Community Pharmacies In Pakistan Research Articles

Impact of patient demographics on control of Asthma in outpatients accessible at the various community pharmacies in Pakistan

Impact of patient demographics on control of Asthma in outpatients accessible at the various community pharmacies in Pakistan

Antibiotic dispensation without prescription by community pharmacies in Pakistan

Antibiotic resistance is a one of the major threats to public health worldwide. Over-the-counter dispensation and utilization of antibiotics are strongly linked with antibiotic resistance. Dispensing without prescription practice is widespread in most countries, including Pakistan. Generally the factors influencing the widespread supply of antibiotics without a prescription in Pakistan include lack of enforcement of laws, lack of knowledge of infectious diseases, patient pressure and socioeconomic factors of patients, the nature of pharmacy operations and monetary incentives from pharmaceutical companies. The objectives of this study were to evaluate the determinants of over-the-counter dispensation of antibiotics in the study area and recognize their motivations and the factors behind this practice. This cross-sectional study was conducted from July 2023 to November 2023 in 10 selected community pharmacies of District Tharparkar, Sindh Pakistan. The sample size calculated were 172 patients using Cochrane’s formula. The sampling technique was non-probability convenience. Out of 172 patients/attendants demanding antibiotics only 56 (33%) were with the prescriptions of a Registered Medical Practitioner while the remaining 116 (67%) were without the prescription. The 81 participants (70%) were unable to afford physicians' consulting charges, 21 participants (18%) had more trust in community pharmacies to suggest antibiotics as compared to physicians, 7 participants (6%) had no time for attending physician’s clinic and 7 participants (6%) were of the view that their consulting physician was not available in chamber/hospital. The top three antibiotics that were dispensed without prescription were metronidazole (75%), ciprofloxacin (15%) and amoxicillin (10%). Out of 10 community pharmacies, only one community pharmacy was run by the in-charge qualified pharmacist (10%) while the rest of the community pharmacies were run by non-pharmacists (90%). These findings emphasize the importance of implementing regulatory measures and enhancing public awareness, emphasizing the role of improved antimicrobial stewardship in restricting such practices

Impact of Community Pharmacy Diabetes Care Program on Knowledge and Glycemic Control: An Unexplored Opportunity for Community Pharmacists in Pakistan

Background: Effective management of diabetes mellitus depends on efficacy of therapy as well as patient adherence to medication therapy and non-pharmacological approaches. One of the most important tools to improve patient adherence is counseling. Community pharmacists can effectively contribute to patient care as they have the expertise and accessibility to do the task appropriately. Objective: The objective of the study was to evaluate the impact of pharmacist counseling on glucose control and medication adherence of diabetic patients attending community pharmacies in Pakistan. Method: A randomized, controlled, single blinded, pre-post intervention study design was used. The respondents included patients diagnosed with both diabetes mellitus (Type I or II) visiting community pharmacies for purchasing their regular medicine. Simple random sampling technique by lottery method was used to select community pharmacies to be included in-group A (intervention n=4) and group B (control n=4). The total number of patients were 40 in each group while estimating a drop-out rate of 25%. Convenience sampling technique was used to select patients visiting community pharmacies. Patients in the intervention group received special counseling. Blood glucose was checked after every 15 days for a period of six months. Pre-validated tools such as diabetes knowledge questionnaire 24 and brief medication questionnaire were used. Data was cleaned, coded and analyzed in SPSS 21. Wilcoxon test (p≥0.05) was used to compare pre-post intervention knowledge regarding diabetes and. Mann-Whitney test (p≥0.05) was used to find differences among medication adherence among control and intervention groups as well as pre and post intervention. Results: The results of the present study showed that respondents having diabetes since the past 1-3 years had comparatively better knowledge scores (18.8, 3±2.04) after intervention. Mean knowledge scores regarding diabetes mellitus among intervention group at baseline was (16.02, ±2.93) which was improved after six months (19.97, ±2.66). Significant difference was observed (p≤0.05) in pre-post intervention knowledge regarding diabetes management. Knowledge of patients was improved regarding different aspects of diabetes management after counseling by community pharmacists. The fasting blood glucose improved at three months (9.32, ±1.92) and after six months (8.95, ±1.45) in intervention group. Conclusion: The results of the current study concluded that counseling by community pharmacist has a positive impact on blood glucose management among diabetic and patients. Educational programs should be initiated by community pharmacists as this can lead to improvement in glycemic control and enhance the image of pharmacist as a key health care member in management of chronic diseases.

Perspectives on an amended law addressing pharmacists' availability in community pharmacies.

