Attitudes and behaviors of practicing community pharmacists towards patient counselling

Pharmacists' perspectives and perceived barriers to counselling patients with kidney stones

BACKGROUND

The global increase in kidney stone incidence and its complications emphasise the need for effective management. While pharmacists can play a significant role in counselling and guiding patients, their practices in managing patients with kidney stones remain unclear.

OBJECTIVE(S)

To explore counselling practices and experiences of pharmacists when dealing with patients with kidney stones and to identify the barriers they face while providing counselling.

METHODS

A qualitative study was performed using semi-structured phone interviews with pharmacists practising in Jordan. Pharmacists were selected using quota sampling from those who took part in a previous study focused on pharmacists' knowledge of kidney stone aetiology and treatment. The COM-B Model of Behaviour Change was used to develop the interview guide and the analytical framework. Interviews were transcribed verbatim and analysed using a deductive thematic approach based on the pre-specified analytical framework.

RESULTS

Seven pharmacists (85.7% female; 57.1% working in community pharmacies) were interviewed. Counselling practices of patients with kidney stones were categorised into five themes: (1) Pharmacists' beliefs about patient counselling: perceived importance and desire to improve health through counselling; (2) Most priority patients: Types of patients mostly counselled; (3) Content of kidney stones-specific counselling: patient assessment and recommendations about kidney stones management; (4) Duration of the counselling sessions: time offered and influencing factors; (5) Barriers to patient counselling: patient-related, and pharmacist- and doctor-related challenges.

CONCLUSIONS

Pharmacists recognise the crucial role of kidney stones counselling but face gaps in their practices, including incomplete dietary education, limited knowledge of medication prescriptions, inconsistent patient-specific approaches, and potential communication challenges. These gaps can be overcome by enhancing training, standardising protocols of kidney stone treatment, promoting interprofessional communication, and improving communication strategies. Future research, including quantitative assessments, is needed to inform strategies that optimise patient counselling practices and facilitate improved outcomes.

Evaluating the Counseling Standards and Ability of Pharmacy Staff to Detect Antibiotic-Drugs Interactions: A Simulated Client Study from Pakistan

Effective and safe medication use can be maximized by providing medication counseling, which aims to optimize therapeutic results. This approach improves the effectiveness of antibacterial treatment, reduces treatment expenses, and mitigates the emergence of antimicrobial resistance. No research from Pakistan has been previously documented. The purpose of this research was to evaluate both the quality of antibiotic counseling provided and the level of understanding exhibited by pharmacy employees with regard to interactions involving antibiotic medications. Using a simulated client method, two scenarios were used to assess 562 pharmacies that were systematically selected. Scenario 1 focused the counseling for use of prescribed medicines with non-prescribed antibiotics. Scenario2 indicated counseling provision for prescribed antibiotics that have possible antibiotic-drug interactions. The evaluation of counseling skills was also conducted. The analysis involved the use of descriptive statistics and chi-square tests. Only 34.1% of simulated clients received medication counseling directly; 45% received it on request. About 31.2% of clients were referred to a physician without counseling. The most frequently provided information was therapy dose (81.6%) and duration (57.4%). More than half (54.0%) of clients were asked about disease duration, but drug storage was ignored. Insufficient information was provided about side effects (1.1%) and antibiotic-drug interactions (1.4%). Most (54.3%) clients were instructed about dietary or lifestyle modifications. Only 1.9% of clients received information about drug administration route. No information was provided about other medication during therapy, effect of medicine withdrawal, and compliance to medication. The current level of antibiotic counseling within Pakistani community pharmacies is inadequate and requires the attention of medical authorities. Professional training of staff could improve counseling.

What influences the information exchange during self-medication consultations in community pharmacies? A non-participant observation study

BACKGROUND

Although pharmaceutical staff consider guideline-compliant information exchange during self-medication consultations as crucial, they have not fully integrated it into practice. It is unclear what prevents pharmaceutical staff from implementing their positive intentions into their actual everyday practice. To improve the information exchange during the current consultation practice, a deeper understanding of its implementation is needed.

