Visiting Community Pharmacies Research Articles

Overview of Indonesian Community Pharmacy: Understanding Practice Changes

<p><span lang="EN-US">Community pharmacy practice in Indonesia has shifted to a patient-centered model, offering a </span><span lang="EN-US">range</span><span lang="EN-US"> of services that include treatment advice, chronic disease management, and public health promotion. This shift benefits consumers who visit community pharmacies as their initial healthcare point. The Indonesian healthcare system, a mix of public and private providers, is governed by a decentralized structure, fostering significant investment in private healthcare despite access limitations due to financial capacity. Medicines distribution, managed by the District Health Office, ensures supply to primary healthcare facilities, with community pharmacies regulated by the Ministry of Health and the Indonesian National Food and Drug Agency. Despite stringent regulations mandating comprehensive services, most pharmacists are not remunerated for their services. Pharmacy staff, including formally qualified pharmacists and pharmacy technicians, are registered professionals, with recent trends indicating a shift towards employing pharmacy technicians to enable pharmacists to focus on clinical roles. Economic factors and innovative service delivery modes, such as telepharmacy and online purchasing, are expected to influence future practices, enhancing the pharmacist's role in chronic disease management and other health conditions. The evolving community pharmacy practice in Indonesia reflects broader changes in the healthcare system and professional roles, with continued progression anticipated.</span></p>

Assessing Public Awareness, Utilization and Satisfaction with Community Pharmacy Services.

The Saudi Community pharmacy sector has been changing towards patient-centred care rather than depending solely on dispensing medications. Accordingly, pharmacies can now provide many services that they previously could not offer. The aims of this study were to identify all pharmacy services provided in a community setting and to assess public awareness and utilization of and satisfaction with these services. This was a cross-sectional study in which the authors first purposively visited community pharmacies to identify the services offered. Pharmacists were asked about pharmacy services currently provided to community. Fieldnotes were used to document pharmacists' responses. After identifying pharmacy services, a questionnaire was desgined and reviewed by experts in the field, piloted and approved by the Ethics Committee at King Faisal University, then disseminated via Google Forms. The satisfaction level with pharmacy services was assessed using a five-point Likert scale. Data were collected from 24 January 2023 to 2 March 2023. Eighteen community pharmacies offering 17 different services were visited across Alahsa Governorate. The number of participants who completed the questionnaire was 350. Of those (232 [66.3%]) were female, and the majority of the sample (80.5%) were younger than 40 years old. The majority of the participants were unaware of pharmacy services. Out of 17 services, six received a score of 50% or higher regarding participant awareness. The most utilized services were the medication dispensing service "Wasfaty" (250 [71.4%]), medication counselling provided by pharmacists (232 [66.3%]) and minor ailment service (231 [66%]). The overall satisfaction score for pharmacy services was 87.2%. The majority of the participants were unaware of the full range of available pharmacy services. There is a potential for community pharmacists to fill the capacity gap in the healthcare system since, overall, the participants rated the pharmacies' clinical services as satisfactory. Commissioners of pharmacy services may consider extending the scope of community pharmacies to include services that best utilize the expertise of clinical pharmacists.

Dispensing of Antimicrobial Agents Without a Prescription in Iraq: A Call for Upholding the Legislations to Change Long-Standing Practices

Background: Antimicrobial prescribing patterns have an important role in the emergence of resistance, and community pharmacists have a substantial influence on this issue. Objective: To assess community pharmacists' behaviors and attitudes toward antimicrobial dispensing, determine their proportions and categories, and examine the underlying rationales for this practice. Methods: A descriptive cross-sectional survey of community pharmacists in Iraq was conducted from June to August 2023, using a self-administered validated questionnaire. The attitudes, practices, and motivations driving the distribution of antimicrobials without a prescription (AWP) were explored in three areas. Results: A sizable proportion (61.6%) of respondents rejected dispensing AWP at community pharmacies. Patients primarily seek antibacterials from community pharmacies owing to budget constraints, according to 82.7% of respondents, rather than for consultation and diagnostic services. The most powerful element in a pharmacist's decision to administer AWP is that patients will seek antimicrobials from another pharmacy if they are not dispensed by the pharmacist, owing to the pharmacist's experience in infection management. The study found that 50%–74% of patients who visited community pharmacies sought AWP. Antimicrobials are most commonly provided without a prescription for cold and flu and urinary tract infections (37.3% and 27.7%, respectively). Conclusions: The majority of pharmacists regularly dispense AWP. To guarantee compliance with Iraqi legislation and laws governing AWP distribution, ongoing training programs should be created to educate the public on the most effective methods.