Little attention has been given to perceptions of pharmacist availability and role in the community setting following policy changes. The Pakistani model is particularly interesting as it encompasses three different pharmacy practice licensure types with major differences in credentials, training, and role. Guided by the theory of planned behaviour (TPB), this study examined factors associated with the availability of pharmacists in the community setting in Pakistan following the implementation of a new policy regulating pharmacist presence in community pharmacies. Fifteen participants were interviewed in three Pakistani cities (Islamabad, Lahore, and Peshawar). Those included pharmacy licence holders (types A, B, and C), non-pharmacist owners and a pharmacist inspector who were purposively sampled to assure variance in education, gender, time in practice, and geographic location. Directed content analysis was performed based on the TPB framework. Description of themes came after discussions among the two authors. Findings indicated a discrepancy between participants about the value of having a pharmacist present with pharmacists showing more appreciation of the value they would provide. Participants felt that the new policy is attempting to change a norm that has existed for a long time. They also pointed to logistical challenges in making a pharmacist available including the feasibility of having a pharmacist present, the financial burden of hiring a pharmacist, and difficulty in enforcing the law uniformly across different geographical areas. Participants were concerned that some type A licence holders sensed that practicing in the community setting and the act of selling medications was beneath their social status as pharmacists. A set of factors contribute to the availability of pharmacists in community pharmacies in Pakistan. The change in law should be supplemented with other interventions that contribute to making well-trained pharmacy personnel available for serving patrons.

A societal perception about community pharmacies in Pakistan: An outline of prospective investigation

Diabetes self-management education (DSME) is a key component of ensuring optimal diabetes outcomes. Electronic medical record (EMR) systems have transformed diabetes management by providing organized and useful data. However, important gaps remain in the process of how practice settings track referrals and attendance to DSME.The purpose of this study was to use EMR data to examine patients' demographic, behavioral, and diabetes risk factors by referral pattern to a DSME program in a large midwestern Academic Medical Center.A retrospective cross-sectional design using 2006–2013 EMR data from a Clinical Research Data Warehouse (CRDW). Data on 10,000 patients with type 2 diabetes mellitus (T2DM) were randomly extracted from the CRDW for analysis. Multiple logistic regression analysis was employed to explore adjusted associations with referral to DSME.Seven hundred forty patients with T2DM were referred to DSME. Results show that age at diagnosis, insurance status, race/ethnicity, language, alcohol use, use of insulin, HbA1c, LDL, systolic blood pressure, ophthalmology appointment, coronary artery disease, neuropathy, diabetic-retinopathy, and nephropathy were found to be factors significantly associated with a referral to DSME. Language emerged as a significant result; non-English speakers were more likely to receive a referral to DSME.Patients referred for DSME had appropriate medical complications or social needs that would benefit from intensive education; however, there remains a considerable opportunity for improving the DSME referral process. Aspects of the physician decision-making process to refer or not refer patients to DSME warrant further investigation.

Rational Drug use in Pakistan: A systematic review

<p style="text-align: justify;"><strong>Background:</strong> This article provides a review of different studies about rational use of drugs in Pakistan and different interventions to improve drug use in the country. The analysis of these studies focused on the quality of services offered by these pharmacies, knowledge of drug sellers and dispensing practices. <strong>Material and methods</strong>: The summary of rational drug use and their possible health consequences is based on reviews of drug use in Pakistan. A systematic inventory of published research work since 1990 to 2015 was undertaken to identify studies which focused on different aspects of rational drug use. Annals and computerized databases of International Network for Rational Use of Drugs (INRUD), WHO, PubMed, Science Direct were screened for relevant journal articles, research reports and newsletters. To expand and fortify the search process, the general search engine Google was utilize. <strong>Results:</strong> Initially, a total of 60 articles were retrieved for electronic databases by the authors. These articles were then again matched with the objectives of this study and those articles which did not qualify, were excluded. After further screening, 20 articles were selected and 15 appropriate studies were finally included in the review. <strong>Conclusion:</strong> In this study, we find out that large number of drugs is being used in wrong way. The current paper highlighted that quality of services provided at community pharmacies in Pakistan is not satisfactory. The situation of rational drug use indicators in the hospitals where the study was conducted is alarming. There is an urgent need for intervention to improve the situation. <strong>Key words: </strong>Rational drug use, Irrational drug use, Pakistan.

