Factors influencing the exit knowledge of patients for dispensed drugs at outpatient pharmacy of Hiwot Fana Specialized University Hospital, Eastern Ethiopia

Community pharmacy professionals' knowledge, attitude, and practice toward nutrition and lifestyle counseling in Gondar City, Ethiopia

Background

Community pharmacy professionals play a vital role in health care, have a greater impact on public health programs, and play a critical role in patient counseling for both non-pharmacological and pharmacological management. This study aimed to evaluate the knowledge, attitude, and practice of community pharmacy professionals toward nutrition and lifestyle counseling in Gondar City, Ethiopia.

Methods

A cross-sectional survey was undertaken in Northwestern Ethiopia from May to June 2021. Face-to-face structured interviews were performed to collect data using a specially created questionnaire. Descriptive, independent t-test, and one-way ANOVA analyses were used. A significant difference was defined as a p-value of less than 0.05.

Results

This survey drew 100 community pharmacy professional from a pool of 105 participants, with a 95.2% response rate. More than a third of the participants (n = 43, 43%) defined medical nutrition therapy as the use of food to prevent disease, and almost half of the participants (n = 51, 51%) viewed therapeutic nutrition to be part of their job responsibilities. More than half (64%) believe that patients should be provided a combination of nutritional and pharmacological treatments in the majority of cases. The majority of participants (75%) gave patients counseling on drug-food interactions.

Conclusion

The majority of community pharmacy professionals said they knew a lot about medical nutrition therapy and were enthusiastic about nutrition evaluation and medical nutrition therapy, they see these tasks as part of their job, and they practiced dietary counseling that was limited to pregnancy and chronic diseases.

Knowledge and practices of private pharmacy auxiliaries on malaria in Abidjan, Côte d'Ivoire

BACKGROUND

The emergence of resistance to artemisinin derivatives in Southeast Asia constitutes a serious threat for other malaria endemic areas, particularly in Côte d'Ivoire. To delay this resistance, the application of the control measures recommended by the National Malaria Control Programme (NMCP) for a correct management, in the private pharmacies, is a necessity. The purpose of this study was, therefore, to assess the level of knowledge and practices of private pharmacy auxiliary in Abidjan about the management of malaria.

METHODS

A descriptive cross-sectional study was conducted from April to November 2015. It included auxiliaries of private pharmacies in Abidjan. Data collection material was a structured an open pretested questionnaire. Data analysis was carried out using Package for Social Science (SPSS) software version 21.1. Chi square test was used to compare proportions for a significance threshold of 0.05 for the p value.

RESULTS

A total, 447 auxiliaries from 163 private pharmacies were interviewed. It was noted that the auxiliaries had a good knowledge of clinical signs of uncomplicated malaria (99.1%), biological examinations (54.6% for the thick film and 40.7% for rapid diagnostic tests (RDTs) and anti-malarial drugs (99.3% for artemether + lumefantrine, AL). The strategies of vector control (long-lasting insecticide-treated mosquito nets (LLITNs, Repellent ointments, cleaning gutters, elimination of larvae breeding site and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) in pregnant women were also known by the auxiliaries, respectively 99.8% and 77.4%. However, the malaria pathogen (25.1%) and the NMCP recommendations (e.g. use of AL or AS + AQ as first-line treatment for uncomplicated malaria and IPTp-SP in pregnant women) were not well known by the auxiliaries (28.2% and 26.9% for uncomplicated and severe malaria). Concerning the practices of the auxiliaries, 91.1% offered anti-malarial drugs to patients without a prescription and 47.3% mentioned incorrect dosages. The combination artemether + lumefantrine was the most recommended (91.3%). The delivery of anti-malarial drugs was rarely accompanied by advice on malaria prevention, neither was it carried out on the result of an RDT.

CONCLUSION

The epidemiology and the NMCP recommendations for the diagnostic and therapeutic management of malaria, are not well known to auxiliaries, which may have implications for their practices. These results show the need to sensitize and train private pharmacy auxiliaries, and also to involve them in NMCP activities.

Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda

Purpose

This study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies in Rwanda, as well as factors associated.

Methods

We employed an embedded mixed-methods design that involved a convenience sample of 235 licensed community pharmacists between February and April 2022. To simultaneously collect qualitative and quantitative data, we used a self-administered questionnaire containing a combination of close and open-ended questions. Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p<0.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analyzed using thematic content analysis as a qualitative analysis approach.

