Upscaling the pharmacy profession in Lebanon: workforce distribution and key improvement opportunities

Pharmacist-led vaccination services in the Middle East

Successful Vaccine uptake relies heavily on the effectiveness of vaccination services. Expanding the scope of pharmacists' involvement in vaccination services can significantly improve vaccination coverage. The level of pharmacists' engagement in immunization services varies globally. The aim of this paper is to describe the current role of pharmacists in vaccination services in the Middle Eastern countries. The provision of vaccination services by pharmacists in the region has evolved notably in recent years. The extent of pharmacists' involvement in immunization services varies from one country to another in the region. They play a more active role in the delivery of vaccinations, not only facilitating but also administering vaccines. Future studies on pharmacist-led vaccination services in these countries are necessary to assess the value of the expanded practice of pharmacists in this field, especially due to the scarcity of evidence.

Academic pharmacist competencies in ordinary and emergency situations: content validation and pilot description in Lebanese academia

BACKGROUND

In the absence of a similar study in the Lebanese context, this study aimed to validate the content of the specialized competencies frameworks of academic pharmacists (educators, researchers, and clinical preceptors) and pilot their use for practice assessment in the context of multiple severe crises.

METHODS

A web-based cross-sectional study was conducted between March and September 2022 among academic pharmacists enrolled by snowball sampling using a questionnaire created on Google Forms.

RESULTS

The suggested frameworks had appropriate content to assess the competencies of academic pharmacists. Educators and clinical preceptors were confident in all their competencies except for emergency preparedness. Researchers had varying levels of confidence, ranging from moderate to high confidence for many competencies, but gaps were reported in fundamental research, conducting clinical trials, and pharmacy practice research (mean < 80). Educators and researchers relied primarily on experience and postgraduate studies, while clinical preceptors emphasized undergraduate studies to acquire their respective competencies. Continuing education sessions/programs were the least cited as a competency-acquiring venue across all roles.

CONCLUSION

This study could develop and validate the content of frameworks for specialized competencies of academic pharmacists, including educators, researchers, and clinical preceptors, in a challenging setting. The frameworks were also piloted for practice assessment, which could contribute to supporting effective performance and sustained development of practitioners and help link the skills and competencies pharmacists learn during their studies with those required for a career in academia.

The MGPIDP-L project: Potentially inappropriate drug prescribing and its associated factors

OBJECTIVE

The aim of this study was to identify the prevalence of potentially inappropriate drug prescribing¹ (PIDP) using a combination of explicit and implicit criteria in a sample of Lebanese older adults taking 5 or more chronic medications per day in ambulatory care settings and to identify which factors were associated with PIDP. The explicit criteria included five different lists: Beers, Laroche, European Union (EU(7)-PIM list), STOPP/ START, STOPP Frail, and Alert and Mastering of Iatrogenesis issued by the French High Authority of Health. We also performed a sensitivity analysis to compare the potentially inappropriate medications according to each criterion.

METHODS

Data were collected from each patient via a face-to-face interview. Logistic regressions were conducted to evaluate both objectives.

RESULTS

Many factors were positively associated with PIDP. The risk of PIDP was positively associated with age (OR =4.692, 95% CI [1.889-11.655]). Treatment for insomnia doubled the odds of PIDP (P<0.05). Participants who picked their medications from the pharmacy and had excess stock of drugs were at higher risk of having PIDP by 2.042 (95% CI [1.199-3.478]) and 2.965(95% CI [1.133-7.762]) respectively. However, patients with a perception of being heavily medicated and patients with a missed dose in the last two weeks had lower odds of PIDP.

CONCLUSION

Our study showed a high prevalence of PIDP in Lebanon, which is associated with various correlates. Selecting the appropriate tools to assess PIDP and providing patient education regarding the risks associated with potentially inappropriate medications are issues to be addressed among older adults.

