Good Pharmacy Practice Research Articles

Community pharmacy practice in China: past, present and future

In 2009, China launched a new healthcare system, with reform of the primary healthcare system as its foundation and focus, to enable residents to access primary healthcare for simple health problems instead of seeking help at hospitals. Community pharmacies and pharmacists were to have increased responsibility in primary healthcare by delivering pharmaceutical care services in China in addition to their traditional roles of dispensing prescriptions and selling medicines. To describe the current status of Chinese community pharmacy education and practice, and discuss future directions. A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts. Additional articles were identified through the cross-referencing of articles and books. Additional data were found from relevant websites. From the 313 publications identified, 98 were included. China currently has 388,000 retail pharmacies, corresponding to one pharmacy per 3,532 population. All pharmacies provide prescription and over-the-counter products, as well as prescription dispensing and patient counselling. However, the lack of reimbursement mechanisms reduces the willingness of pharmacists to offer high-quality dispensing and counselling services. There is a shortage of qualified pharmacists to meet increasing patient needs. This, coupled with a shortage of pharmacist training, has resulted in pharmaceutical care being a low priority for delivery in routine pharmacy practice. To meet the increasing demand for pharmacists, 25 universities have been allowed to offer BS, MS and PhD degrees (3-7 years in length) in clinical pharmacy since 2008. The adoption of Good Pharmacy Practice as a recommended standard for community pharmacy practice provides pharmacists with a framework to aid them in service delivery. A number of undertakings still require development, including the enactment of the Chinese Pharmacist Law, development of a standard for pharmaceutical care activities, development of the pharmacy workforce, increasing public awareness of pharmacists, and proper reimbursement for care provision. Although pharmaceutical care services are underdeveloped in China, they will become an integral part of the professional work of all pharmacists in the future, particularly in community pharmacy settings.

Professional standards to review medication orders. Recommendations for Good Clinical Pharmacy Practice in France

Professional standards to review medication orders. Recommendations for Good Clinical Pharmacy Practice in France

Strengthening pharmacy practice in vietnam: findings of a training intervention study

To assess the effectiveness of a training and supportive supervision intervention in strengthening the capacity of pharmacy staff in Vietnam to deliver client-oriented, accurate healthcare information and appropriate services for childhood diarrhoea and emergency contraceptive pills (ECP). Pre- and post-intervention study using a cross-sectional design. Pharmacy staff participated in 3 days of training on customer relations, good pharmacy practice, childhood diarrhoea and ECP over a period of 1month, consisting of lectures, discussion, question-and-answer sessions and role-playing. We compared baseline and 6-month post-intervention surveys to ascertain changes in knowledge, attitudes and practice of pharmacists, using univariate statistics to find significant differences. More than 1200 pharmacists received training and supportive supervision. After interventions, pharmacy staff knowledge was significantly improved on most of the measured indicators. Knowledge of dehydration symptoms for diarrhoea increased from 19% to 88%, and for side effects of ECP increased from 27% to 77%. While assessment of actual practice revealed that this knowledge was not always used, significant improvement was observed. Before interventions, 12% gave information on dehydration symptoms but 45% did so afterwards. The proportion giving information on side effects of ECP increased from 13% to 54%. Providing a programme of training and supportive supervision is an effective way to improve knowledge and practice of pharmacists at private pharmacies in Vietnam. These improvements have the potential to lead to better community health care.

Suspected tuberculosis case detection and referral in private pharmacies in Viet Nam

Private pharmacies in Hanoi, Viet Nam. To explore the response of health care providers (HCPs) in private pharmacies to suspected tuberculosis (TB) patients. A simulated patient method combined with an interview in 128 randomly selected private pharmacies and 10 private pharmacies near TB hospitals. In the simulated patient method and interview, respectively 59 (46%) and 70 (55%) of HCPs referred the TB suspect to general health care. Only 11 (9%) referred the simulated patient to a TB care facility. Fifty-two (42%) of the HCPs identified suspected TB from a fictitious case described on paper; 34 (27%) were aware that free treatment was provided under the National Tuberculosis Programme (NTP). Knowledge about free NTP treatment predicted a higher rate of direct referrals to TB facilities (OR 5.80, 95%CI 1.88-19.62) and greater ability to identify suspected TB from a fictitious case on paper (OR 5.14, 95%CI 2.36-11.73). Pharmacies with Good Pharmacy Practice (GPP) certification were less likely to refer simulated patients to TB facilities than non-GPP pharmacies (OR 0.10, 95%CI ≤0.01-0.79). Nearly half of HCPs in private pharmacies do not refer TB suspects, possibly contributing to delays in diagnosis and treatment. Knowledge about free NTP treatment predicted better performance of HCPs.