Results

Most respondents (88.5%) were asked to dispense antimalarial medicines by clients without a prescription. More than half of them (54%) agreed, but 34.5% refused; instead, they referred clients to malaria diagnostic testing facilities. Those who had rapid diagnostic tests for malaria in stock (OR=2.08, 95% CI:1.1-3.94), and thought that antimalarials were over-the-counter medicines (OR=7.03, 95% CI:2.01-24.5) were more likely to dispense antimalarial medicines without prescriptions. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions.

Conclusion

Dispensing antimalarial medicines without prescriptions is a common practice in community pharmacies in Rwanda. The main factors contributing to this practice include lack of awareness regarding the classification of antimalarials as prescription medicines, the availability of malaria diagnostic tests, client pressure, and fear of losing clients.

Pharmacists' Medication Counseling Practices and Knowledge and Satisfaction of Patients With an Outpatient Hospital Pharmacy Service

The degree of communication between patients and pharmacists has a significant impact on the process of medication counseling. The purpose of this study was to evaluate pharmacists' practices of medication counseling and to assess patients' knowledge of medications and satisfaction with pharmacy services at Woldia Comprehensive Specialised Hospital (WCSH). A cross-sectional study involving 23 pharmacists and 339 patients was carried out between February and May 2022 at WCSH. A self-administered structured questionnaire was used to assess the medication counseling activities of pharmacists, whereas interview-based questionnaires were used to evaluate patients' knowledge of the drugs prescribed to them and their level of satisfaction with outpatient hospital pharmacy services. The Statistical Package for Social Sciences (SPSS) Version 25.0 was used to analyze the data. Around two-thirds of pharmacy professionals (73.9%) agreed that they were satisfied with their counseling activities. But a very low number of them always provided counseling regarding the purpose of medications (13%), major drug-drug interactions (26.1%), possible side effects (30.4%), the importance of compliance (30.4%), storage conditions (34.8%), and drug-food interactions (39.1%). Among the 339 patients involved in the study, less than half (46.3%) of them had sufficient knowledge of their dispensed medication at the exit interview. Only nearly half of the patients (54.3%) agreed that they were satisfied with the pharmacy service. Despite the fact that a significant proportion of the pharmacy professionals agreed that they were satisfied with their counseling practices, their level of involvement in major counseling activities was limited, which impacted the knowledge of patients about their medication and patients' satisfaction with pharmacy services. This might be because of potential barriers in terms of workload and lack of resources. The findings may indicate that pharmacy services need to improve through identifying potential gaps and tackling barriers.

An exploratory study of outpatient medication knowledge and satisfaction with medication counselling at selected hospital pharmacies in Northwestern Nigeria

Background

Medication counselling is an important activity that improves patient therapeutic outcomes. After this activity has been carried out, patients should be satisfied with counselling, and possess adequate knowledge about their medications.

Objectives

To describe outpatient/caregiver medication knowledge and satisfaction with medication counselling at the main outpatient pharmacies of eight public secondary and tertiary hospitals located in two states in Northwestern Nigeria.

Methods

Exit interviews were conducted from December 2019 to March 2020 with randomly sampled patients/caregivers who had just been dispensed one or more prescription medications from the main pharmacies of the hospitals. The questionnaire used contained 31 questions in three sections. The first section collected demographic information. The second section assessed respondents’ experiences and overall satisfaction with the counselling they had received. The last section evaluated respondents’ knowledge of one randomly selected prescription medication that had been dispensed to them. Data collected were coded and analyzed to generate descriptive statistics. To explore associations between respondent characteristics and overall satisfaction, non-parametric tests were used, and statistical significance set at p<0.05.

Results

A total of 684 patients/caregivers were interviewed. Majority of respondents agreed that the time spent (97.1%) and quantity of information (99.1%) provided during counselling was adequate. However, over 60% of them also agreed that dispensers did not assess their understanding of information provided or invite them to ask questions. Despite this, their average overall satisfaction with counselling on a 10-point scale was 8.6 ± 1.6. Over 90% of them also correctly identified the routes and frequency of administration of the prescribed medication selected for the knowledge assessment. Although, more than 60% of respondents did not know the duration of therapy or names of these medications.

Conclusion

Respondents’ satisfaction with medication counselling was fairly high even though they did not seem to know much about their medication.