PHP43 - Drug related problems, prescribing pattern and Polypharmacy: evidence from Community Pharmacies in Pakistan

PHP43 - Drug related problems, prescribing pattern and Polypharmacy: evidence from Community Pharmacies in Pakistan

Assessment of disease management of insomnia at community pharmacies through simulated visits in Pakistan

The study aimed to document the state of insomnia management at community pharmacies in Pakistan. A cross-sectional study was conducted at randomly selected 371 pharmacies in three cities of Pakistan. Simulated patient visits were performed to collect information on case management of insomnia in terms of history taking and patient counseling at community pharmacies. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis and Mann Whitney tests (p<0.05) were performed to find out differences. The patients were mainly handled by salesman 83.8% (n=311), by pharmacist 3.5% (n=13) and pharmacy assistants 12.7% (n=47). The mean dispensing time was 1.11 minutes (SD=5.61) with the range of 0.5 - 6 minutes. Of the 371 simulated patients who visited the pharmacies, 72.8% (n=270) subjects were given medicines and 24.3% (n=90) subjects were referred to the doctor for treatment of insomnia. 61.8% (n=193) of the subjects were given benzodiazepines, 35.6% (n=111) antihistamines and 2.6% (n=8) NSAIDs at community pharmacies in the three cities. The mean cost of treatment in case of insomnia was PKR12.7 (SD=10.13, median=10). The disease management of insomnia by community pharmacies in Pakistan is not appropriate. The overall process of history taking, medication counselling and referral practices at community pharmacies either located in rural or urban setting and irrespective of the provider type and location of pharmacies, in the three cities is limited.

Evaluation of the Perception of Community Pharmacists Regarding their Role in Pakistan's Healthcare System: A Qualitative Approach

Purpose : To explore the perception of community pharmacists regarding their role in Pakistan's healthcare system. Methods: A qualitative study design was adopted. A semi-structured interview guide was developed and face to face interviews were conducted. The participants were community pharmacists and were recruited through one of the researcher’s personal contacts in two cities of Pakistan (Islamabad and Lahore) from April to June 2008. The interviews were conducted at the pharmacists’ work-place. Arrangements for the time and place of interview were made during initial contacts. Written consent was obtained from the participants prior to the interview. Results: Among the respondents interviewed, seven were male and three female community pharmacists aged between 25 and 50 years. All the participants regularly dispensed > 50 prescriptions daily. Thematic content analysis yielded 5 major themes: (a) provision of pharmacy services to consumers, (b) counseling at pharmacy, (c) application of Good Pharmacy Practice (GPP), (d) Pakistan Pharmacy Association (PPA) contribution towards pharmacy profession, and (e) strategies to improve community pharmacies. Conclusion: Community pharmacies in Pakistan currently face shortage of pharmacists. This has resulted in non-provision of patient counseling; rather services are more focused more on the management of pharmacies than clients. As a result, there is little public awareness of the pharmacist’s role in health care. Keywords : Perception, Community pharmacist, Patient care, Pakistan, Qualitative methodology.

Impact of educational intervention on knowledge of dispensers working at community pharmacies in Pakistan

To evaluate the impact of training of dispensers on knowledge of dispensers working at community pharmacies in context to storage temperature, prescription terminologies and status of medicines in Islamabad, Pakistan. A randomized, controlled, blinded intervention study was designed and implemented. Before the implementation of intervention, a baseline study was performed to assess the knowledge of dispensers working at community pharmacies. The study population included all community pharmacy outlets in Islamabad. Pharmacies of Islamabad which were visited in pre intervention phase (n=118) were divided into two geographical regions: A (intervention) and B (control). Thirty pharmacies were randomly selected from each region. Keeping in view the results of the baseline study an educational intervention was designed to improve the knowledge of dispensers working at community pharmacies in Pakistan. A significant difference in the overall knowledge of dispensers was observed between the pre-post intervention groups. Knowledge of dispensers regarding storage of drugs, prescription terminologies and status of drugs was improved after the training. On the other hand no significant difference was observed between the pre-post control groups. The study has highlighted that improvements in knowledge of dispensers working at community pharmacies are possible through suitable interventions. But, results of interventions can only be sustainable through continuous monitoring and reinforcement of the training.

Case management of malaria fever at community pharmacies in Pakistan: a threat to rational drug use.

To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy's management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities. The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities. The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel's at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.