Indicators of quality use of medicines in South‐East Asian countries: a systematic review

To identify indicators of quality use of medicines used in South-East Asian region. A systematic review was conducted searching MEDLINE, Embase and The International Network for Rational Use of Drugs (INRUD) and The World Health Organization (WHO) website. Original studies or reports carried out in the South-East Asian region, explicitly using indicators to measure quality use of medicines, and published between January 2000 and July 2011 were included. A total of 17 studies conducted in 7 of 11 countries in South-East Asia were included. WHO indicators focusing on general medication use in health facilities were most widely used (10 studies). Twelve studies used non-WHO indicators for measuring quality use of medicines in clinical areas (geriatrics and obstetrics) or specific diseases, such as diarrhoea and pneumonia. In five studies, WHO indicators were used along with non-WHO indicators. There was little information available about validity, reliability and feasibility of the non-WHO indicators. The majority of indicators measured process rather than structure or outcome. There were very few indicators addressing non-communicable diseases. A limited number of studies have been published explicitly using indicators of quality use of medicines across South-East Asia. Importantly, existing indicators need to be complemented with valid, reliable and feasible indicators related to non-communicable diseases, particularly those with a high financial burden to meet the current medical challenges in the region.

Legal status of the pharmacy practice in the European Union and the Republic of Macedonia

From a historical point of view, one can notice that the role of the pharmacists employed in community and hospital pharmacies became more complex. Today, they do not only supply, store, prepare and dispense medicines with ensured quality, but they also provide professional services based on the concept of pharmaceutical care and good pharmacy practice. In this paper, detailed review on the current legislative regulating the status and practice of the community and hospital pharmacies in some EU-member countries and in Macedonia is given. The implementation of the concept of pharmaceutical care and good pharmacy practice in selected EU member-countries, Great Britain, Germany and Slovenia, and in Croatia as a future EU member as well as in Macedonia is also discussed. In addition, set of recommendations for establishing the good pharmacy practice standards is prepared and presented. At the end, an attempt is made to establish a basis for development a modern Law on Pharmacy Practice in the Republic of Macedonia.

Quality in pharmaceutical compounding for paediatric patients

BackgroundLicensed medicines for children are rare. Pharmacy preparation plays a crucial role in this vulnerable patient group but its quality must be assessed carefully. Our hospital pharmacy prepares various capsules...

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

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

IMPORTANCE OF PROFESSIONAL PRACTICE IN PHARMACIST LIFE

INTRODUCTION Professional practice is a blueprint of good pharmacy practice. It is the foundation for all college of pharmacists. It describes the standards the college uses to assess quality of pharmacy practice, and provides the basis of current and future practice support initiatives. It supports the college’s mission to ensure safe and effective pharmacy care to help the people achieve better health. Professional Practice is designed to help pharmacists enhance their practice and patient outcomes and guide their professional development.

Pharmacy practice in the Republic of Macedonia.

As part of wider reforms within the pharmaceutical sector, the pharmaceutical care concept has been introduced in the Republic of Macedonia. This article provides discussion on current opportunities and challenges which pharmacy practice face in Macedonia. The emphasis is on three prerequisites for the implementation of pharmaceutical care including: organization of pharmaceutical services, legislation, and professional training. The author argues that Macedonia possesses a favorable pharmacy workforce, solid legal basis and supportive structures of healthcare services in order to implement pharmaceutical care. Implementing pharmaceutical care has not been without its challenges, such as: lack of clinical skills, inadequate continuing education and the current remuneration structure for pharmacy services. While Good Pharmacy Practice (GPP) Guidelines have been developed, wider professional debate and practical steps have not been undertaken to promote the concept of pharmaceutical care nationally. Therefore, an integrated national approach to develop strategy, standards and tools for patient-oriented pharmaceutical practice has to be formulated. In addition, there is a need to undertake more comprehensive analysis of current pharmacy practice, to explore the awareness and willingness of the pharmacists to embrace pharmaceutical care practices, and to identify the opportunities and barriers for implementation of pharmacy practice.