Pharmacy education and workforce: strategic recommendations based on expert consensus in Lebanon

Pharmacy in Lebanon has been taught for years, and the profession has known the golden ages in previous years. However, with the recent graduation of hundreds of pharmacists, without prior workforce planning, the oversupply of non-specialized pharmacists caused a mismatch with the needs of the market. The context of severe socioeconomic and sanitary crises has further exacerbated the situation, with hundreds of pharmacists leaving the country. A group of pharmacy experts joined to suggest strategic solutions to face such challenges, suggesting a clear strategy for education and the workforce, overarched by educational and professional values and based on six main pillars: (1) implement a national competency framework (including the core and specialized competency frameworks) to be used as a basis for licensure (colloquium); (2) implement a national pharmacy program accreditation, encompassing standards related to competencies adoption and assessment, curricula, teaching methods, research and innovation, instructors' and preceptors' skills, and experiential training; (3) organize training for students and early-career pharmacists; (4) optimize continuing education and implement continuous professional development, fostering innovation and specialization among working pharmacists; (5) develop and implement a pharmacy workforce strategy based on pharmacy intelligence, job market, and academic capacities; (6) develop and implement a legal framework for the above-mentioned pillars in collaboration with ministries and parliamentary commissions. Under the auspices of the relevant authorities, mainly the Order of Pharmacists of Lebanon and the Ministry of Education and Higher Education, the suggested strategy should be discussed and implemented for a better future for the pharmacy profession.

Impact of the COVID-19 pandemic on pharmacy practice and on the provision of pharmaceutical care: A cross-sectional study among community pharmacists

Background:

Community pharmacists played an essential role in the control and management of the COVID-19 pandemic; both pharmaceutical care and community pharmacists were affected, given that, patients’ needs and demands increased due to the fear of lockdowns and shortage of medication throughout the pandemic.

Objectives:

This study was based in Lebanon and aimed to assess the impact of the COVID-19 pandemic on (1) pharmacists, including infection rates, pay, and working hours, and (2) pharmacy practice, including medicine and personal protective equipment (PPE) shortages.

Design:

A cross-sectional study involving 120 community pharmacists was carried out between August and November 2021.

Methods:

Data were collected using an online survey filled out by pharmacists working in Lebanon.

Results:

Most participants (71.7%) reported an increase in their income during the pandemic, and 60% reduced their working hours. A significant association was noted between being previously infected and marital status, level of education, work position, and salary of the participants. Most participants (95.8%) encountered a shortage of medications during the pandemic leading to high home storage of medication, searching for other sources of medicines, and decreased patient/pharmacist interactions.

Conclusion:

The COVID-19 pandemic imposed new challenges on pharmacists and the provision of pharmaceutical care. It affected pharmacists’ daily routines, putting them at risk of infection with limited availability of medicines and PPE. This study suggests that establishing effective crisis management plans to increase community pharmacists’ resilience during similar outbreaks.

Assessment of community pharmacists' knowledge of the differences between generic drugs and biosimilars: A pilot cross-sectional study

Background

Pharmacists' knowledge of the differences in the characteristics between generic drugs and biosimilars is essential to ensure good practice and lower pharmaceutical bills.

Objectives

This study aimed to evaluate community pharmacists' knowledge and perception of using and substituting biosimilars and generic drugs.

Design

A pilot cross-sectional study was performed over 2 months (August-September 2022) targeting community pharmacists in their work site.

Method

Data were collected using a uniform survey given to 75 pharmacists. Afterward, a knowledge score was generated by summing several individual scores of statements regarding generic drugs and biosimilars.

Results

Overall, pharmacists had moderate to low knowledge scores, namely, with the statements tackling biosimilars. No significance was reported between these scores and their general characteristics. As regards their substitution, most pharmacists agreed to substitute generic drugs if the brand was not available, while the doctor's approval was crucial for biosimilar switching. Most participants perceived equal effectiveness of generic drugs but similar to a lower one for biosimilars compared to the reference medication. Pharmacists highlighted the need to include generic drugs and biosimilars in the continuing education program and workshops.