Surveillance of antimicrobial awareness among patients visiting community pharmacies

ObjectiveAlthough antimicrobial resistance (AMR) measures have been progressing, cases of patients requesting their doctors to prescribe antimicrobial agents and patients mistakenly believing that these agents are effective against viruses occasionally occur. In the AMR action plan (2023–2027) in Japan, one of the primary goals are public awareness and education. However, public understanding of AMR and antimicrobial agents has been reported to be at an unsatisfactory level. Here, we conducted a surveillance of antimicrobial awareness among patients visiting community pharmacies. Material and methodsA questionnaire survey was conducted among patients visiting nine pharmacies in Hachioji, Tokyo, Japan. A total of 1887 active questionnaires were collected. The relationship between answers was analyzed using logistic regression analysis. ResultsOf the patients, 72% were unaware of AMR, and 68% believed that antimicrobials are effective against viruses. In addition, 28% of the patients answered that they did not take antimicrobial agents as prescribed by their physicians. Seventeen percent of the patients had never received appropriate instruction of antimicrobial use from pharmacists. Analysis of the relationship between answers showed that patients with correct knowledge were 1.65 times more likely to take antimicrobial agents as prescribed by their physicians (P < 0.01). Furthermore, the factors that led to the inappropriate behaviors of patients were associated with preliminary antimicrobial prescriptions from physicians (odds ratio, 3.18; 95% CI, 2.12–4.76) (P < 0.01). ConclusionThis study strongly suggests that physician and pharmacist interventions regarding the appropriate use of antimicrobial agents are important to improve awareness of antimicrobial agents.

Medication risk checklist for older adults (LOTTA) – development and validation of a self-assessment tool

Background Patient safety strategies highlight patients’ own active involvement in ensuring medication safety. A prerequisite for involving patients in their medication therapy is having tools that can assist them in ensuring safe medicine use. Older home-dwelling adults with multiple medications are at high risk for medication-related problems, yet only a few age-specific patient self-administered medication risk screening tools exist. This study aimed to develop, validate, and assess the feasibility of a self-administered medication risk checklist for home-dwelling older adults ≥65 years. Materials and methods The draft checklist was formed based on a validated practical nurse-administered Drug Related Problem Risk Assessment Tool supplemented with findings from two systematic literature reviews. The content validity of the draft checklist was determined by a three-round Delphi survey with a panel of 19 experts in geriatric care and pharmacotherapy. An agreement of ≥80% was required. A feasibility assessment (i.e. understandability of the items, fill-out time of the checklist) of the content-validated checklist was conducted among older adults ≥65 years (n = 87) visiting community pharmacies (n = 4). Data were analysed using qualitative content analysis. Results The final validated and feasibility-tested Medication Risk Checklist (LOTTA) for home-dwelling older adults consists of eight items screening the highest priority systemic risks (three items), potentially drug-induced symptoms (one item), adherence, and self-management problems (four items). The checklist proved feasible for self-administration, the mean fill-out time being 6.1 min. Conclusions A wide range of potential medication risks related to the medication use process can be identified by patient self-assessment. Screening tools such as LOTTA can enhance early detection of potential medication risks and risk communication between older adults and their healthcare providers. A wider and more integrated use of the checklist could be facilitated by making it electronically available as part of the patient information systems.

