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Elshami S, Ibrahim MIM, Abdel-Rahman ME, Rahim HA, Mukhalalati B. Developing and evaluating a Disaster Management Assessment Tool for Health Care Practitioners. BMC Emerg Med 2025; 25:41. [PMID: 40050754 PMCID: PMC11887106 DOI: 10.1186/s12873-025-01199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 02/28/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Over the last fifty years, the frequency and intensity of disasters have escalated, highlighting the importance of healthcare practitioners (HCPs) being thoroughly prepared for disaster management. Despite this pressing need, there is a notable lack of well-developed and rigorously evaluated assessment tools to evaluate disaster preparedness among HCPs across various disciplines and disaster scenarios. This study aims to develop and evaluate a Disaster Management Assessment Tool for Health Care Practitioners (DMAT_HCP). METHODS The DMAT_HCP was designed following the four stages of the Disaster Management Framework and a literature review of similar previously validated tools. Content validity was assessed through two rounds of review by nine and six experts, whereas face validity was assessed by 11 HCPs. DMAT_HCP was tested on 107 HCPs from different health disciplines and settings to evaluate the structural (factor analysis) and construct (convergent and divergent) validities as well as internal consistency reliability. RESULTS DMAT_HCP comprised five Likert scales that assess the preparedness and readiness of HCPs for disaster, with satisfactory content validity indices (CVI > 0.83 for six experts). Factor analysis of the entire set of DMAT_HCP items suggested six factors: knowledge, two sub-domains of attitude, practice, willingness to practice, and organization-based management, which together accounted for 77.9% of the variance in the data. Convergent and divergent validity analyses showed that all items within a section had a correlation coefficient greater than 0.4 with their corresponding section score, and they were more strongly correlated with their own section than with scores from other sections. Cronbach's alpha values for the individual sections ranged from 0.89 (attitude) to 0.97 (organization-based management), and the overall Cronbach's alpha for the DMAT_HCP was 0.90. CONCLUSIONS This study substantiated that DMAT_HCP is both conceptually and methodologically valid and reliable. It has demonstrated strong content validity, accurately measures the intended constructs, and effectively distinguishes between unrelated constructs. The tool also exhibited excellent internal consistency reliability across its components. The tool offers a comprehensive, globally applicable assessment of disaster management, suitable for use across various healthcare professions, settings, disaster contexts, and management phases.
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Affiliation(s)
- Sara Elshami
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
- Public Health Department, College of Health Sciences, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Mohamed Izham Mohamed Ibrahim
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Manar E Abdel-Rahman
- Public Health Department, College of Health Sciences, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Hanan Abdul Rahim
- Public Health Department, College of Health Sciences, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Banan Mukhalalati
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar.
- Clinical Pharmacy and Practice Department, Director of Integrated Learning, Vice President for Medical and Health Sciences Office, Qatar University, PO Box 2713, Doha, Qatar.
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Al Meslamani AZ, Jarab AS, Abdel-Qader DH, Mohamed Ibrahim O, Al Mazrouei N. Adoption of electronic patient medication records in community pharmacies in the United Arab Emirates: A cross-sectional survey. HEALTH INF MANAG J 2025; 54:55-63. [PMID: 37551925 DOI: 10.1177/18333583231190744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Access to accurate and relevant patient health information is crucial for community pharmacists to deliver high-quality care. The use of electronic patient medication records (e-PMR) in the United Arab Emirates (UAE) is currently limited to hospital settings, and community pharmacists do not have access to patient records. OBJECTIVE To evaluate the perceptions of community pharmacists regarding the potential benefits, barriers, and concerns associated with the implementation of the e-PMR system in community pharmacies in the UAE. METHOD A validated questionnaire was administered to a sample of licensed community pharmacists using proportionate random sampling. The survey was structured and consisted of 40 questions in four sections: characteristics of community pharmacists and pharmacies; perceived usefulness of e-PMR; perceived barriers; and concerns about the use of e-PMR. RESULTS In total, 552 pharmacists filled out the questionnaire (82.1% response rate). The majority of participants somewhat or strongly agreed that e-PMR would reduce drug abuse (71.6%), dispensing errors (64.4%) and prescribing errors (69.0%), and believed that e-PMR would enhance pharmacists' ability to perform medication reviews (76.0%). Pharmacists in charge (adjusted odds ratio (AOR) = 2.5; 95% confidence interval (CI): 1.6-3.6), facing difficulty tracking the medical history of patients (AOR = 3.2; 95% CI: 2.8-3.9) and working in pharmacies providing telepharmacy services (AOR = 3.4; 95% CI: 2.7-3.8) were more likely to consider e-PMR useful. IMPLICATIONS The implementation of the e-PMR system in community pharmacies has potential benefits for patient safety and medication therapy management in the UAE.
