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

Actual practices of community pharmacists in the management of diabetes: a comparison of simulated patient-based study with perceived role of involvement

Objectives

This study evaluated the level of community pharmacy professionals' (CPPs) actual practices and contrasted it with their self-reported perceived involvement in diabetes management.

Methods

A self-reported cross-sectional and simulated patient (SP)-based study were employed at community drug retail outlets (CDROs) in Northwest Ethiopia. SP-case scenarios were used to examine the actual practices of CPPs in diabetes management and were compared with self-reported perceived involvement. The data were managed and analysed using SPSS version 26.

Results

About 184 participants in the self-reported and 100 CPPs' actual practices using three SP visits were included. The overall actual practice (17.8%) was found to be significantly different compared with the perceived level of involvement (73.5%) (p-value <0.05). About 94.3% of CPPs dispensed requested medications to the SP without a prescription. Despite most participants being perceived to be involved, more than 76% of CPPs did not counsel the SP for lifestyle modifications, avoiding risky behaviours, adherence to treatment, routine blood glucose checkups, diabetic foot care techniques, or consultation with physicians for further management.

Conclusion

A significant discrepancy between actual practices and perceived CPPs' involvement in the management of diabetes was observed. The findings may suggest that exploring possible gaps may be crucial.

Determine the perceived level of involvement and factors affecting diabetes management by community pharmacy professionals at drug retails in northwestern amhara region, Ethiopia

Background

Pharmacists in community drug retail outlets (CDROs) have significant involvement in diabetes prevention and management by providing more direct interventions in medication education, preventive measures, and disease management. This study examined the perceived level of involvement of community pharmacy professionals (CPPs) in diabetes management at CDROs in Northwest Ethiopia.

Methods

A multicenter cross-sectional study was conducted among CPPs in Northwest Ethiopia between September 1 and 30, 2022. The Statistical Package for Social Science (SPSS) version 26 was used to analyzed the data, which had been gathered using a self-administered structured questionnaire. An independent sample t-test and one-way ANOVA were used to examine the mean perceived involvement score difference between CPPs. The association between CPPs' involvement and other sociodemographic variables was examined using linear regression analysis. At a 95% confidence interval (CI), a p-value <0.05 was considered statistically significant.

Results

The study included 184 (94.3%) of 195 CPPs approached. The overall mean perceived involvement score of CPPs in diabetes management was 3.80 ± 0.63 out of 5. CPPs with a bachelor's degree or higher [β = 3.065, 95% CI: 2.704, 3.641; p < 0.001], CPPs with a higher monthly income (≥5000 ETB) [β = 0.242, 95% CI: 0.112, 0.596; p = 0.034], and those who provided more than 8 hours of service per day [β = 0.163, 95% CI: 0.051, 0.332; p = 0.043] had higher perceived involvement in the management of diabetes compared with their counterparts.

Conclusions

This study found that most CPPs had a high level of perceived involvement in diabetes management. Higher educational backgrounds, a higher monthly salary, and working longer hours were associated with an increased level of perceived involvement. Promoting the educational background of CPPs may be crucial to enhance their active involvement in the management of diabetes.

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.

Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana

OBJECTIVE

The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death.

STUDY DESIGN

Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method.

RESULTS

Three discrete themes around bereavement communication emerged. (1) Concern for the degree of grief experienced by mothers and apprehension to further contribute to it. This led to modified communication to shield her from emotional trauma. (2) Acknowledgment of cultural factors impacting neonatal loss. Clinicians reported that loss of a newborn is viewed differently than loss of an older child and is associated with a diminished degree of public grief; however, despite cultural expectations dictating private grief, interview subjects noted that mothers do suffer emotional pain when a newborn dies. (3) Barriers impeding communication and psychosocial support for families, often relating to language differences and resource limitations.

CONCLUSIONS

Neonatal mortality remains the leading global cause of mortality under age 5, with the majority of these deaths occurring in low- and middle-income countries, yet scant literature exists on approaches to communication around end-of-life and bereavement care for neonates in these settings. We found that medical providers in Ghana and Ethiopia described structural and cultural challenges that they navigate following the death of a newborn when communicating and supporting bereaved parents.

Pharmacists' involvements and barriers in the provision of health promotion services towards noncommunicable diseases: Community-based cross-sectional study in Northwest Ethiopia

BACKGROUND

Community drug retail outlets (CDROs) are among the initial healthcare facilities where pharmacists play a crucial role in preventing and managing noncommunicable diseases (NCDs). Therefore, this study assessed pharmacists' level of involvement and barriers in the provision of health promotion for noncommunicable diseases at CDROs in Northwest Ethiopia.

METHODS

A community-based multicenter cross-sectional study was conducted among community pharmacists in Northwest Ethiopia from April to June 2022. Data was collected using a self-administered structured questionnaire, and analyzed using the Statistical Package for Social Science (SPSS) version 26. The level of involvement mean score difference among pharmacists was investigated using an independent samples t-test and a one-way ANOVA. Logistic regression analysis was used to examine the association between pharmacists' level of involvement and other variables. A p-value < 0.05 at a 95% confidence interval (CI) was considered statistically significant.