Assessing consumers’ perception and demand on the community pharmacists’ dispensing

BackgroundThis study aimed to assess the general public's perception of services provided by community pharmacies, their willingness to utilize these services, their satisfaction with and understanding of community pharmacists, and their views on dispensing separation and pharmacy medicines (P medicines).MethodsAn online cross-sectional study was conducted, in which questionnaires were distributed among the general public. A novel questionnaire was designed and validated specifically for this study. It was composed of six sections: demographics, pharmacy usage and service preferences, understanding and satisfaction with pharmacists, views on dispensing separation, private community pharmacies, and knowledge of P medicines. Statistical analyses such as one-way ANOVA, independent t test, and binary logistic regression were employed, with a p value of < 0.05 considered statistically significant.ResultsThe study received 222 responses. The majority of the respondents were females within the 20–29-year-old age group (62.2%). Most respondents preferred to consult doctors for medical treatment, with their primary reason for visiting community pharmacies being to collect prescribed medicines. About 52.7% of respondents expressed their willingness to avail of screening services and treatment for minor illnesses at community pharmacies. A statistically significant difference was found among different age groups regarding their views on the dispensing separation system, with those aged 41–50 years demonstrating higher scores. However, the binary logistic regression analysis did not reveal any statistical significance when comparing the understanding of P medicines among respondents.ConclusionsIn general, the public prefers to consult doctors for medical treatment and visit community pharmacies predominantly to collect prescriptions or purchase over-the-counter medications. Nonetheless, they are also open to utilizing services provided by community pharmacists, particularly screening services and treatment for minor illnesses.

Public awareness regarding the manufacturer provided information about medicine usage, safety, and adverse drug reactions in Balochistan, Pakistan.

Objectives: This study aimed to analyze the general public's awareness of medicine information, safety, and adverse drug reactions in Quetta, Pakistan. Methods: A cross-sectional descriptive study was conducted using random sampling from April 2020 to April 2021 in Quetta. Samples were collected from respondents who met the inclusion criteria and had visited community pharmacies. The analysis was done using SPSS version 23. Bivariate and multivariate analyses were performed to assess factors associated with good knowledge. Results: Multivariate analysis revealed that purchase on prescription was a determining factor of knowledge regarding knowledge of pharmaceutical products and their provided information, medicines usage and safety, and Medication ADRs. Patients who bought medicines on prescriptions were more likely to have better knowledge. Patients having education were more likely to have better knowledge. Conclusion: Public awareness about medicine information, safety, and the information provided by manufacturers is crucial to ensuring that patients have access to accurate information about their medications and can make informed decisions about their health. Healthcare providers and regulatory bodies must work together to improve access to information and promote safe medication practices.

Assessment of Medication Regimen Complexity of COPD Regimens in Individuals Visiting Community Pharmacies.

Non-adherence is common and linked to poor COPD outcomes. Medication Regimen Complexity Index (MRCI) scores affect other disease outcomes. Little is known about the implications of MRCI scores in COPD. Secondary analysis was done to calculate MRCI scores assessing relationship to symptoms, COPD severity and health literacy (HL) to identify potential interventions to optimize adherence. Secondary analysis was conducted of cross-sectional, non-randomized survey data. Participants with self-reported COPD completed a survey of demographics, exacerbations, symptoms (COPD Assessment Test (CAT)), and self-reported COPD regimens. COPD severity was classified into Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD categories using exacerbation history and CAT. CAT scores were categorized as low (<10), high (>10) and very high (>20). A 1-year proportion of days covered (PDC) was calculated. A MRCI calculator scored regimens (primary endpoint). Published cut-off points were used to categorize MRCIs as low (≤4), medium (5-8) and high (>8) and inhaled device polypharmacy (IDP) as ≥3 devices. Risk for low HL was assessed using a Single Item Literacy Screener. Descriptive and Chi-squared statistics were used. Participants' (N = 709) PDC for 1 maintenance medicine averaged 0.43 ± 0.37; 28.7% were adherent (PDC ≥ 80%). CAT scores were very high in 54.6% and high in 35.8%. Distribution of GOLD categories were A (6%), B (35%), C (4%) and D (55%). High, medium and low MRCI were 85%, 14% and 9%, respectively. Mean devices per regimen was 2.05 ± 0.8; IDP was 28%. MRCI and IDP increased with worsening CAT scores and COPD severity per GOLD category (p<0.05), but not low HL. MRCI scores for COPD regimens increased with COPD severity and symptoms. Overall adherence was low despite high symptom scores; high MRCI scores could contribute. All COPD medication classes are available in multiple devices, combinations, and daily formulations; there is potential to simplify regimens. Prospective studies are needed to evaluate if interventions minimizing MRCI scores improve adherence and COPD outcomes.