Tuberculosis, good pharmacy practice statements adopted by FIP, WHO

This year’s congress of the International Pharmaceutical Federation (FIP) opened September 4 with an address by host country India’s president and a ceremony involving an assistant director general of the World Health Organization (WHO). Nearly 2000 delegates representing national pharmacist

Drug dispensing systems in Gaza hospitals: a comparative study

Implementing an appropriate drug dispensing system in hospitals is essential to ensure the safe and rational use of drugs. This study aimed to assess the unit-dose drug dispensing system (DDS) and the ward-stock DDS utilized in Gaza hospitals to ascertain which system is more beneficial. The quantitative, comparative cross-sectional design utilized structured interviews with pharmacists and head nurses, missing drug registration sheets and drug administration observation checklists. The number of missing units per drug item dispensed (mean 3.4 and 1.8 respectively) and medication administration errors per patient (mean 1.8 and 0.9 respectively) were statistically significantly lower in the hospital using the unit-dose DDS than the ward-stock DDS. The unit-dose DDS appeared to be safer, with fewer missing drugs, was more positively perceived by staff and was more supportive of good clinical pharmacy practice. Its use in other hospitals in the Gaza Strip is recommended.

AFFILIATIONS

ABSTRACT: Good pharmacy practice in community pharmacies (CP) is essential in promoting the rational use of drugs (RUD). The aim of this study was to evaluate the quality of pharmacy practice in CP according to RUD principles. The following data were a part of an interventional study in which 84 community pharmacists in the Umraniye district of Istanbul were evaluated by face to face interviews and an unannounced simulated case scenario in 2002. The average dispensing time, dispensing practice, and adequate labelling were evaluated as rationality indicators. Our results showed that 32% of the pharmacists were not present in their pharmacies during the simulation studies. Only 40.5% of the prescriptions were dispensed by the pharmacists. Forty four percent of the pharmacy employees had no more than a primary school degree. Half of the patients applying to a pharmacy had no prescription. The average dispensing time for a single drug was 149 seconds in simulated cases although the pharmacists declared 287 seconds in the questionnaires. All pharmacists reported that they explained to the patients how to administer their drugs but only 43% of the prescriptions were adequately labelled and only 6.5% included a verbal warning by the dispensers of possible interactions. In conclusion, good pharmacy practice was poorly applied in CP in the selected district of Istanbul. Since most patients consulted a pharmacist for their medication (with or without a prescription), it seemed that continuing education would be essential for pharmacists and pharmacy employees in promoting RUD. KEYWORDS: Rational use of drug, Pharmacy practice, Community pharmacist, Prescription, Dispensing time, Dispensing score.

Rational use of medicines: Achievements and challenges

Rational use of medicines: Achievements and challenges

Self-efficacy in counseling in Norwegian chain pharmacies: A cross-sectional study

Background After pharmacy reform in Norway in 2001, pharmacy chains have systematically trained their personnel in advising self-medication of some symptoms and diseases to increase their competence. It may be important to reveal factors at work that increase self-efficacy in counseling as part of enhancing good pharmacy practice. Objectives The aims of this study were to investigate (1) self-efficacy in counseling among pharmacy personnel in respect to a range of medical complaints, and (2) the relationship between self-efficacy in counseling and pharmacy staff's education, age, years of work in pharmacy and psychosocial factors. Methods A web-based questionnaire about self-efficacy in counseling, psychosocial factors, and demographic variables was completed by 693 individuals from 299 randomly selected community chain pharmacies in Norway. Multiple regression analysis was used to assess the relationship between self-efficacy and gender, age, years of work in pharmacy, and psychosocial factors. Results On a scale from 0 (very difficult) to 10 (no problem), the mean score for self-efficacy on all 21 symptoms or needs was 7.2 (SD = 1.3). Allergy, flu, and headache received the highest self-efficacy scores and leg ulcer treatment, self-test kits, and tiredness received the lowest scores. Significant associations between self-efficacy in counseling and years of work in pharmacy ( P = .017), role clarity ( P < .001), positive challenges at work ( P = .002), and role conflict ( P < .001) were observed. Conclusions Self-efficacy in counseling among pharmacy personnel seems to be high for providing advice for symptoms where over-the-counter medicines are available. Role clarity, positive challenge, and years of work in pharmacy are associated positively with self-efficacy in counseling, whereas role conflict is associated negatively. Future research may examine implications for self-efficacy in actual behavior and patient outcomes.

