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Bucknell L, Chambers B, Nott S, Webster E. Community pharmacists' perceptions of a hospital based virtual clinical pharmacy service: Findings from qualitative research. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100437. [PMID: 38660625 PMCID: PMC11040165 DOI: 10.1016/j.rcsop.2024.100437] [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: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Background A Virtual Clinical Pharmacy Service (VCPS) was introduced in selected rural and remote NSW hospitals in 2020 to address a gap in onsite clinical pharmacy services. Follow-up research determined hospital staff and patients at these locations perceived the service as a safe, effective and efficient system for delivering clinical pharmacy services. Community pharmacists are key stakeholders in medication safety and continuity of management in these regions, however, their insight on the VCPS had not yet been sought. Objective To understand perspectives of community pharmacists on the implementation of VCPS in rural and remote hospitals and impacts on medication management at transitions of care. Methods Semi-structured interviews were conducted via videoconference with seven community pharmacists with at least three months exposure to VCPS following service implementation. Thematic analysis of transcribed interviews was conducted influenced by Appreciative Inquiry. Results Participants identified that the VCPS had supported and enhanced their community pharmacy practice and acknowledged its future potential. Identified themes were interaction with VCPS, acceptability of VCPS, community pharmacy workflow, and involvement in patient care. Suggested improvements included involving community pharmacists early in the implementation of the service and establishing clear expectations and procedures. Conclusions The experiences of community pharmacists with VCPS were positive and there was a consensus that the introduction of the service had assisted interviewees in providing medication management to patients at transition of care. The ease of communication and efficiency of the service were recognised as key factors in the success of VCPS for community pharmacists.
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Affiliation(s)
- Lucy Bucknell
- University of Sydney School of Rural Health, 4 Moran Dr, Dubbo, NSW 2830, Australia
| | - Brett Chambers
- Western NSW Local Health District, PO Box 4061, Dubbo, NSW 2830, Australia
| | - Shannon Nott
- University of Sydney School of Rural Health, 4 Moran Dr, Dubbo, NSW 2830, Australia
- Western NSW Local Health District, PO Box 4061, Dubbo, NSW 2830, Australia
| | - Emma Webster
- University of Sydney School of Rural Health, 4 Moran Dr, Dubbo, NSW 2830, Australia
- Western NSW Local Health District, PO Box 4061, Dubbo, NSW 2830, Australia
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Urionagüena A, Piquer-Martinez C, Benrimoj SI, Calvo B, Garcia-Cardenas V, Gastelurrutia MA, Martinez-Martinez F, Fernandez-Llimos F. Mapping the concept of health care integration: A lexicographic analysis of scientific literature. Res Social Adm Pharm 2024; 20:506-511. [PMID: 38336512 DOI: 10.1016/j.sapharm.2024.01.013] [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: 05/08/2023] [Revised: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Systems fragmentation is a major challenge for an efficient organization, integration being a potential solution also proposed in health care field, including pharmacy as a player. However, the use of different terms and definitions in the literature hinders the comparison of different integration initiatives. OBJECTIVE To identify and map the terms used in scientific literature regarding integration in health care and to characterize each emerging topic. METHODS A lexicographic analysis of the integration of healthcare systems literature indexed in PubMed was conducted. Ten different systematic searches, four using only Medical Subject Headings (MeSH) and six using text words, were conducted in March 2023. Journal scattering was analyzed following Bradford's distribution using the Leimkuhler model. An overall text corpus was created with titles and abstracts of all the records retrieved. The corpus was lemmatized, and the most used bigrams were tokenized as single strings. To perform a topic modeling, the lemmatized corpus text was analyzed using IRaMuTeQ, producing descending hierarchic classification and a correspondence analysis. The 50 words with higher chi-square statistics in each class were considered as representative of the class. RESULTS A total of 42,479 articles published from 1943 to 2023 in 4469 different journals were retrieved. The MeSH "Delivery of Health Care, Integrated", created in the 1996 MeSH update, was the most productive retrieving 33.7 % of the total articles but also retrieving 22.6 % of articles not retrieved in any other search. The text word "Integration" appeared in 15,357 (36.2 %) records. The lexicographic analysis resulted in 7 classes, named as: Evidence and implementation, Quantitative research, Professional education, Qualitative research, Governance and leadership, Clinical research, and Financial resources. Association between the classes and the searches or the text-words used ranged from moderate to weak demonstrating the lack of a standard pattern of use of terms in literature regarding healthcare integration. CONCLUSIONS The term "integration" and the MeSH "Delivery of Health Care, Integrated" are the most used to represent the concept of integration in healthcare and should be the preferred terms in the literature.