Practice of pharmaceutical care by community pharmacists in response to self-medication request for a cough: a simulated client study

BackgroundCommunity pharmacy practice worldwide has been shifting from product-focused to patient-oriented. However, due to the absence of separation between prescribing and dispensing in Malaysia, community pharmacists may have limited roles in the provision of pharmaceutical care to patients with chronic diseases. Therefore, the main functions of community pharmacists in Malaysia are related to self-medication requests for minor ailments and the supply of non-prescription medications. The objective of this study was to determine the practice of pharmaceutical care by community pharmacists within the Klang Valley, Malaysia in response to self-medication requests for a cough.MethodsThis study utilised a simulated client method. A research assistant, acting as a simulated client, visited community pharmacies in the Klang Valley, Malaysia to consult the pharmacists on the treatment of a cough experienced by his father. Upon leaving the pharmacy premise, the simulated client entered the pharmacist’s responses in a data collection form which was structured based on pharmacy mnemonics for the response to symptoms, OBRA’90 on counselling elements, the five practice principles of pharmaceutical care by the American Pharmacists Association and literature review. Visits to the community pharmacies were conducted from September to October 2018.ResultsThe simulated client visited a total of 100 community pharmacies. None of these community pharmacists practised adequate patients’ data collection, with only a low proportion who practised all the components studied under medication information evaluation (13%), formulating a drug therapy plan (15%) and monitoring and modifying the plan (3%). Of the 100 community pharmacists, 98 recommended treatment but none of them provided all the counselling elements studied in implementing the drug therapy plan.ConclusionThe present study showed that community pharmacists within the Klang Valley, Malaysia were not providing adequate pharmaceutical care services to patients seeking self-medication for a cough. Such practice may compromise patient safety if inappropriate medicines or advice are given.

Attitudes of the general public toward community pharmacy services in Saudi Arabia: A cross-sectional study.

This research was conducted to evaluate the attitudes of the general public toward community pharmacy services in Saudi Arabia. The current study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study was conducted in Saudi Arabia between February and April 2022. The study participants were selected and recruited using a convenience sampling strategy. The questionnaire was adapted from previous work and involved four sections: demographic information, use of community pharmacy, perception and willingness to use community pharmacist services, and barriers to approaching a community pharmacist for advice. A total of 449 participants agreed to take part in this study and completed the questionnaire. Just above half (55%) of the participants indicated that they had visited a community pharmacy at least once a month over the last 12 months. The most frequently reported reason for visiting community pharmacies was to buy over-the-counter (OTC) medications. The majority (n = 318) of the participants were satisfied or highly satisfied with community pharmacy services in Saudi Arabia. A willingness to use community pharmacy services was expressed mostly for the essential community pharmacist roles, involving selecting over-the-counter products, management of minor ailments, selecting non-pharmaceuticals and receiving counseling on using medications. However, an unwillingness was noted to approach a community pharmacist for counseling on alcohol dependence and drug misuse. Lack of privacy in the community pharmacy was found to be the most frequently reported barrier that would hinder individuals from approaching community pharmacists to get help or advice. Policymakers in Saudi Arabia could considerably advance the community pharmacy practice and improve the public utilization of various community pharmacist services beyond their limited essential roles such as dispensing and counseling.

The Role of Pharmacists and Community Pharmacies in the Screening, Knowledge, and Awareness of Diabetes Mellitus Type 2 in Jordanian People Visiting Community Pharmacies.

