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Shaikh BT. Universal health coverage in Pakistan: exploring the landscape of the health system, health seeking behaviours, and utilization of health services. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 27:100440. [PMID: 39015938 PMCID: PMC11251088 DOI: 10.1016/j.lansea.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024]
Abstract
The attainment of the noble objective of Universal Health Coverage (UHC)- 'leaving no one behind' necessitates sufficient financial resources, an ample supply of skilled healthcare professionals, and the availability of essential services as part of a basic package This paper presents an analysis of the health system, health seeking behaviours and health service utilization en route to UHC in Pakistan. We have used the UHC 14 tracer indicators of service coverage to see where Pakistan stands, what are the gaps and what needs to be done. Pakistan clearly is lagging behind its neighboring countries. The country's health system ought to work on health seeking behaviours and broader determinants of health. The pursuit of UHC demands a shared responsibility and collective action, with stakeholders from different sectors uniting their efforts and expertise. Together, they can establish robust systems, design comprehensive policies, allocate adequate resources, and implement interventions that transcend disciplinary boundaries.
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Vann Yaroson E, Quinn G, Breen L. Medicines Shortages Reporting Systems (MSRS): An exploratory review of access and sustainability. Res Social Adm Pharm 2024; 20:72-83. [PMID: 38458895 DOI: 10.1016/j.sapharm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The efficacy of medicines depends on their accessibility and availability. Dedicated medicine shortage reporting systems (MSRS) have been set up in different countries, either mandatory or voluntary, following the recommendations of the World Health Organisation to ensure these. OBJECTIVES To explore how the Medicine Shortages Reporting System (MSRS) can tackle medicine shortages through improved access and sustainability. METHODS Personnel directly involved in the reporting mechanisms for medicine shortages in eight (8) countries participated in semi-structured interviews. An interview protocol based on the Dynamic Capabilities View and Organisational Information Processing Theory (OIPT) was developed. It contained questions related to participant's views on the process involved in MSRS and how it was used to tackle shortages. Data were thematically analysed. RESULTS Three core elements were identified to influence MSRS's ability to tackle shortages and ensure sustainability; (1) the ability to identify what information requirements the reporting system needs, (2) identify information processing capabilities, and (3) the ability to match requirements and information processing capabilities through a dynamic capability decision-making process. The dynamic decision-making process involves reiteratively sensing shortages by understanding and validating information received. CONCLUSION Building MSRS to tackle shortages for accessibility and sustainability is a systemic process that entails understanding the various elements and processes of MSRS. It includes defining medicine shortages, reconfiguring resources, defining accessibility and ensuring the system's sustainability. Our study provides insights into MSRS developed for mitigating medicine shortages and provides a framework for a sustainable MSRS. The findings extend the literature on medicine shortage management by identifying the various elements required to set up an MSRS. It also provides practical implications for countries that seek to establish MSRS to mitigate medicine shortages. Further studies could extend the number of participating countries to provide a clearer picture of the MSRS and how it can reduce medicine shortages.
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Affiliation(s)
- Emilia Vann Yaroson
- University of Huddersfield Business School, Charles Sykes Building, Queensgate, HD1 3DH, UK.
| | - Gemma Quinn
- University of Bradford School of Pharmacy and Medical Sciences, Richmond Building, Richmond Road, Bradford, BD7 1DP, UK.
| | - Liz Breen
- University of Bradford School of Pharmacy and Medical Sciences, Richmond Building, Richmond Road, Bradford, BD7 1DP, UK.
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Adhikari B, Ranabhat K, Khanal P, Poudel M, Marahatta SB, Khanal S, Paudyal V, Shrestha S. Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003128. [PMID: 38696399 PMCID: PMC11065305 DOI: 10.1371/journal.pgph.0003128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024]
Abstract
Ensuring access to essential medicines remains a formidable challenge in Nepal. The specific reasons for the shortage of essential medicines within Nepal have not been extensively investigated. This study addresses challenges associated with access to essential medicines, procurement process difficulties, and functionality of inventory management systems at different levels of public health facilities. Fifty-nine semi-structured in-depth interviews were conducted with health managers and service providers at provincial and local levels in six randomly selected districts of Bagmati province, Nepal. Interviews were audiotaped and transcribed verbatim, and the results were analyzed using the inductive approach and were later mapped within the four domains of "Procurement of essential medicines". The major barriers for the effective management of essential medicines included delays in the procurement process, primarily locally, leading to frequent stock-out of essential drugs, particularly at the health post level. Additionally, challenges arise from storage problems, mainly due to insufficient storage space and the need to manage additional comorbidities related to COVID-19. Other identified challenges encompass the absence of training on logistics management information systems, a lack of information technology resources in primary health facilities, inadequate qualified human resources to operate the IT system, and insufficient power backup. Moreover, unrealistic demand estimation from the service points, inadequate transportation costs, and manual inventory management systems further contributed to the complex landscape of challenges. This study identified procurement delays as the primary cause of essential medicine shortages in Bagmati Province, Nepal. We recommend implementing comprehensive procurement guidelines, collaborative training, and dedicated budgets to address this issue. Improving the procurement and inventory management process in low-resource settings requires a well-trained workforce, suitable storage spaces, and enhanced coordinated administrative tiers within health facilities at different levels to ensure the year-round availability of essential medicines in these settings.
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Affiliation(s)
- Basant Adhikari
- Ministry of Health, Bagmati Province, Hetauda, Nepal
- Nepal Public Health Association, Lalitpur, Nepal
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
| | - Kamal Ranabhat
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
- Central Department of Public Health, Institute of Medicine, Tribhuwan University, Kathmandu, Nepal
| | - Pratik Khanal
- Nepal Public Health Association, Lalitpur, Nepal
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
| | - Manju Poudel
- Oxford University Clinical Research Unit, Patan Academy of Health Science, Lalitpur, Nepal
| | - Sujan Babu Marahatta
- Nepal Open University, Lalitpur, Nepal
- Manmoohan Memorial Institute of Health Science, Kathmandu, Nepal
- Department of Public Health Sciences, University of California Davis, Davis, California, United States of America
- Bournemouth University, Poole, United Kingdom
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College, London, United Kingdom
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
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Rafi S, Anjum SM, Usman M, Nawaz HA, Chaudhry M, Babar ZUD, Rasheed H. Availability of Access, Watch, and Reserve groups of essential antibiotics: a cross-sectional survey. Front Public Health 2024; 11:1251434. [PMID: 38239798 PMCID: PMC10794303 DOI: 10.3389/fpubh.2023.1251434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
Background Lower-middle income countries face drastic challenges in Access to essential medicines. Data regarding Pakistan is scarce with no comprehensive study in this regard. The objectives of the study are to document and compare public and private sector availability of all essential antibiotics as well as to conduct a comparison among the AWaRe groups. Methods The study analyzed 103 essential antibiotics comprising 51 Access, 29 Watch, 6 Reserve, and 17 anti-tuberculosis drugs from 15th August to 10th September 2020 in Lahore, Pakistan. It included on-spot physical availability and availability trend surveys. The survey sites included five public tertiary care hospitals with one as anchor and four randomly selected. Their hospital pharmacies and one randomly selected private retail pharmacy from the vicinity each hospital comprised the ten sampling sites. Percentage availability for each antibiotic was categorized as high (>80%), fairly high (50-80%), low (30-<50%), very low (<30->0%), and not available (0%). Results The mean percentage on-spot availability was 23.76% ± 5.19 (14-25%) for public facilities and 59.20% ± 4.45 (54-66%) for private sector retail pharmacies. The overall percentage of available essential antibiotics varied significantly (p** < 0.001) in public and private sector sampling sites. Except for the Watch group, all other groups showed the mode of 0% availability. A significant difference (p**** < 0.00001) was seen in percentage availability by Access, Watch, Reserve, and anti-TB-all groups of essential antibiotics. The availability trend survey revealed a list of 18 medicines as 'as never been available', and five medicines were 'not available for 5 years or more than 5 years.' Fourteen medicines as 'never been heard.' Conclusion Non-availability of essential medicines is a significant public health challenge at public-sector facilities in Pakistan. It was observed that a number of essential antibiotics were not available in both public and private sectors. A number of corrective strategies are required. This includes the engagement of stakeholder and government bodies. This can help to improve supply chain barriers.