The PharmD Degree in Developing Countries

To the Editor. A doctor of pharmacy degree program must have a multidisciplinary curriculum that produces pharmacists with sufficient mental acuity to differentiate their position from that of simply dispensers of drugs to that of providers of pharmaceutical care. The PharmD program in the United States is the epitome of the practice-based model as it evolved from industrial and compounding pharmacy to a more patient-focused program. Now, as there is an upsurge in clinical pharmacy, many developing countries have expanded their pharmacy curriculum to a 5- or 6-year program that issues a doctorate of pharmacy degree. However, it is still to be determined whether these countries are genuinely interested in a practice-based model or simply want their graduates to enroll in the US system. Let us look at the situation in various developing countries. Recently, the Pharmacy Council of India (PCI) decided to introduce PharmD (post-bacclaureate degree) courses for the first time in the country in the coming academic year. This decision has been appreciated in a previous letter to the editor entitled “India to Introduce Five-year Doctor of Pharmacy program” in AJPE.1 However, it is imperative to evaluate the state of pharmacy education in India before fully supporting this decision. There are more than 600 pharmacy institutes in India producing over 13,000 pharmacy graduates every year. Pharmacy practice experiences are more or less non-existent with particularly no emphasis on pharmacotherapeutics and clinical pharmacy. There may be exceptions like Jadavpur University and JSS College of Pharmacy.2 As the principal author of this letter and a former lecturer in one of the pharmacy colleges in Delhi, I want to share my experience and observation on the infrastructure of pharmacy colleges, especially those in north India. The pharmacy colleges are in a debilitating state. Their curricula are devised by highly non-technical personnel who have no idea about clinical pharmacy or pharmacy practice. Most of the pharmacy colleges do not have any alternatives to animal experiments as software for undergraduate education. However, they are busy producing postgraduates and PhDs, obviously in bulk. More or less all of the pharmacy colleges are recognized by PCI as well as the All India Council of Technical Education. In Pakistan, a universal PharmD program has been started; however, questions have been raised regarding inadequacies within the curriculum. There are also issues in terms of lack of experienced academicians and practice-based facilities. It is imperative to revisit these issues because, since its inception, pharmacy education in Pakistan has not contributed in any notable way to healthcare policy.3 In Iran, although implemented, the PharmD degree does not provide pharmacy students with clinical insight through active participation in patient care at the interdisciplinary level.4 According to Iranian academcians,5 pharmacy education and pharmaceutical services in Iran must be in accordance with social needs. In Korea, though the curriculum seems clinically orientated, the induction of a 6-year curriculum in pharmacy education is likely to cause educational inequality and may ignite a struggle for power between pharmacists and physicians.6 Clinical pharmacy promotes rationale drug use and plays an important role in patient care. However, in developing countries, clinical pharmacy is promoted as an isolated single entity and not related to a stable population-based pharmaceutical system.7 In the United States and in other Western countries where clinical pharmacy was established, a stable drug distribution system was in place in the hospitals and drug regulatory authorities were efficient. However, how developing countries will promote the PharmD degree and clinical pharmacy in the absence of good governance of pharmaceuticals it is still a question mark. According to the International Pharmaceutical Federation (FIP), there must be well-planned execution of good pharmacy practice in developing countries. Thus, the implementation of the PharmD program must largely emphasize pharmaceutical care encompassing areas of patient care such as hospital and clinical pharmacy. It should not be used as a tool for the pharmacist to be employed internationally or as a sole instrument of professional power and status. If it is so, then implementation of the PharmD degree is certainly questionable and merits justification. We hope that the FIP as well as other national pharmacy councils would take heed of this situation. Shazia Jamshed, M Phil Zaheer Ud Din Babar, PhD Imran Masood, MBA IT School of Pharmaceutical Sciences Universiti Sains Malaysia Penang, Malaysia

The role of the pharmacist–voices from nine African countries

To explore views on pharmacy practice in Africa as perceived by pharmacists from several African countries. METHOD AND SETTING: Data was collected using pre-tested semi-structured interview guides. A total of 15 pharmacists from nine African countries were interviewed. The analysis used a phenomenographic approach where categorisation with regard to differences in expressed perceptions of the pharmacist's role was made. Perceptions on pharmacy practice in Africa as expressed by pharmacists from nine African countries. Four qualitatively different ways of perceiving the pharmacist's role were identified and sorted into subcategories under the two main categories A and B as follows A. Pharmaceutical information provider with the sub-categories: A1. The satisfied dispenser, and A2. The dissatisfied dispenser; and B. Health care provider, with the sub-categories: B1. The health care team member, and B2. The lifesaver. In category A, the pharmacist is described foremost as a provider of pharmaceuticals and information with a distinction being made with regard to whether the interviewees expressed dissatisfaction with their situation or not. In category B, the pharmacist was described as a provider of health care and two different approaches to this were found. The study describes different ways of perceiving the role of the pharmacist in nine African countries. It offers an insight into the situation of the African pharmacist that can be used as a starting point for further discussion and research on the development of pharmacy practice and for the creation and implementation of national Good Pharmacy Practice (GPP) guidelines.