Knowledge of prescribed drugs among primary care patients: findings from Prover Project

Background Evidence on patient medication knowledge and associated factors within primary care patients is limited, especially in developing countries. Objective To estimate the prevalence and investigate the role of individual and contextual factors on insufficient medication knowledge among primary care patients. Setting Public community pharmacies in a health pole city (234,937 inhab.) in Minas Gerais State, Brazil. Methods Exit-survey conducted with a representative sample of 1221 patients (≥ 18 years) interviewed after dispensing. Data collected for medicines included its name, therapeutic indication, dosage, time of administration, treatment duration, side effects and warnings. Information were compared to the prescription and official guidelines. Descriptive statistics and logistic regression analysis were applied. Main outcome measure Insufficient patient medication knowledge. Results Prevalence of insufficient medication knowledge was 30.1%. Side effects (96.3%) and warnings (71.1%) had the highest percentage of misses. Musculoskeletal system drugs presented the lowest knowledge score (mean = 5.9; SD = 1.9). Significant determinants of insufficient medication knowledge with respective odds ratio (OR) were: level of education (≤ 3 years, OR 1.50; 95% CI 1.06-2.11 and 4-7 years, OR 1.37; 95% CI 1.02-1.84), number of comorbidities (≤ 2, OR 1.36; 95% CI 1.04-1.77), use of prescription drugs in the last 15 days (no, OR 2.22; 95% CI 1.31-3.76) and number of people able to lend money (no person, OR 1.34; 95% CI 1.04-1.74). Conclusion Counselling and monitoring practices should be tailored to patients with less schooling, that are initiating treatment and with low disease burden. Equally important is the need to implement strategies to increase the patient's level of social capital to improve treatment knowledge.

Exit-Knowledge About Dispensed Medications and Associated Factors Among Patients Attending the Outpatient Pharmacy of Ambo General Hospital, Western Ethiopia

BACKGROUND

Insufficient knowledge of patients about their dispensed medications may result in inappropriate use of medication which can lead to treatment failure and poor therapeutic outcome.

PURPOSE

This study aimed to determine the exit-knowledge level and its determinants among patients attending outpatient pharmacy of the Ambo General Hospital.

PATIENTS AND METHODS

Hospital-based cross-sectional study was conducted on 400 study participants who visited the outpatient pharmacy in Ambo General Hospital from October to December 2019. Face-to-face interview was conducted using structured questionnaires to assess the exit-knowledge of the patients about their dispensed medication at the pharmacy exit. A binary logistic regression was employed to determine factors associated with the exit-knowledge. The association was statistically significant at 95% of confidence interval with a p-value less than 0.05.

RESULTS

A total of 400 patients participated in the study with a 100% response rate. Of the total, 222 (55.5%) patients had sufficient exit-knowledge about their dispensed medication. Patients in the age group of 19-29 (AOR=3.1; 95% CI (1.7-5.6) and 49 -59 (AOR = 3.7; 95% CI (2.3-6.0)) had greater exit-knowledge than the elderly participants (>60 years). Participants who reported the comfort of the waiting area was not suitable had lower odds of sufficient exit-knowledge (AOR= 0.7; 95% CI (0.2-3.0)) in comparison to those who reported a suitable waiting area. Lower odds of sufficient exit-knowledge (AOR=0.4; 95% CI (0.3-0.7)) was determined among those who responded fairly clarity of the dispensers guidance in comparison with those reported clear guidance. The gender and the residence of the participants were also had a significant association with the exit-knowledge level.

CONCLUSION

Modest number of the patients had sufficient exit-knowledge of their dispensed medication. Age, gender, residence, perceived comfort of the waiting area and perceived clarity of the pharmacists' guidances were significantly associated with the exit-knowledge.

Knowledge on Dispensed Medications and Its Determinants Among Patients Attending Outpatient Pharmacy at Chencha Primary Level Hospital, Southwest Ethiopia

Background

According to World Health Organization (WHO) drug use indicators manual, the patients' knowledge on dispensed medication is a crucial patient care indicator. There is a dearth of studies about patients' knowledge of dispensed medication at the primary health care facility. The objective of this study was to assess the knowledge of dispensed medication and associated factors among patients attending in the outpatient pharmacy of Chencha primary level hospital, Southwest Ethiopia.