Conclusion

To promote their use, improving pharmacists' knowledge can help overcome misconceptions about generic drugs and biosimilars. It is recommended that health care stakeholders focus on fostering good understanding among pharmacists to enhance access to medication.

Evaluation of Pharmacists' Preferences and Barriers to Access Continuing Education: A Cross-Sectional Study in Lebanon

The implementation of continuing education programs for pharmacists in Lebanon is emerging and needs to be further developed and strengthened to fill the gaps between knowledge acquisition and its application in the workplace. This study examined the perceptions of pharmacist preferences for and barriers to access programs. A crosssectional descriptive study was undertaken with a convenience sample of 142 pharmacists who were surveyed in their workplace. Almost 83.1% of pharmacists reported their day-to-day workplace experiences were the best way to learn. The high cost (50%) and time away from work (37.8%) were the main barriers to continuing education. Pharmacists reported a mean satisfaction of 5.8 (sd = 2.2)/10 with programs suggesting a need for routine needs assessments and adaptation of programs to better meet their learning needs.

A pilot assessment of the career and job satisfaction of the pharmaceutical workforce in Lebanon

BACKGROUND

Lebanon has been recognized as a center for high-quality healthcare services in the Middle East because of its prestigious facilities certified by international bodies, competent health workers, and credible pharmaceutical sector. This study assessed the professional situation of the Lebanese pharmaceutical workforce upon graduation and entry to the job market. It also evaluated the satisfaction of pharmacists with the financial, physical, and psychological aspects of their job and the effect of the current socioeconomic crisis on their profession.

METHODS

A cross-sectional study was performed between January and May 2021 among 114 Lebanese pharmacists from all pharmaceutical sectors across Lebanon. A self-administered questionnaire was elaborated to assess the pharmaceutical workforce in Lebanon. The online questionnaire was built using Google Forms and disseminated via emails and social platforms.

RESULTS

Fresh graduates seemed more oriented toward community pharmacies, and 78.1% of the participants worked at least once in their lifetime in a community pharmacy. Pharmacists from the public university worked predominantly in the community pharmacy sector, while those who graduated from private universities worked mainly as medical representatives. Hospital pharmacy comprised significantly more PharmD graduates than other sectors; medical representatives had mainly a BS pharmacy, while those working as industrial pharmacists had a Master's degree. A low percentage (31.6%) of participants found it easy to get hold of a job across different pharmaceutical sectors while 64.0% considered the internships experience insufficient to get employed. Nearly half (48.2%) of the respondents were poorly satisfied with their job, and 54.0% of community pharmacists reported not working in their preferred field compared to 39.1% of pharmacists from other sectors. Also, 65.79% felt that the economic crisis and the consequent medication shortages affected their credibility and how society perceived them. About half (45.61%) of the participants reported that their employment status was not affected by the crisis; the rest got a second job to cover their expenses (15.79%) or changed jobs (14.91%).

CONCLUSION

Our study findings revealed that most Lebanese fresh graduates worked as community pharmacists, which does not correspond to their preference, the available job market, and the modern pharmacy wingspan. Most pharmacists were also financially, physically, and emotionally dissatisfied due to the Lebanese economic crisis that added heavy workloads and responsibilities without any financial raise.

Improving the availability of prescription drugs in Lebanon: a critical analysis of alternative policy options

The economic downfall in Lebanon and the destruction of the Beirut Port have had a crippling effect on all players in the health sector, including hospitals, healthcare providers, and the pharmaceutical and medical supply industry. The outbreak of COVID-19 has further aggravated the crisis. To address the challenges facing the pharmaceutical industry, Lebanon must create a stable and secure source of prescription drug production. Two alternative approaches are presented to address the crisis: (1) amending the subsidy system and supporting local pharmaceutical production, and (2) promoting the prescription and use of generic drugs. Investing in local production is promising and can lead to establishing trust in the quality of drugs produced locally. These efforts can be complemented by promoting the prescription and use of generic drugs at a later stage, after having had established a well-operating system for local drug production.