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Affiliation(s)
- Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | | | | | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | - Victoria Garcia-Cardenas
- Pharmacy and Pharmaceutical Technology Department, Social and Legal Pharmacy Section, Faculty of Pharmacy, University of Granada, Granada, Spain.
| | - Miguel Angel Gastelurrutia
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain; Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
| | | | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit (UCIBIO), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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Lynch M, O'Leary AC. Understanding the factors influencing community pharmacist retention - A qualitative study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100329. [PMID: 37780550 PMCID: PMC10534253 DOI: 10.1016/j.rcsop.2023.100329] [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: 06/21/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background Shortages in healthcare workers affects the overall delivery and effectiveness of the provision of healthcare. There are currently insufficient pharmacists working in the community sector in Ireland. While several studies have reported on the factors leading to retention in the medical and nursing profession, there is an absence of robust research examining retention within the pharmacist workforce in Ireland. Objective To identify and understand the range of factors currently at play in the community pharmacy sector in Ireland which influence the decision-making process for pharmacists deciding whether or not to continue to practice as a community pharmacist. Method A cross-sectional qualitative descriptive study was used to investigate the factors influencing community pharmacist retention as elicited from the lived experiences of 23 pharmacists. Study recruitment was undertaken using both convenience and purposive sampling. Qualitative content analysis was used to analyze the interview data to identify and explore themes. Results A broad and diverse range of factors were identified as affecting community pharmacist retention including working conditions, career fulfilment and progression, regulatory and administrative burden, the commercial focus within community practice, lack of representation and their overall health and well-being. Conclusion The findings show that there are a number of factors which either individually or cumulatively influence a pharmacist's decision to stay in or leave community practice. Various areas for change were identified, which if addressed are considered likely to improve retention in the sector. These include enhanced terms and working conditions, better acknowledgement and resourcing of professional activities, improved opportunities for career progression, reforms to the regulatory model including the personal accountability of a supervising pharmacist for all of the pharmacy's professional activities, a more streamlined model of reimbursement and more effective collective representation.
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Affiliation(s)
- Matthew Lynch
- School of Pharmacy & Biomolecular Sciences , University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Aisling C. O'Leary
- School of Pharmacy & Biomolecular Sciences , University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- National Centre for Pharmacoeconomics, St. James's Hospital, James's St., Dublin 8, Ireland
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Ishaky L, Sivanthan M, Tadrous M, Nowrouzi-Kia B, McCarthy L, Papadopoulos A, Gohar B. Pharmacists' Mental Health during the First Two Years of the Pandemic: A Socio-Ecological Scoping Review. PHARMACY 2023; 11:pharmacy11020064. [PMID: 37104070 PMCID: PMC10141393 DOI: 10.3390/pharmacy11020064] [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: 01/29/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/28/2023] Open
Abstract
Healthcare workers have been under a great deal of stress and have been experiencing burnout throughout the COVID-19 pandemic. Among these, healthcare workers are pharmacists who have been instrumental in the fight against the pandemic. This scoping review examined the impact of the pandemic on pharmacists' mental health and their antecedents using three databases (CINAHL, MEDLINE, and PsycINFO). Eligible studies included primary research articles that examined the mental health antecedents and outcomes among pharmacists during the first two years of the pandemic. We used the Social Ecological Model to categorize antecedents per outcome. The initial search yielded 4165 articles, and 23 met the criteria. The scoping review identified pharmacists experiencing poor mental health during the pandemic, including anxiety, burnout, depression, and job stress. In addition, several individual, interpersonal, organizational, community, and policy-level antecedents were identified. As this review revealed a general decline in pharmacists' mental health during the pandemic, further research is required to understand the long-term impacts of the pandemic on pharmacists. Furthermore, we recommend practical mitigation strategies to improve pharmacists' mental health, such as implementing crisis/pandemic preparedness protocols and leadership training to foster a better workplace culture.