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Affiliation(s)
- Sunaina Rafi
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Syed Muneeb Anjum
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Usman
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Hafiz Awais Nawaz
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mamoona Chaudhry
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Huma Rasheed
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Asghar S, Atif M, Arshad S, Masood I, Hashmi A. Probing the parental cognizance of antibiotic resistance by using Health Belief Model: An exploratory study. Res Social Adm Pharm 2024; 20:28-35. [PMID: 37752028 DOI: 10.1016/j.sapharm.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To explore the determinants that innervate or avert the parents to use antibiotics responsibly for their children in Bahawalpur, Pakistan. Further, to assess the cognizance of Pakistani parents about antibiotic resistance. METHODS The Health Belief Model (HBM) was utilized to design this study. Parents who were using antibiotics for their children were taken as study participants. They were recruited purposively from various public and private healthcare settings and were asked to conveniently participate in the study. A total of 18 in-depth interviews were conducted at time and place convenient to the study participants. Data were transcribed, translated and analyzed by framework analysis in accordance with the constructs of Health Belief Model including perceived susceptibility, severity, benefit, barriers, self-efficacy and cues to action. RESULTS Within each HBM construct, responses of participants were analyzed, yielding 8 themes and 17 subthemes. Parents had a knowledge of antibiotics but considered their families to be at low risk of antibiotic resistance since their families were "low users" of antibiotics. Majority of the participants were not aware of the indications and risks of antibiotic use and perceived the antibiotics as a quick fix for every ailment. Communicating the risks of antibiotic resistance to parents and providing actionable solutions to tackle antibiotic resistance may address these perceptions. CONCLUSION Though parents revealed awareness about antibiotics, they continue to overestimate the value of antibiotics. Refocus of the antibiotic stewardship interventions are required and these campaigns are needed to be tailored to target their intended audience in a format that is appropriate to them.
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Affiliation(s)
- Saima Asghar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Saria Arshad
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Masood
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Ayesha Hashmi
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Bou Malhab S, Haddad C, Sacre H, Hajj A, Zeenny RM, Akel M, Salameh P. Adherence to treatment and harmful effects of medication shortages in the context of severe crises: scale validation and correlates. J Pharm Policy Pract 2023; 16:163. [PMID: 38031177 PMCID: PMC10685472 DOI: 10.1186/s40545-023-00667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medication shortage is a public health problem, affecting patients' outcomes mainly through the difficulty in maintaining adherence, particularly in the context of a severe economic crisis. There is a need for a new scale that assesses the effect of medication shortage on adherence. AIM To develop and validate a scale to evaluate the harmful impact of medication shortage among the general Lebanese population and assess its correlates and association with medication adherence. METHODS A questionnaire was used to assess medication shortage harmful effects and patients' adherence, allowing to generate the Harmful Impact of Medication Shortage scale (HIMS). The factor analysis, convergent validity and reliability of the generated scale were assessed, followed by multivariable regressions to evaluate its correlates. RESULTS The developed HIMS scale is a 9-item tool, used to assess how difficult it was for people to deal with medication shortages and their harmful effects on treatment. It was significantly and inversely linked to treatment adherence and affected by the patients' socioeconomic status and the type of chronic disease. CONCLUSION The Harmful Impact of Medication Shortage scale could be an efficient tool to measure the detrimental effects of medication shortages among the Lebanese adult population with chronic diseases, particularly affecting treatment adherence. Future studies and evidence are still needed to confirm our findings and help build global mitigation policies addressing medication shortages.
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Affiliation(s)
- Sandrella Bou Malhab
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Department of Natural Sciences, School of Arts and Science, Lebanese American University, Beirut, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon.
- School of Medicine, Lebanese American University, Beirut, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jall-Eddib, Lebanon.
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Aline Hajj
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Faculté de Pharmacie, Université Laval, Québec, Canada
- Oncology Division, CHU de Québec Université Laval Research Center, Québec, Canada
| | - Rony M Zeenny
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Akel
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus
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Shukar S, Shahid MH, Zhang J, Din SM, Khan FU, Fang Y, Yang C. Pharmacists' approach to oncology medicine shortages: results of a cross-sectional survey in Pakistan. BMJ Open 2023; 13:e070634. [PMID: 37723107 PMCID: PMC10510916 DOI: 10.1136/bmjopen-2022-070634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVES The study estimated the shortages of oncology medicines in Pakistan, their causes, impacts, mitigation strategies, and possible interventions. DESIGN Cross-sectional survey. SETTING Oncology pharmacists working at 43 oncology settings (out of 80) from five regions of Pakistan (four provinces (Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan) and one federal territory (Islamabad)) were approached. PARTICIPANTS Oncology pharmacists with more than 1 year of experience were selected using stratified random sampling, and data were collected using a questionnaire from September 2021 to January 2022. PRIMARY AND SECONDARY OUTCOME MEASURES To estimate the prevalence of oncology medicine shortages in Pakistan and establish recommendations to overcome them. RESULTS Of 167 responded pharmacists, 87% experienced shortages in their practice. Most respondents (50%) experienced both oncology and support agent shortages. It was a current problem in hospitals (58%) and increased with time, but the situation varied across regions (p=0.007). Mainly shortages occur half-yearly (p=0.001) and last for <3 months. Injectable (56.8%) and branded drugs (44.9%) were short. The most frequently mentioned drugs affected by shortages were etoposide, paclitaxel, dacarbazine, bleomycin and carboplatin. Usually, distributors (51.5%) notify the pharmacists about the shortages, and federal agencies (36%) are responsible for these shortages. Distributors (53.4%) were the main source of supply, and shortages were encountered by them as well. The impacts included delayed care (25%) and suboptimal outcomes (23%) on patients, extra time (32%) for staff, prioritisation issues (31%) for pharmacists, delayed clinical trials (60.5%) and increased drugs prices (52.1%). Some hospitals have reporting systems (39.5%) and recording (29.3%) drug shortages. The shortages were managed using available alternative options (21%) and redistributing (21%) the currently available stock. CONCLUSION Pakistan's healthcare system is affected by oncology medicine shortages. The government should establish a cancer registry and drug shortage platform, revise drug prescribing/pricing policies and practice penalties for breaching regulations. Oncology medicines must be widely available to avoid the grey market.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | | | - Jinwei Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shayan Muhammad Din
- Department of Hospital Pharmacy, National Hospital and Medical Center, Lahore, Pakistan
