Physicians' perceptions and expectations of pharmacists' professional duties in government hospitals in Kuwait

Exploring the training of pharmacists oriented to the demands for clinical pharmacy services: from the perspective of physicians

BACKGROUND

To evaluate physicians' perceptions, experiences and expectations of clinical pharmacists in China from the perspective of physicians' demands, to improve the training of pharmacists.

METHODS

A cross-sectional survey involving physicians (except for primary physicians) was conducted from July to August 2019 in China. Using a field questionnaire, this study gathered data on descriptive information about the respondents and their perceptions, experiences and expectations of clinical pharmacists. Data were analysed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify physicians' demands for clinical pharmacists in China.

RESULTS

A total of 1376 physicians from secondary and tertiary hospitals in China (response rate = 92%) participated. The majority of the respondents were comfortable with clinical pharmacists providing education to patients (59.09%) and detecting and preventing prescription errors (60.17%), but they appeared uncomfortable when asked about clinical pharmacists suggesting the use of prescription medications to patients (15.71%). Most respondents agreed that clinical pharmacists are a reliable source of general drug information (81.84%) instead of clinical drug information (79.58%). The majority of the respondents expected clinical pharmacists to be knowledgeable drug therapy experts (95.56%) and to educate their patients about the safe and appropriate use of medications (95.56%).

CONCLUSION

Physicians' perceptions and experiences were positively associated with the frequency of their interaction with clinical pharmacists. They had high expectations of clinical pharmacists as knowledgeable drug therapy experts. Corresponding policies and measures are needed to improve the education and training system of clinical pharmacists in China.

Pain Physicians' Attitudes and Experiences Regarding Clinical Pharmacy Services in China: A National Cross-Sectional Survey

Purpose

Pharmacists are key members of the pain management interdisciplinary team in many developed countries. However, the implementation of clinical pharmacy services in pain management is impeded by the imbalance between the pain physicians and clinical pharmacists specializing in pain management in China. The purpose of this study was to elucidate the perceptions, expectations and current experience of Chinese pain physicians regarding clinical pharmacy services.

Patients and Methods

An anonymous, self-administered questionnaire was designed according to previously published studies with minor modifications and distributed online to 1100 pain physicians selected randomly in hospitals across all 31 provinces of mainland China in 2021. Data were analyzed using descriptive and inferential statistics.

Results

A total of 1071 valid questionnaires were included for analysis. The pain physicians were from all 31 provinces of mainland China and most of them were from tertiary hospitals holding an undergraduate degree. Among listed kinds of clinical pharmacy services, pain physicians were less comfortable with pharmacists treating minor illnesses (p < 0.001). Pain physicians' experiences with clinical pharmacy services were far less than their expectations (p < 0.001), which is in line with the results that most of pain physicians (65.9%) interacted with pharmacists at a frequency of less than once a week. Significant differences in the experiences were found among ages (p < 0.01) and among years of work experience (p < 0.05) of pain physicians. Pain physicians' expectations of pharmacists were positively correlated with their experiences with clinical pharmacy services (p < 0.001).

Conclusion

Pain physicians in China had positive perceptions and high expectations, but relatively low experiences regarding clinical pharmacy services. Expanding clinical pharmacist pain management credentialing and increasing pain physicians' exposure to clinical pharmacy services are favourable to support the interdisciplinary collaboration in pain management in China.

The Role of Clinical Pharmacists in Improving Quality of Care in Patients with Inflammatory Bowel Disease: An Evaluation of Patients’ and Physicians’ Satisfaction

Background: Inflammatory bowel disease (IBD) is a chronic and complex disease that requires a multidisciplinary team, including clinical pharmacists, to improve the quality of care and patient outcome. This present study aimed to assess the satisfaction of patients with IBD and physicians regarding clinical pharmacist interventions in outpatient and inpatient settings. Methods: A survey-based study was performed between 1 March and 1 August 2022 in a tertiary care IBD center. Two different questionnaires were distributed among patients and physicians focusing on satisfaction with the clinical pharmacist services. Patient demographics were obtained. Descriptive statistics were used to summarize the results of the survey. Results: A total of 108 patients with IBD and 23 physicians participated in this study. Among study participants, Crohn’s disease (CD) accounted for 64.8% of the total participants, while 35.2% of patients had ulcerative colitis (UC). Regarding the patient survey, most patients were extremely satisfied with clinical pharmacists’ services, during which the majority strongly agreed or agreed that they were satisfied with the counseling session. However, five patients were unsure about the amount of time spent with the clinical pharmacist. There were no patients dissatisfied with any of the services. Finally, two physicians were not sure regarding clinical pharmacists monitoring patients’ responses in of terms of toxicity and adverse effects. Conclusions: the current study illustrates patients’ and physicians’ high satisfaction with clinical pharmacists’ services in outpatient and inpatient settings. The findings of this study as well as previous studies necessitate expanding the clinical pharmacist services in the gastroenterology field.

Gaps in expectations and current practices of pharmacy services among doctors and patients - an exploratory study in a Sri Lankan tertiary care hospital providing free healthcare

The pharmacist is an important link between doctor and patient. To optimise patient care, it is essential that expectations of doctors and patients regarding pharmacy services are met. Hence the objective of this study was to assess the satisfaction levels of doctors and patients on pharmacy services currently provided, and their expectations from pharmacy services. This cross sectional study was conducted in selected clinics of a university based teaching hospital. Questionnaires developed in-house by referring previously published resources, content validated by a group of experts, and face validated through a pilot study were used. Doctors and patients of chronic disease clinics were selected for the study. All doctors involved in prescribing for more than six months, and patients or their regular care givers attending clinics for more than one year were included. Mentally incapacitated patients were excluded. An interviewee administered questionnaire was distributed to doctors and an interviewer administered questionnaire was used for patients. Exploratory factor analysis (EFA) (principal component analysis with Varimax rotation) was conducted to divide variables of the questionnaires into reliable components. Response rate of doctors was 82.3%. Among them 59.6% (50/84) doctors said that they have a good relationship with pharmacists, and 89.3% (75/84) expected communication with pharmacists more often. EFA for doctors’ perceptions resulted in four components. A statistically significant difference was observed between doctors’ expectation (95.9% - 81/84) and current practice (22.6% - 19/84) on communicating medication issues (p<0.001). A total of 380 patients participated. EFA for patients’ perceptions resulted in ten components. The majority considered pharmacists as an integral part of the healthcare system (98.7% - 375/380) and experts in medication (84.7% - 322/380). They further perceived that dispensed medications are safe (82.9% - 315/380) and of good quality (76.3% - 290/380). Further 95.5% (363/380) were satisfied with dispensing label information. A statistically significant difference was found between the expectations (93% - 353/380) and satisfaction levels (86.5% - 329/380) of patients on pharmacy services (p=0.003). According to findings, both doctors and patients held a positive perception on pharmacy services and pharmacists, but the statistically significant gap reported between expectations and current level of pharmacy service, highlighting both the potential and scope for service improvement.

Pharmacists' Perspectives on Interprofessional Collaboration with Physicians in Poland: A Quantitative Study

Over the years, many studies have emphasized the pharmacist’s importance as part of the patient care team. Still, the interprofessional collaboration between physicians and pharmacists in their everyday work seems rare. Therefore, this study aimed to investigate the types of contact between them, possible mutual collaboration, and barriers to implementation. This study was conducted from April to August 2020. The study group included licensed pharmacists working in community pharmacies in Poland (n = 207). The results show that, according to the respondents, physician–pharmacist contact mainly concerns formal aspects, such as correcting prescription errors. They occasionally communicate for other matters, such as consultation regarding drug availability and drug dosage. However, when asked to divide responsibilities between them and physicians, pharmacists indicate areas that should involve interprofessional collaboration, e.g., monitoring adverse drug reactions, analysis of multi-drug therapy, and checking the regularity of taking medications. They indicated the lack of specific collaboration rules, limited willingness to establish relationships and low mutual respect and trust among existing barriers. It is worth considering the possibility of overcoming these barriers provided by interprofessional education in order to develop communication skills and build relationships based on respect.