Methods

A facility-based cross-sectional study was employed among 403 patients attending in the outpatient pharmacy of Chencha primary level hospital. The data collection techniques were observation of dispensing process and face-to-face interview by using WHO patient care indicators and a structured questionnaire, respectively. Descriptive statistics, univariable and multivariable logistic regression were determined using the SPSS version 20.

Results

A total of 403 patients participated which make the response rate 100%. Fifty-three (13.2%) patients had adequate knowledge on dispensed medication. The findings of multivariable logistic regression indicated that tertiary levels of education (AOR = 3.87; 95% CI [1.25, 11.96]), being private employee (AOR = 10.98; 95% CI [3.25, 37.04]), having severe perception of illness (AOR =3.77; 95% CI [1.43, 9.94]), having three or more visits (AOR =3.20; 95% CI [1.21, 8.44]) and being counseled by pharmacist (AOR = 10.02; 95% CI [4.45, 22.56]) significantly increased the odds of having a "adequate knowledge of medicines."

Conclusion

This study showed inadequate level of knowledge of dispensed medicine among patients attending in outpatient pharmacy of Chencha primary level hospital. Patient education, employment status, number of visits, perception of illness, dispenser qualification and experience were the factors for knowledge of dispensed medicine. Dispensers need into account patients' perception of their illness of illness and frequency of visits during counseling.

Patient-Pharmacist Interaction in Ethiopia: Systematic Review of Barriers to Communication

Despite the fact that pharmaceutical care has been expanding simultaneously with the increasing role of pharmacists and the number of prescriptions dispensed, the extended role of community pharmacists is largely confined to the dispensing of medications. This advancement in pharmacy services demands competent pharmacists and patient-centered communication. The objective of this review was to explore the barriers to patient-pharmacy interaction. Relevant kinds of literature were searched from Google Scholar, PubMed, Hinari, We of Science, Scopus, and Science Direct. A total of 3025 kinds of literature were searched. After excluding redundant and irrelevant literature, 13 kinds of literature were reviewed. Lack of adequate knowledge of drugs, lack of updated drug information, work experience, poor job satisfaction, lack of good communication skills, shortage of time, and clearness of pharmacist's voice and tone were barriers to communication from the side of pharmacy professionals. Factors like not wanting to talk much, bad attitude toward the pharmacy, being in a rush to leave, lack of willingness, language and educational status of the patient were patients' communication obstacles while high patient load, the suitability of dispensing area, and waiting time for service were associated challenges for patient-centered communication faced by health facilities. Barriers to patient-pharmacist interactions were related to patients, pharmacy professionals, and health institutions. These factors are not independent and the presence of one factor may trigger others and further compromise the patient-pharmacist interaction and result in poor medication outcomes.

Exit-Knowledge About Dispensed Medications and Associated Factors Among Ambulatory Patients Attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

BACKGROUND

Optimizing exit-knowledge of ambulatory patients is a major professional responsibility of pharmacists to reassure safe and cost-effective medicines use. The study assessed the exit-knowledge of ambulatory patients on their dispensed medications and associated factors.

PATIENTS AND METHODS

Institutional-based cross-sectional study was conducted among ambulatory patients who visited the outpatient pharmacy of Ayder Comprehensive Specialized Hospital (ACSH) from December 2019 to February 2020. Data were entered, cleaned, and analyzed using SPSS version 20. Binary logistic regression was employed to determine factors associated with exit-knowledge on their dispensed medications. At a 95% confidence interval (CI), p≤0.05 was considered statistically significant.

RESULTS

The study analyzed 400 patients; more than half of the participants were males (55.5%). The mean age of the participants was 41.3 years (mean ± standard deviation (SD), ±13). Less than half of the patients did not recall the name (44.5%) and major side effects (31.2%) of each medication. Furthermore, the overall sufficient knowledge was found to be 81%. Patients with single marital status were 4.454 times to have sufficient exit-knowledge of their dispensed medications than widowed (p=0.050) participants. Besides, patients who responded neutral clarity of pharmacist instruction had 4.745 times sufficient exit-knowledge than those who responded not clear (p=0.049). On the other hand, participants who got "enough" (p<0.0001) and "not enough" (p=0.006) information from the pharmacist were found to have a positive association with sufficient exit-knowledge than those who responded "I do not know".