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Song Y, Li J, Zhao F, Jin P. Drug shortages in China: a cross-sectional study. BMC Health Serv Res 2023; 23:438. [PMID: 37143100 PMCID: PMC10159680 DOI: 10.1186/s12913-023-09295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/15/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Drug shortages significantly threaten public health and medical service provision worldwide. Research evidence on the complete picture of drug shortages is currently scant in China. This study aimed to provide a descriptive overview and a reference for alleviating of drug shortages in China. METHODS National and provincial lists of drug shortages issued in China from 2018 to 2021 were collected and summarized. The information on essential medicines, medical insurance drugs, emergency drugs, and volume-based purchasing drugs was then matched with a drug shortage list to analyse the characteristics, proportion and incidence of drug shortage on each list based on the analysis of information such as dosage form, shortage frequency, and Anatomical Therapeutic Chemical (ATC) classification of the drugs in shortage. RESULTS A total of 24 provinces issued drug shortages lists involving 408 drugs from 2018 to 2021. All 58 drugs in the national drug list were included on the provincial drug shortage list. Among all the drugs in shortage, the most significant shortage involved injections, accounting for 45.3% (185/408). Ninety-five drugs (23.3%) were in shortage 5 times (annual shortage > 1 time) or more in the provincial lists, and 199 drugs (48.8%) were on the shortage list only once. In terms of therapeutic property, nearly all categories of drugs had been reported in shortage, among which cardiovascular drugs, nervous system drugs, anti-tumor and immunomodulatory drugs, and blood and hematopoietic organ drugs accounted for more than 10%. There is no significant difference in drug shortage among economic regions. Comparing drugs in shortage and various lists, 81.9% (334/408), 51.0% (208/408) and 67.9% (277/408) fell on the National Medical Insurance Drug List, National Essential Medicines List, and WHO Model List of Essential Medicines, respectively, while the volume-based purchasing drugs accounted for 3.4% (14 drugs). The incidence of drug shortages on NEML, WHO Model List of Essential Medicines and medical insurance category A was significantly higher than that of medical insurance category B and volume-based purchasing drugs (P < 0.05). Of the Emergency Drugs List, 72.0% (36/50) also experienced shortages, significantly higher than all the above categories (P < 0.05). CONCLUSIONS In China, drug shortages were severe and complicated. Drug shortages vary among economic regions but are not significant. In comparison, the national procurement pattern of volume-based drug purchasing may be conducive to alleviating the drug shortage problem. Collaboration of all partners was recommended to ensure the supply of clinically necessary drugs.
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Affiliation(s)
- Yinyin Song
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Jianchun Li
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China
| | - Pengfei Jin
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China.
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Arif R, Khan AZ, Hammad M, Ghani U, Vaddepalli R, Sanker V. Current Practices and Perceived Role of Community Pharmacists in Type 2 Diabetes Services in Pakistan. Cureus 2023; 15:e37311. [PMID: 37182028 PMCID: PMC10166723 DOI: 10.7759/cureus.37311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/16/2023] Open
Abstract
Background Diabetes mellitus is a chronic illness which is becoming more prevalent in developing countries, and it is being managed mostly in hospitals or clinics in underdeveloped nations. Other strategies for treatment delivery in emerging nations must be considered as the number of diabetic patients grows. Community pharmacists are a valuable choice for diabetes care. However, only developed countries have data on community pharmacists' diabetes treatment practices. Methodology A non-probability consecutive sampling strategy was used to gather a self-administered questionnaire from 289 community pharmacists. Six points Likert scale was employed to score current practices and pharmacists' perceived role. A response rate of 55% was attained. Characteristics associated with present behaviors and perceived roles were analyzed using Chi-square and logistic regression. Results The majority of the respondents were males, 234 (81.0%). Out of 289, 229 (79.2%) were of 25-30 years of age and were pharmacists as well as qualified persons (QP) 189 (65.4%). A QP is one who has the legal authority to sell drugs to customers. The majority had <5 years of working experience as a community pharmacist, 268 (92.7%), and did not have diabetes training, 237 (82.0%). Most community pharmacies were stand-alone, 110 (38.1%), and had a single or a group of proprietors, 248 (85.8%). Open hours of most of the pharmacies were 16-20 hours per day, 202 (69.8%), and most had one pharmacist, 243 (84.1%), i.e., working as a pharmacist as well as a qualified person. Approximately 203 (70.2%) of the pharmacies had customers >2000 in a month and >100 customers purchased anti-diabetes medications per month. Only 44 (15.2%) community pharmacies had a designated room or space for patient counselling. The majority of pharmacists were also in favor of providing services other than dispensing such as counselling the patients about prescribed medicines, direction of use, use of devices for insulin administration, training on self-monitoring of glucose, and healthy lifestyle and diet practices. Pharmacy setting, ownership, patient counseling area, and the number of customers per month were key factors in the provision of diabetes services. The main obstacles identified were a lack of pharmacist availability and academic competency. Conclusion In Rawalpindi and Islamabad, most community pharmacies only provide a basic dispensing service for diabetes patients. Most of the community pharmacists agreed to extend their duties. The expansion of pharmacist professional responsibilities would help control the rising diabetes burden. The facilitators and hurdles identified would serve as a foundation for the introduction of diabetic care in community pharmacies.
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Affiliation(s)
- Rasikh Arif
- Clinical Research, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Ali Zeb Khan
- Clinical Research, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Muhammad Hammad
- Pharmacy, Shifa Tameer-E-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Usman Ghani
- Clinical Research, Aga Khan University Hospital, Karachi, PAK
| | | | - Vivek Sanker
- General Surgery, Noorul Islam Institute of Medical Science and Research (NIMS), Trivandrum, IND
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Malik M, Khan FA. Anesthetic drug shortages in Pakistan: a multicentre nationwide survey. Can J Anaesth 2023; 70:335-342. [PMID: 36577892 PMCID: PMC9797251 DOI: 10.1007/s12630-022-02381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/24/2022] [Accepted: 09/20/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE There is a paucity of literature on anesthetic drug shortages and their impact on patient safety in lower-middle-income countries. We sought to determine the magnitude of the problem, the effect on patient care and safety, and the adverse patient outcomes witnessed by anesthesiologists in Pakistan METHODS: We conducted a nationwide, multicentre, cross-sectional survey of a representative sample of anesthesiologists in Pakistan (January 2021 to June 2021). The survey questionnaire was adapted from the American Society of Anesthesiologists (ASA) survey on drug shortages and was modified based on the national essential medication list 2018 of Pakistan. It was distributed through Google Forms to anesthesiologists practicing in both the private and government sector. The names of hospitals or the identity of anesthesiologists was not required. The questionnaire consisted of 20 items and focused on the anesthesiologists' experience of drug shortages, the availability of drugs, and the impact of drug shortages on their individual practice. RESULTS Two hundred and forty-six responses were received. Approximately 50% (122/246) of anesthesia practitioners in Pakistan reported anesthetic drug shortages. Fifty-seven percent of respondents mentioned using an inferior drug that may have significantly affected the delivery of anesthetic care. Four participants mentioned severe morbidity and another four mentioned observing a mortality associated with drug shortage. CONCLUSION Anesthetic drug shortages are common in anesthetic practice in Pakistan and they appear to affect patient care and outcomes.
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Affiliation(s)
- Mehreen Malik
- Aga Khan University Hospital, Karachi, Pakistan
- Department of Anaesthesiology, King Hammad International Hospital, Al Sayh, Bahrain
| | - Fauzia Anis Khan
- Department of Anaesthesiology, Faculty of Health Sciences, Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications. Antibiotics (Basel) 2022; 12:antibiotics12010070. [PMID: 36671271 PMCID: PMC9854885 DOI: 10.3390/antibiotics12010070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals, raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis.