A Literature Review: Pharmaceutical Care an Evolving Role at Community Pharmacies in Pakistan

The aim of this paper is to highlight the role of pharmaceutical care at community pharmacies in Pakistan. The paper draws on the literature related to current dispensing practices at community pharmacies in developing countries as well as in Pakistan. There are approximately 63,000 community pharmacies in Pakistan, and according to an estimate, 80% of the medicines are being distributed through this channel to majority of the population. They often lack adequate facilities, staffing and equipments. Absence of pharmacists and their roles being performed by the non-qualified personnel working at community pharmacies are a common practice. There are 8102 pharmacists who are categorized as a category, 31,000 pharmacy technicians categorized in B & C category in the country. There is a shortage of pharmacists who could be engaged for ensuring good pharmacy practices. There are only ten percent of the total pharmacists who work at community pharmacies in the country according to the Pharmacy Council of Pakistan. All kind of medicines are freely available irrespective of their status as prescription or over the counter drugs. The paper highlights that the professional role of pharmacist in hospitals and community pharmacies is switching from dispensing and sale of drugs, to patient counselling. But, the concept of pharmaceutical care at community pharmacies has not been acknowledged yet in Pakistan. The process of prescription handling is poor and patients are often treated without a proper prescription. Prescription validation, drug labeling and patient counseling are the missing components in effective patient management at the community pharmacies. The paper concludes that although laws exist, but due to lack of accountability and weak regulatory framework their proper implementation is not witnessed. Moreover, due to lack of research and evidence related to problems in dispensing practices in healthcare system of Pakistan, the counteractive actions for resolving these problems are limited.

Assessment of case management of dyspepsia at community pharmacies in two cities of Pakistan

ABSTRACT This study aimed to document the management of dyspepsia by community pharmacies in two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). A comparative, cross-sectional study was designed to document the management of dyspepsia including history taking and provision of advice at 238 randomly selected pharmacies through simulated patient visits in twin cities of Pakistan. Kruskal-Wallis test and Man- Whitney test (p ≤ 0.05) were used to compare management of dyspepsia by the dispensers working at community pharmacies handled by different provider types in the two cities. The simulated patients were dealt by a pharmacy salesperson in 75.6% (n= 180) of visits. Medication was dispensed in 73.5% (n= 175) of the visits, while in 10.9% (n= 26) of the cases the customer was referred directly to a physician. No significant difference at (p ≤ 0.05) was observed among history taking and advice provision in treatment of dyspepsia by the dispensers working at community pharmacies handled by different provider types and situated at different settings in the two cities. This study highlighted poor case management and dispensing practices of dyspepsia at community pharmacies in Pakistan. Absence of qualified people, lack of provision of advice and lack of professionalism by the dispensers are the main reasons for the poor quality of services at community pharmacies. KEYWORDS: Community pharmacies, dyspepsia, dispensers, history taking, provision of advice, Pakistan.

Impact of Training of Dispensers on Case Management of Acute Respiratory Tract Infections at Community Pharmacies in Pakistan

Purpose: To evaluate the impact of training of dispensers on the process of case management of ARI at community pharmacies in context to history taking and provision of advice working at community pharmacies in Islamabad, Pakistan. Method: A randomized, controlled, blinded intervention study was designed and implemented. Before the implementation of intervention, a baseline study was performed to assess the process of case management for ARI at community pharmacies. The study population included all community pharmacy outlets in Islamabad. After data collection, data was analyzed. The result of the study revealed that the overall process of disease management of ARI at community pharmacies in Pakistan is not satisfactory. Pharmacies of Islamabad which were visited in pre intervention phase (118) were divided into two geographical regions A (intervention) and B (control). From which thirty pharmacies were selected randomly from each region. The targeted group of the interventions was drug sellers. Keeping in view the results of the base line study an educational intervention was designed to improve the case management of ARI at community pharmacies in Pakistan. Results: No significant difference (p ≤ 0.05) was seen in the process of history taking and advice provision in case of ARI management at community pharmacies between pre and post control groups. On the other hand significant difference in the process of history taking and provision of advice for ARI was observed in the intervention group before and after training. Conclusion: The study has highlighted that improvements in the current dispensing practices at community pharmacies are possible through appropriate educational interventions. The dispensers have the potential to provide fast and low cost healthcare to the masses in the country where the presence of doctors and qualified pharmacist is low; to date they are an untapped and underutilized source in the country.