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Affiliation(s)
| | - Anan S Jarab
- Al Ain University, UAE
- Jordan University of Science and Technology, Jordan
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Weier N, Patel R, Fazal-E-Hasan S, Zaidi STR. Determinants of pharmacists' confidence to participate in antimicrobial stewardship: A confirmatory factor analysis. Br J Clin Pharmacol 2024; 90:2019-2029. [PMID: 38779884 DOI: 10.1111/bcp.16095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
AIM Pharmacists are essential members of hospital antimicrobial stewardship (AMS) teams. A lack of self-perceived confidence can limit pharmacists' involvement and contributions. Pharmacists working in AMS have reported a lack of confidence. There is currently a lack of validated measures to assess pharmacists' self-perceived confidence when working in AMS and contributors to this confidence. This study aimed to identify variables contributing to pharmacist self-perceived confidence and validate an AMS hospital pharmacist survey tool using confirmatory factor analysis (CFA). METHODS Responses from a survey of Australian and French hospital pharmacists were used to undertake CFA and path analysis on factors related to pharmacists' self-perceived confidence. It was hypothesized that pharmacists' self-perceived confidence would be impacted by time working in AMS, perceived importance of AMS programmes, perceived barriers to participating in AMS and current participation. RESULTS CFA demonstrated a good model fit between the factors. Items included in the model loaded well to their respective factors with acceptable reliability. Path analysis demonstrated that time working in AMS had a significant impact on pharmacists' self-perceived confidence, while perceived barriers had a negatively significant relationship. Pharmacy participation in AMS and perceived importance of AMS programmes had a non-significant impact. CONCLUSION Findings demonstrated that the survey tool showed good validity and identified factors that can impact pharmacists' self-perceived confidence when working in hospital AMS programmes. Having a validated survey tool can identify factors that can reduce pharmacists' self-perceived confidence. Strategies can then be developed to address these factors and subsequently improve pharmacists' self-perceived confidence.
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Affiliation(s)
- Naomi Weier
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Rahul Patel
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Syed Fazal-E-Hasan
- Peter Faber Business School (Sydney), Australian Catholic University, Sydney, New South Wales, Australia
| | - Syed Tabish R Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
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Baek Y, Park SK, Lee YH, Son KH, Na HJ, Choi HG, Kwon YG, Lee EK. Comparison of Perceived Importance and Performance of Community Pharmacists' Role in South Korea During the Coronavirus Disease 2019 Pandemic. Disaster Med Public Health Prep 2023; 17:e569. [PMID: 38044034 DOI: 10.1017/dmp.2023.221] [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] [Indexed: 12/05/2023]
Abstract
OBJECTIVE This study aimed to identify the roles of community pharmacists (CPs) during the coronavirus disease 2019 (COVID-19) pandemic, the differences in their role performance compared with their perceived importance, and limiting factors. METHODS A cross-sectional online survey of CPs was conducted. The CPs self-measured the importance and performance of each role during the pandemic using a 5-point Likert scale. A paired t-test was used to compare each role's importance and performance scores. A logistic regression analysis of the roles with low performance scores, despite their level of importance, was conducted to determine the factors affecting performance. The limiting factors were also surveyed. RESULTS The 436 responses to the questionnaire were analyzed. The performance scores were significantly lower than the perceived importance scores for 15 of the 17 roles. The source and update frequency of COVID-19 information and participation in outreach pharmaceutical services were associated with low performance scores. Insufficient economic compensation, the lack of communication channels, and legal limitations were the limiting factors in performing the CPs' roles. CONCLUSIONS The participation in outreach pharmaceutical services, economic compensation, and communication channel should be improved to motivate the CPs in performing their roles.
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Affiliation(s)
- Youngsuk Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Sun-Kyeong Park
- College of Pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, South Korea
| | - Yong Hwa Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Kyung-Hwa Son
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Hye-Jung Na
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Hyun-Gyu Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Young-Gyu Kwon
- College of Pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
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Kambayashi D, Manabe T, Hirohara M. Adaptations in the role of pharmacists under the conditions of the COVID-19 pandemic: a systematic review and meta-analysis. BMC Health Serv Res 2023; 23:72. [PMID: 36691043 PMCID: PMC9870779 DOI: 10.1186/s12913-023-09071-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Community pharmacists actively engage in managing the health of local residents, but the COVID-19 pandemic has necessitated rapid adaptations in practice activities. OBJECTIVES We sought to identify the specific adaptations in practice and the expanded roles of community pharmacists in response to the COVID-19 pandemic. METHODS We conducted a systematic review of published studies reporting the tasks of pharmacists in community pharmacies or who were involved in pharmacy practices addressing the pandemic. Two investigators independently searched PubMed (December 2019-January 2022) for eligible articles. We conducted a meta-analysis to measure the frequencies of practical activities by pharmacists in response to COVID-19. RESULTS We identified 30 eligible studies. Meta-analysis of these studies found that the most commonly reported adaptation in pharmacist practice activities was modifying hygiene behaviors, including regular cleaning and disinfection (81.89%), followed by maintaining social distance from staff and clients (76.37%). Educating clients on COVID-19 was reported by 22 studies (72.54%). Telemedicine and home delivery services were provided to clients by 49.03 and 41.98% of pharmacists, respectively. CONCLUSIONS The roles of community pharmacists in public health activities have adapted and expanded in response to COVID-19, notably by incorporating public health education activities.