According to the International Diabetes Federation (IDF), diabetes is increasing exponentially worldwide and will become more prevalent than ever in the Middle East by 2045, with a 110% increase. This study aims to clarify the role of pharmacists and community pharmacies in the screening, knowledge, and awareness of Type 2 diabetes among Jordanian people who visit community pharmacies in Amman, Jordan. Study design: This was a cross-sectional prospective study that was conducted from September to December 2021 in Amman, Jordan. Data were collected using a standardized questionnaire that was composed of multiple parts. The first part collected information on demographics, residence, educational level, and insurance status; the second part was composed of 14 knowledge assessing questions; the last part was composed of the American Diabetes Association (ADA) diabetes risk score card test. Additionally, after confirming that each participant had returned their completed sheets, participants who scored greater than 5 had their blood sugar levels checked using a finger-prick blood test. The questionnaire was administered in person by a trained researcher. Using Slovin's formula, a 95% confidence interval (CI), and a 0.05 margin of error, the sample size was determined to be 267 participants. The study included 305 participants. Descriptive and regression analyses were performed by using the Statistical Package for Social Science (SPSS) with a significance level of p < 0.05. A significant relationship was found between specialty (medical education) and the knowledge of risk factors for Type 2 diabetes mellitus (T2DM), (p < 0.012). In terms of knowledge, from a total of 13 correct knowledge points (13 marks for correct answers out of 14), some subjects scored slightly higher than others (n = 175; 57.4% of participants scored above 7, nearly over half of the correct answers, compared to n = 130; 42.6% scoring below 7). We found 132 individuals (44%) with risk scores of five or above (high risk for developing T2DM according to ADA). Smokers comprised n = 138, 45%, and nonsmokers comprised n = 148, 48%. Although 50.5% of the participants (n = 154) held a bachelor's, master's, or doctorate degree, these degrees did not improve the participants' overall general knowledge levels. The association was tested using chi-squared analysis, but no significance was found. Random visitors to Jordanian community pharmacies are expected to benefit from awareness and educational campaigns. These test results revealed a lack of knowledge, indicating the need for education to dispel myths and highlight the serious risks associated with T2DM. The study discovered that participants' understanding of diabetes disease prevention through lifestyle and dietary changes was inadequate. A specialist-led educational program may increase knowledge among visitors who participate. In order to prevent the spread of diabetes, more campaigns and health-promoting and prevention educational activities are required.

Perception of the community toward the transition of pharmaceutical care services from ministry of health primary healthcare centers to community pharmacies

Introduction: There is a lack of research on the impact of the transition of pharmaceutical care service from Ministry of Health (MOH) primary healthcare centers (PHCs) to community pharmacies (Wasfaty service) in Saudi Arabia. This study explored the Saudi community’s perception toward the transition of pharmaceutical care service. Community needs and expectations from the Wasfaty service were assessed, and its experience, concerns, and limitations were evaluated.Methods: Qualitative, in-depth, semistructured interviews of Saudi community members who visited community pharmacies with electronic prescriptions from MOH PHCs were conducted. The data obtained from participants were thematically organized and analyzed using NVivo software.Results: Seven themes related to the new Wasfaty service were identified and divided into three categories: perception toward the transition in pharmaceutical care, experience with the Wasfaty service, and concerns about limitations of the Wasfaty service. The Saudi community was generally satisfied with the new Wasfaty service and highlighted its benefits compared to PHCs pharmacies. These include: easier access, time flexibility, lower crowds, better communication with pharmacists, better medication education, better medication availability, better control over dispensing, and easier refills. However, the community complained about the lack of privacy in community pharmacies, the lack of female pharmacists, and the low number of Saudi pharmacists. They also were concerned about the number and location of community pharmacies featuring the Wasfaty service, some technical issues, and the lack of labels on medications (i.e., receiving no instructions about medication storage).Conclusions: The Saudi community showed its need for the transition in pharmaceutical care services.

