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ORIGINAL ARTICLE
Year : 2022 | Volume
: 14
| Issue : 1 | Page : 13-18
Exploring community pharmacist's knowledge, attitude, and practice toward the provision of pharmaceutical care. A prospective cross-sectional study from Saudi Arabia
Abubakar Siddique1, Ejaz Ahmed2, Mohammed Al Zoghabi3, Emad Alsaif3, Faisal Alhawshani3
1 Department of Pharmacy Practice Unaizah College of Pharmacy Qassim University, Saudi Arabia; Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, Bangalore, Karnataka, India
2 Department of Pharmacy Practice Unaizah College of Pharmacy Qassim University, Saudi Arabia
3 Pharmacy intern Unaizah college of pharmacy Qassim University, Saudi Arabia
Correspondence Address:
Dr. Abubakar Siddique
Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jpbs.jpbs_16_21
Abstract
Background: Pharmaceutical care (PC) is the new way of practicing the pharmacist's rule; practicing the PC will improve the quality of life of the patient by providing advices and counseling such as following up the patient after taking the medicines. Objective: Evaluating the knowledge, attitude, practice, and perceived barriers of community pharmacists in Qassim, Saudi Arabia, toward the provision of PC. Materials and Methods: A cross-sectional study consisting of a questionnaire was conducted to gather data from pharmacy professionals working in community pharmacies in Qassim region of Saudi Arabia between September 2019 and May 2020. A sample of 130 pharmacists were given the questionnaire by the investigator. Results: The respondents showed a positive knowledge as 60% think that the medications should be dispensed to patients only, and 95.4% of the respondents are willing to counsel and offer advice to the patients. For attitude, there was also a positive response as 92.3% agreed that primary responsibility of community pharmacists is for providing PC. For practicing, a positive response was also found as 94.6% of the respondents do collect medication history from the patient, while 68.5% of the respondents follow up the patient's progress and assured that desired outcomes have been achieved. For barriers, lack of space and privacy were the most agreed barriers by the respondents with 63%. Conclusions: Community pharmacists have shown good knowledge, attitude, and practice in relation to the provision of PC in our study and major barrier we found in our study that lack of privacy in the pharmacy in which the patients will not be willing to express or explain their health or drug-related problems comfortably.
Keywords: Pharmaceutical care, Knowledge, Attitude, Practice, Community pharmacist, Qassim region
Introduction 
For many years, the pharmacist role used to be only to preparing, dispensing, and selling the medications, but this role has been changed recently, in a more involving way. Their function has been shifted from product-oriented to a patient-oriented. Pharmaceutical care (PC) is now the name of the new role of the pharmacists. The concept of PC was introduced in the United States around three decades ago.[1]
In 1990, Hepler and Strand define the PC for the first time as the responsible provision of drug therapy to achieve a specific goal of improving the quality of life of patients. While the International Pharmaceutical Federation has defined PC as 'the responsible provision of pharmacotherapy to achieve definitive outcomes that improve or maintain the quality of life of a patients. These outcomes include disease cure, elimination of patient symptomatology, stopping or slowing down of the disease process, and prevention of disease or symptomatology.[2]
PC process is built on a relation between the patient and the pharmacist who acknowledges duty for the patients. Agreement between the patient and the well-being care supplier on the helpful result, remedy of a malady, disposal or curtail patient's side effects, capturing or abating an infection progress or symptoms, and basic patient checking exercise s. PC aims to develop overall patient's health-related quality of life and accomplish specific clinical results inside practical financial expenditures.[3]
Medication errors increase the cost of health care and account for increased utilization of hospitals, nursing homes, and physician consultations and health risks for patients.[4],[5] Applying the philosophy of PC is needed to achieve clinical, economic, and humanistic outcomes. In the creation, execution, and supervision of a treatment plan, this should be achieved in close collaboration with patients and other health-care professionals.[6],[7] As the community pharmacists act as a primary communicator between the patients and other health-care professionals.[8] Studies have investigated communication between patient and health-care professionals as a bridge minimizing communication gaps helps in achieving desired outcomes of PC.[9]
The pharmacy profession in Saudi Arabia in general and community pharmacy, in particular, still lags behind the strides made by the health-care system because of many difficulties and challenges in the implementation of PC services at community pharmacies.[10] This research aims for exploring knowledge, attitude, and also about the practice percentile of community pharmacies in the region to provide a clear picture about PC process and services to understand the limitations and to minimize the gaps this study aims to with to evaluate extent of their knowledge, attitude, practice (KAP), and barriers toward the provision of PC.
