions

Egyptian pharmacists generally apply high percentage of ACCP competencies but the provided clinical pharmacy services need to be improved through applying the standards of best practice.

A Review of Strategies for Enhancing Clarity and Reader Accessibility of Qualitative Research Results

Objective. To characterize elements of the results section of qualitative research reports that make findings more accessible to readers. Methods. Two analytical methods were used for this review. First, published reviews and textbooks written by experts outlining how to evaluate qualitative research were retrieved and reviewed to identify common elements that enhance clarity of the results section. In the second analysis, the authors analyzed the results sections of a subset of qualitative studies to identify, from a reader's point of view, aspects that enhanced and detracted from communication of the results. Findings. Four elements improve accessibility of the results section for readers of qualitative research reports. Content, the first element, describes what information the reader should look for in the results section. Style of results, the second element, identifies wording choices that improve reader accessibility and understanding. Narrative flow, the third element, describes a results section that flows smoothly and logically. Structural cohesiveness, the final element, outlines effective organization of the results section. Results. While authors take several approaches to the presentation of results in qualitative research reports, some strategies appear to be more common and effective than others. The efficient presentation of results can impact a reader's assessment of the quality and credibility of a study. Identified content and stylistic elements should be considered by authors hoping to make the results of their qualitative research more accessible and comprehensible to readers.

The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives

The role of the pharmacist in healthcare has evolved greatly over the last half-century, from dispensing to providing direct patient-oriented activities not associated with dispensing. However, pharmacist-led healthcare services in Sri Lanka must undergo reform to fully take advantage of their expertise and training in medicine management and related outcomes in Sri Lankan patients. As befits a profession's role development and value, professional and educational standards for pharmacists need ongoing development and growth. Currently, university curricula and continuing professional education in Sri Lanka require further development and optimisation to provide the theoretical and practical knowledge and skills regarding quality use of medicines and patient-oriented care. Furthermore, pharmacists' roles in Sri Lankan hospital and community pharmacist settings need to be recognised and should include the pharmacist as an integral part of the multidisciplinary healthcare team in Sri Lanka. Studies from developed countries and some developing countries have demonstrated that expanded pharmacists' roles have had a significant positive cost-effective impact on the population's health. Therefore, the availability of qualified Sri Lankan pharmacists trained to deliver expanded professional services accompanied by greater pharmacist integration into healthcare delivery is crucially important to ensure quality use of medicines within the Sri Lankan healthcare system and optimise the medication-related needs of Sri Lankans.

Evaluation of the impact of pharmacist-led medication reconciliation intervention: a single centre pre-post study from Ethiopia

Background The role of pharmacists in medication reconciliation (MedRec) is highly acknowledged in many developed nations. However, the impact of this strategy has not been well researched in low-and-middle-income countries, including Ethiopia. Objective The aim of this study was to investigate the impact of pharmacist-led MedRec intervention on the incidence of unintentional medication discrepancies in Ethiopia. Setting Emergency department in a tertiary care teaching hospital in Ethiopia. Method A single centre, prospective, pre-post study was conducted on adults (aged 18 years or over) that had been hospitalized for at least 24 h and were taking at least 2 home medications on admission. The intervention involved assignment of a pharmacist to an emergency care team so as to take the best possible medication history and reconcile this list with the current medications in use. Main outcome measure Incidence and potential clinical severity of unintentional medication discrepancies. Results 123 patients were included (pre-intervention, 49; post-intervention, 74). The proportion of patients with at least one unintended discrepancy was reduced from 59 to 10.5% after the intervention (p < 0.001). Similarly, the percentage of patients with potentially severe clinical impact medication discrepancies reduced significantly after the intervention (p < 0.01). Most importantly, the likelihood of occurrence of unintentional medication discrepancies was approximately 17 times more often in the absence of pharmacist intervention (OR 16.45, 95% CI 5.22, 51.85). Conclusion This study has found that pharmacist-led MedRec intervention was impactful, and it was able to minimize the incidence of unintentional medication discrepancies significantly.

Funding models and medical dominance in interdisciplinary primary care teams: qualitative evidence from three Canadian provinces

BACKGROUND

Primary care in Canada is the first point of entry for patients needing specialized services, the fundamental source of care for those living with chronic illness, and the main supplier of preventive services. Increased pressures on the system lead to changes such as an increased reliance on interdisciplinary teams, which are advocated to have numerous advantages. The functioning of teams largely depends on inter-professional relationships that can be supported or strained by the financial arrangements within teams. We assess which types of financial environments perpetuate and which reduce the challenge of medical dominance.

METHODS

Using qualitative interview data from 19 interdisciplinary teams/networks in three Canadian provinces, as well as related policy documents, we develop a typology of financial environments along two dimensions, financial hierarchy and multiplicity of funding sources. A financial hierarchy is created when the incomes of some providers are a function of the incomes of other providers. A multiplicity of funding sources is created when team funding is provided by several funders and a team faces multiple lines of accountability.

RESULTS

We argue that medical dominance is perpetuated with higher degrees of financial hierarchy and higher degrees of multiplicity. We show that the financial environments created in the three provinces have not supported a reduction in medical dominance. The longstanding Community Health Centre model, however, displays the least financial hierarchy and the least multiplicity-an environment least fertile for medical dominance.