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Affiliation(s)
- Liam Ishaky
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Myuri Sivanthan
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada
- Centre for Research in Occupational Safety & Health, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON L5B 1B8, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Basem Gohar
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
- Centre for Research in Occupational Safety & Health, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada
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Urionagüena A, Piquer-Martinez C, Gastelurrutia MÁ, Benrimoj SI, Garcia-Cardenas V, Fernandez-Llimos F, Martinez-Martinez F, Calvo B. Community pharmacy and primary health care - Types of integration and their applicability: A narrative review. Res Social Adm Pharm 2023; 19:414-431. [PMID: 36336618 DOI: 10.1016/j.sapharm.2022.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is an urgent need for health care systems to be more efficient and efficacious. An approach to integrate public and private provider organizations such as community pharmacies and public primary health care (PHC) merits consideration. The objective of this review was to identify the types of integration in health care settings and discuss their applicability to the potential integration of community pharmacy and PHC. METHODS A narrative review using Medline, Scopus and SciELO databases was performed in which terms related to health were combined with terms related to integration. Levels and Types of integration: 14 types of integration were identified (two in breadth, seven as enablers and five in system levels). A model was created which classifies and assigns the types of integration to the different levels of the health system and to the breadth, intensity, and enablers of the integration process. Due to the nature of community pharmacy and PHC system, a horizontal integration at the micro level, supported by meso and macro levels policy, is suggested. The different elements of intensity and enablers can significantly influence the process. CONCLUSION The application of principles, concepts and types of integration suggest that it might be feasible and practical to integrate community pharmacies and PHC. However, the conflictive historical context would need to be overcome with appropriate policy and incentives.
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Affiliation(s)
- Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | | | - Miguel Ángel Gastelurrutia
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain; Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
| | | | - Victoria Garcia-Cardenas
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Fernando Fernandez-Llimos
- Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | | | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
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Piquer-Martinez C, Urionagüena A, Benrimoj SI, Calvo B, Martinez-Martinez F, Fernandez-Llimos F, Garcia-Cardenas V, Gastelurrutia MA. Integration of community pharmacy in primary health care: The challenge. Res Social Adm Pharm 2021; 18:3444-3447. [PMID: 35016847 DOI: 10.1016/j.sapharm.2021.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
Community pharmacies and pharmacists predominantly operate in a retail environment independently of other health care providers, and they are not often viewed as an integral member of the healthcare team. Thus, they remain overlooked or excluded during integration processes of health care systems. At the same time, there are calls by the profession at national and international levels for community pharmacy to be integrated within primary care systems. The COVID-19 pandemic appears to have further stimulated this desire. When pressing for integration, various terms, such as integration, integrated care, or interprofessional collaboration, are used in an interchangeable manner leading to lack of clarity, ambiguity and confusion for health care policy makers, planners, and other healthcare professionals. The literature was reviewed to identify critical components for community pharmacy to consider for integration. From the five selected articles describing integration of community pharmacies, four different constructs were identified: consensus, connectivity, communication and trust. The integration of community pharmacy into the health system may translate into better access for patients to primary care services, contribute to cost effectiveness, and promulgate the sustainability of the system. However significant political, economic, social, and practice change would be required by all stakeholders. Further research is needed to underpin a consensus for a definition, the type of integration, and the model optimally suited to integrate community pharmacy into primary care. These models, specific and adaptable to each national health care system and political environment, would need to be consensus-based by principal stakeholders to overcome a variety of barriers, including government resistance. Mere calls or demands by the pharmaceutical profession, although laudable, will not be sufficient to overcome the historical, cultural, and economic challenges.