Materials and Methods Study design
A prospective cross-sectional evaluation was carried out in community pharmacies of the Qassim region.
Study duration
The study was carried out for the period of 9 months in the field (September 2019–May 2020).
Study material
Adapted questionnaire from a study conducted in Karnataka, India, by Inamdar SZ et al., is used to collect the data of four domains (KAP and barriers).
Data analysis
The Collected data were arranged in Microsoft excel 2007 version as a data entry and IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp was used to analyze the statistical data, descriptive and frequency method is used to compare between the practicing community pharmacists' knowledge, attitude, practice and barriers towards the pharmaceutical care.
Study criteria
Inclusion criteria
Pharmacists working in community pharmacies in Qassim region.Exclusion criteria
Pharmacists working in areas other than Qassim regionHospital pharmaciesThe pharmacists who were uncooperative.Development of questionnaire and data collection
Adapted questionnaire was modified by distributing among the experts for face validation by using Hardesty and Bearden method. Based on response of expert panel, we modified the questions.
Study population and sample size
Pharmacists working in community pharmacies in Qassim region were included in the study. One hundred and fifty pharmacists were participated in this study; 134 questionnaires were received back from the community pharmacists. Four questionnaires were found to be incomplete and which were not included in the data analysis, and 130 questionnaires were completed and included to analyze the data.
Ethical approval
The study protocol was approved by the Subcommittee of Health Research Ethics, Deanship of Scientific Research, Qassim University, Saudi Arabia, with reference number 19-06-07.
Results A total number of 150 questionnaires were administered; of which 130 were completed with an 86.6% response rate of 100% of the respondents were males while there were no accounts for females. Distribution of experience of respondents illustrated that 66% of the workforces had <10 years of experience [Figure 1] and [Figure 2]. Out of the 130 respondents, 129 pharmacists had a bachelor degree and one pharmacist had a master degree. Seven cities were covered in this study; the majority of the pharmacists were in Buraydah with 31%, then Unaizah with 23% and Ar-Rass with 19%, then Albukairyah with 9% and Albadayea with 8% and finally Riyadh Alkhabra and Al Muthneb which were 5% [Table 1] and [Table 2].
Table 1: Demographic data of the highest qualification of the respondentsOn knowledge, 60% described PC as dispensing of medication to patients, 95.4% of the respondents gave advice and counseling during dispensing, while 33.8% offered advice to patients. 59.2% defined as PC as a responsibility of pharmacists to dispense and provide appropriate counseling on drugs prescribed by the physician. 85.4% think that patient medication therapy review and secondary prescription changes were needed. In addition, 40.8% agreed that pharmacists should take full responsibility for patients' drug-related needs [Table 3]. On attitude toward PC practice, 58.5% of participants considered that PC is a mandate of pharmacists only, 92.3% thought that it is a primary responsibility of pharmacists. 98.5% of participants considered that PC is a valuable mode of practice and will serve to enhance overall patient's quality of life. 94.6% of participants agreed upon practicing PC in community pharmacies, increases patients' confidence over profession and develop definite pharmacy practice. Around 59.2% of participants believed that PC practicing is resource-intensive and its takes time, it requires effective manpower, and is not worth the problem. 93.1% felt that PC movement will improve patient health and quality of life [Table 4].
Table 4: Community pharmacist's attitude toward practice of pharmaceutical careOn the practice of respondents to PC, 94.6% of community pharmacists collect information from patients prior to dispensing the prescribed drug. 97.7% of participants usually identify prescription errors. 66.2% of participants agreed that changes in prescribed medication are part of PC, while 78.5% contacted the doctor to provide their information about drug-related problems. 93.1% advised the patient about modification on lifestyle or nonpharmacological therapy, and only 68.5% follow up on the patients' progress and ensure the desired outcomes has been achieved [Table 5].