OBJECTIVES

The aim was to evaluate the factors influencing information exchange during self-medication consultations in German community pharmacies.

METHODS

We performed a non-participant observation of real-life consultations with post-consultation interviews of pharmaceutical staff in 10 pharmacies. The information exchanged during self-medication consultations was evaluated via 7 guideline-recommended information parameters in 2 stages of information exchange: (a) 'information gathering' and (b) 'provision of information'. Directly after each observed consultation, pharmaceutical staff's opinion about the consultation, the customer's interest and their own performance was questioned. Factors associated with the observed extent of information exchange were analysed by Poisson regression analysis.

RESULTS

In the 379 self-medication consultations with 46 pharmaceutical staff members, 454 different customer enquiries were addressed, and 483 medications were dispensed. In median, 2 predefined information parameters (First-/Third quartile: 1/4) were fulfilled during an enquiry and 2 parameters (First-/Third quartile: 1/3) were fulfilled for a dispensed medication. Pharmaceutical staff were satisfied with 85% of their consultations and perceived 76% of them as easy to handle. In both information stages, information exchange increased when 'customers were perceived to be interested in counselling' (p < 0.001) and decreased when customers had a 'specific medication request' (p < 0.001).

CONCLUSIONS

Information exchange in pharmacies needs to be better integrated into daily practice. Strategies to encourage information exchange should also include pharmaceutical staffs' perception of their own counselling technique. Ongoing patient-centred trainings should facilitate strategies to engage uninterested customers or costumers with specific medication requests in consultations.

Impact of interdisciplinary education on pharmacy student knowledge and comfort with counseling on drug-nutrient interactions

INTRODUCTION

Drug-nutrient interactions (DNIs) can negatively impact the medication use process and cause patient harm. Education in basic nutrition is often not included within pharmacy school curricula despite pharmacists needing to be proficient in identifying sources of potentially interacting nutrients. We evaluated the impact of an online education module about common DNIs and their sources on fourth-year student pharmacist knowledge, comfort with counseling, and perceived importance of DNIs.

METHODS

Fourth-year pharmacy students participating in their first community pharmacy advanced pharmacy practice experience (APPE) were incentivized to view an educational module developed by pharmacists and a dietitian. Pre- and post-assessments were given to determine the impact of the module on knowledge, comfort with counseling, and perceived importance of DNIs. An end-of-rotation assessment was administered to examine the use of module information during the APPE. Pre- and post-assessment responses were compared utilizing paired t-test analyses.

RESULTS

The pre- and post-module assessment results demonstrated statistically significant increases in knowledge, comfort, and perceived importance. Baseline knowledge scores increased from 65% to 80% and comfort increased for all included medication classes, most notably for bisphosphonates, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers. Perception of DNI importance increased across all classes. Students reported identifying DNIs at least weekly during the five-week APPE.

CONCLUSIONS

An educational module about DNIs increased student knowledge, comfort with counseling, and perceived importance in fourth-year pharmacy students. Students reported encountering DNIs weekly during a community pharmacy rotation and found the module information useful.

Public's perspectives on guideline-recommended self-medication consultations in German community pharmacies

The aim of this study was to assess the public's opinions and expectations of self-medication consultations in German community pharmacies with special emphasis on the acceptance of guideline-recommended consultation. In a cross-sectional study in the city centre of Leipzig, Germany, we conducted a questionnaire-based survey administered via an interview with passers-by from June to September 2018. The structured questionnaire contained questions assessing (I) previous experience with self-medication consultations, (II) possible reasons for declining self-medication consultations, (III) the attitude towards information gathering and (IV) expectations of self-medication consultations. (I) 92% of the 963 respondents stated they were generally satisfied with self-medication consultations in community pharmacies. Around one-fifth of all respondents claimed that they would like to be asked more health-related questions (22%) and receive more information on non-prescription drugs (20%). (II) Privacy issues (39%) and reluctance to talk about some medical conditions (43%) were the most frequent reasons for declining self-medication consultation. (III) Respondents understood the need for answering guideline-recommended questions (85-96%) and did not mind being asked these questions (70-96%). (IV) Most of the respondents expected to be counselled even if they did not ask for it directly (69%). Pharmacies were further expected to recommend the best drug, even if it was not what the customer initially intended to buy (87%). However, more than half of the respondents would consider counselling as unimportant if they knew exactly which medication they wanted to buy (56%) or if they had used the non-prescription drug before (70%). The majority also expected to receive guideline-recommended drug information (each item at least 52%). Thus, our study shows that respondents were mostly in line with the required standards of self-medication counselling guidelines. Customers expect high-quality counselling on self-medication. These findings support pharmaceutical staff's understanding of customers' barriers and expectations during self-medication consultations.