How to effectively promote interprofessional collaboration? - a qualitative study on physicians' and pharmacists' perspectives driven by the theory of planned behavior

BACKGROUND

Ajzen's theory of planned behavior (TPB) postulates that individuals' behavioral intention is influenced by their attitudes, subjective norms, and perceived behavioral control. Therefore, it can be used to broaden the understanding of particular behaviors, including healthcare workers' professional activities.

METHODS

In this study, we used TPB as a theoretical framework to evaluate semi-structured interviews with pharmacists and physicians to build an understanding of the interprofessional collaboration between them. Sixteen semi-structured interviews were conducted with pharmacists and eleven with physicians. The sample of participants comprised a diverse group with varying work experience and workplaces. Data were analyzed independently by two researchers following the thematic analysis method using ATLAS.ti software. Data saturation was set in the absence of new issues arising during the interviews.

RESULTS

The content analysis allowed for the determination of six main themes: the relationship between previous experiences and attitudes towards collaboration, pharmacist's role in collaboration, mutual reluctance toward collaboration, the role of decision- and policy-makers, knowledge and qualifications gaps regarding collaboration, and lack of organizational paths.

CONCLUSIONS

Despite both physicians and pharmacists displaying positive attitudes towards collaboration may foster their intention to establish a professional partnership, subjective norms (e.g., the lack of appropriate legal regulations) and perceived behavioral control (physicians' lack of awareness about pharmacists' qualifications and the low level of interpersonal skills) might impede the process.

Cooperation Between Pharmacists and Physicians - Whether It Was Before and is It Still Ongoing During the Pandemic?

Nowadays, it is very important to put an emphasis on widely understood teamwork. This is of great importance for achieving and maintaining success in all areas, especially in medicine. This kind of unity has many advantages, including unique ideas that are very helpful in a competitive environment, improve performance and knowledge, and create stronger supportive work relationships. Patient’s health can be improved by using comprehensive treatment. This provides an urgent need for multidisciplinary partnership in the medical community. Optimal pharmacological treatment is crucial to achieving treatment goals. To ensure excellent quality of medical care, interprofessional cooperation between physicians and pharmacists and/or other medical professionals is necessary. Their complementary knowledge and experience can lead to improved health outcomes and can also reduce treatment costs. There are also many barriers and difficulties in legal systems that would allow for more effective inter-professional cooperation. The COVID-19 pandemic contributed to emphasizing the role of the pharmacist, increasing powers, and at the same time to teamwork, sometimes forced by the situation. The purpose of this publication is to view the literature on the cooperation of physicians and pharmacists in the provision of medical services for patients. Professional cooperation has been well known in many countries for years, as it is a key medium supporting optimized patient care. Analyzing the challenges and approaches can lead to better and improved health care.

Contribution of faculties of pharmacy in Arab countries to pharmacy practice research: a bibliometric analysis (1990-2020)

OBJECTIVE

To provide an overview of pharmacy practice research by faculties of pharmacy in the Arab region using a bibliometric methodology.

METHOD

Relevant articles were retrieved from SciVerse Scopus. The search strategy was developed to retrieve all articles published in pharmacy practice journals and those with specific keywords such as 'clinical pharmacy', 'community pharmacy', 'hospital pharmacy', 'pharmacy education' and 'pharmacy practice'. The country affiliation function was used to limit the results to the Arab region.

KEY FINDINGS

The search strategy found 1496 articles authored by 8210 researchers and disseminated through 337 journals. Research on pharmacy practice produced by faculties of pharmacy in the Arab region (1) has experienced a steep growth over the last decade; (2) is mainly published by scholars in Saudi Arabia, Jordan, Qatar and the United Arab Emirates; (3) has benefited from non-Arab scholars affiliated with faculties of pharmacy in the Arab Gulf; (4) has benefited from international collaborations, specifically with researchers in the UK and Malaysia; (5) has mainly addressed seven research topics: adverse drug reactions and pharmacovigilance, medication adherence, self-medication, patient counselling, pharmacy education, perception of physicians towards pharmacists; (6) has shown a relationship between institutional funding and research output and (7) has shown the highest number of readers for topics related to polypharmacy, over-the-counter medications, self-medications, medication adherence and pharmacist intervention in disease management.

CONCLUSION

Pharmacy practice research in Arab countries has witnessed a steep rise in the last decade, partially due to international research collaboration.

Enablers and challenges to pharmacy practice change in Kuwait hospitals: a qualitative exploration of pharmacists' perceptions

RATIONALE, AIMS, AND OBJECTIVES

The practice of hospital pharmacists in many developing countries has been changing to include the delivery of direct patient care services, but practice change can be a challenging process. This article explores the perceptions of hospital pharmacists in Kuwait about the enablers and challenges to expanding their scope of practice to include direct patient care.

METHODS

A phenomenological qualitative approach was employed to conduct focus group interviews to explore pharmacists' perceptions about their professional practice at different hospitals across Kuwait. Data were collected from 110 pharmacists using 11 focus group interviews. The interviews were audio-recorded, transcribed verbatim, and analysed using framework analysis.

RESULTS

The practice of most hospital pharmacists includes limited direct patient care role. However, a growing number of pharmacists have been introducing clinical pharmacy services at hospitals. Three themes about enablers to practice change emerged from data: (a) increasing physicians' acceptance to pharmacists' role in patient care, (b) patients' trust in pharmacists' knowledge about medications, and (c) pharmacists' perceived benefits of providing direct patient care. These benefits includes enhancing patients' safety and adherence to therapy and improving the professional identity of pharmacists. Participants' perceived challenges to practice change include professional, individual, and organizational challenges. Most participants welcomed assuming direct patient care role. They agreed that pharmacists need to receive adequate education and training and to be equipped with a clinical degree to responsibly provide direct patient care services at hospitals.

CONCLUSIONS

Pharmacists have been increasingly attempting to provide clinical pharmacy services in Kuwait hospitals. This qualitative data revealed breadth of challenges hindering pharmacists' attempts to expand their professional practice to include direct patient care role. It also outlines facets of improvement and enablers to practice change. The collaboration between different stakeholders in the profession is essential to support pharmacists' efforts in achieving the change in the scope of pharmacy practice to improve patient care services.

A country-level national needs assessment of the Indonesian pharmacy workforce

BACKGROUND

Conducting a systematic country-level workforce needs-assessment is a way to develop coherent strategic and justifiable workforce planning.

OBJECTIVE(S)

This article describes a country-level needs-assessment process using a systematic approach (via the FIP Development Goals (FIP DGs) workforce element) as an analytical framework. The needs-assessment aimed to prioritise gaps toward transforming the pharmacy workforce as a prelude to practice and pharmaceutical services reform in Indonesia.

METHODS

The needs assessment consisted of three stages: needs identification, needs analysis, and needs prioritisation. The needs (workforce development gaps) were defined as the discrepancies between the perceived workforce challenges and the existing national workforce development projects. Interviews or group discussions were conducted to gather the workforce challenges of individual pharmacists. A structured workshop was conducted to identify workforce challenges and existing organisations' projects, with main stakeholders contributing to pharmacists' development in Indonesia. Perceived challenges findings and identified national workforce projects were mapped to the FIP DGs workforce element. The needs prioritisation was conducted by comparing the proportional mapping to the FIP DGs workforce element.