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Atif M, Munir K, Malik I, Al-Worafi YM, Mushtaq I, Ahmad N. Perceptions of healthcare professionals and patients on the role of the pharmacist in TB management in Pakistan: A qualitative study. Front Pharmacol 2022; 13:965806. [PMID: 36588713 PMCID: PMC9798110 DOI: 10.3389/fphar.2022.965806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Globally, tuberculosis (TB) is the second major cause of death from infectious diseases, particularly in developing countries. A multidisciplinary approach to the management of TB may help to curb the disease burden. Objective: The objective of this study was to outline the perceptions of healthcare professionals and patients regarding the potential role of pharmacists in TB management in Pakistan. Method: This was a large-scale qualitative study conducted at the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Punjab, Pakistan. Data were collected through semi-structured interviews with physicians, pharmacists, and patients recruited using a mix of convenient and snowball sampling. The sample size was decided through standard saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using a thematic analysis approach. Results: Analysis of the data yielded 19 categories and seven themes. Physicians considered pharmacists qualified healthcare professionals, whereas patients considered them merely dispensers. Inventory management and dispensing of medicines were considered as major responsibilities of pharmacists. Physicians were extremely overburdened and wanted to delegate certain duties to pharmacists, subject to their prior extensive trainings. However, most of the physicians were unaware of the legal scope of pharmacy practice in Pakistan. With regard to the potential duties of pharmacists, physicians, pharmacists, and patients (patients-upon explaining the potential roles during the interview) endorsed monitoring, counseling, medicine brand selection, dose adjustment, inventory management, dispensing, and polypharmacy assessment as their potential roles. In view of all stakeholders, the rationale for integrating pharmacists in TB management included overburdened physicians, sub-standard patient care, medication safety issues, and patient dissatisfaction. The healthcare professionals highlighted that the major barriers to integrating pharmacists within the TB management system were limited interest of regulatory authorities and policy makers, followed by inadequate training and experience-driven questionable competency of pharmacists. Conclusion: The study participants acknowledged the potential role of pharmacists in TB management. However, it was emphasized that healthcare policy makers should devise strategies to overcome the underlying barriers before assigning medicine-related clinical roles to pharmacists.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan,*Correspondence: Muhammad Atif,
| | - Kiran Munir
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Yaser Mohammed Al-Worafi
- Department of Clinical Pharmacy, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
| | - Irem Mushtaq
- Department of Education, Faculty of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
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Shukar S, Zahoor F, Omer S, Awan SE, Yang C, Fang Y. Experience of Pharmacists with Anti-Cancer Medicine Shortages in Pakistan: Results of a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16373. [PMID: 36498446 PMCID: PMC9740989 DOI: 10.3390/ijerph192316373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to examine the current situation of anti-cancer drug shortages in Pakistan, namely its determinants, impacts, adopted mitigation strategies, and proposed solutions. Qualitative semi-structured, in-depth interviews were conducted with 25 pharmacists in oncology hospitals in Pakistan from August to October 2021. Data were collected in person and online, recorded, and subjected to inductive thematic analysis after being transcribed verbatim. Most participants experienced anti-cancer drug shortages that increased during the pandemic. Etoposide, paclitaxel, vincristine, dacarbazine, and methotrexate were frequently short. Important causes included the compromised role of regulatory authorities, lack of local production, and inventory mismanagement. The impacts were delayed/suboptimal treatment and out-of-pocket costs for patients, patients' prioritization, increased workload, negative work environment, and patients' trust issues for pharmacists. The participants proposed that a cautious regulator's role is needed to revise policies for all stakeholders and support all stakeholders financially at their level to increase access to these medicines. Based on the outcomes, it is clear that anti-cancer medicine shortages are a current issue in Pakistan. Governmental authorities need to play a role in revising policies for all levels of the drug supply chain and promoting local production of these drugs. Stakeholders should also collaborate and manage inventory.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Fatima Zahoor
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway 47500, Malaysia
| | - Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Sundas Ejaz Awan
- Faculty of Pharmacy, Gadjah Mada University, Yogyakarta 55281, Indonesia
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
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Stakeholders’ Perspectives Regarding Supply Chain System of Pharmaceuticals and Vaccines in Pakistan: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10091738. [PMID: 36141350 PMCID: PMC9498743 DOI: 10.3390/healthcare10091738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
The present study was undertaken to assess the current supply chain system of pharmaceuticals and vaccines in Pakistan in terms of structure, process, and outcomes, as well as related barriers and solutions for an effective supply chain system. A qualitative study was designed to explore stakeholders’ perceptions selected using the snowball sampling technique. A semi-structured interview guide was used to interview these respondents at a convenient time and place. After data collection, recorded interviews were transcribed verbatim and subjected to thematic analysis. The results highlighted that the standard operating procedures (SOPs), checklists, and government guidelines were available at different levels, except for community pharmacies. Timely delivery of quality products and services along with market reputation, experience, and authorization were the key criteria used for supplier selection and evaluation. Good inventory management, financial models, effective coordination, training, and skill development programs were identified as key factors responsible for an efficient supply chain process. Availability of vaccines, their appropriate temperature monitoring, and transportation are also highly compromised in Pakistan. The results of the present study concluded that the current supply chain system in Pakistan is not up to the mark; major factors include poor forecasting and inventory control, delayed order placement, lack of training, inadequate involvement of professionally qualified staff, inadequate financing and procurement processes, and poor coordination and integration among all stakeholders.