RESULTS

A total of 285 (94.4%) participants participated in the study out of 302 approached samples. Overall, more than half (58.9%) of the participants showed a high level of involvement in health promotion. Pharmacists who had a degree and/or above (AOR = 0.03, 95% CI: 0.01-0.63; p < 0.001) and served a lower number of clients per day (AOR = 0.19, 95% CI: 0.04-94; p = 0.042) were less likely to have low involvement in health promotion services. Pharmacists who worked fewer hours per day (AOR = 3.65, 95% CI: 1.79-7.48; p = 0.005) were more likely to have low involvement. Lack of an appropriate area in the CDROs (52.1%) and lack of coordination with other healthcare providers (43.6%) were the most reported barriers to the provision of health promotion.

CONCLUSION

Most pharmacists were found to have a high level of involvement in health promotion activities. A lack of an appropriate area in the CDROs and a lack of coordination with other healthcare providers were among the most reported barriers. Pharmacists might benefit from training to increase their educational backgrounds, and barriers could be addressed to enhance the pharmacist involvement.

Assessment of patient satisfaction towards auditable pharmaceutical transactions and services implemented in outpatient hospital pharmacy in Ethiopia

BACKGROUND

Patient satisfaction is a widely used indicator to measure quality of pharmacy services. Currently, a transformational pharmacy service called auditable pharmaceutical transactions and services is being implemented nationally in Ethiopia. However, there is a dearth of evidence regarding the national impact of this system on patient satisfaction.

OBJECTIVE

To assess patient satisfaction in hospital pharmacies that have implemented auditable pharmaceutical transactions and services in Ethiopia.

METHOD

This is a national study conducted based on a cross-sectional study design. Data were collected using a structured questionnaire from September 5 to October 5, 2020. The collected data was analyzed using spreadsheet excel and Statistical Package for the Social Sciences (SPSS) version 23. The proportions, ratios, and percentages were used for presenting data. A binary logistic regression test was used to determine the association of patient satisfaction with dispensary infrastructure, medicines availability, scores of labeling, and scores of patient knowledge on dispensed medicines. A p value < 0.05 was considered statistically significant.

RESULT

A total of 650 participants were included in this study for whom a total of 1422 medicines were prescribed which gives an average of 2.19 medicine per patient. The availability of the prescribed medicines in the pharmacies was 1061 (75%), and the affordability of medicines was 1.93 WD that indicates an unaffordable price. The average written medication labels score of 3.1 out of 8 points and the average patient knowledge score for correct usage of medicines was 4.5 out of 6 points. Overall, 585 (90%) of patients reported being satisfied with pharmacy services; the counseling skill of pharmacists 609 (93.7%), and dispensing area 607 (93.4%) cited the most. The only significantly associated factor for satisfaction was the infrastructure of the pharmacy.

CONCLUSION

Overall satisfaction of patients with the auditable pharmaceutical transactions and services implemented in hospital pharmacy services was generally high. The participants were most satisfied with the pharmacist counseling and dispensary area. The medication availability is moderate but the cost is unaffordable. Advanced infrastructures have resulted in a significant improvement in patient satisfaction.

Improving outpatient medication counselling in hospital pharmacy settings: a behavioral analysis using the theoretical domains framework and behavior change wheel

Background:

Despite the importance of medication counselling for patients, it is common knowledge that it is often sub-optimally carried out by pharmacy staff. While some interventions have been designed to help improve counselling, no study till date has used the Capability Opportunity and Motivation behavior model (COM-B) or Theoretical Domains Framework (TDF) as a basis for identifying evidence-based intervention strategies to improve medication counselling.

Objective:

To understand barriers/facilitators to optimal medication counselling by conducting a behavioral analysis using the COM-B model and TDF, and use the Behavior Change Wheel (BCW) as a basis for identifying evidence-based intervention strategies and policy categories that could be used to improve outpatient medication counselling by pharmacy staff in hospital settings located within Northwest Nigeria.

Methods:

Semi-structured interviews were used to collect data from 25 purposively sampled pharmacy staff working at eight major public hospitals, from January till March 2020. Data from the interviews were then transcribed and deductively coded using the COM-B model and TDF. These findings were then used to identify areas requiring change, as well as the intervention type and policy functions required to support these changes.

Results:

Findings from the behavioral analysis revealed shortfalls in pharmacy staff capability, opportunity and motivation with respect to outpatient medication counselling. To improve their counselling behaviors, change was identified as necessary in eight TDF domains namely ‘knowledge’, ‘interpersonal skills’, ‘memory’ ‘environmental context’, ‘social influences’, ‘intentions’, ‘reinforcement’ and ‘beliefs about capabilities’. Seven intervention functions including ‘education’, ‘training’, ‘modelling’, ‘enablement’ and ‘environmental restructuring’, in addition to three policy categories (‘guidelines’, ‘regulations’ and ‘environmental/social planning’) were also identified as relevant to future intervention design.

Conclusions:

Various factors were identified as affecting medication counselling by the pharmacy staff, with several of them requiring changes if counselling was to be improved upon. Multi-component interventions combining several of these intervention functions are recommended for hospital authorities and other relevant stakeholders to improve outpatient medication counselling.