CONCLUSION

The majority of patients had sufficient exit-knowledge of their dispensed medications. Martially single, neutral clarity of pharmacist's instructions and adequacy of the information delivered by the pharmacist were positively associated with participants' exit-knowledge of their dispensed medications. Hence, conducting a multicenter study, we recommend pharmacists to counsel their patients to underpin patients' knowledge of their dispensed medications.

Dispensing practices for anti-malarials in the La Nkwantanang-Madina municipality, Greater Accra, Ghana: a cross-sectional study

Background

Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, private retail pharmacies are the most accessible health facilities for managing diseases of common occurrence. However, there is growing concern about the number of patients harmed by dispensing errors in the management of malaria in retail pharmacies. Although considerable work has been done in this area, several questions regarding dispensing practices remain unanswered. This study, therefore, sought to investigate the predictors of appropriate dispensing practices for anti-malarials in community pharmacies in the La Nkwantanang-Madina municipality of Greater Accra, Ghana.

Methods

A cross-sectional analytic study was conducted in sixty-one randomly selected community pharmacies in the La Nkwantanang-Madina. Data from 230 clients and 106 dispensers were analysed. It was checked for internal consistency and completeness then entered and analysed using STATA I/C version 14.0. Frequencies, Chi square tests, and logistic regression analyses were conducted, accounting for clustering.

Results and discussion

Of the 106 dispensers interviewed, 71.4% were medicine counter assistants. The mean age of dispensers was 30.4 years (SD 8.8). Over 88.0% of clients were advised to complete the full course of their anti-malarials. However, the 8-h loading dose principle for artemether-lumefantrine was not explained to 88.3% of the clients. More than half of the clients (52.2%) were given appropriate dispensing information on anti-malarial use. Most clients (66.1%), were dispensed anti-malarials without malaria tests. Dispensers with more than a 10-years experience were less likely to dispense artemisinin-based combinations appropriately relative to dispensers with less than 2 years experience (AOR = 0.04, 95% CI 0.002–0.802 p-value = 0.036) while pharmacy interns were about 19 times more likely (AOR = 18.5, 95% CI 1.40–245.6 p-value = 0.03) to dispense artemisinin-based combinations appropriately compared to pharmacists.

Conclusion

Dispensing practices for anti-malarials is unsatisfactory. There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience. Specific adherence to the World Health Organization Test, Treat and Track initiative should be encouraged to ensure effective use of anti-malarials.

The Extent and Reasons for Dissatisfaction From Outpatients Provided With Pharmacy Services at Two Public Hospitals in Eastern Ethiopia

Background: Satisfaction of patients for pharmaceutical services reflects their preferences and expectations, and the realities of care. It is critical to understand the extent of dissatisfaction for pharmaceutical services and its associated factors in order to optimize the required quality of the services provided. Therefore, this study is aimed to explore the extent and reasons for dissatisfaction from outpatients provided with the pharmacy services at Hiwot Fana Specialized University Hospital and Federal Harar Police Hospital in Harar, eastern Ethiopia.

Methods: An institution-based cross-sectional study was conducted on 844 outpatients. Data were collected by interviewer administered interviews that employed a structured questionnaire which was meant to estimate dissatisfaction/satisfaction of the outpatients for the pharmacy services provided using a 1–5 point LIKERT scale. SPSS version 20.0 was employed to analyze data. Accordingly, potential covariates were identified using chi-squared test and binary logistic regression analyses were undertaken to adjust for the covariates.

Results: The highest (61.1%) dissatisfaction was scored for lack of consistent availability of prescribed drug(s). Factors that showed significant association with dissatisfaction were marital divorce [adjusted odds ratio (AOR) 2.67; 95% CI 1.01–7.06]; lack of quality system or Auditable Pharmaceutical Transaction Services (AOR 13.56; 95% CI 9.10–20.23); and patients’ perceived insufficient knowledge of pharmacists (AOR 2.50; 95% CI 1.61–3.87) and good interaction with their pharmacists (AOR 0.28; 95% CI 0.14–0.56).

Conclusion: Outpatients’ highest dissatisfaction was related with the inadequate availability of prescribed drug(s). Lack of quality system; marital divorce; and patients’ perceived insufficient knowledge of pharmacists increased the likelihood of dissatisfaction but it was less likely to occur in outpatients who perceived their interaction with pharmacists as positive. Therefore, in addition to securing consistent availability of drugs and implementing a quality system, improving the technical and personal skills of pharmacists is likely to improve satisfaction of patients with the pharmacy services.