RESULTS

There were forty-three individual pharmacists and 7 principal stakeholder categories that provided information related to perceived workforce challenges; thirty national projects were identified from stakeholders. While this study identified perceived challenges with workforce "competency development" and "pharmacy workforce intelligence," there were no active ongoing national projects mapped to those goals. The framework mapping analysis showed there are workforce development gaps centred on "competency development" initiatives, "advanced and specialist development" initiatives, and strategic pharmacy workforce intelligence data gathering. Additionally, there were policy gaps with initiatives for strengthening "working with others" and a lack of clarity on infrastructure for early-career training strategies and workforce impact.

CONCLUSIONS

This study prioritises the gaps in developing pharmacists in Indonesia. This process could be used in conducting needs assessment of pharmacy workforce development in other Low and Middle-Income Countries (LMICs).

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

The acceptance and awareness of healthcare providers towards doctor of pharmacy (Phram D) in the Palestinian health care system

Clinical pharmacy (Pharm.D or MSc Clinical Pharmacy graduates) is a patient care oriented specialty. It aims to improve patient therapeutic outcomes and minimize medication errors. In Palestine, it is a new specialty taught at two universities. In order to implement this new specialty in healthcare settings, healthcare providers should have a high awareness about it, its role and importance in clinical settings. This study aimed to evaluate the awareness and acceptance levels among healthcare providers' about clinical pharmacy specialty. A cross sectional study carried out using a self-administered questionnaire that was developed and tested by a panel of experts for validity and reliability, then it was distributed and filled by the convenient sample of health care providers in the northern and middle of Palestine between January and March 2019. An awareness scale and acceptance scale were developed from the questions used to identify the healthcare providers' awareness and acceptance. Chi-square (X2) -testing was performed to check for the significant association. Data were analyzed using SPSS (version22). Among 309 respondents, 203(65.7%) were male, 67(21.7%) were working at Jerusalem, 229(74.1%) of them completed their first degree at Arab countries and 69(54.7%) completed higher education. Regarding their work, 169(54.7%) were physicians, followed by 85(27.5%) nurses and 55(17.8%) pharmacists. Results revealed that the majority of healthcare providers had a moderate 182(58.9%) and good 81(26.2%) awareness level toward the Clinical pharmacy specialty roles and 217 (70.2%) had a good acceptance level toward their implementation among the health worker team. Significant differences were found between healthcare providers' awareness level and their sex (P = 0.001), professions (P = 0.006) and job descriptions (P = 0.013). There were no significant differences between the health care providers' acceptance level and their age, sex, qualification, profession and job descriptions. Our results revealed the ability to collaborate in the integration of such specialty within the Palestinian healthcare system. Additional interest from the Ministry of Health is recommended to integrate clinical pharmacy workers among the health system and promote their relations with other disciplines.

Physicians' and pharmacists' perception and practice of hospital pharmacist professional role in Egypt

OBJECTIVES

This study aimed to investigate physicians' and pharmacists' perceptions of the importance of pharmacists' role in healthcare in Egypt, and actual delivery of these roles in practice. Identifying any differences and inconsistencies between these will inform future strategies that maximize pharmacists' professional contribution to hospital practice.

METHODS

A self-administered questionnaire using a 5-point Likert scale was distributed to a convenience sample of physicians (500) and pharmacists (500) practicing in selected private or public hospitals in Egypt. The main sections of the questionnaire comprised statements that pertained to physicians'/pharmacists' views on the importance of pharmacists' roles and their actual delivery in practice.

KEY FINDINGS

In this study, physicians showed low scores for both the importance of and the delivery of advanced patient-facing clinical pharmacy roles such as suggesting prescription medications, and designing treatment plans. In comparison, pharmacists were more positive on both of these aspects of their roles. High mean scores were reported by the physicians for pharmacist's traditional roles such as patient counselling, assessing compliance, preventing medication errors and treating minor illnesses. Both physicians and pharmacists reported poor pharmacists practice as drug information resources despite their high perception of the importance of that role.

CONCLUSION

This study suggested that in hospitals in Egypt, there are significant differences between physicians' and pharmacists' perception and practice, and pharmacists' clinical skills are underutilized in health care.

Attitudes, Opportunities, and Challenges for Clinical Pharmacy Services in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: Health Care Providers' Perspective

Background

Clinical pharmacy is a branch of health sciences that focuses more on the patient than on drug product-oriented services to optimize drug therapy. This study aimed to assess attitudes, opportunities, and challenges for clinical pharmacy services from the health care providers' perspective in Mizan-Tepi University Teaching Hospital.

Methods

A cross-sectional study was conducted among physicians, nurses, pharmacy professionals, and public health officers working in Mizan-Tepi University Teaching Hospital. A total of 119 health care providers participated in the study, and data were collected using a pretested self-administered questionnaire. The study tool was designed based on the instruments used in the previously conducted studies. Collected data were coded, entered, and analyzed using Statistical Package for the Social Sciences (SPSS, version 21). Furthermore, the descriptive and inferential statistics were performed.

Results

Out of 119 health care providers included in the study, 59.66% of them were nurses. The majority of the health care providers (85.71%) had a positive attitude towards clinical pharmacy services. Most of the study participants mentioned that acceptance of clinical pharmacy services among health care providers as a major opportunity to clinical pharmacy services in Mizan-Tepi University Teaching Hospital. The major challenges described for the clinical pharmacy services include lack of support from hospital management, absence of clearly defined roles and responsibilities for the clinical pharmacists, and shortage of pharmacy workforce and staff turnover.

Conclusion

Proper strategies should be in place to improve clinical pharmacy services and promote pharmacists' role in providing patient care.

Doctors' perceptions, expectations and experience regarding the role of pharmacist in hospital settings of Pakistan

Background The inclusion of pharmacist in health care system is essential to ensure optimal patient care. However, with the passage of time, pharmacist's role has transcended from dispensing, compounding and counting of pills, to more sophisticated clinical duties. Objective To evaluate doctors' experience, perceptions and expectations regarding pharmacists' role in Pakistani healthcare settings. Setting All tertiary care hospitals across 26 cities of Pakistan. Method A cross-sectional study using a self-administered questionnaire was carried out targeting doctors practising in Pakistan. The survey was conducted from January to April 2018. Chi square (χ²) test was used to analyse responses of doctors regarding pharmacist's role in the healthcare system of Pakistan. The associations were considered significant at p value less than 0.05. The study was approved by concerned ethical committee. Main outcome measure Doctors' experience, perceptions and expectations regarding pharmacists' role. Results A total of 483 questionnaires were received and analysed (response rate; 87.9%). Most participants (67.5%) reported interaction with pharmacists at least once daily, and that was mostly related to drug availability inquiry (73.7%). 86.7% of doctors expected pharmacists to ensure safe and appropriate use of medicines to patients. 87.6% of doctors expected pharmacists to monitor patient's response to drug therapy (p < 0.05) and 66.5% expected pharmacists to review patient's medicines as well as discuss possible amendments to therapy (p < 0.05). Besides, most doctors (84.9%) disagreed with the notion of pharmacists prescribing medicine for patients (p < 0.05). Most participants (81.6%) did not want pharmacists to prescribe independently. Conclusion The study highlights that doctors considered pharmacists as drug information specialists, dispensers, educators and counsellors; however, their expectation of pharmacists performing the clinical role and being involved in direct patient care was limited. They negated the idea of prescription intervention and direct involvement of pharmacists in pharmacotherapy plan for patients. It is imparative  to increase doctors' awareness regarding the role pharmacists could play in Pakistan's healthcare system. Currently, the clinical role of pharmacists in Pakistan's healthcare system seems minimal and is seen with scepticism within the community of doctors.

Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach

Insomnia is one of the most common minor ailments to which patients seek advice in a community pharmacy setting. Due to the availability of a wide variety of over-the-counter (OTC) products, community pharmacists are in the front line to safe-guard patients looking for self-medication or advice for treatment of insomnia. The purpose of this study was to assess the content of community pharmacists' interactions with patients seeking advice for insomnia in Jordan. A cross-sectional study using a simulated patient methodology was conducted across a stratified convenience sample of community pharmacies in three major cities in Jordan. The visits were evaluated using pre-defined criteria adapted from published literature relating to content and counseling skills. Visits were audio-recorded using a hidden microphone and the simulated patient completed a data collection form immediately after each visit. A total of 67 community pharmacies (response rate = 93.0%) agreed to participate and were all visited once by the simulated patient. The median duration of the visit was 2 minutes (range: 0.2-4 minutes). The majority (86.6%) of visits resulted in the sale of a drug, most commonly a combination product (paracetamol and diphenhydramine) for 30 recommendations (44.8%). This was followed by a natural plant extract combination product, namely valerian and lemon balm (Melissa officinalis L.) for 23 (34.3%). Pharmacists often did not question medical history or other symptoms prior to product sale. Frequently, the recommended dose (49.3%) and administration time (38.8%) were the only information provided to the patient. No information was provided in relation to potential drug interactions or contraindications. No advice was offered on lifestyle or good sleeping hygiene. This study provided evidence that community pharmacists in Jordan in general did not offer adequate counseling for patients seeking advice for insomnia. Exploration of the reasons and factors contributing to this practice and highlighting professional opportunity and responsibility is recommended.

Perceptions and expectations of health care providers towards clinical pharmacy services at a tertiary cancer centre in Qatar

Background

Clinical pharmacy services started in 2009 at the National Center for Cancer Care and Research, Qatar. Clinical pharmacy services was established to provide comprehensive prescription of drug management and support, and consulting services to build clinically efficient and cost-effective pharmacy program.

Aim

To determine perceptions and expectations of healthcare providers toward the clinical pharmacy services at the National Center for Cancer Care and Research.

Methods

A cross-sectional survey of healthcare providers was conducted from January to May 2018. A self-administered electronic/paper survey containing four domains assessing healthcare providers’ perceptions and expectations towards clinical pharmacy services, perceived barriers to clinical pharmacist role and suggested area for improvement was sent to 375 healthcare providers including physicians, operational pharmacists, nurses and dietitians.

Results

The response rate was 112/375. Most of the healthcare providers (74%) perceived the increasing interest in clinical pharmacy services. Also, they expected (1) providing consultations regarding appropriate medication choices (82%); (2) providing information about medication availability and shortages (82%); (3) assisting in the prescribing of cost-effective drugs by providing pharmacogenomics information routinely (75%) and (4) Participating actively in research activities (74%). Overall, healthcare providers have a high level of trust in the clinical pharmacists’ abilities (P < 0.01). Nurses were less appreciative (P < 0.002) of the positive role of clinical pharmacists in direct patient care as compared to both physicians and pharmacists (64.2%, 90% and 95.7%, respectively).

Conclusion

This study revealed a positive attitude towards the role of clinical pharmacists by healthcare providers at National Center for Cancer Care and Research. However, there is an area of improvement by empowering with privilege and staffing, elevating the awareness and expansion in the ambulatory care settings.

Physicians' perceptions, expectations, and experiences of clinical pharmacists in Jordan-2017

Background A decade ago, clinical pharmacy was a new concept in hospital settings in Jordan, as evidenced in our 2006/2007 study. Changes in the perceptions, expectations, and experiences of physicians regarding the role of clinical pharmacists need to be investigated. Objective To document physicians' perceptions and expectations of, and experiences with, clinical pharmacists in hospital settings in 2017, and to assess differences in these areas between the 2017 and the 2006/2007 samples. Setting: The study was conducted at four hospitals in the north of Jordan. Method Physicians completed a self-administered questionnaire similar to the one used in our 2006/2007 study, which recorded demographics and assessed physicians' perceptions, expectations, and experiences regarding clinical pharmacists. Data of the 2017 sample were analyzed and compared descriptively to those of the 2006/2007 sample. Main outcome measure Physicians' perceptions, expectations, and experiences of pharmacists in hospital settings in 2017. Results Two hundred and ninety-five physicians completed the questionnaire. Physicians in the 2017 sample were most comfortable with pharmacists suggesting the use of prescription medications such as antibiotics (53.6%). Physicians in the 2017 cohort agreed with the eight expectations stated in the questionnaire. Physicians' experiences with clinical pharmacists improved in 2017 from 2006/2007 in all eight areas evaluated. Conclusion Physicians' perceptions, expectations, and experiences towards the professional role of pharmacists have changed over the past 10 years in Jordan.

Perceptions and expectations of health care providers towards clinical pharmacy services in a mental health hospital in Qatar

BACKGROUND

With the growing burden of mental disorders, pharmacists are ideally positioned to play an important role in supporting people with a mental illness. However, the value of clinical pharmacists within mental health remains unrecognized by other healthcare professionals.

AIMS

The purpose of this study was to explore the perceptions and expectations of mental health professionals on the provision of clinical pharmacy services (CPS) at a psychiatric hospital.

METHODS

A cross-sectional, self-administered, online survey was administered to physicians and nurses working at a psychiatric hospital. Five-point likert scales were used to measure participant's perceptions and expectations about the CPS provided. Descriptive and inferential statistical analysis were undertaken.

RESULTS

Both physicians and nurses reported positive perceptions regarding the CPS provided at the hospital, although physicians agreement with positive statements was higher than those reported by nurses (mean likert scale score 4.76 and 4.45, respectively). There was a statistically significant positive association between participants' years of experience and agreeing that clinical pharmacy services are essential for achieving hospital accreditation (χ2 = 13.11, φ = 0.41, p = 0.04). A statistically significant positive association was noted between the physicians' current position and agreeing that pharmacists assist physicians in selecting more cost effective medication regimens (χ2 = 16.55, φ = 0.62, p = 0.04).

CONCLUSION

Physicians and nurses have mostly positive perceptions and expectations from clinical pharmacists at the psychiatric hospital. However, traditional clinical pharmacy services were more favorably viewed than those associated with advanced clinical roles such as prescribing and pharmacist-led medication management clinics.

As the twig is bent, so is the tree inclined: a survey of student attitudes toward interprofessional collaboration supported with the curricula analysis

Pharmaceutical care was legally introduced as an interprofessional service in Poland in 2009. However, a collaboration between physicians and pharmacists remains incidental. Proper education at the undergraduate level is necessary to shape the attitudes of students toward establishing interprofessional relations. The aim of the study was to assess the perception of physician-pharmacist collaboration among final-year medical and pharmacy students through questionnaires with both closed-ended and open-ended questions. The study also includes an analysis of medicine and pharmacy curricula in terms of promoting interprofessional collaboration between the two fields. The statistical analysis of data obtained from 502 respondents revealed significant differences between the perceived areas for such collaboration. Moreover, the division of roles and responsibilities during the pharmacotherapy process between both professions seems to be unclear. Importantly, only 10.14% of the respondents evaluated these professional relations as 'good' or 'very good'. Also, 66.87% of the students emphasized the importance of educational interventions to improve interprofessional collaboration between pharmacists and physicians. Although 70% of medical and 87% of pharmacy students wish to establish such collaboration in the future, only 15% and 35%, respectively feel adequately prepared for the task. Understanding similarities and differences in this field appears to be the key to designing effective educational solutions for promoting interprofessional attitudes among healthcare undergraduates.