The current trends and challenges towards good community pharmacy practice and the way forward

Background

The practice of pharmacy continues to evolve. Comprehensive research to monitor and assess the development of the practice is needed. Good Pharmacy Practices (GPP) have been adopted by many countries to enhance the quality of services. Little information is available concerning how pharmacy practices are being implemented in developing countries. Lebanon being a developing country is a good example where community pharmacy practice doesn't follow clear guidelines and no evidence of good clinical practice.

Objectives

This study aims to highlight GPP implementation, to identify obstacles impeding implementation, and to suggest how its application could be facilitated in Lebanon.

Methods

The review included studies published in English during the last five years covering aspects of pharmacy practice in relation to GPP standards. The search excluded research related to hospital pharmacy practice and primary health care centers since they have their own quality standards.

Results

The research identified 20 recent studies that covered aspects of community pharmacy practice in Lebanon in relation to GPP standards. Eight of the studies related to research and professional development,5 related to the provision of medicines,4 related to interaction and communication,1 related to trainees,1 related to pharmacotherapy monitoring, and 1 related to documentation systems. An additional 6 studies provided insight into factors that affect the pharmacy practice in general. It is apparent that the pharmacy practice would benefit if pharmacists were better supported with financial incentives and a readjustment of their working conditions as this would have a positive impact on their productivity, job satisfaction, and overall well-being. The review indicated that the standard of research and professional development was the most studied topic and it was recommended that pharmacists develop their research capabilities. It was observed that there is a tendency towards implementing Continuous Education for pharmacists and obstacles primarily included work and family commitments, lack of interest, lack of time, difficulties in commuting, and lack of competence in the use of technology. This standard is aligned with the FIP's developmental goal of continuing professional development strategies. The search also identified only one pilot study to assess GGP compliance among community pharmacies in Lebanon. This pilot study was limited and showed low adherence of community pharmacies in Lebanon to GPP standards.Barriers to implementation are lack of enforcing laws,inadequate dissemination of the standards among the community pharmacists, poor public perception, and the financial and soscioeconomically crisis facing Lebanon.

Conclusion

Collaborated efforts are needed to implement GPP standards in Lebanon.It is recommended to undergo training and awareness sessions to community pharmacists thus enhancing their commitment and motivation. It is also recommended to establish key performance indicators to monitor the implementation. İndicators should include structure indicators for regulating the storage of medications, process indicators for regulating the dispensing, and outcome indicators for reporting patient safety incidents, measuring public satisfaction and the provision and use of medicines.These recommendations can be used by Health authorities and Pharmacy educational institutions in Lebanon and in all similar low-income countries.

Assessment of knowledge, attitude and practice of Lebanese pharmacists in providing patient counseling on urinary tract infection and its treatment

Background

Urinary tract infection (UTI) is the second most common type of infections, accounting for about 7 million annual visits to health-care providers. Pharmacists have an important role in counseling patients about this disease.

Objectives

The study explored the Lebanese pharmacists' knowledge, attitudes and counseling practices (KAP) around UTI. The aim was to provide a better understanding on the pharmacist role in this context, and improve the patient care process and the health of the public.

Methods

A cross-sectional knowledge attitudes practice study was conducted and enrolled pharmacists who were practicing in the community setting. The questionnaire collected data about the sociodemographic characteristics, pharmacist's knowledge about UTIs, their attitudes and practice in providing patient counseling.

Results

A sample of 450 pharmacists was reached, the majority (>90%) of which had good knowledge about UTIs. Moreover, greater than 90% of pharmacists believe that UTIs are serious, and that being unhygienic is one of its causes (93.6%). The majority reported educating patients about the most common causes (90.4%), risk factors (88.4%) and preventive measures (95.1%) of UTIs. A mean score of 8.44 was reported for the knowledge score and multivariable linear regression has shown that female pharmacists have higher knowledge score than males. A significant association between having a PhD degree and believing that men are more prone to UTI. Furthermore, the province of the pharmacists' practice, being in Beirut, was positively and significantly correlated with better practice.