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Shukar S, Yang C, Khan SA, Bhutta OA. Anti-cancer medicine shortages in an oncology tertiary hospital of Pakistan: A five-year retrospective study. J Oncol Pharm Pract 2022:10781552221114278. [PMID: 35837718 DOI: 10.1177/10781552221114278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Anti-cancer medicine shortages are advancing challenges for patients and hospitals. This study aims to evaluate anti-cancer and supportive medicine shortages in a tertiary hospital in Pakistan and propose solutions. METHOD A retrospective observational research was performed in a tertiary care hospital in Pakistan from 2016 to 2020. Data was retrieved from the hospital database using a questionnaire regarding short medicines' generic name, brand, dosage, source, total source, frequency, causes, impact, management, and analyzed by Microsoft Excel 2013. RESULTS Between January 2016 and December 2020, 43 individual medicine shortages were observed, with an average of 8.6 shortages per year. There were shortages of 22 medicines, including 8 anti-cancer (36.4%) and 14 supportive agents (63.6%). Total shortage days were 27,100, with an average of 1232 days (SD 757) per medicine. Supportive medicines' shortages were frequent, but oncology agents' shortages were constant. The most affected dosage form was injection. Cardiovascular drugs and alkylating agents were the most affected class in supportive and anti-cancer medicines, respectively. The use of "alternative medicine" and "patient needs based importation" were the most common mitigation strategies. CONCLUSION Shortages of oncology medicines are challenging in Pakistan. The most prominent causes are the lack of updated governmental regulations, registration, and import issues. The tertiary care hospital has very few sources of supply, so it imports these drugs on a need basis to manage the shortages. But it is still concerning because of the huge financial burden on patients and institutions due to expensive import, and therapy become delayed as the import process takes time. Moreover, the most affected drug class was alkylating agents, and dosage was both injectable and oral medicines.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, China
| | - Shahbaz Ahmad Khan
- Department of Pharmacy, Shaukat Khanum Memorial Hospital & Research Center, Lahore, Pakistan
| | - Omar Akhlaq Bhutta
- Department of Pharmacy, Shaukat Khanum Memorial Hospital & Research Center, Lahore, Pakistan
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Neurological manifestations of COVID-19: A perspective from Pakistani medical students. Ann Med Surg (Lond) 2022; 79:104035. [PMID: 35757270 PMCID: PMC9212922 DOI: 10.1016/j.amsu.2022.104035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
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Atif M, Ahmed W, Nouman Iqbal M, Ahmad N, Ahmad W, Malik I, Al-Worafi YM. Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study. Front Med (Lausanne) 2022; 8:790718. [PMID: 35300176 PMCID: PMC8922404 DOI: 10.3389/fmed.2021.790718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Treatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events. Study aim This study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Study design This retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018). Measures and outcomes The Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events. Results A total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [AOR] 2.951; 95% CI 1.423, 6.118) and being employed (AOR 3.445; 95% CI 1.188, 9.993). Conclusion Adverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Waqar Ahmed
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | | | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Wajiha Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Yaser Mohammed Al-Worafi
- College of Medical Sciences, Azal University for Human Development, Sana'a, Yemen.,Department of Clinical Pharmacy, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
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Shrestha R, Shrestha S, Sapkota B, Thapa S, Ansari M, Khatiwada AP, Roien R, Ozaki A. Generic Medicine and Generic Prescribing in Nepal: An Implication for Policymakers. J Multidiscip Healthc 2022; 15:365-373. [PMID: 35237042 PMCID: PMC8884710 DOI: 10.2147/jmdh.s348282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022] Open
Abstract
Generic medicines are being promoted in many countries for their added benefits over branded drugs, such as reduced price, therapeutic equivalence, and convenience to the patients. However, generic prescribing is still not up to the optimum level in Nepal to assure access to cost-effective, quality medicines to the public and to reduce the overall economic burden and practice-related errors of medications. This review aimed to discuss the current scenario of generic medicine, generic prescribing, hurdles on the one hand, and potentials ways in promoting generic medicine usage and generic prescribing in Nepal on the other. Extensive literature on generic medicine usage and generic prescribing practice in Nepal was reviewed. This review found some of the major challenges to be addressed for the proper implementation of generic medicine prescribing, and utilization. These challenges include lack of facilities and competency to assure therapeutic equivalence of different brand-name medicines, lack of understanding about generic medicines among health care providers (HCPs) and the public, and lack of stringent regulation towards promoting generic medicines. Rational pharmaceutical promotion and awareness about generic medication to the medical students are also inevitable towards promoting the practice of generic medicines. The practice of generic medicine and generic prescribing is not possible without the assurance of therapeutically equivalent generic alternatives. The study recommended the prompt effort of the regulatory authority to enforce the generic prescribing and generic substitution policy through strengthening policies, procedures and laboratory testing to assure citizens’ right to access to cost-effective, and affordable quality medicine, as the Nepal’s National Health and Drug Policy mandated.
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Affiliation(s)
- Rajeev Shrestha
- Department of Pharmacy, District Hospital Lamjung, Lamjung, Nepal
| | - Sunil Shrestha
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal
- Department of Nursing, Nobel College, Sinamangal, Kathmandu, Nepal
| | - Binaya Sapkota
- Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, Nepal
| | | | - Mukhtar Ansari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Asmita Priyadarshini Khatiwada
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal
| | - Rohullah Roien
- Medical Research Centre, Kateb University, Kabul, Afghanistan
- Correspondence: Rajeev Shrestha; Rohullah Roien Email ;
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
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Atif M, Mukhtar S, Sarwar S, Naseem M, Malik I, Mushtaq A. Drug resistance patterns, treatment outcomes and factors affecting unfavourable treatment outcomes among extensively drug resistant tuberculosis patients in Pakistan; a multicentre record review. Saudi Pharm J 2022; 30:462-469. [PMID: 35527826 PMCID: PMC9068524 DOI: 10.1016/j.jsps.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Extensively drug resistant tuberculosis (XDR-TB) is considered as a major threat to global health. This study aimed to analyse the treatment outcomes and identify the factors significantly associated with unfavourable treatment outcomes among XDR-TB patients. Methods We conducted a retrospective observational study at 10 Programmatic Management Units of the National Tuberculosis Control Program of Pakistan. The Electronic Nominal Recording Reporting System records were used to collect data of all eligible XDR-TB patients registered at the study sites between March 2012 and August 2018. Treatment outcomes were analysed as per the standard criteria. Factors associated with unfavourable treatment outcomes were analysed by using multivariate binary logistic regression analysis. Results Out of the total 184 patients, 59 (32.1%) completed their treatment successfully. Whereby, 83 patients (45.1%) died, 24 (13%) had treatment failure, and 11 (6%) were lost to follow-up. Treatment outcomes were not evaluated in 7 (3.8%) patients. Factors significantly associated with unfavourable treatment outcomes included; conventional therapy with bedaquiline, unfavourable interim treatment outcomes and occurrence of adverse drug events (negative association). Conclusion Treatment success rate in the study cohort was sub-optimal (i.e., <75%). The poor success rate and high mortality are concerning, and requires immediate attention of the program managers and clinicians.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
- Corresponding author.
| | - Saba Mukhtar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sajjad Sarwar
- Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | - Mehwish Naseem
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Azam Mushtaq
- Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur, Pakistan
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Omer S, Pan M, Ali S, Shukar S, Fang Y, Yang C. Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey. BMJ Open 2021; 11:e050196. [PMID: 34949612 PMCID: PMC8713015 DOI: 10.1136/bmjopen-2021-050196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to explore pharmacists' perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care. DESIGN Online questionnaire survey. SETTING AND PARTICIPANTS Hospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh). PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence and type of shortages were identified along with strategies to reduce its effect on patient care. METHOD A validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages. RESULTS Out of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. 'Creating new communication system' (65%) and 'readjust budget plans' (41%) were the two most frequently indicated recommendations for shortages management at hospital, while 'circulars or alerts from the regulatory authority' (60%) and 'time to time directives from local health statuaries' (48%) were two most widely suggested policy solutions. CONCLUSION Drug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients' health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.
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Affiliation(s)
- Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Mengyuan Pan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Salamat Ali
- Department of Pharmacy, Quaid-i- Azam University, Islamabad, Islamabad, Capital, Pakistan
| | - Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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A Qualitative Study Exploring the Management of Medicine Shortages in the Community Pharmacy of Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010665. [PMID: 34682409 PMCID: PMC8535806 DOI: 10.3390/ijerph182010665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 01/22/2023]
Abstract
Managing medicine shortages consumes ample time of pharmacists worldwide. This study aimed to explore the strategies and resources being utilized by community pharmacists to tackle a typical shortage problem. Qualitative face-to-face interviews were conducted. A total of 31 community pharmacists from three cities (Lahore, Multan, and Dera Ghazi Khan) in Pakistan were sampled, using a purposive approach. All interviews were audio taped, transcribed verbatim, and subjected to thematic analysis. The analysis yielded five broad themes and eighteen subthemes. The themes highlighted (1) the current scenarios of medicine shortages in a community setting, (2) barriers encountered during the shortage management, (3) impacts, (4) corrective actions performed for handling shortages and (4) future interventions. Participants reported that medicine shortages were frequent. Unethical activities such as black marketing, stockpiling, bias distribution and bulk purchasing were the main barriers. With respect to managing shortages, maintaining inventories was the most common proactive approach, while the recommendation of alternative drugs to patients was the most common counteractive approach. Based on the findings, management strategies for current shortages in community pharmacies are insufficient. Shortages would continue unless potential barriers are addressed through proper monitoring of the sale and consumption of drugs, fair distribution, early communication, and collaboration.