The perspectives of patients and physicians on the role of pharmacists in improving medication adherence in type 2 diabetes: a qualitative study

BACKGROUND

Pharmacy practice has been expanded to include responsibility for the outcomes of medication therapy. However, in developing countries the pharmacist's role is still limited to dispensing medications. The aim of this study is to explore the perspectives of patients and physicians on the pharmacist's role in improving medication adherence in type 2 diabetes.

METHODS

Data were collected via semi-structured interviews with patients and physicians. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

A total of 40 patients and 21 physicians were interviewed. The interviews revealed different pharmacy-related issues that negatively affected patients' adherence, such as a lack of pharmacist counselling and inappropriate scheduling of refills. Various recommendations to improve adherence were emphasised such as dedicating some pharmacists to counselling patients and providing pharmacists with the appropriate training.

CONCLUSION

From the perspectives of patients and physicians, the pharmacist's role in the management of type 2 diabetes is still limited to dispensing medications. In order to improve medication adherence and consequently patient outcomes, policy-makers need to be aware of the importance of supporting pharmacists and providing them with the appropriate training.

Stakeholders' Perspectives on Quality Assurance of Pharmacy Education in the Eastern Mediterranean Region

Objective. To explore pharmacy stakeholders' perspectives in the Eastern Mediterranean Region (EMR) on pharmacy education and quality assurance. Method. Thirty-two interviews were conducted with professionals from 15 EMR countries, exploring pharmacy education in the region. Themes were mapped to the five pillars of the International Pharmaceutical Federation's Global Framework on Quality Assurance of Pharmacy Education. Results. Nine challenges were identified across the framework on country-, institution-, and faculty-level. These challenges were political-socioeconomic instability; limited accreditation and quality assurance measures; insufficient engagement of professional organizations; disconnect between academia, practice and regulatory sectors; curricula shortcomings; skills-gaps; absence of competency frameworks; inconsistencies in pre-registration training; and professional development mechanisms. Conclusion. Vast inter-/intra-regional variability in pharmacy education and quality assurance measures was revealed. The lack of pharmacy-specific national/regional competency frameworks and quality assurance systems has implications for stakeholders in the profession. Progress in this area is crucial for pharmacy education in the EMR.

Drug therapy problems identification by clinical pharmacists in a private hospital in Kuwait

OBJECTIVES

To report the types and frequency of drug therapy problems (DTPs) identified and the physician acceptance of the clinical pharmacist interventions in a private hospital in Kuwait.

METHODS

A retrospective cross-sectional study was conducted on 3500 patients admitted to the hospital between December 2010 and April 2013. A structured approach was used to identify DTPs and recommend interventions. Data were analyzed using MAXQDA version 11.

KEY FINDINGS

A total of 670 DTPs were identified and recommendations were proposed to treating physicians for each DTP. Overdosage was the most frequently identified drug therapy problem (30.8%), followed by low dosage (17.6%), unnecessary drug therapy (17.3%), need for additional drug therapy (11.6%), and need for different drug product (11.6%). The drug classes most frequently involved were anti-infectives (36.9%), analgesics (25.2%), and gastrointestinal agents (15.5%). More than two-third of the interventions (67.5%) were accepted and implemented by physicians. The most frequently accepted interventions were related to nonadherence, adverse drug reaction, monitoring parameters, inappropriate dosage, and need for additional drug therapy.

CONCLUSION

The current findings expand the existing body of data by reporting on pharmacist recommendations of identified DTPs and importantly, their high rate of acceptance and implementation by the treating physician. These results could serve as a springboard to support further development and implementation of clinical pharmacy services in other healthcare settings in Kuwait.

Clinical pharmacy in Kuwait: Services provided, perceptions and barriers

Introduction

Pharmacy practice has considerably evolved from a dispensing role to a patient-centered profession. Kuwait has minimal clinical pharmacy services established in its healthcare settings.

Objectives

The objectives of this study were to document existing clinical pharmacy services in public hospitals, identify barriers to their implementation and assess perceptions regarding pharmacists providing clinical services.

Material & Method

A cross sectional study using self-administered questionnaires among a total of 166 pharmacists and 284 physicians across 6 public hospitals in Kuwait was conducted.

Results

Over half of pharmacists (54%) provided clinical services, with the most common service being education and drug information (86%). Forty percent (40%) of the pharmacists reported that clinical services offered were of their own initiative but most of them (71%) were not sure whether they would offer additional services in the future. The majority of physicians were receptive to an expanded patient-centered role of the pharmacist (97%), believed pharmacists add to patient clinical care (92%) and considered pharmacists members of the healthcare team (96%). Major barriers reported by pharmacists to implement clinical pharmacy services included lack of policy (49%), time (36%) and clinical skills (28%), which is similar to barriers reported by physicians.

Conclusion

Although clinical pharmacy is in its infancy in Kuwait, it is well perceived and requested by physicians. Major barriers must be addressed and in this context, having a national framework for pharmacy practice from Ministry of Health, supported by cutting edge education and a pro-active professional association would be key assets to evolve the practice in Kuwait.

Perceptions, experiences and expectations of physicians regarding the role of pharmacists in low-income and middle-income countries: the case of Tehran hospital settings

OBJECTIVE

Pharmacists play a pivotal role in the health continuum, and the perceptions and expectations of physicians towards pharmacists have been reported as a key factor in the interprofessional relationship. This study aimed to elicit the perceptions and expectations of physicians towards the role of pharmacists in hospitals to clarify the level of interaction between physicians and pharmacists in hospital settings.

DESIGN

A cross-sectional survey using a self-administered questionnaire was conducted to collect data in 2016.

METHODS

A cross-sectional study was carried out at 20 large government hospitals in Tehran Province. Data was collected using a questionnaire consisting of four sections. It includes a section on demographic profile and three sections to measure the perceptions of physicians towards pharmacists, the expectations of physicians and their experiences with pharmacists, respectively.

RESULTS

More than two-thirds of physicians (67.2%) agreed that pharmacists were a reliable source of general drug information. The majority of physicians (90.6%) expected pharmacists to advise their patients about the dose and administration of their medications. Almost half of the physicians (51.6%) agreed that they were usually informed by pharmacists regarding potential problems in their prescriptions. Both senior and junior residents had the view that pharmacists would inform them if any potential problems with their prescriptions were discovered (P=0.04).

CONCLUSION

This study demonstrated that physicians had positive view on pharmacists' clinically defined roles and also accepted pharmacists as a valuable source of general drug information. However, the perceptions and expectations of physicians towards pharmacists did not match their real experience. Therefore, improving the awareness of physicians about the benefits of interprofessional collaboration with pharmacists seems to be a key step towards the implementation of pharmaceutical care practices in Iran.

Exploring the challenges for clinical pharmacists in Sudan

Background Clinical pharmacy practice in hospitals is a new role for pharmacists in Sudan. Pharmacists have to face the challenge of moving from their traditional roles within the pharmacy premises to new roles on the wards with direct contact with patients and other healthcare professionals. Objectives To explore the role and challenges facing the clinical pharmacists of Sudan. Settings Two of the main government hospitals in Sudan and an online survey. Method This study applied a two phase mixed method, a focus group discussion and a survey. A FGD was conducted with the clinical pharmacists in two of the main government hospitals in Sudan. This was followed by an on-line survey among the clinical pharmacists of Sudan. Main outcome measure The role of the clinical pharmacists of Sudan and the challenges facing clinical pharmacy practice. Results Four pharmacists participated in the focus group and 51 out of 140 pharmacists (34%) completed the on-line survey. The roles that were perceived by the majority of pharmacists as part of their duties in hospitals in Sudan were identifying drug-related problems (100%, n = 51), providing drug-related information to healthcare professionals by (96%, n = 47), and educating patients about their medicines (96%, n = 48). The pharmacists identified a number of obstacles that hindered their progress in practice. These obstacles were related to the pharmacists themselves, the lack of senior clinical pharmacists for leadership, the environment they were working in and the training they had received in clinical pharmacy. Conclusion The new clinical pharmacists in Sudan faced several challenges that need to be overcome in order to move forward in their clinical practice. To do so they will require support from pharmacy educational institutions, other healthcare professionals and the healthcare institutions they are working within.