What is the attitude towards and the current practice of information exchange during self-medication counselling in German community pharmacies? An assessment through self-report and non-participant observation

Background

Guidelines encourage relevant information exchange between pharmaceutical staff and patients during self-medication consultation. Thereby, assessing the patient’s situation and providing information is crucial for patient safety. So far, limited studies have investigated this information exchange, particularly in Germany. We aimed to assess the attitude towards and the current practice of guideline-recommended information exchange in German community pharmacies.

Methods

In total, twelve guideline-recommended parameters were predefined for gathering patient-related information and for the provision of information. These information exchange parameters were evaluated in two parts: Firstly, in a self-report of pharmaceutical staff via an online questionnaire to assess the reported importance, difficulty and frequency of the parameters as well as barriers to their implementation; secondly, in a non-participant observation in five pharmacies to evaluate the actual consultation practice.

Results

In the self-report, all parameters were rated by more than 76% of 1068 participants as important. ‘Concurrent medication’ was determined to be the most difficult parameter to address (54%). All parameters of information gathering were rated to be addressed during routine counselling by at least 70% of the respondents. Parameters of information provision were all rated to be addressed by at least 45%. ‘Lack of patient’s interest’ was identified as the most frequent barrier to appropriate counselling (84%). During the observation, the information gathering parameters were each addressed between 8 to 63% in the consultations, parameters of information provision between 3 to 34%.

Conclusion

Despite broad acceptance, the guideline parameters of information exchange were comparatively little addressed during the actual routine care. This might be due to a perceived ‘lack of patient’s interest’ in counselling. Our results suggest to scrutinize whether patients are in fact not interested in counselling and to further explore how the positive intention of pharmaceutical staff towards information exchange can be further translated into everyday practice.

Quality of Community Pharmacy Practice in Antibiotic Self-Medication Encounters: A Simulated Patient Study in Upper Egypt

Antibiotic misuse, either by patients or healthcare professionals, is one of the major contributing factors to antimicrobial resistance. In many Middle Eastern countries including Egypt, there are no strict regulations regarding antibiotic dispensing by community pharmacies. In this study, we examined antibiotic dispensing patterns in Egyptian community pharmacies. About 150 community pharmacies were randomly chosen using convenience sampling from the five most populous urban districts of Minia Governorate in Egypt. Two simulated patient (SP) scenarios of viral respiratory tract infection requiring no antibiotic treatment were used to assess the actual antibiotics dispensing practice of. Face-to-face interviews were then conducted to assess the intended dispensing practice. Descriptive statistics were calculated to report the main study outcomes. In 238 visits of both scenarios, 98.3% of service providers dispensed amoxicillin. Although stated otherwise in interviews, most pharmacy providers (63%) dispensed amoxicillin without collecting relevant information from presenting SPs. Findings showed high rates of antibiotic misuse in community pharmacies. Discrepancies between interviews and patient simulation results also suggest a practice‒knowledge gap. Corrective actions, whether legislation, enforcement, education, or awareness campaigns about antibiotic misuse, are urgently needed to improve antibiotic dispensing practices in Egyptian community pharmacies.