Community pharmacy practice in Pakistan

Objectives: This study was planned to determine the extent to which the role of a pharmacists is established in community pharmacies in Pakistan and to determine the need of qualified and experienced pharmacists in provision of healthcare at these medical stores or so called community pharmacies. Materials and Methods: A structured questionnaire was distributed to a random sample of 175 attendants at various medical stores located in different areas of Karachi with a response rate of 90.28%. Questionnaire consisted of 24 closed ended questions whose consistency and reliability were determined by Cronbach's alpha. Statistical analysis were done using SPSS (v.16.0) Results: The result shows that the average age of pharmacy attendant lies between 21 and 30 years. Only 9.49% of attendants have professional pharmacy education. It was noted that only 22.6% check prescriber signature before dispensing prescription, which is quite a low as compared with standard practice. Interestingly 57.6% attendants think that presence of qualified pharmacy at medical stores does not make any difference in the efficacy and the business of medical stores. Conclusion: This study concludes that the current status of community pharmacy practice is below par. There is a need to involve more pharmacists at community level and develop awareness programs to counter patients' routine drug issues and reducing the burden of disease from society.

Medication counselling and dispensing practices at community pharmacies: a comparative cross sectional study from Pakistan

The study aimed to assess and compare medication counselling and dispensing practices at community pharmacies in three major cities of Pakistan. A total of 1113 patient dispenser interactions were observed from a randomly selected sample of 371 pharmacies by using convenient sampling technique in the three respective cities namely Islamabad (118), Peshawar (120) and Lahore (133). The data collection tool was adapted from WHO structure observation form and was modified according to the objectives of the study. The process of prescription handling at community pharmacies in terms of patient dispenser interaction, prescription validation and medication counseling was assessed. The data was coded, entered and analyzed by using SPSS Version 16. A total of 1113 patient dispenser interactions were observed at the community pharmacies in the three respective cities namely Islamabad (n = 354), Peshawar (n = 360) and Lahore (n = 399). Out of 1113 patient/dispenser interactions the providers present at the community pharmacies were; pharmacist (degree of B-pharm/pharm D) 1.6% (n = 18), pharmacy assistant (diploma in pharmacy) 7% (n = 78), diploma holder (certified course of drug dispensing) 5.6% (n = 62) and salesmen (no medicine related education) 85.8% (n = 955).There was no significant difference in the practice between pharmacists, pharmacy assistants, diploma holders and salesmen. Prescription validation was carried out in 18% (n = 206) of the cases, drugs verification in 32% (n = 360) of the cases while labelling of drugs was performed in only 6% (n = 76) of the cases. Completely counselling about medication was provided in 3.1% (n = 35) of the cases while no counselling at all was given in 52.7% (n = 582) of the cases. The process of medication counselling and dispensing practices at community pharmacies in Pakistan is not satisfactory. The patients are largely handled by unqualified salesmen. Thus there is a strong need to improve medication counselling and dispensing practices at community pharmacies by improving the skills of the dispensers through a mix of interventions, and law should be implemented to ensure presence of qualified person which in turn will result in the provision of better patient oriented services at community pharmacies.

Qualification, knowledge and experience of dispensers working at community pharmacies in Pakistan

Pharmacies are managed by a variety of dispensers in terms of qualification, knowledge and experience in Pakistan. The study aimed to document the state of knowledge, experience and qualification of dispensers working at community pharmacies in Pakistan. A comparative cross sectional study was conducted at a randomly selected sample of 371 pharmacies in the three cities of Pakistan. A structured questionnaire for data collection was developed and finalized by focused group discussions and pilot testing. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis and Mann-Whitney tests (p≤0.05) were performed to find out differences. Out of total sample of 371 pharmacies, 31.8 % (118) were in Islamabad, 32.4 % (120) in Peshawar and 35.8 % (133) were in Lahore. Fifty percent of the respondents had correct knowledge of range of room temperature at which medicines should be stored. Only 11.1% (41) of the respondents knew about OTC (over the counter drugs) which can be sold without prescription while 5.9 % (22) of the respondents were aware of POM (prescription only medicines) which can be only sold on a valid prescription. While 87.6% (325), 88.1% (327), 58.7% (318) and 95.7 % (355) of the respondents did not know the meaning of the dispensing abbreviations such as 'h.s', 'q.d', 'sos' and 'p.r.n'. The respondents did not know correctly the status of Deltacortil® (Prednisolone), Septran® (Sulfamethoxazole) and Fansidar® (Pyrimethamine and Sulfadoxine) either as OTC or POM in 26.7% (99), 64.2% (238), and 44.5 % (165) of the cases, respectively. There was a significant difference (p≤0.05) in knowledge of dispensers regarding storage temperature, prescription terminologies and status of medicines having different level of qualification and experience. The overall knowledge and training of dispensers working at community pharmacies is inadequate in Pakistan. However, pharmacists had relatively better knowledge regarding storage temperature, prescription terminologies and status of medicines as compared to pharmacy assistants, diploma holders and salesperson.