Medical and pharmacy students' attitudes towards physician-pharmacist collaboration in Kuwait

OBJECTIVE

To assess and compare the attitudes of medical and pharmacy students towards physician-pharmacist collaboration and explore their opinions about the barriers to collaborative practice in Kuwait.

METHODS

A cross-sectional survey of pharmacy and medical students (n=467) was conducted in Faculties of Medicine and Pharmacy, Kuwait University. Data were collected via self-administered questionnaire from first-year pharmacy and medical students and students in the last two professional years of the pharmacy and medical programs. Descriptive and comparative analyses were performed using SPSS, version 22. Statistical significance was accepted at p<0.05.

RESULTS

The response rate was 82.4%. Respondents had overall positive attitudes towards physician-pharmacist collaboration. Pharmacy students expressed significantly more positive attitudes than medical students (p< 0.001). Medical students rated the three most significant barriers to collaboration to be: pharmacists' separation from patient care areas (n=100, 70.0%), lack of pharmacists' access to patients' medical record (n=90, 63.0%) and physicians assuming total responsibility for clinical decision-making (n=87, 60.8%). Pharmacy students' top three perceived barriers were: lack of pharmacists' access to patients' medical record (n=80, 84.2%), organizational obstacles (n=79, 83.2%), and pharmacists' separation from patient care areas (n=77, 81.1%). Lack of interprofessional education was rated the fourth-largest barrier by both medical (n=79, 55.2%) and pharmacy (n=76, 80.0%) students.

CONCLUSIONS

Medical and pharmacy students in Kuwait advocate physician-pharmacist collaborative practice, but both groups identified substantial barriers to implementation. Efforts are needed to enhance undergraduate/postgraduate training in interprofessional collaboration, and to overcome barriers to physician-pharmacist collaboration to advance a team approach to patient care.

Pharmacists' Attitudes and Role in Diabetes Management in Kuwait

OBJECTIVES

The objectives of this study were to measure pharmacists' attitudes toward management of diabetes, identify current levels of pharmacy service provided to patients with diabetes, and identify barriers for further provision of diabetes-related services.

SUBJECTS AND METHODS

A descriptive, cross-sectional study was conducted on a sample of 198 pharmacists working in primary and secondary health care settings in one health region of Kuwait using a pretested self-administered questionnaire. Descriptive statistics, correlations, and comparative analysis were performed.

RESULTS

The response rate was 84.4% (n = 168). Respondents had overall positive attitudes toward management of diabetes. Pharmacists regularly provided their patients with counseling on the appropriate time to administer their medications; however, services related to hypoglycemia and management of comorbid diseases were rarely provided. A negative correlation was found between the positive overall diabetes-related attitudes and pharmacists' involvement in providing the following diabetes-related services: glucose monitoring (r = -0.25, p = 0.001), comorbid disease management (r = -0.243, p = 0.001), and healthy living choices (r = -0.237, p = 0.002). The perception that some physicians and patients have of pharmacists as dispensers only was identified as the most important barrier to providing diabetes-related services.

CONCLUSION

Pharmacists have positive diabetes-related attitudes; however, they provide limited diabetes-related services to their patients. Barriers to provision of pharmacy services to patients with diabetes should be addressed to enable optimum patient care delivery.

Hospital doctors' views of, collaborations with and expectations of clinical pharmacists

Objective

The collaboration between doctors and clinical pharmacists is a key factor in the provision of drug therapy and the continuity of patient care. The aim of this study was to explore the views of hospital doctors on the clinical role of pharmacists, barriers to interaction with them and their expectations of them.

Methods

A self-administered survey was conducted among a representative sample of doctors (n=400) recruited in hospitals in the Madinah region of Saudi Arabia; 270 surveys were returned, yielding a 67.5% response rate.

Key findings

Most doctors knew about clinical pharmacy (85.19%), but only 42.96% of them were aware of the existence of clinical pharmacy services in their hospital. Nearly three-quarters of doctors (74.07%) were willing to collaborate with a clinical pharmacist despite existing barriers that hinder interprofessional collaboration. Approximately 67.78% of the doctors strongly agreed or agreed that a clinical pharmacist was a reliable source of drug information. The most common queries from doctors to pharmacists were about drug alternatives (46.29%), drug interactions (39.26%), drug availability (37.77%), side effects (34.81%), drug dosage (26.29%), drug indications (24.81%), drug costs (21.48%) or other (7.41%). Only 19.63% of respondents would always accept a pharmacist's modification to a prescription. Most of the doctors (70%) expected the clinical pharmacist to advise them on rational use of drugs, to resolve drug-related problems and to counsel patients.

Conclusions

Doctors widely accept that clinical pharmacists can make a great contribution to the provision of drug therapy. However, strong interprofessional collaboration between doctors and clinical pharmacists is needed to optimise patient care.

Hospital pharmacists seen through the eyes of physicians: qualitative semi-structured interviews

Background Pharmacist-physician collaboration can lead to many positive outcomes. However, collaboration between healthcare providers is complex and rarely performed optimally. Objectives To study physician-pharmacist collaboration in hospital settings, from the physician's point of view. Setting Eight regional non-teaching hospital facilities, within a local area of northwest Switzerland, supplied by an independent central pharmacy. Method Physicians were sampled using a maximal variation purposive method. Qualitative semi-structured interviews were conducted and their content was recorded. Mind maps were made with the collected data. An inductive approach was used for the analysis. Main outcome measure Physicians' main perceptions of hospital pharmacists. Results Twelve physicians and one medical student were interviewed (average interview length 37 min). Key opinions (n ≥ 7) include the following: physicians lack knowledge about hospital pharmacists' roles, competences and activities. Physicians report a lack of presence and involvement of hospital pharmacists. Although physicians value hospital pharmacists' complementary competences, they also point out a knowledge gap between them and that hospital pharmacists lack clinical competences. Some pharmaceutical activities (e.g. drug formulary management or participation in ward rounds) lead to significant drawbacks for physicians. Other pharmaceutical activities (e.g. teaching and supervision) are valued and sought for by physicians. Physicians report they take drug treatment decisions as they bear the legal responsibility. Conclusion The presence, visibility and implication of hospital pharmacists need to be improved, and physicians should be more aware of what they can offer them. Physicians' expectations and needs should be taken further into consideration and new models of interaction should be developed.

Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait

BACKGROUND

Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN) therapy by working within Nutrition Support Teams (NSTs).

OBJECTIVE

This study was designed to explore pharmacists' role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices.

METHODS

Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN) pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital) in Kuwait. Descriptive statistics were used to describe pharmacists' demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists' education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists' communication and conducting TPN-research research.

CONCLUSION

TPN pharmacists in Kuwait are confined to performing TPN manufacturing processes. There are promising avenues for future development of their role in patient care. This can be achieved by overcoming the barriers to pharmaceutical care practice and providing pharmacists with educational opportunities to equip them with the clinical competencies needed to practise as nutrition support pharmacists with patient-centred roles.