Toward barriers, implementing PC process, 60% agreed that improper relationship between community pharmacists and other health-care professionals is one of the barriers. 66.9% agreed that the current curriculum and education inadequate to practice. Lack of training and confidence in PC were agreed by 62.3%, while lack of space and privacy were agreed by 63.1%. 46.2% agreed that improper design of community pharmacy is also one of the barriers while attitude toward counseling others was agreed by 59.2% [Table 6].
Discussion PC is a new term brought into the pharmacy practicing field, which is different from the normal practicing, PC is more involved with patient other than only dispensing the drugs, where the pharmacists are aware of the patient's medical history and are able of giving advises toward the given drug.[1]
The philosophy of PC focuses on pharmacists' responsibility to gather respective drug-related needs of patient's and help in achieving their goal through collaboration with other health care providers. Nowadays, a concept of PC is not well understood in many places over the world, depending on whether the pharmacist has a positive knowledge or attitude toward the PC or how the pharmacy is designed to implement the pharmacist from practicing the PC. In our study, we aimed to ascertain the knowledge, attitude, and practice of community pharmacists with regard to the provision of PC in the Qassim region in Saudi Arabia.
The present study included 130 community pharmacists. We found that all the community pharmacists were male with 100% response rate as described in the analysis of the results [Figure 1]. Unlike the study conducted by Maaji and Ilyas in Nigeria in 2014, they described the findings for the respondents were about (10) (25%) of pharmacists were female gender and around (30) (75%) were male pharmacists in community pharmacies respectfully.[11] Another study conducted by Mishore et al., in Eastern Ethiopia in 2020 with a response rate of 78 (97.5%) showing that 65 (88.3%) accounts for male pharmacists and 13 (16.7%) are female pharmacists. Gender plays a vital role in the attitude component between the pharmacist and patient, especially in the communication between them, proving that the female gender has a better attitude toward the patients.[12]
Year of experience of the study participants pharmacists described shown in [Figure 2], the pharmacists who have (0–10) and (11–20) years of experience show the highest number with (85 pharmacists) 66% for (0–10) and (33 pharmacists) 25% for (11–20). Moreover, this is one of the significant reasons that may describe the positive attitude toward practicing PC in Qassim region, As the study conducted by Dunlop and Shaw in New Zealand in the year (2002), They found that the years of postqualification experience of the pharmacists were significantly associated with the pharmacists' attitude toward practicing PC as we expected in our study, and the results of their study showed that the pharmacists who had higher attitude scores have (6–10) years of experience compared to those with 1–5 years, and those with 11–15 years also had higher scores than those with over 15 years postqualification experience. In contrast, the study of Mishore et al. findings demonstrated that the majority of the pharmacists 49 (62.8%) have (0–5) years of experience showing that more than half (52.6%) of the pharmacists had a positive attitude. The link between our study and New Zealand and Eastern Ethiopia study is that the higher the pharmacists' experience, the more positive the attitude becomes.[12],[13] We covered most of the pharmacies in the Qassim region, for example: (Alnahdi pharmacy, Dawaea, Aadel, Alrazi, Bait aldwaea, Altadawi, Asdaf, Allazzam, Almallah, etc.). The cities we covered in our study are seven cities, including; (Buraydah, Unaizah, Arrass, Almethnab, Al-Bukairiyah, Badaya'a, and Riyadh Al-Khabra) as illustrated in [Table 2].