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Affiliation(s)
- Dan Kambayashi
- grid.412579.c0000 0001 2180 2836Laboratory of Pharmacy Practice, Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, Machida, Tokyo 194-8543 Japan ,grid.260433.00000 0001 0728 1069Department of Medical Innovation, Nagoya City University Graduate School of Medicine, Nagoya, Aichi 467-8601 Japan
| | - Toshie Manabe
- grid.260433.00000 0001 0728 1069Department of Medical Innovation, Nagoya City University Graduate School of Medicine, Nagoya, Aichi 467-8601 Japan ,grid.260433.00000 0001 0728 1069Center for Clinical Research, Nagoya City University West Medical Center, Nagoya, Aichi 462-8508 Japan
| | - Masayoshi Hirohara
- grid.412579.c0000 0001 2180 2836Laboratory of Pharmacy Practice, Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, Machida, Tokyo 194-8543 Japan
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Kusuma IY, Pratiwi H, Pitaloka DAE. Role of Pharmacists in Antimicrobial Stewardship During COVID-19 Outbreak: A Scoping Review. J Multidiscip Healthc 2022; 15:2605-2614. [PMID: 36388623 PMCID: PMC9656343 DOI: 10.2147/jmdh.s385170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/25/2022] [Indexed: 08/11/2023] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, pharmacists have been on the front lines of health care, offering vital services. Consequently, the need for pharmacists to support an effective antibiotic stewardship (AMS) program during the COVID-19 outbreak has become increasingly evident. This scoping review was performed to examine related articles in 2020-2022 published in the Scopus, SAGE, and Cochrane databases with the keywords "Pharmacist" and "Antibiotic Stewardship" and "COVID-19". The inclusion criteria were full-text articles written in English. A total of 15 articles were included in this review to describe the role of pharmacists in AMS during the COVID-19 outbreak. In general, pharmacists are responsible for identifying and treating patients during pandemics, ensuring the continued supply and accessibility of medications, promoting health policies, and monitoring antibiotic use for COVID-19 cases and co-infections. At the hospital, as the most significant element for pharmacists on the AMS team, the apparent change is demonstrated in educating patients on telehealth services, clarifying misconceptions about treatments and antibiotic consumption, as well as taking a leadership position to establish local guidelines for the COVID-19 treatment protocol. Pharmacists have an important role in the AMS program, and the COVID-19 pandemic was perceived as a highlight their importance. Therefore, their work with the AMS program needs to be improved as they learn to extend their role in telehealth services, educate and clarify the misconceptions about COVID-19 treatments and other antibiotic consumption in the community, inventory control the COVID-19 drug, antibiotics, and vaccine, as well as take the lead in establishing local guidelines on antibiotic consumption during the pandemic outbreak.