Exit-Knowledge of Ambulatory Patients About Medications Dispensed in Government Hospital in Eastern Ethiopia: The Need for Focused Patient Counseling

Background: In the counseling process, a multi-cultural competence of dispenser is among the key factors affecting his/her successful communication with patients for achieving optimal use of medications. For patients to use dispensed drugs appropriately, it is a must for them to understand the medication related information provided by the dispenser. Hence, the objective of this study was to identify parameters that likely affect ambulatory patients' knowledge of medication(s) provided at the exit of outpatient pharmacy of Federal Harar Police Hospital, Eastern Ethiopia. Methods: Cross-sectional study design was employed to conduct this study. An interview of patients was made at the exit of hospital pharmacy using a semi-structured questionnaire. The interview tool primarily assessed the knowledge of the patients for a maximum of three medications provided. Statistical Package for Social Sciences (SPSS), Version 20.0, was employed for analysis of the data. Chi-squared test was done to retain parameters with potential to have association; and the retained parameters were adjusted by performing bivariate and multivariate logistic regression analyses. Results: The result showed that only 37.2, 33.4 and 28.7% of the patients were able to recall the name of the drug(s), common side effects, and actions to be taken for missed doses, respectively. The likelihood of patients' knowledge for dispensed medications was high among patients aged 19-39 years (adjusted odds ratio [AOR]: 5.0; 95% CI: 1.04-24.2) and who thought their communication with dispenser had been polite (AOR: 4.62; 95% CI: 1.48-14.4). However, the knowledge status was found low among patients who were Afan Oromo speakers (AOR: 0.58; 95% CI: 0.35-0.95) and who came from rural residence (AOR: 0.48; 95% CI: 0.25-0.90). Conclusion: A high proportion of patients were unable to recall the drug (s) name, associated common toxicities, and actions to be taken in case of missed dose. In addition, patients who were at early adulthood and who were positive for the politeness of dispenser had better exit-knowledge of their medication. Therefore, for the patients' clear understanding of medications provided, it is mandatory to optimize patient-dispenser communication possibly by adapting multi-cultural communication skills and by providing focused training for dispensers to address factors that likely affect patient-dispenser interactions.

Factors affecting patients' knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan

BACKGROUND

Patients' knowledge about their prescribed medicines is one of the most important antecedents of successful therapy. Poor knowledge about medicines can lead to serious consequences such as non-adherence and misunderstanding of the significance of adverse events. The objective of this study is to understand the factors that are responsible for a patients' lack of knowledge regarding their medicines, by taking the perspective of the patient as well as that of healthcare professionals. Much of the work in this area has been undertaken in the setting of developed or semi-developed countries, and there is a scarcity of information from developing nations such as Pakistan.

METHODS

This was a large qualitative study set in the hospital outpatient environment in a teaching hospital in the Punjab province of Pakistan. Data were collected from dialogue with patients (n = 19) and healthcare providers (n = 16) i.e., doctors and dispensers (where a dispenser is a person who merely dispenses medicines; i.e. is not a pharmacist) through in-depth semi-structured interviews. Patients having limited knowledge about their dispensed medicines were assessed using a checklist. The healthcare providers were recruited through a convenience sampling strategy, based on their availability and willingness to participate in the study. Based on the objectives of the study, a pilot tested interview protocol was developed, and used to conduct the interviews. The sample size was controlled by using saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis.

RESULTS

The analysis of data yielded 31 categories (patients = 19, healthcare professionals = 12), 10 subthemes and three themes. The major themes were healthcare professional-related factors, patient-related factors and system-related factors. The health professional related subthemes included: behaviour and attitude and professional liabilities and liaison. The patient related subthemes included: eagerness of the patients and lack of understanding and misconception. The system-related factors included: patients with special needs, perceived role of the pharmacist, prescription and medicines, and staff workload.

CONCLUSION

Healthcare professional related, patient related and system related factors have a significant influence on patients' knowledge about dispensed medicines. The non-professional behaviour of doctors, increased staff workload, inadequate time and attention provided by healthcare professionals to patients, illiteracy of patients, lack of specialized labelling on medicines for illiterate patients and absence of pharmacists at the hospital, were the major concerns identified in this study. The study points to a need for appropriate patient education and counselling with regards medicines, improved coordination between hospital staff, and provision of some basic system-related facilities which are pivotal for enhancing patients' knowledge and adherence to their treatment regimens.