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Atif M, Sehar A, Malik I, Mushtaq I, Ahmad N, Babar ZUD. What impact does medicines shortages have on patients? A qualitative study exploring patients' experience and views of healthcare professionals. BMC Health Serv Res 2021; 21:827. [PMID: 34404420 PMCID: PMC8369330 DOI: 10.1186/s12913-021-06812-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background The shortage of medicines represents a complex global phenomenon that triggers patient care and safety issues. The study was undertaken to explore the impact of medicines shortages on patients in Pakistan. The study also identified barriers which hinder the solutions of medicines shortages issue. Methods A qualitative study design was adopted and the data was collected in stages between July and September 2019using an in-depth interview approach. The purposive and convenient sampling strategy was used to recruit the study participants. Sample size was limited by using the saturation point criteria. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results A total of 35 stakeholders including 13 physicians, 12 pharmacists and 10 patients participated in the study. The findings of the study were classified into five key themes and seven subthemes. The five themes included, ‘impact of medicine shortages on patients’, ‘patients’ practices in response to medicine shortages’, ‘influence of medicines shortages on medical practice or pharmaceutical business’, ‘barriers to solutions for medicines shortages’, and ‘suggestions to assuage the impact of medicine shortages.’This study showed that the medicine shortages had significant clinical and financial impact on patients. Patients’ opted for a number of risk-prone practices to avoid treatment disruption during shortages. An array of pharmaceutical market, medicines quality and patient related factors refrain physicians to switch from brand name medicine to generics and lead to ineffective management of medicines shortages. Promotion of generic prescription, implementation of punitive policies and proper patient consultation was advised to assuage the impact of medicine shortages on patients. Conclusion The adverse clinical, economic and humanistic impact affirmed in this study demand the introduction of risk-management strategies for medicines shortages in hospital and community settings in accordance with the international standards. Promotion of effective patient counselling by the healthcare professionals to deter risk-prone practices associated with medicines shortages is mandatory. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06812-7.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Azka Sehar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Irem Mushtaq
- Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Atif M, Ahmad M, Malik I, Mushtaq I, Ahmad N, Mehjabin, Babar ZUD. How medicines sales staff is responding to presumptive COVID-19 patients attending drug retail outlets: An exploratory qualitative study. Int J Health Plann Manage 2021; 36:2297-2312. [PMID: 34390010 PMCID: PMC8426854 DOI: 10.1002/hpm.3293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022] Open
Abstract
The objective of this qualitative study was to explore how the medicine sales staff responded to presumptive COVID‐19 patients in Pakistan. The data were obtained from the medicine sales staff working at drug retail outlets of Bahawalpur, Punjab, Pakistan, through in‐depth face‐to‐face interviews using a semi‐structured interview guide. A two‐step sampling strategy was used, including purposive and convenient sampling techniques. Sample size was determined by applying the saturation point criteria. A total of 17 interviews were audio‐recorded, transcribed verbatim and analysed using the thematic analysis. Analysis of data yielded six themes and seven sub‐themes. The themes included (1) knowledge about various aspects of COVID‐19, (2) practices of sales staff in response to COVID‐19 pandemic, (3) attitude of sales staff towards COVID‐19 pandemic, (4) services offered to presumptive COVID‐19 patients, (5) challenges encountered during pandemic and (6) suggestions to improve delivery of pharmacy services by sales staff. In Pakistan, non‐pharmacist sales staff had superficial knowledge about COVID‐19. Presumptive COVID‐19 patients were provided with only basic pharmacy services. Professional training is advised among pharmacy sales staff as a short‐term solution to improve their knowledge. As a long‐term goal, the availability of pharmacists at drug retail outlets is warranted.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Irem Mushtaq
- Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Mehjabin
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Shukar S, Zahoor F, Hayat K, Saeed A, Gillani AH, Omer S, Hu S, Babar ZUD, Fang Y, Yang C. Drug Shortage: Causes, Impact, and Mitigation Strategies. Front Pharmacol 2021; 12:693426. [PMID: 34305603 PMCID: PMC8299364 DOI: 10.3389/fphar.2021.693426] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Fatima Zahoor
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
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Rafi S, Rasheed H, Usman M, Nawaz HA, Anjum SM, Chaudhry M, Babar ZUD. Availability of essential medicines in Pakistan-A comprehensive document analysis. PLoS One 2021; 16:e0253880. [PMID: 34242249 PMCID: PMC8270130 DOI: 10.1371/journal.pone.0253880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Access to essential medicines (EMs) is a basic human right. Non-availability and shortages of EMs are reported for Pakistan but there is insufficient data to define the nature and magnitude of this problem. The current study is designed to systematically analyze the medicines included in the National Essential Medicines List (NEML) for their availability through comprehensive document analysis. METHODS An expanded list of medicinal items was developed using the NEML of Pakistan (2018) to enlist individual medicines with their specifications. Registration status of the medicines was searched using three publicly accessible information sources; Pharmaguide 25th Edition, 2018-19, the on-line Drug Information System, and the Mobile Application Pharmapedia followed by a later 3-step validation of the data. The unregistered EMs were then further categorized into three subgroups in accordance with their possible remedial strategies. FINDINGS The 19 studied categories comprised 690 EMs and it was found that 179 (26%) of these EMs don not have a registration status. However, it was also identified that the availability of 47 (26.2%) out of 179 unregistered EMs can be enssured by strengthening compounding services, and prioritizing registration of age-appropriate formulations. Availability of another 39 (21.7%) such medicines can be ensured by revising the NEML or the product registrations for the slight differences in their different specifications. The categories showing high proportion of unregistered medicines included anti-Parkinson's medicines (100%), antidotes and other substances used in poisoning (60%), diuretics (47%), anticonvulsants/antiepileptics (42%), hormones and other endocrine medicines and contraceptives (38%), medicines for mental and behavioral disorders (30%), anti-infectives (27%), medicines for pain and palliative care (26%), medicines for neonatal care (25%), medicines for diseases of joint (25%), gastrointestinal medicines (24%) and cardiovascular medicines (15%). CONCLUSION The study shows the absence of registration status of a significant number of EMs in Pakistan. This could be major barrier in their access. Strategies are needed to strengthen the processes of their registration on priority basis.