ReCAP: Pharmacists' Impact in Hematopoietic Stem-Cell Transplantation: Economic and Humanistic Outcomes

PURPOSE

This study seeks to evaluate the impact of pharmacists' involvement in the care of patients undergoing bone marrow transplantation (BMT).

METHODS

This was a three-phase study. In phase 1, inpatient and outpatient pharmacist encounters were totaled and services provided were translated to revenue generated from prescription revenue and billing charges. In phase 2, pharmacists' activities and interventions were associated with time savings estimated by providers. In phase 3, patients and providers were surveyed to assess their expectations, experiences, and value perceptions of pharmacists.A positive response rate of 80%for each survey item was set as the threshold for high expectations and successful service delivery.

RESULTS

In phase 1, after 6 months of data collection, clinical services were provided to 170 inpatients and 290 outpatients. For inpatients, there was an average discharge prescription revenue of $990 per patient through the outpatient pharmacy. In the outpatient clinic, pharmacist visits generated an additional $23,000 in charges (approximately $80 per patient) and an annual prescription revenue of approximately $840,000 through the outpatient pharmacy. In phase 2, pharmacists' activities led to a total time savings of 122 hours. In phase 3, patients and providers met the predetermined 80% positive response rate for most survey items. The item for which patient and provider responses consistently did not meet this threshold related to pharmacists educating patients about their BMT.

CONCLUSION

Pharmacists are valuable resources in the care of patients undergoing BMT, as their care translates to increased revenue, provider time savings, and positive perceptions from patients and providers.

Physicians’ attitudes towards provision of primary care services in community pharmacy in the United Arab Emirates

Objectives

This study aims to explore physicians' views of pharmacists' roles in providing primary care services through community pharmacies in the United Arab Emirates (UAE).

Methods

A qualitative approach involving semi-structured interviews conducted one-to-one or in group discussions was employed. The interviews explored participants' views of pharmacists' primary care services including screening and monitoring of disease, health advice, referral, lifestyle and preventive care, supply of printed information, counselling on medications, patient record keeping, and pharmacist intervention in chronic disease management. Data were analysed using the Framework approach.

Key findings

Fifty-three physicians participated; 27 were interviewed individually and 26 participated in five group discussions. Four major themes were identified: competence, business orientation, territorial control and service delivery. Participants were supportive of verbal counselling about medications, checking for drug dosing, interactions, duplications and errors, and keeping patient medication profiles. Physicians generally did not favour pharmacists' involvement in screening or monitoring of disease, providing information about diseases, diagnosis or long-term management of disease, or intervention directly with patients, mainly due to perceived lack of competence, territorial encroachment and business orientation of community pharmacy.

Conclusions

Despite some reservations, participants showed support for pharmacist involvement in providing primary care services, provided certain quality and territorial issues were addressed. Understanding physicians' attitudes will facilitate interventions to enhance the contribution of community pharmacists to primary care in the UAE, and possibly in other regions with similar healthcare systems.

Pharmaceutical care in Kuwait: hospital pharmacists' perspectives

BACKGROUND

Pharmaceutical care practice has been championed as the primary mission of the pharmacy profession, but its implementation has been suboptimal in many developing countries including Kuwait. Pharmacists must have sufficient knowledge, skills, and positive attitudes to practise pharmaceutical care, and barriers in the pharmacy practice model must be overcome before pharmaceutical care can be broadly implemented in a given healthcare system.

OBJECTIVE

To investigate hospital pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care, and the barriers to its implementation in Kuwait.

SETTING

Six general hospitals, eight specialized hospitals and seven specialized health centers in Kuwait.

METHOD

A descriptive, cross-sectional survey was distributed to all pharmacists working in the governmental hospitals in Kuwait (385 pharmacists). Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (standard deviations) were calculated and compared using statistical package for social sciences, version 20. Statistical significance was accepted at a p value of <0.05.

MAIN OUTCOME MEASURE

Pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care competencies, and the barriers to its implementation in Kuwait.

RESULTS

Completed surveys were received from 250 (64.9%) of the 385 pharmacists. Pharmacists expressed overall positive attitudes towards pharmaceutical care. They felt well prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Pharmacists with more practice experience expressed significantly more positive attitudes towards pharmaceutical care (p = 0.001) and they felt better prepared to provide pharmaceutical care competencies (p < 0.001) than those with less experience as practitioners. The respondents agreed/strongly agreed that the most significant barriers to the integration of pharmaceutical care into practice were lack of private counseling areas or inappropriate pharmacy layout (87.6%), organizational obstacles (81.6%), inadequate staff (79.6%), and lack of pharmacist time and adequate technology (76.0%).

CONCLUSION

Hospital pharmacists in Kuwait advocate implementation of pharmaceutical care while also appreciating the organizational, technical and professional barriers to its widespread adoption. Collaborative efforts between health authorities and educational institutions, and the integration of innovative approaches in pharmacy management and education could overcome these barriers and achieve the transition towards pharmaceutical care practice.

Practice nurses and pharmacists: a perspective on the expectation and experience of nurses for future collaboration

OBJECTIVES

To explore the nurses' expectations and experience about pharmacists in private sector hospitals of Karachi, Pakistan.

METHODS

A cross-sectional study was conducted from June to September 2012 in five private sector hospitals of Karachi, Pakistan. A convenient sample of nurses (n=377) were enrolled in this study. Data was obtained through a previously validated questionnaire. Responses were statistically analyzed using SPSSv.17.

RESULTS

Questionnaires were returned giving a response rate of 63.6% of which 20 were unusable (n=240). Out of the remaining 220, 24.1% (n=53) responded that they never or rarely interacted with a pharmacist. Respondents who expect pharmacists to collaborate with nurses to solve drug related problems were 45% (n=99). Nurses' experience of pharmacists was not substantial as only 44.5% (n=98) respondents consider pharmacists as a reliable source of clinical drug information.

CONCLUSION

The role of pharmacists is not well appreciated among nurses in Pakistan. Hence, pharmacists must bridge the observed gap and use a more strategic and consistent approach to build a more positive image in line with other healthcare professionals and in providing patient-centred pharmaceutical care. This research would impress upon the pharmacists the need to redefine their role in the healthcare settings.

Physicians' and patients' valuation of pharmaceutical care implementation in Poznan (Poland) community pharmacies

Implementation of pharmaceutical care (PC) in Poland is of great importance to patients, who, on the one hand, often follow complex pharmacological treatment regimens recommended by several physicians of different specialties, and, on the other, take up the decision on self-treatment due to availability of OTC medications. The aim of the present study was to assess the opinion of both patients and physicians about implementation of PC service in Polish community pharmacies.

A cross sectional study was carried out from September 2009 to September 2010 by a pharmacist (author of the study) on the basis of an anonymous questionnaire, where demand of physicians (n = 104) and patients (n = 202) for implementation of PC in a community pharmacy was assessed. The study was planned to determine the relationship between implementation of PC, cost and time of this service and patients’ and physicians’ socio-economic information.

Responding patients (85.64%) and physicians (76.92%) unanimously confirmed the need for implementation of PC. Most people convinced of the service implementation were 88.89% of physicians under the age of 35 and all the respondents were over 65 years of age (p = 0.027), just as 93.33% with service lesser than 5 years and 73.68% of respondents working a maximum of 20 years (p = 0.023). Mainly according to 90.00% of physicians with specialty in internal medicine and 92.59% of physicians of the group “Others” (p = 0.012), PC should be implemented in pharmacies. Women more frequently than men reckoned that appointments with a pharmacist should last up to 15 min (p = 0.012). According to 77.78% of the youngest physicians and 83.33% of the oldest ones, appointments should last from 5 to 15 min (p = 0.049), and a similar opinion was shared by 80.77% of physicians without specialty and 77.78% of physicians of the group “Others” (p = 0.0009). According to patients, the mean cost of the visit should be USD 7. Physicians most often assessed the mean cost of the appointment at USD 14.