Definition of professionalism and tools for assessing professionalism in pharmacy practice: a systemic review

PURPOSE

In contemporary pharmacy, the role of pharmacists has become more multifaceted as they now handle a wider range of tasks and take more responsibility for care provision for patients than 20 years ago. Such an evolution in the pharmacist's responsibilities is accompanied by the need for pharmacists to display high-quality patient-centred care and counselling, and to demonstrate professionalism, which now needs to be taught and assessed are part of pharmacy education and practice. This workaimed at identifying definition of professionalism in pharmacy practice and critically evaluatingpublished instruments for assessing professionalism in pharmacy practice.

METHODS

We searched the medical literature listed in Scopus, Medline, andPsycINFOdatabasesfrom 1 January 2000 to 31 December 2018. All papers meeting our selection criteria, were reviewed and summarised into a clear review of professionalism requirements in pharmacy practice. Details of the instruments measuring professionalism were reviewed in detail.

RESULTS

There is no accepted simple definition of professionalism, although we identified several theoretical and policy frameworks required for professional pharmaceutical practice. We identified 4 instruments (Behavioural Professionalism Assessment Instrument (BPAI), Lerkiatbundit's Instrument, Pharmacy Professionalism Instrument (PPI) and Professionalism Assessment Tool (PAT) that build on these frameworks and measure professional practice in pharmacy students. These were found to be reliable and valid but had only been used and tested in student populations.

CONCLUSION

Given the increasing role of community pharmacisits there is a need for assessment of professionalism in practice. Professionalism is a complex concept that is challenging to measure because it has no standardised definition and existing literature related to the topic is limited. Current instruments available focus on measuring the development of the elements of professionalism among pharmacy students rather than pharmacists.

Customers' perceptions of and satisfaction with medicine retail outlet services in Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

The aim of this study was to assess customers' perceptions of and satisfaction with MRO services in Addis Ababa and to explore factors associated with their satisfaction and reasons for visits.

METHODS

A cross-sectional survey was conducted among customers selected from 28 MROs in Addis Ababa, using multi-stage sampling techniques. Simple descriptive statistics and multivariable logistic regression at 95% confidence interval were used for the analysis.

KEY FINDINGS

Of 396 respondents, 324 (81.8%) visited MROs to purchase prescription medicines. A majority (338/396; 85.4%) of them perceived that pharmacists and druggists (pharmacy professionals) play a major role in healthcare delivery. A third (140/396; 35.4%) of the respondents agreed with the statement that pharmacy professionals are more concerned about patient care than about their business. Regarding reasons for visiting, being married was positively associated with buying over-the-counter, higher educational status was linked with more satisfaction. Overall, 56.8% (225/396) of the respondents reported that they were satisfied with the service provided by MROs.

CONCLUSION

Customers of MROs had mixed perceptions of and satisfaction with the current service. Marital status and age were associated with the reason for visiting, while the educational level was associated with the level of satisfaction. The overall positive perceptions and satisfaction about MROs should be taken as an opportunity to promote and improve pharmaceutical services rendered in MROs, to ensure that the public is receiving maximum benefit.

Community Pharmacistsꞌ Role in Controlling Bacterial Antibiotic Resistance in Aleppo, Syria

Antibiotic resistance is a major public health concern. This study was conducted to evaluate the knowledge, attitudes of community pharmacists regarding antibiotic use and potential drug resistance besides assessing their behaviors about dispensing antibiotic without prescription and correlation of the outcomes with demographic variables. A cross-sectional survey was conducted on a random sample of 250 pharmacies in Aleppo, using validated self-administered questionnaire. The total scores of the pharmacists' knowledge and attitudes were correlated with participant demographics using Chi-squared test. One-hundered-seventy-three pharmacies out of 250 agreed to participate in the study. The overall prevalence of dispensing antibiotic without prescription was 85.5%. Only 30.8% of participants exhibited good attitude and 37% had adequate knowledge about antibiotic resistance. Good attitude was strongly correlated with age (P = 0.023), years of experience (P = 0.007), socioeconomic location of the pharmacy (P = 0.009) and number of clinics near pharmacy (P = 0.008). The results of this study confirmed that dispensing antibiotic without prescription is a common practice in Aleppo pharmacies despite being unlawful. The half of community pharmacists has a poor attitude and inadequate knowledge with regard to antibiotic resistance, reflecting the need for awareness-raising campaigns directed to community pharmacists to equip them for their main role in the community.