Our study found that community pharmacists in Qassim region had a reasonable understanding of the PC practicing process and they were well organized toward it. In general, the PC concept was better understood and encouraged by younger pharmacists. The knowledge of the community pharmacists included in this study show that they have a positive knowledge about the PC concept with 95.4% (124) of the pharmacists offer advice or counseling during dispensing the drugs as shown in [Table 3], similar to a study conducted by Maaji and Ilyas in Nigeria in the year 2014 and the result of knowledge component show that (97%) of the pharmacists offer advice or counseling during dispensing the drugs. (MA'AJI, et, Ilyas OS, 2014). However, overall, according to the WHO, it was noticed that the contribution of the pharmacists as an active member of healthcare team. It has indicated the requirements of continues mandatory pharmacy professional development education for all community pharmacists.[11]
The present study showed that community pharmacists in Qassim region have a positive attitude toward PC as 92.3% (120) of the pharmacists think that the primary responsibility of pharmacists in general is to provide PC and 98.5% (128) think that PC is valuable and will improve quality of life as shown in [Table 4]. This is similar to the study in Nigeria conducted by Maaji and Ilyas in 2014, where the students also showed positive attitude toward PC with 90% (36 pharmacist) think that the primary responsibility of pharmacists is to provide PC and 95% (38 Pharmacist) agreed that PC is valuable and will improve quality of life.[11]
Another study conducted by Ung et al. in Macao in the year (2016) the study findings show that the pharmacists have a positive attitude and firm commitment to the provision of PC, 95% of the pharmacists agreed that patient's health should be their primary responsibility and should try their best to the provision of the most suitable medications.[14]
Where it comes to the analysis of practicing PC, the respondents showed high percentage in collecting the patient medication history as 94.6% (123 pharmacists) they do collect medication\medical history from the patient as shown in [Table 5], While the study conducted by Inamdar et al. in the year 2018, The study found that only 70% (105) of the pharmacists collected patients medication history.[15]
In our study, we also carried out the analysis of the possible barriers that affecting practicing PC by the pharmacist, and we found that about 60% (78) of pharmacists agreed that there is a poor relationship with the physician, and despite having good PC knowledge and attitude 46.2% (60) of pharmacists agreed that the design of the pharmacy is improper to do the PC and stopping them from practicing it, while 62.3% (81) of pharmacists agreed on lack of training and confidence which is related to their current curriculum and education as 66.9% (87) agreed that their curriculum and education were inadequate to practice is illustrated in [Table 6]. the study conducted in Nigeria by Maaji and Ilyas in the year 2014, revealed that 93% (37) of the pharmacists said that they would participate in any training program to enable then to practice PC.[11] Some chain pharmacies revealed that they are using specific programs to follow up with the patient as well as having private rooms to practice the PC, unlike the other pharmacies which pharmacists find it difficult to follow up with the patients when they don't have programs to use or private rooms to consult the patient. The Nigerian study which was conducted by MA'AJI, et al., had the highest knowledge response in dispensing the medication to the patient only. As for counseling the patient, the Nigerian study also had a higher response. However, these results could be affected by the number of the respondents. For attitude, the response we received was positive, unlike the New Zealand study, which had a significant variation in response between different groups of pharmacists, based on gender, age, and role.[13]
In practice, the patient's medication history was low in the Nigerian study as 65% of the respondents do not take the medication history, which is the opposite of the result we found in our study as 94.6% of the respondents do collect the medication history.[11]
On barriers, all of the studies, the Nigerian, Indian, New Zealand, and our study agreed that pharmacists' lack of practice is the main barrier to providing PC.
Conclusions In our study, we found a positive response in parameters of knowledge, attitude, and practice with regard to the PC services providing by community pharmacists in the region and have a good knowledge and concept of PC process. And also community pharmacists are well determining to practice. However, despite the good knowledge and attitude that the community pharmacists have, there are barriers impeding the community pharmacists from practicing the PC, the major barrier was the lack of privacy in the pharmacy in which the patients will not be willing to express or explain their health or drug-related problems comfortably. However, to deal with the barriers, a good pharmacy set up with a standard patient counseling service should be provided as a private room or counseling area in the community pharmacies in the region where the patients can discuss their health or drug-related problems comfortably while communicating with the pharmacists appropriate patient consultation services plays a vital role in minimizing drug-related problems overall for the patient safety by mean of PC. Lack of privacy between the pharmacists and the patients may lead to drug-related problems as the community pharmacist plays a vital role in identifying and solving drug related problems. Moreover, additional training programs for students should be given during their curriculum, practice, and continuous professional development activities to take place and improve their concept of the PC services and overall understanding of PC practice.
Acknowledgment
The authors are highly thankful to Dr. Alian Ali Alrasheedy, Dean, Unaizah College of Pharmacy (UCP), for supporting throughout and approving the dissertation project. We would like to express our heartfelt gratitude to Dr. Saud Alsahali, Vice Dean, UCP, for his expert guidance and support for this dissertation work. Also, the authors are thankful to Dr. Abubakr Alfadl, Head, Department of Pharmacy Practice, UCP, for helping and encouragement throughout the research. Also, the authors are thankful to Dr. Mohammed Saif who has done the statistical analysis. We also thank Dr. Shazia Jamshed and Dr. Maryam Farooqui for providing inputs to our manuscripts.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
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