CONCLUSIONS

The functioning of interdisciplinary primary care teams can be negatively affected by the unique positioning of the medical profession. The financial environment created for teams is an important consideration in policy development, as it plays an important role in establishing inter-professional relationships. Policies that reduce financial hierarchies and funding multiplicities are optimal in this regard.

Facilitators and strategies to implement clinical pharmacy services in a metropolis in Northeast Brazil: a qualitative approach

Background

Clinical Pharmacy Services (CPS) are a reality in many health systems around the world. However, there are few studies that discuss the facilitators and the strategies to implement CPS in healthcare systems. In this way, the objective of this study was to identify the facilitators and strategies involved in the CPS implementation process in some public health units in a metropolis in the Northeast Brazil.

Methods

A qualitative study was carried out with health-system pharmacists and managers who experienced the implementation of CPS. Therefore, focus groups were conducted with pharmacists, and the interviews with the managers. The discussions were carried out through semi-structured scripts and were recorded in audio and videos, after the signature of the consent form. The recordings were transcribed and analyzed independently through content analysis, followed by consensus meetings between researchers.

Results

Two focus groups were conducted, with an average of seven pharmacists per group, and five interviews with local health managers. Participants reported 39 facilitators who were related to the categories: local healthcare network, healthcare team, pharmacists and implementation process of the CPS. And 21 strategies attributed to the following categories: local healthcare network, pharmacists and implementation process of the CPS.

Conclusions

This study identified facilitators and strategies of the implementation of CPS. Most of the positive experiences were related to the clinical skills and proactive attitudes of pharmacists. These findings may support pharmacists and health managers to implement CPS in health systems.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3403-4) contains supplementary material, which is available to authorized users.

Pharmacist prescribing: a cross-sectional survey of the views of pharmacists in Nigeria

OBJECTIVES

This study was carried out to: (1) explore the views of pharmacists in Nigeria on the extension of prescribing authority to them and determine their willingness to be prescribers and (2) identify the potential facilitators and barriers to introducing pharmacist prescribing in Nigeria.

METHOD

An online cross-sectional survey was conducted from August to October 2014 among 775 pharmacists recruited from the Facebook group of the Pharmaceutical Society of Nigeria using a simple random technique. The questionnaire used for the survey was developed based on the review of the literature and previous qualitative studies conducted in Nigeria. The instrument was evaluated for content validity by two external pharmacy practice researchers and the reliability of items assessed using internal consistency tests. Data obtained from the survey were entered into SPSS v.22, and descriptive statistics were generated. Relationships between variables were evaluated using the chi-square test, and P < 0.05 was considered statistically significant.

KEY FINDINGS

The response rate was 40.6% (315/775). Three hundred and six (97.1%) respondents agreed that pharmacists should be given prescribing authority. Of these 306, 295 (96.4%) were willing to be prescribers, and just over half of them (148/295; 50.2%) would prefer to prescribe in collaboration with medical doctors. Of those willing to be prescribers, 285 (96.6%) reported that they would need additional training. The most perceived areas of training needed were in the principles of differential diagnosis (81.4%), pathophysiology of diseases (74.0%) and interpretation of laboratory results (68.1%). Respondents identified increasing patients' access to care (308/315; 97.8%) and better utilisation of pharmacists' skills (307/315; 97.5%) as the most likely facilitators to pharmacist prescribing in Nigeria. On the other hand, resistance from the medical doctors (299/315; 94.9%) and pharmacists' inadequate skills in diagnosis (255/315; 81.0%) were perceived as the most likely barriers.

CONCLUSION

Pharmacist prescribing represents an opportunity to promote patients' access to care and the utilisation of pharmacists' skills in Nigeria. The majority of pharmacists showed a positive attitude towards pharmacist prescribing and were willing to be prescribers. The findings of this study could potentially contribute to future medicine prescribing policy and pharmacy practice in Nigeria.

Exploring clinical pharmacists' perception of their impact on healthcare in Khartoum State, Sudan

Objective:

The principal aim of this study was to explore the self-perception of clinical pharmacists of their impact on healthcare in Khartoum State, Sudan, how they think doctors perceive their impact, exploring the obstacles that clinical pharmacists are facing, and identifying what clinical pharmacists recommend for a better clinical pharmacy practice in Sudan.

Methods:

This was an exploratory cross-sectional study that employed a qualitative method. Individual, in-depth interviews were conducted with a convenient sample of 26 clinical pharmacists working in 14 governmental hospitals in Khartoum State, Sudan, in March 2016. Each interview was recorded, transcribed, and coded into themes. Thematic analysis was carried out.

Findings:

The study revealed different themes regarding clinical pharmacists' perception of their impact on healthcare. The majority believed that they made an improvement in healthcare but not to the level they aspire to. Participants expressed that junior doctors and nurses had a better acceptance of clinical pharmacists' interventions compared to senior doctors. The main obstacles that clinical pharmacists were facing were their limited number, lack of support from health authorities, lack of training and educational program, lack of job descriptions, lack of specific area in patient files for clinical pharmacist intervention, and low salaries. Most participants showed dissatisfaction with the syllabus of the master of clinical pharmacy they studied.

Conclusion:

The study revealed that clinical pharmacists were looking for a better contribution in healthcare in Sudan. This can be achieved by solving the problems identified in this study.