Comparative analysis of depression, anxiety, stress, and eating disorders among working and nonworking women visiting community pharmacies in Lahore, Pakistan

Anxiety and depression are common worldwide and often occur together. Anxiety can alter appetite, causing women to consume more food than usual, leading to changes in eating behavior and obesity. This comparative cross-sectional study compared the severity of depression, anxiety, stress, and eating disorders among working and nonworking women visiting community pharmacies. Data were collected through face-to-face interviews with 244 working women and 267 nonworking women. The data were analyzed using descriptive statistics, and a chi-square test was conducted to evaluate differences in the severity of depression, anxiety, stress, and eating disorders between the two groups of participants. Most participants were literate; approximately half of the working (50.82%) and nonworking women (55.06%) had a normal body mass index. There were significant differences between the working and nonworking women in terms of their education and physical activity levels (p &lt; 0.05). Both groups were identified as being at risk of developing bulimia, but their ability to control eating habits differed significantly (p = 0.008). Most participants reported never using laxatives, diet pills, or diuretics to control their weight. Moreover, they reported that they had never received treatment for eating disorders or experienced thoughts of suicide. The study found no significant difference in depression (p = 0.085) and anxiety levels (p = 0.207) between working and nonworking women. However, a significant difference was found in stress levels between working and nonworking women (p = 0.001). Our study highlights a significant prevalence of psychological issues among working and nonworking women in Pakistan, impacting their eating habits and contributing to developing eating disorders and obesity. Interestingly, working women display higher physical activity levels, while nonworking women demonstrate better oral control to prevent eating disorders. To improve women's mental and physical well-being, we recommend prioritizing mental health interventions for all women, promoting healthy eating habits, supporting physical activity, and investigating underlying factors influencing psychological well-being.

Community pharmacy-based SOAP notes documentation.

There is still scarce and sparse evidence regarding documentation of the subjective, objective, assessment and plan (SOAP) note in community pharmacies despite its long implementation history in clinical and academia settings. Hence, we aimed to document and maintain SOAP notes for individual patients visiting community pharmacies for their health problems.We conducted a community-based cross-sectional study at 2 community pharmacies in Nepal from July to December 2019. We recruited 400 patients from all age groups suffering from any health problem using simple random sampling. Patients’ subjective complaints were retrieved from their respective prescriptions and verified by interviewing them. Data were collected on the standard format of the SOAP notes and all data related to patients’ subjective and objective evaluations, and assessments and plans were descriptively analyzed with R programming 4.0.3. Drug interaction profile was checked with the Medscape Drug Interaction Checker.A total of 87 (21.8%) patients aged 42 to 51 years participated in the research, out of whom 235 (58.8%) were female, 208 (52%) illiterate, 359 (89.8%) were facing mild polypharmacy, and 40 (9.9%) were suffering from joint, leg, ankle, and knee pain. There were 41 minor (11.4%), 130 major (32.7%), and 3 severe (0.9%) drug interaction cases (i.e., medication-related problems), with 11 (2.8%) occurring between amlodipine and metformin, which required close monitoring. There were 226 (56.5%) cases with follow-up planned for the patients when necessary.This novel approach in documenting SOAP notes at community pharmacies during dispensing would be an extended form of the same being applied in clinical settings. Hence, this would open a new arena for the community pharmacists to expand their professionalism beyond the clinical and academia by documenting patients’ complex disease and medication profiles in their documentation.

Intervention of Screening Programme for Hypertension and Lipid Profile on Prescribing Pattern of Antihypertensive and Antihyperlipidemic Agents

The aim of the present study is to assess the impact of screening programme for the patients visiting community pharmacies and factors influencing the prescribing pattern of antihypertensive and/ or antihyperlipidemic agents. The study was designed as a prospective cohort study conducted between December 2017 and November 2019. Data were collected from the hypertensive patients visiting regularly in the 5 selected community pharmacies located at 5 Taluks of Erode district, Tamil Nadu, India. The required data were collected either from the patient’s record or interview. Data were collected from 946 (75.68%) patients of 1250 patients visited the selected community pharmacies.49.4% and 50.6% of patients were randomly allotted to the control (group I) and intervention (group II) groups respectively.In this study 50.56% and 46.67% of males were in group I and II respectively. Average SBP was measured as 151.5 ± 11.8 mmHg and 168.1 ± 13.6 mmHg for the patients in group I and II respectively whereas 92.9 ± 9.3 mmHg and 92.6 ± 9.5 mmHg were the DBP readings among the patients in group I and II respectively. Average total cholesterol was measured as 253.66 ± 33.67 mg/dL and 271.04 ± 39.91 mg/dL for the patients in group I and II respectively. The difference in the prevalence is 0.7 and 2.05 for the antihypertensive and antihyperlipidemic agents respectively whereas the incidence was observed as 4.75 and 2.5 for the antihypertensive and antihyperlipidemic agents respectively. The odds ratio of SBP and DBP is 1.12 and 0.99 respectively in the group II. The values of multivariate analysis showed that there is an agreement between intervention and utilization pattern of antihypertensive and antihyperlipidemic agents. It is to conclude that the preliminary screening of blood pressure and lipid profile showed many patients were not visiting regularly for consultations. The screening programme has resulted in good improvement in the utilization pattern of antihypertensive and antihyperlipidemic agents. The age, lipid levels and comorbid conditions were main factors among the individuals which have determined the prescribing pattern of agents.