An assessment of the compliance with good pharmacy practice in an urban and rural district in Sri Lanka

To evaluate the compliance of private pharmacies to good pharmacy practice (GPP) in an urban and rural district in Sri Lanka and identify deficiencies with a view to improving supply of safe and effective drugs to consumers. Lot quality assurance sampling (LQAS) method was used to determine the number of pharmacies that need to be studied and the threshold limit of defective elements. An inspection of 20 pharmacies in the urban and all 18 pharmacies in the rural district was carried out using a structured checklist. Compliance to seven subsystems of GPP was studied. Storage of drugs, maintenance of cold chain, dispensing and documentation were comprehensively substandard in both districts. Individual items of supervision in registration, physical environment and order of the pharmacy were also found to be substandard in both districts. This study shows that the LQAS method can be used to identify inadequate pharmacy services in the community as a whole. There was poor compliance to GPP by the private pharmacies in both districts. There are concerns about the quality of drugs and the safety of private pharmacy services to the community. Some of the deficiencies could be easily corrected by educating the pharmacists and authorised officers, and more effective and streamlined supervision.

Decision-makers and the usefulness of research evidence in policy implementation—a case study from Lao PDR

The involvement of researchers in the policy process and policy-makers in research is little studied, particularly in developing countries. In 1993, the Lao National Drug Policy (NDP) was endorsed in a consultative process involving many stakeholders. Lao People's Democratic Republic is a poor country in South East Asia. Five pilot provinces were selected for implementation of the policy, which had a health system research (HSR) component. This case study explores decision-makers’ knowledge and attitudes regarding the usefulness of HSR in the NDP implementation process. Ninety decision-makers from different health institutions including hospitals, medical schools and main drug suppliers were surveyed using a self-administrated structured questionnaire, filled in during a NDP conference in 2001. Results from six HSR projects related to the NDP implementation had been presented during the conference, but also 6 months previously and through written reports. There were 75 respondents (83% of attendees, 90% of whom were men), 39% with medical, 50% with pharmacy and 11% with other background. Ninety-eight percent of the participants found operational research useful, and 87% supported it to be an element of the NDP. Two-thirds knew the objectives of the NDP. There was no significant difference in knowledge and attitudes between pilot and non-pilot provinces and between professions. Ninety-two percent were aware of the Essential Drug List, and 88% found it adequate to drug need. Ninety-seven percent agreed with generic drug prescribing. Seventy percent reported to have heard about Good Pharmacy Practice (GPP), but only a few could explain it. Although most participants agreed that HSR should be one main component of the NDP and found HSR results useful, few had heard about them before the conference, and research was not well understood. The paper discusses various factors influencing decision-makers’ perceptions of usefulness of research in this case during the NDP implementation process. It is concluded that the acceptance of research and major NDP concepts probably is a result of close interaction between researchers and policy-makers and that the interface between research and policy-making needs further studies.

The Quality of Pharmacy Practice Among Dispensers in Private Pharmacies: A Case Study in Dar es Salaam, Tanzania

The quality of pharmacy practice provided by dispensers in private pharmacies was studied. Parameters used include levels of education of the dispensers, access to health information, knowledge and practice regarding dispensing of drugs to patients, and disposal of expired drugs. A total of 150 dispensers selected from 150 pharmacies participated in the study. Data was collected by interviewing the dispensers through structured questionnaires and observations. Regarding the levels of education of the respondents, the study revealed that 26.7 % had neither pharmaceutical nor medical education and that only 25.3 % of the respondents had regular access to health information. However, results showed that 75 % of all pharmacists interviewed were knowledgeable about good practice regarding dispensing of drugs to patients. Further, the results revealed that 92.7 % of the pharmacies had their drugs arranged on the shelves according to pharmacological classification. Results on assessment of knowledge about disposing of expired drugs showed 66.7% of the respondents were not knowledgeable. It is concluded that, there is a need for training of dispensers on good pharmacy practice through continuing education in order to achieve quality pharmaceutical services in private pharmacies. Key Words: Pharmacy practice, dispensers, pharmaceutical services, private pharmacies. East and Central African Journal of Pharmaceutical Sciences Vol.5(2) 2002: 24-27