Opinion of community pharmacists on use of nonprescription medications in Alexandria, Egypt

BACKGROUND

Many studies have reported the use of over-the counter (OTC) or nonprescription medications (medications that are available to consumers without a prescription) to be inappropriate and associated with risks to consumers. Among healthcare professionals, pharmacists have a key role in providing information and helping customers make a safe choice of nonprescription medicines.

OBJECTIVE

This study aimed to measure the attitudes and beliefs of community pharmacists toward the use of nonprescription medications by Egyptian customers.

SUBJECTS AND METHODS

A cross-sectional descriptive study was carried out among community pharmacies in Alexandria. A self-administered questionnaire was used to collect data from 335 pharmacists working in community pharmacies.

RESULTS

The use of nonprescription medicine among patients/consumers was reported by 66.9% of pharmacists to have increased in the past 4 years and 94.1% of them considered such a use to be very serious or somewhat serious. Long-term or chronic use was cited by 76.7% of pharmacists as the most common reason for the widespread inappropriate use of nonprescription medications, and 82.4% of the pharmacists considered the most common contributing factor to be lack of knowledge of patients/customers about the active ingredients in a branded product. The most common medications enquired about by patients/consumers were those for cough, cold, or sore throat, as reported by 73.5% of pharmacists, whereas 79.4% of pharmacists reported that patients asked about how to use nonprescription drugs. Sixty percent of pharmacists reported that the main reason that patients/customers did not seek consultation for nonprescription medicines was that they believed that nonprescription medicines were safe, and 52.5% reported that patients believed that taking advice on how to use it was unnecessary. To learn about nonprescription medicine, 93.7% of pharmacists turned to drug product labeling.

CONCLUSION AND RECOMMENDATIONS

Use of nonprescription drugs is a serious problem that has increased over the past few years. Long-term or chronic use of nonprescription medicine was the most common form of inappropriate use of nonprescription medications and lack of knowledge on the part of patients/customers about the active ingredient in a branded product was the most common factor contributing to its inappropriate use. Pharmacists should receive continuous professional education to increase their knowledge on and improve their practice of prescribing nonprescription medication; further, drug companies should be precise when disclosing information on OTC drug labels as the majority of pharmacists consult the drug label as a source of information about OTC.

Dispensing practice in the community pharmacies in the Turkish Republic of Northern Cyprus

BACKGROUND

Good pharmacy practice is the process of supplying the accurate drug to the right patient for an adequate period of time with the lowest cost to the patient and the community. Pharmacist have a crucial role in promoting good pharmacy practice.

OBJECTIVE

To assess the dispensing practice of the community pharmacists in the Turkish Republic of Northern Cyprus (TRNC) regarding RDU and to evaluate the quality of dispensing. Setting Community pharmacies in TRNC. Method The study consists of two parts: a face to face interview and a simulated patient visit to these pharmacies.

MAIN OUTCOMES MEASURE

Rationality indicators (average dispensing time, stock availability and adequate labelling), presence of the pharmacist on the premises, dispenser characteristics, prescription checking, and the provided patient information.

RESULTS

The majority of the prescriptions (73.3%) were dispensed by the pharmacists. None of the pharmacy employees had pharmacy based training. Eighty nine percent of the pharmacists believed that their employees could very well dispense drugs on their own. The declared average dispensing time for a prescription of a single drug was 233 s while the measured one was 149 s. Few dispensers in reality warned the patient about potential interactions. The difference between the average dispensing scores of the pharmacists and the non-pharmacist dispensers was not significant.

CONCLUSIONS

The dispensing practice in the community pharmacies in the Turkish part of Cyprus seems inadequate in terms of GPP.