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Affiliation(s)
| | - Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
| | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | | | - Fernando Fernandez-Llimos
- Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | | | - Miguel Angel Gastelurrutia
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain; Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
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Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations. PLoS One 2021; 16:e0260928. [PMID: 34879101 PMCID: PMC8654230 DOI: 10.1371/journal.pone.0260928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The objectives of this study were 1) to describe how case management programs engaged community pharmacies and community-based organisations in a perspective of integrated care for people with complex needs, and 2) to identify enablers, barriers and potential strategies for this engagement. Methods Using a descriptive qualitative design, individual interviews and focus groups with patients, healthcare providers and managers were analysed according to a mixed thematic analysis based on a deductive (Rainbow Model of Integrated Care) and an inductive approach. Results and discussion Participants highlighted the individualized service plan as a significant tool to foster a shared person-focused vision of care, information exchanges and concerted efforts. Openness to collaboration was also considered as an enabler for community stakeholders’ engagement. The lack of recognition of community-based organisations by certain providers and the time required to participate in individualized service plans were outlined as barriers to professional integration. Limited opportunities for community stakeholders to be involved in decision-making within case management programs were reported as another constraint to their engagement. Cultural differences between organisations regarding the focus of the intervention (psychosocial vs healthcare needs) and differences in bureaucratic structures and funding mechanisms may negatively affect community stakeholders’ engagement. Formal consultation mechanisms and improvement of communication channels between healthcare providers and community stakeholders were suggested as ways to overcome these barriers. Conclusion Efforts to improve care integration in case management programs should be directed toward the recognition of community stakeholders as co-producers of care and co-builders of social policies across the entire care continuum for people with complex needs.
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Mubarak N, Raja SA, Khan AS, Kanwal S, Saif-ur-Rehman N, Aziz MM, Hussain I, Hatah E, Zin CS. A Conceptual Framework of the Way Forward to a Community Pharmacist-General Practitioner Collaborative Medication Therapy Management Model for Chronic Diseases in Malaysian Primary Care: A Qualitative Study. Risk Manag Healthc Policy 2021; 14:1615-1627. [PMID: 33907479 PMCID: PMC8064717 DOI: 10.2147/rmhp.s296113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a growing global interest in formulating such policies and strategic plans that help devise collaborative working models for community pharmacists (CPs) and general practitioners (GPs) in primary care settings. OBJECTIVE To conceptualize a stakeholder-driven framework to improve collaboration between CPs and GPs in Malaysian primary care to effectively manage medicines in chronic diseases. DESIGN AND SETTING A qualitative study that involved individual semi-structured interviews of the leadership of various associations, guilds, and societies representing CPs, GPs, and Nurses in Malaysia. METHODS This study collected and reported data in accordance with the guidelines of the Consolidated Criteria for Reporting of Qualitative Studies. Key informants were recruited based on purposive (expert) sampling. Interviews were transcribed verbatim and data were coded based on the principles of thematic analysis in NVivo. RESULTS A total of 12 interviews (5 CPs, 5 GPs, and 2 nurses) were conducted. Five themes emerged: Theme 1 highlighted a comparison of community pharmacy practice in Malaysia and developed countries; Theme 2 involved current practices in Malaysian primary care; Theme 3 encompassed the advantages of CP-GP collaboration in chronic diseases; Theme 4 highlighted the barriers which impede collaboration in Malaysian primary care; and Theme 5 delineated the way forward for CP-GP collaboration in Malaysia. CONCLUSION The actionable insights obtained from the Malaysian stakeholders offered an outline of a framework to enhance collaboration between CPs and GPs in primary care. Generally, stakeholders were interested in CP-GP collaboration in primary care and identified many positive roles performed by CPs, including prescription review, adherence support, and patient education. The framework of the way forward includes: separation of CP and GP roles through a holistic revision of relevant legislation to grant an active role to CPs in chronic care; definition of protocols for collaborative practices; incentivization of both stakeholders (CPs and GPs); and design and implementation of an effective regulatory mechanism whereby the Malaysian Ministry of Health may take a leading role.
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Affiliation(s)
- Naeem Mubarak
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Sarwat Ali Raja
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Asma Sarwar Khan
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore, Punjab, Pakistan
- Department of Pharmacy Practice, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Sabba Kanwal
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Nasira Saif-ur-Rehman
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Muhammad Majid Aziz
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Irshad Hussain
- Department of Pharmacy, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh, Pakistan
| | - Ernieda Hatah
- Department of Pharmacy, The National University of Malaysia, Bangi, Malaysia
| | - Che Suraya Zin
- Kulliyyah of Pharmacy, International Islamic University, Kuantan, Malaysia
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