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Affiliation(s)
- Ikhwan Yuda Kusuma
- Institution of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, 6725, Hungary
- Pharmacy Study Program, Faculty of Health, Universitas Harapan Bangsa, Purwokerto, 53182, Indonesia
| | - Hening Pratiwi
- Department of Pharmacy, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto, 53122, Indonesia
| | - Dian Ayu Eka Pitaloka
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, 45363, Indonesia
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Jairoun AA, Al-Hemyari SS, Shahwan M, Alorfi NM, El-Dahiyat F, Hossain MS, Jairoun M, Jaber AAS. Exploring the knowledge, attitude and practice towards disaster medicine preparedness and readiness: A prescriptive insight by the community pharmacists in the United Arab Emirates. PLoS One 2022; 17:e0273209. [PMID: 36006935 PMCID: PMC9409571 DOI: 10.1371/journal.pone.0273209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Proper disaster preparedness by community pharmacists has the potential to counter many of the factors that cause threats and high-risk outcomes. Their preparedness and awareness may also help health practitioners and governments to improve disaster response planning. OBJECTIVES This aims to explore the knowledge, attitude, and practice (KAP) towards disaster medicine preparedness and readiness among community pharmacists in the United Arab Emirates (UAE). METHOD A cross-sectional study was conducted over the ten months among licensed community pharmacists who had three months' professional experience or more. Face-to-face interviews were carried out and a structured questionnaire was used for data collection. Logistic regression models were used to determine the factors influencing aboucine preparedness and readiness. SPSS Version 24 was used to analyze the data collected. RESULTS A total of 500 community pharmacists participated in the study. The average knowledge score was 25.6% with a 95% confidence interval (CI) of [21.7%, 29.4%]. Better knowledge scores were observed in the male gender (OR 2.43; 95% CI 1.05-3.72), participants aged ≥ 31 years old (OR 2.97; 95% CI 1.16-7.6), postgraduates (OR 4.36; 95% CI 2.6-7.3), participants from independent Pharmacies (OR 6.5; 95% CI 4.04-10.4 3), chief pharmacists (OR 3.1; 95% CI 1.86-5.07), participants with 16 years and more experience years (OR 2.42; 95% CI 1.063-5.522) and participants who graduated from regional/international universities (OR 5.92; 95% CI 2.65-13.2). Better attitude and practice about disaster medicine preparedness were observed in postgraduates (OR 2.54; 95% CI 1.26-pharmacists from independent pharmacies (OR 1.35; 95% CI 2.43-2,.66), and chief pharmacists (OR 1.26; 95% CI 1.17-1.35). CONCLUSIONS It's essential to provide a continuing education program using different educational strategies urgently needed to improve community pharmacy competencies (e.g. knowledge attitudes, and perceptions) to improve the skills and practices regarding disaster medicine preparedness and readiness.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
| | - Sabaa Saleh Al-Hemyari
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, United Arab Emirates
| | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
- Center of Medical and Bio-allied Health Sciences Research, Ajman University Ajman, Ajman, United Arab Emirates
| | - Nsser M. Alorfi
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Md. Sanower Hossain
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
- Faculty of Science, Sristy College of Tangail, Tangail, Bangladesh
| | - Miamona Jairoun
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Ammar Ali Saleh Jaber
- Department of Clinical Pharmacy & Pharmacotherapeutics, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
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Gharaibeh L, Alameri MA, Sibai OA, Alfreahat S, Saeed F, Badran MA, Al-Qaisi A. Practices, knowledge, and attitudes of community pharmacists towards dispensing drugs during the COVID-19 pandemic: A cross sectional study from Jordan. Pharm Pract (Granada) 2022; 20:2692. [PMID: 36733512 PMCID: PMC9851824 DOI: 10.18549/pharmpract.2022.3.2692] [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: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background Pharmacists have an important role in providing correct information, education, and counseling to the public during the COVID-19 pandemic and other health crisis. In order to perform their duties in a correct manner, they must receive adequate and evidence-based information from official resources. Objectives The objectives of the study were to examine the practices of community pharmacists towards dispensing drugs during the COVI-19 pandemic and assess their knowledge concerning the safety and efficacy of these drugs in managing the COVID-19 infection. Methods This was a web-based cross-sectional study conducted through the distribution of the questionnaire via the social media through a google form. The drugs examined were azithromycin, hydroxychloroquine, dexamethasone, and certain antiviral drugs. Results A total of 485 community pharmacists responded to the questionnaire. Pharmacists dispensed these medications based on the physician's orders, 420 (86.6%), according to the pharmacist´s recommendations 327 (67.4%), or upon patient´s request 278 (57.3%). Azithromycin was the most dispensed drug and two thirds of the pharmacists dispensed drugs more than 10 times. Community pharmacists did not possess adequate knowledge concerning the effectiveness and safety of the drugs in the management of COVID-19 infection. In the multivariate linear regression analysis; education, type of university, and the average number of daily customers were statistically significant, p values: 0.004, 0.002, and 0.016, respectively. Pharmacists did not have a positive attitude towards dispensing drugs based on their own recommendations. More than half of the pharmacists agreed that they thought it was a correct decision to give these drugs based on their own judgment. Conclusion Community pharmacists should not receive information from non-official sources. Strict regulations and implementation of disciplinary actions against pharmacists that dispense prescription only drugs based on their medical judgment are necessary to stop this illegal behavior. A proactive role demonstrated by the pharmacists and based on scientific facts will reduce misconceptions and hazardous behavior of self-medication using prescription only drugs based on rumors and fictitious news.
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Affiliation(s)
- Lobna Gharaibeh
- PhD. Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan.
| | - Mariam Ahmad Alameri
- PhD. Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan.
| | - Obada A Sibai
- Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan.
| | - Shirin Alfreahat
- Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan.
| | - Fadi Saeed
- Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan.
| | | | - Ahmed Al-Qaisi
- Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan.
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