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Affiliation(s)
- Sunaina Rafi
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Huma Rasheed
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Usman
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Hafiz Awais Nawaz
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Syed Muneeb Anjum
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mamoona Chaudhry
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zaheer-Ud-Din Babar
- Centre for Pharmaceutical Policy and Practice Research, University of Huddersfield, Huddersfield, United Kingdom
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Manaf RA, Mahmud A, Ntr A, Saad SR. A qualitative study of governance predicament on dengue prevention and control in Malaysia: the elite experience. BMC Public Health 2021; 21:876. [PMID: 33957870 PMCID: PMC8101109 DOI: 10.1186/s12889-021-10917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background The challenges faced by healthcare personnel in relation to dengue prevention and control are perennial but noticeably unexplored. It is often difficult to translate policies and decision making by the elite into astute management in consonance with the needs of rank-and-file personnel. In this study, we assess the impact of governance on dengue prevention and control activities in Malaysia as narrated by the elite. Methods A qualitative study using a case-study approach was conducted between January 2019 and November 2019 in the districts of Gombak and Klang, where the relevant key informants were located. Nineteen interviews were conducted among elite healthcare personnel from different divisions: management, vector, laboratory, inspectorate, health promotion and entomology. Semi-structured interviews were conducted. The sample size was determined through saturation point criteria. Purposive sampling techniques were used to recruit the participants. The interviews were audio recorded, and the transcribed text was analysed with deductive thematic analysis. Results Data analysis led to the development of 5 themes and 13 categories. The major principles of governance were embodied in a milieu of predicament, linked to constraints but also opportunities. The constraints resulted from inherent determinants of dengue outbreaks, the serviceability of governing policies and the macro-economics of budget allocation. The opportunities to sustain governance at the local operating level stem from a prevalent supportive internal management system, collaborative efforts among corresponding external government agencies and willingness to innovate and embrace novel technology. Conclusion Elites are influential, often well-informed personnel tasked with making decisions that can reverberate across an organisation, impacting future plans and strategic policies. Political arrangements at higher levels will reflect in advance the tone of how governance in dengue prevention and control is operationalised by entities and individuals at lower levels of the health system. The prevailing centralised structure in the Malaysian health system will continue to entrench the position of the elite and intertwine it with governance and its predicaments. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10917-3.
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Affiliation(s)
- Rosliza Abdul Manaf
- Health Management Unit, Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
| | - Aidalina Mahmud
- Health Management Unit, Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Anthony Ntr
- Health Management Unit, Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siti Rohana Saad
- Hulu Selangor Health District Office, Kuala Kubu Bharu, Malaysia
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Siddiqui A, Ahmed A, Tanveer M, Arshad A. The crux of Pakistan's prolonged rabies vaccine shortage: A rising mortal threat in the COVID-19 pandemic. J Med Virol 2021; 93:5221-5222. [PMID: 33851738 PMCID: PMC8251377 DOI: 10.1002/jmv.27024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Adeel Siddiqui
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Ali Ahmed
- School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia
| | - Maria Tanveer
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Asma Arshad
- Allama Iqbal Open University, Islamabad, Pakistan
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Atif M, Ihsan B, Malik I, Ahmad N, Saleem Z, Sehar A, Babar ZUD. Antibiotic stewardship program in Pakistan: a multicenter qualitative study exploring medical doctors' knowledge, perception and practices. BMC Infect Dis 2021; 21:374. [PMID: 33882843 PMCID: PMC8059254 DOI: 10.1186/s12879-021-06043-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/05/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The emerging threat of antibiotic resistance is growing exponentially and antibiotic stewardship programs are cornerstone to fight against this global threat. The study aimed to explore the knowledge, perspectives and practices of physicians regarding various aspects of antibiotic stewardship program including antibiotic stewardship activities, rational use of antibiotics, antibiotic resistance, prescribing practices and factors associated with these practices. METHODS In this qualitative study, a total of 17 semi-structured, in-depth interviews with doctors of three tertiary care public sector hospitals in Bahawalpur and Rahim Yar Khan were conducted. The convenient sampling method was adopted to collect the data and the saturation point criterion was applied to determine the sample size. Thematic analysis approach was used to draw conclusions from the data. RESULTS The analysis of data yielded five themes, 12 subthemes and 26 categories. The themes included, (i) perception about antibiotic use and antibiotic stewardship, (ii) antibiotic prescription practices, (iii) antibiotic resistance, (iv) limited strategies adopted by hospital administration to ensure quality and safe distribution of antibiotics, (v) implementation of antibiotic stewardship program: barriers, suggestion and future benefits. Doctors had misconceptions about the rational use of antibiotics. The perception regarding antibiotic stewardship programs was poor. Moreover, very few activities related to ASP existed. The participants gave many suggestions for successful implementation of ASP in order to reduce the burden of antibiotic resistance, including development of guidelines for the use of antibiotics, strict legislation regarding use of antibiotics, active participation of healthcare professionals and awareness program among general public about the use of antibiotics. CONCLUSION This study concluded that poor knowledge of doctors regarding ASP, non-existence of antibiogram of hospital and lack of rules for the safe use of antibiotics were the main driving factors associated with irrational antibiotic prescription practices and development of AR.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Beenish Ihsan
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Zikria Saleem
- Department of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Azka Sehar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Godman B, Haque M, Islam S, Iqbal S, Urmi UL, Kamal ZM, Shuvo SA, Rahman A, Kamal M, Haque M, Jahan I, Islam MZ, Hossain MM, Munzur-E-Murshid, Kumar S, Charan J, Bhatt R, Dutta S, Abhayanand JP, Sharma Y, Saleem Z, Phuong TNT, Kwon HY, Kurdi A, Wale J, Sefah I. Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future. Front Public Health 2020; 8:585832. [PMID: 33381485 PMCID: PMC7767884 DOI: 10.3389/fpubh.2020.585832] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Samiul Iqbal
- Department of Orthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Umme Laila Urmi
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Zubair Mahmood Kamal
- Integrated Sleep Disorders Center, McGuire VAMC/VCU Health, Richmond, VA, United States
| | | | - Aminur Rahman
- Finance & Account Division, Grameen Euglena, Dhaka, Bangladesh
| | - Mustafa Kamal
- Al-Manar Hospital Ltd., Modern Hospital Cumilla Ltd., Dhaka, Bangladesh
| | - Monami Haque
- Human Resource Department, Square Toiletries Limited, Rupayan Center, Dhaka, Bangladesh
| | - Iffat Jahan
- Department of Physiology, Eastern Medical College, Comilla, Bangladesh
| | - Md. Zakirul Islam
- Department of Pharmacology, Eastern Medical College, Comilla, Bangladesh
| | | | - Munzur-E-Murshid
- WISH2ACTION Project, Handicap International, Kurigram, Bangladesh
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati University, Gandhinagar, India
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Yesh Sharma
- Department of Conservative Dentistry and Endodontics, Rajasthan University of Health Sciences, Jaipur, India
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hye-Young Kwon
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Israel Sefah
- Ghana Health Service, Keta Municipal Hospital, Pharmacy Department, Keta, Ghana
- University of Health and Allied Sciences, School of Pharmacy, Pharmacy Practice Department, Volta Region, Ghana
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Hussain K, Ambreen G, Muzammil M, Raza SS, Ali U. Pharmacy services during COVID-19 pandemic: experience from a tertiary care teaching hospital in Pakistan. J Pharm Policy Pract 2020; 13:74. [PMID: 33292772 PMCID: PMC7604651 DOI: 10.1186/s40545-020-00277-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022] Open
Abstract
The coronavirus disease 19 (COVID-19) is rapidly spreading across the world. Pharmacy services play a vital role in public health in preventing and containing the COVID-19 pandemic. All over the world, especially in the developed countries pharmacists have responded smartly and speedily for public health, such as establishing professional protective and service guidance for pharmacy staff and services, creating and updating drug formularies, addressing the issues of drug shortages, providing public education for prevention and management of infection, contributing in drug evaluation and clinical trials. In this commentary, we review the exclusive demands from pharmacy services in Pakistan during coronavirus disease 2019 pandemic and sharing the responses of our hospital pharmacy to these demands and needs with the international pharmacy community, especially of the low and middle-income countries like Pakistan.