Conclusions

Lebanese pharmacists are well knowledgeable about UTIs and showed good attitude and practice in this field. This study provides insight for discussion with policy makers to upgrade legislation to enable pharmacists to legally prescribe antibiotics for uncomplicated UTIs, similar to other countries, to improve the patient care process and minimize the burden of the disease.

A national study on the resilience of community pharmacists in Lebanon: a cross-sectional survey

Background

Community pharmacists are among the most accessible healthcare professionals and are likely to experience the full brunt of public health crises. In Lebanon, the COVID-19 pandemic, added to a severe economic meltdown, have significantly disrupted an already suffering profession.

Methods

The objective of this study was to determine the level of resilience and its relationship to burnout, job satisfaction, intention to quit, and changes in practice. The study utilized a cross-sectional design to survey community pharmacists using an online questionnaire that included the Connor-Davidson Resilience Scale and the Copenhagen Burnout Inventory. All community pharmacists were invited to participate. Multiple logistic regression identified variables significantly associated with the resilience of pharmacists.

Results

A total of 459 community pharmacists completed the questionnaire. Respondents had a relatively low resilience level (68.0 ± 13.37). They also had higher scores on the client-related burnout (58.06 ± 17.46), followed by the personal burnout (56.51 ± 16.68) and the work-related burnout (55.75 ± 13.82). In this sample, 52.3% of pharmacists indicated that they are dissatisfied with their job and 41.1% indicated an intention to quit in the coming year. According to multivariate analysis, marital status (ß = 0.38; 95% CI 0.16–0.91; p = 0.03), intention to quit (ß = 0.384; 95% CI 0.149–0.987; p = 0.047), workload (ß = 0.275; 95% CI 0.096–0.783; p = 0.016), perception of safety (ß = 0.267; 95% CI 0.078–0.909; p = 0.035), and personal burnout (ß = 0.321; 95% CI 0.152–0.677; p = 0.003) were independent influencing factors for resilience.

Conclusions

Multiple challenges and crises have culminated to the low job satisfaction, high burnout, and high the intention to quit of community pharmacists. This seriously destabilized the labor market of pharmacists which could negatively affect public safety. Effective interventions are essential to enhance the well-being and job satisfaction of pharmacists during public health crisis.

Prevalence and risk factors of burnout among Lebanese community pharmacists in the era of COVID-19 pandemic: results from the first national cross-sectional survey

BACKGROUND

Community pharmacists (CPs) are increasingly facing occupational challenges as a result of the COVID-19 pandemic, putting them at high risk of burnout. This study aimed to assess the prevalence of burnout among Lebanese CPs during the COVID-19 pandemic and to identify its associated factors.

METHODS

An online survey was conducted among Lebanese CPs between February 1st and March 30, 2021. Collected data included information on sociodemographic characteristics, exposure and work-related variables, the Copenhagen burnout inventory (CBI), and the COVID-19 threat perception scale. Prevalence of burnout was calculated. Multiple logistic regressions were performed to identify the factors associated with the three burnout domains.

RESULTS

A total of 387 CPs participated in the survey. Of the total, 53.7% were females; and 43.2% were aged less than 40 years old. The prevalence of moderate-to-high personal, work-related and client-related burnout was 77.8%, 76.8, and 89.7%, respectively. Younger age, staff pharmacist, working more than 40 h per week, high perceived COVID-19 threat were associated with a moderate-to-high likelihood of burnout in all three domains. However, altruistically accepting the risks of caring for COVID-19 patients was the only variable that was associated with a lower likelihood of burnout in all three domains.