This study provides new data about implementation of PC in Poland. The increased patients’ and physicians’ willingness to benefit from this service provides pharmacists with opportunities to develop PC in community pharmacies.

The role of clinical pharmacists as perceived by Egyptian physicians

OBJECTIVES

Clinical pharmacists play an important role in ensuring the safe and rational use of medicines; however, physicians in developing countries may not always recognize the wide scope of services that a pharmacist can provide to improve patient safety and achieve clinical outcomes. The aim of this study was to investigate the perceptions and experience of physicians regarding the role of the pharmacists, the pharmacists' ability to perform clinical services, their acceptance of new pharmacist roles and the extent of collaboration that can occur between the two disciplines.

METHODS

In this cross-sectional survey, 583 randomly selected physicians from the Grand Cairo area were invited to complete a survey composed of 25 questions designed to determine their perceptions of the role of clinical pharmacists.

KEY FINDINGS

The response rate was 53%. Of the 312 physicians who completed the questionnaire, 50.5% reported direct contact with the pharmacists using the pharmacist as a source of information about the name of the medication, side effects, drug interactions or efficacy as the main role. About one-third believed that pharmacists could be a reliable source of clinical information, identify clinically related problems or advise the physicians about medication's cost effectiveness. More than 80% agreed that physicians and clinical pharmacists should have daily cooperation, and face-to-face contact was selected to be the best method of communication.

CONCLUSION

Although a wide proportion of the physicians were aware of the clinical pharmacy principle, the service itself is not well promoted or applied. Greater effort needs to be directed towards increasing physicians' awareness and knowledge of the importance of clinical pharmacist and promote the benefit of the clinical pharmacy service.

Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

OBJECTIVE

To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine.

METHODS

A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists.

KEY FINDINGS

One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5-81.2%) and patient education (57.9%; CI 51.2-63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8-62.4%). Most physicians (62.4%; CI 56.8-69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0-39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2-81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2-16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems.

CONCLUSION

The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

Physician perceptions of pharmacist roles in a primary care setting in Qatar

Purpose

Pharmacists are uniquely trained to provide guidance to patients in the selection of appropriate non-prescription therapy. Physicians in Qatar may not always recognize how pharmacists function in assuring safe medication use. Both these health professional groups come from heterogeneous training and experiences before migrating to the country and these backgrounds could influence collaborative patient care. Qatar Petroleum (QP), the largest private employer in the country, has developed a pharmacist-guided medication consulting service at their primary care clinics, but physician comfort with pharmacists recommending drug therapy is currently unknown. The objective of this study is to characterize physician perceptions of pharmacists and their roles in a primary care patient setting in Qatar.

Methods

This cross-sectional survey was developed following a comprehensive literature review and administered in English and Arabic. Consenting QP physicians were asked questions to assess experiences, comfort and expectations of pharmacist roles and abilities to provide medication-related advice and recommend and monitor therapies.

Results

The median age of the 62 (77.5%) physicians who responded was between 40 and 50 years old and almost two-third were men (64.5%). Fourteen different nationalities were represented. Physicians were more comfortable with pharmacist activities closely linked to drug products than responsibilities associated with monitoring and optimization of patient outcomes. Medication education (96.6%) and drug knowledge (90%) were practically unanimously recognized as abilities expected of pharmacists, but consultative roles, such as assisting in drug regimen design were less acknowledged. They proposed pharmacist spend more time with physicians attending joint meetings or education events to help advance acceptance of pharmacists in patient-centered care at this site.

Conclusions

Physicians had low comfort and expectations of patient-oriented pharmacist roles but were not threatened to learn more about these capabilities or explore enhanced collaboration in patient care.

A survey of psychiatrists' expectations of clinical pharmacists in Riyadh, Saudi Arabia

OBJECTIVES

To measure psychiatrists' experience and their expectations of the role of clinical pharmacists in Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

The psychiatrists' experience and their expectations were collected using a 4-part self-completed questionnaire: (a) demographic information, (b) psychiatrists' current expectations of the roles of pharmacists, (c) psychiatrists' actual experience with pharmacists, and (d) psychiatrists' future expectations of pharmacists' roles. Each part included a set of statements for which respondents were asked to indicate their level of agreement using a 5-point Likert scale.

RESULTS

Of the 102 questionnaires delivered to the Department of Psychiatry at 7 hospitals, 77 were returned, representing a response rate of 75%. 59 (77%) psychiatrists expected pharmacists to take personal responsibility for resolving any drug-related problems; 62 (81%) expected them to maintain a complete medication profile, and 58 (75%) expected them to educate patients about the safety and appropriate use of their medication. From their current experience with pharmacists, respondents indicated that pharmacists routinely counsel patients (33, 43%), inform them about the most cost-effective alternative (37, 48%), and discuss with them the therapeutic value of the drugs (37, 48%). 49 (63%) of respondents agreed that in the future, pharmacists should routinely adjust the drug therapy for patients under protocol approved by the physician, and 51 (66%) felt that pharmacists should share legal responsibility for clinical outcomes.

CONCLUSION

Psychiatrists in Riyadh had great expectations of clinical pharmacists to take personal responsibility for resolving drug-related problems they discovered and to assist in designing drug therapy treatment plans. The psychiatrists' current experience with pharmacists did not, in some cases, meet their expectations.

Patient self-management and pharmacist-led patient self-management in Hong Kong: a focus group study from different healthcare professionals' perspectives

Background

Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM) practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong.

Methods

Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly.

Results

The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients.

Conclusions

An effective chronic disease management model should involve patients in stable condition to participate in self-management in order to prevent health deterioration and to save healthcare costs. The role of pharmacists should not be limited to drugs and should be extended in the primary healthcare system. Pharmacist-led patient self-management could be developed gradually with the support of government by enhancing pharmacists' responsibilities in health services and developing public-private partnership with community pharmacists. Developing facilitating measures to enhance the implementation of the pharmacist-led approach should also be considered, such as allowing pharmacists to access electronic health records, as well as deregulation of more prescription-only medicines to pharmacy-only medicines.

Physicians' perceptions, expectations, and experience with pharmacists at Hamad Medical Corporation in Qatar

Objectives:

The purpose of this study was to investigate the physicians’ perceptions, and expectations of their experiences with the pharmacists at Hamad Medical Corporation (HMC) in Qatar.

Method:

A cross-sectional study was conducted at HMC between January and March 2006 using a validated questionnaire. The self-administered questionnaire was distributed to 500 physicians who were working at HMC comprising Hamad General Hospital, Women’s Hospital, Rumaila Hospital, Al-Amal Hospital, Al Khor Hospital, and primary health centers. The questionnaire was composed of four parts, investigating the physicians’ expectations, experiences, and perceptions of the pharmacists.

Results:

A total of 205 questionnaires were completed (response rate 41%). A total of 183 physicians (89%) expected the pharmacist to educate patients about safe and appropriate use of drugs, whereas 118 (57%) expected the pharmacist to be available for health-care team consultation during bedside rounds. The indices of physicians showing how comfortable they were with pharmacists, and their expectations of pharmacists, were 61% and 65%, respectively, whereas the index on experience of physicians with pharmacists was lower (15%).

Conclusions:

Physicians were comfortable with pharmacists and had high expectations of pharmacists in performing their duties. However, physicians reported a poor experience with pharmacists, who infrequently informed them about the effectiveness of alternative drugs, patients experiencing problems with prescribed medications, and who took personal responsibility to resolve any drug-related problem.