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Affiliation(s)
- Kashif Hussain
- Department of Pharmacy, Aga Khan University Hospital, Stadium Road (Main Pharmacy), P.O Box 3500, Karachi, 74800, Pakistan.
| | - Gul Ambreen
- Department of Pharmacy, Aga Khan University Hospital, Stadium Road (Main Pharmacy), P.O Box 3500, Karachi, 74800, Pakistan
| | - Mehreen Muzammil
- Department of Pharmacy, Aga Khan University Hospital, Stadium Road (Main Pharmacy), P.O Box 3500, Karachi, 74800, Pakistan
| | - Syed Shamim Raza
- Department of Pharmacy, Aga Khan University Hospital, Stadium Road (Main Pharmacy), P.O Box 3500, Karachi, 74800, Pakistan
| | - Umer Ali
- Department of Pharmacy, Aga Khan University Hospital, Stadium Road (Main Pharmacy), P.O Box 3500, Karachi, 74800, Pakistan
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Atif M, Malik I. Why is Pakistan vulnerable to COVID-19 associated morbidity and mortality? A scoping review. Int J Health Plann Manage 2020; 35:1041-1054. [PMID: 32700410 PMCID: PMC7404956 DOI: 10.1002/hpm.3016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022] Open
Abstract
The scoping review was undertaken to outline the vulnerabilities of Pakistan's public health and healthcare system, which put the population at increased risk of coronavirus disease 2019 (COVID‐19) associated morbidity and mortality. The major electronic databases were searched using both “text words” and “thesaurus terms,” focusing on viral infections, COVID‐19 and healthcare systems in Pakistan. The content of the selected articles was analyzed by using thematic approach. Out of the total 171 potentially relevant citations, 24 articles were included in the data synthesis. We found that the recent COVID‐19 outbreak is a major threat to Pakistan's public health and healthcare system, and the country is not in a position to control spread of disease and provide required standards of care deemed necessary by the World Health Organization. A number of intertwined reasons that expose the Pakistani population at increased risk of COVID‐19 associated morbidity and mortality, include public related demurrals, healthcare workforce related demurrals, organizational and regulatory voids, and travel patterns. To cope with the upsurge of COVID‐19 in Pakistan, the regulators need to re‐examine and recognize deficiencies in the healthcare system, and thereafter reinforce core capacities in workforce and monetary resources, surveillance, laboratory services, and hospital preparedness for isolation and ventilation of patients.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Atif M, Malik I. COVID-19 and community pharmacy services in Pakistan: challenges, barriers and solution for progress. J Pharm Policy Pract 2020; 13:33. [PMID: 32547769 PMCID: PMC7294513 DOI: 10.1186/s40545-020-00240-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
In the wake of atrocious rise in COVID-19 cases, developed countries are leveraging a range of community pharmacy services with the goal of improving access to essential medication and healthcare services. While in the developing nations, including Pakistan, pharmacists are unable to perform COVID-19 containment roles in community, since presence of pharmacists at community pharmacy settings and delivery of pharmacy services have historically been plagued by shortcomings at various levels. In this document, we identified these shortcomings which need to be resolved on many fronts. Broadly, a number of intertwined government related, public related, academic curricula and pharmacist related, and drug retailers' related factors refrain community pharmacists from performing and facilitating Pakistan's fragile public and healthcare system in the midst of COVID-19 pandemic. Government led multifaceted approaches are urgently needed to strengthen this unrecognized domain and thereby effectively combat COVID-19 by utilizing community pharmacy services, as evidenced in the developed world. [Note: Part of this article is published in Pakistan Observer Newspaper; dated 17 May 2020).
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Iram Malik
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
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Atif M, Hasan S, Mushtaq I, Javaid S, Asghar N, Scahill S. A qualitative study to explore the role of pharmacists in healthy weight management in adults in Pakistan: current scenario and future perspectives. BMC Health Serv Res 2020; 20:541. [PMID: 32539709 PMCID: PMC7296957 DOI: 10.1186/s12913-020-05419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Pharmacists possess significant potential for providing health services to the public when it comes to issues of weight management. However, this practice has not been observed in most parts of the world including low- and middle-income countries (LMICs) such as Pakistan. The aim of this study was to explore the potential role of pharmacists in providing healthy weight management (HWM) services to adults in Pakistan, and the barriers associated with the implementation of this type of role. Methods This descriptive qualitative study was set in seven hospitals (public and private) and three chain pharmacies in Lahore, Punjab – a province of Pakistan. Data was collected from in-depth individual interviews with pharmacists (n = 19) and medical doctors (n = 15). Purposive sampling techniques were applied to recruit both types of study participants. Telephone contact was made by the trained data collectors with the pharmacists to set the date and time of the interview after explaining to them the purpose of the study and obtaining their willingness and verbal recorded consent to participate. Registered medical doctors were recruited through snowball sampling techniques. The sample size was determined by applying the point at which thematic saturation occurred. All interviews were audio-recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis. Results Through inductive qualitative analysis eight themes emerged; potential role for community pharmacists, collaborative approaches, barriers, ideal pharmacist-based weight management program, professional requirements and need for training, potential for implementation, current scenario in pharmacies and level of trust of pharmacists. The first six themes were common to both pharmacists and medical professionals. The unique theme for doctors was the ‘level of trust of pharmacists’, and for the pharmacists was the ‘current scenario in pharmacies’. Conclusion The majority of participants in our study had strong convictions that Pakistani pharmacists have the potential for provide effective HWM services to their communities. Of concern, none of the participating pharmacies were offering any sort of weight management program and none of the medical professionals interviewed were aware of HWM programs taking place. Medical doctors were of the opinion that pharmacists alone cannot run these programs. Doctor participants were firm that after being adequately trained, pharmacists should only carry out non-pharmacological interventions. To implement a HWM pharmacy model in Pakistan, it is necessary to overcome barriers outlined in this study.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan.
| | - Sanah Hasan
- College of Pharmacy, Ajman University, Ajman, United Arab Emirates
| | - Irem Mushtaq
- Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Sareema Javaid
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Noureena Asghar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Shane Scahill
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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Pharmacy Services beyond the Basics: A Qualitative Study to Explore Perspectives of Pharmacists towards Basic and Enhanced Pharmacy Services in Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072379. [PMID: 32244475 PMCID: PMC7177847 DOI: 10.3390/ijerph17072379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/17/2022]
Abstract
Enhanced pharmacy services have been identified as a mechanism to address medicines and drug-related problems. The aim of the study was to explore the perspectives of practicing pharmacists on the scope of pharmacy service provision in Pakistan. This qualitative study was conducted at the Department of Pharmacy, the Islamia University of Bahawalpur (IUB). Face-to-face, in-depth interviews were conducted with practicing pharmacists at the university who were undertaking postgraduate studies. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. A total of 13 pharmacists were interviewed. The analysis of data yielded four themes and 12 subthemes. The themes included the current scenario of pharmacy services, the benefits of pharmacy services, barriers to implementation of pharmacy services, and strategies to improve their delivery. Pharmacist participants reported that patient-oriented pharmacy services have not been properly implemented in Pakistan. Pharmacists appear to be undertaking only conventional roles at various levels within the healthcare system. The participants indicated multiple benefits of patient-oriented pharmacy services, including safe and effective use of medicines, minimization of drug-related problems, and financial benefits to the healthcare system. Based on the findings, policy-makers are required to take the necessary steps to overcome pharmacist-related and policy-related barriers associated with the implementation of patient-oriented pharmacy services in Pakistan.
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71st anniversary of pharmacy profession in Pakistan: Why pharmacists' are still flying under the radar? Res Social Adm Pharm 2019; 15:1495-1496. [PMID: 31615728 DOI: 10.1016/j.sapharm.2019.09.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
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