CONCLUSION

An alarming prevalence of personal, work-related and client-related burnout was revealed among Lebanese CPs. This study has many implications for practice and provides a framework for establishing policy interventions to reduce burnout levels among Lebanese CPs. Preventive strategies and interventions on individual and organizational basis are recommended.

Pharmacists as immunizers in Lebanon: a national survey of community pharmacists' willingness and readiness to administer adult immunization

BACKGROUND

Since the focus of healthcare has shifted toward prevention, pharmacists were highly encouraged to expand their practice to include immunization services. Our study aimed to assess the knowledge, attitudes and beliefs of community-based Lebanese pharmacists, in addition to their willingness to expand their practice scope to include vaccine administration.

METHODS

A cross-sectional study was conducted during the phase preceding the arrival of the COVID-19 vaccine in Lebanon between 1 and 31st December 2020. Using a stratified random sampling method, data were collected from Lebanese community pharmacists (CPs) through an online survey that included information on socio-demographic characteristics, clinical experience, willingness to administer vaccines, knowledge about vaccination, attitudes towards immunization, reasons supporting utilizing pharmacists as immunizers and the requested elements to incorporate immunization in pharmacists' practice scope. Multivariable analyses were performed to identify the factors associated with knowledge.

RESULTS

A total of 412 community pharmacists participated in this survey. Of the total, 66.5% of the surveyed CPs are willing to administer vaccines. The majority of them (89.8%) had an overall good level. Out of all, 92.7% showed a positive overall attitude score toward immunization, 95.4% agreed that community pharmacists can play an important role in advertising and promoting vaccination. The main needed elements for implementing immunization services in pharmacies listed by participants were: support of health authorities (99.3%), statutory allowance (82.8%), patient demand (95.4%), pharmacist's interest (96.1%) and continuous education and training workshops on immunization. Older CPs (50 years and above) [aOR = 0.703, CI 95% (0.598-0.812)] and those working in Bekaa and North have lower knowledge score than their counterparts. High educational level [aOR = 1.891, CI 95% (1.598-2.019)], previous experience in immunization [aOR = 3.123, CI 95% (2.652-4.161)] and working in urban areas [aOR = 3.640, CI 95% (2.544-4.717)] were positively associated with a good knowledge level.

CONCLUSION

Most of Lebanese community pharmacists are willing to offer immunizations. The expansion of the pharmacists practice scope to include provision of immunizations required a national plan that encompasses strengthening knowledge, training, certification for eligibility to administer vaccines, enhancing pharmacovigilance and statutory reform.

Exploring determinants of community pharmacist-led influenza vaccination in a Middle Eastern country: a national web-based cross-sectional study

BACKGROUND

Utilizing community pharmacists (CPs) as immunizers has being adopted in various countries as approach to boost influenza vaccination coverage. Our study aims to explore the Lebanese CPs' willingness to administer influenza vaccine, and to identify factors associated with this willingness.

METHODS

This is a web-based, cross-sectional study, conducted over 2 months, from the 1st of November to the end of December 2020. Self-reported data were collected electronically from Lebanese CPs through an anonymous, questionnaire using google form. The collected data were analyzed using the statistical software SPSS (Statistical Package for Social Sciences). Bivariate and multivariable analyses were performed to examine factors associated with the willingness of CPs to administer influenza vaccine.

RESULTS

A total of 412 CPs participated in this survey of which 76.9% are willing to administer influenza vaccines. More than 90% of them had a good overall knowledge score and 88.8% of CPs showed a positive overall attitude score, particularly towards involvement of CPs in influenza vaccine provision. Their willingness to administer vaccine was positively associated with the younger age (aOR = 3.12 with 95% CI (1.597-4.040)), higher education level (aOR = 2.02 with 95% CI (1.093-3.741)), previous experience in immunization (aOR = 2.72 with 95% CI (1.320-5.627)) and urbanicity of pharmacy (aOR = 1.542 with 95% CI (1.219-4.627)). Extensive working hours (aOR = 2.34 with 95% CI (1.131-4.845)), working in pharmacies that are operating round-the-clock, showing positive attitude towards immunization (aOR = 3.01 with 95% CI (1.872-6.422)) and towards provision of influenza vaccines (aOR = 13.72 with 95% CI (13.721-38.507)) were also positively associated to this willingness. Conversely, patient privacy (aOR = 0.55 with 95% CI (0.079-0.983)), time and cost for professional development (aOR = 0.55 with 95% CI (0.172-0.918)), limited patient's trust (aOR = 0.39 with 95% CI (0.203-0.784)), financial remuneration (aOR = 0.18 with 95% CI (0.088-0.377)), and requirement of formal certification in vaccine administration (aOR = 0.07 with 95% CI (0.020-0.279)) were negatively associated to this willingness.

CONCLUSION

Addressing the unearthed concerns related to utilizing CPs as influenza immunizers through a concerted effort is a key to success in any future implementation of vaccination services in pharmacies.

Health seeking behaviour among Lebanese population: A highlight on seeking care from pharmacists

Background

Understanding health-seeking behaviour could significantly reduce the impact of illness on patients’ lives. Fragmentation of the Lebanese healthcare system and presence of variability in socio-economic factors have affected some aspects of the Lebanese population’s overall health seeking behaviour. One of these aspects is seeking diagnosis from pharmacists, which is prohibited by the Lebanese law but reinforced by the absence of supervision of concerned authorities.

Objectives

This study aimed to assess the Lebanese population’s knowledge, attitude, and practice towards seeking health care from pharmacists, exploring particularly the practice of seeking diagnosis from pharmacists.

Methods

A cross-sectional study was conducted by surveying a convenient sample of 493 participants across the eight governorates of Lebanon between July and October 2016. A self-administered questionnaire was used. Questions assessed the health care seeking behaviour of the participants.

Results

Two-thirds of the study participants (63.9%) did not have a general practitioner whom they visit regularly. Nearly half of the participants (48.9%) reported seeking diagnosis from pharmacists. Noteworthy, seeking diagnosis from pharmacists’ behaviour declined significantly with having a general practitioner visited regularly. More than half of participants (59.5%) believed that dealing with emergencies is among the pharmacists’ duties. In addition, 62.8% perceived that pharmacists are ‘often/always’ capable of managing common complaints.

Conclusion

Our study showed that a significant proportion of the Lebanese population seek a diagnosis from pharmacists and a significant proportion of them have a misconception about the role of pharmacists in the Lebanese healthcare system.

The role of pharmacists in complementary and alternative medicine in Lebanon: users' perspectives

Background

Customers’ expectations and satisfaction are critical to ensure a more effective role of the community pharmacists in promoting the safe use of Complementary and Alternative Medicine (CAM). The aim of this study is to examine the perceptions and practices of customers buying their CAM products from pharmacies and explore their satisfaction with CAM-related services offered by the community pharmacists in Lebanon.

Methods

A national cross-sectional study was conducted among users of CAM (age > =18 years) who obtained their CAM from community pharmacies in Lebanon (n = 832). Within the proximity of the pharmacy, subjects were invited to complete a multi-component questionnaire. The latter consisted of four sections related to CAM: general beliefs, perception of pharmacists’ role, practices, satisfaction with services offered by the pharmacists. In addition, the questionnaire included questions about sociodemographic characteristics of participants.

Results

The majority of participants agreed to an active role of the pharmacists’ in guiding CAM use, however over half of the participants (61.3%) did not agree that the pharmacist is more knowledgeable in this field than other healthcare providers. As for practices, one in two surveyed customers (47%) did not always give feedback to their pharmacists about the outcomes after using CAM, 20% did not often ask the pharmacists about the safe and effective mode of use of the products and 28.1% did not discuss their medical history. For services offered by the pharmacist, the majority of participants reported receiving good education about the CAM product (87.1%), its side effects (87.1%) and mode of use (93.4%), while significant proportions of participants reported that pharmacists were not asking questions about their medical history before dispensing CAM products (22%) nor were they providing information on CAM-drug interactions (30%).

Conclusions

The results of this study highlighted important gaps between the perceptions of customers and the services they received from the pharmacists about CAM use. These findings could be used by concerned stakeholders, including public health authorities and educational bodies, to develop evidence-based interventions aimed at promoting the role of pharmacists in ensuring a safe and effective CAM use Lebanon.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-021-03256-8.

Physicians' attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals

BACKGROUND

Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program.

OBJECTIVES

To examine physicians' attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals.

METHODS

A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians' attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements.

RESULTS

158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians' autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents.

CONCLUSIONS

Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians.

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

Background

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

Methods

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

Results

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

Conclusion

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

Role of community pharmacists in weight management: results of a national study in Lebanon

BACKGROUND

Ideally situated within the community, pharmacists can be involved in a broad range of health promotion campaigns including prevention of obesity. Limited evidence is available regarding their involvement in weight management in Lebanon, a country with escalating prevalence rate of obesity.

OBJECTIVE

To examine the role of community pharmacists in weight management in Lebanon, specifically studying their beliefs, current practices, services, and knowledge.

METHODS

Using a stratified random sampling approach, a cross sectional national survey of community pharmacists was conducted (n = 341, response rate 89%). At the pharmacy, and through a face-to-face interview, pharmacists completed a multi-component questionnaire that addressed, in addition to socio-demographic and work characteristics, their beliefs, practices, knowledge in relation to weight management. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analyses were used to examine the determinants of knowledge in the study population.

RESULTS

Over 80% of study participants agreed that they have an important role to play in weight management. However, 50% of pharmacists did not agree that weight loss products are well regulated and 81.1% thought that companies marketing weight loss products are making false promises. The majority of pharmacists always/often sold weight loss products (84.7%) and counseled their patients for diet (86.3%) and physical activity (91.7%). Despite taking weight and height measurements, 50% of pharmacists rarely/never calculated BMI. Among the pharmacists who reported side effects of weight loss products (46.5%), the majority (91.3%) did so to the pharmaceutical company. The knowledge of pharmacists was better for the use of weight loss products as opposed to their side effects and interactions. Significant predictors of knowledge were holding a Masters/ PhD degree in Pharmacy, graduating from a university inside Lebanon, obtaining weight management training within the academic degree, and receiving inquiries about weight management in the pharmacy more than once daily.

CONCLUSIONS

The results of the study provided important insights on the beliefs, practices and knowledge of community pharmacists in weight management in Lebanon. These findings could be used to inform the development of future evidence-based community pharmacists led weight management service provision nationally and internationally.

Developing the health workforce for universal health coverage

Optimizing the management of the health workforce is necessary for the progressive realization of universal health coverage. Here we discuss the six main action fields in health workforce management as identified by the Human Resources for Health Action Framework: leadership; finance; policy; education; partnership; and human resources management systems. We also identify and describe examples of effective practices in the development of the health workforce, highlighting the breadth of issues that policy-makers and planners should consider. Achieving success in these action fields is not possible by pursuing them in isolation. Rather, they are interlinked functions that depend on a strong capacity for effective stewardship of health workforce policy. This stewardship capacity can be best understood as a pyramid of tools and factors that encompass the individual, organizational, institutional and health system levels, with each level depending on capacity at the level below and enabling actions at the level above. We focus on action fields covered by the organizational or system-wide levels that relate to health workforce development. We consider that an analysis of the policy and governance environment and of mechanisms for health workforce policy development and implementation is required, and should guide the identification of the most relevant and appropriate levels and interventions to strengthen the capacity of health workforce stewardship and leadership. Although these action fields are relevant in all countries, there are no best practices that can simply be replicated across countries and each country must design its own responses to the challenges raised by these fields.