Effectiveness of Community Pharmacy Diabetes and Hypertension Care Program: An Unexplored Opportunity for Community Pharmacists in Pakistan.

Background: The effective management of patients diagnosed with both Diabetes as well as Hypertension is linked with administration of efficacious pharmacological therapy as well as improvement in adherence through counseling and other strategies. Being a part of primary healthcare team, community pharmacists can effectively provide patient care for chronic disease management. The objective of the study was to evaluate the impact of pharmacist counseling on blood pressure and blood glucose control among patients having both hypertension and diabetes attending community pharmacies in Pakistan. Method: A randomized, controlled, single-blind, pre-post-intervention study design was used. The respondents included patients diagnosed with diabetes mellitus (Type I or II) and hypertension visiting community pharmacies to purchase their regular medicine. A simple random sampling technique using the lottery method was used to select community pharmacies in groups A (intervention, n = 4) and group B (control, n = 4). The total number of patients was 40 in each group, while estimating a dropout rate of 25%. The patients in the intervention group received special counseling. Blood pressure and blood glucose were checked after every 15 days for 6 months. Prevalidated tools such as the hypertension knowledge level scale, the diabetes knowledge questionnaire 24, and a brief medication questionnaire was used. Data were coded and analyzed using SPSS 21. Wilcoxon test (p < 0.05) was used to compare pre-post intervention knowledge regarding the disease, while the Mann-Whitney test (p < 0.05) was used to find differences in medication adherence among control and intervention groups. Results: A significant improvement in mean knowledge scores of patients with diabetes (16.02 ±2.93 vs. 19.97 ±2.66) and hypertension (15.60 ±3.33 vs. 18.35 ±2.31) in the intervention group receiving counseling for 6 months than control group (p < 0.05) was noted. Furthermore, the fasting blood glucose levels (8.25 ±1.45) and systolic BP (130.10 ±6.89) were significantly controlled after 6 months in the intervention group. Conclusion: The current study results concluded that community pharmacists’ counselling has a positive impact on blood glucose and blood pressure management among patients suffering with both diabetes and hypertension.

EVALUATION OF EDUCATIONAL NEEDS FOR DIABETIC PATIENTS

Objective: Our study aimed to assess the role of pre-graduate pharmacy students’ participation in a diabetic education program on improving diabetic self-care. Material and Method: This study included both a cross-sectional and a longitudinal follow-up. Altinbas University fifth-year pharmacy students gathered relevant information from diabetic patients that visited community pharmacies, under the supervision of their instructor pharmacist. The participants filled out the diabetic self-care scale on their first visit before they were given the education. Patients refilled the same self-care questionnaire after three months. Statistical package for the social science (SPSS) 26 was used for all statistical analysis. Result and Discussion: The study comprised 86 diabetic patients. The second questionnaire results showed significant improvement in all patients. The total diabetic self-care scale scores were improved remarkably after the training session. HbA1c and BMI values decreased significantly. An educational program can improve diabetic self-care and diabetic outcomes. Active participation of final year pharmacy students in patient care can also improve pharmacists' participation and contribution to patient care delivery.

Knowledge, attitude, and practice of patients with diabetes towards diabetic nephropathy, neuropathy and retinopathy.

Background:Epidemiological and knowledge, attitude and practice (KAP) studies about diabetic microvascular complications are lacking. The goals of this study are: determining 1) the prevalence of diabetes mellitus subtypes and microvascular complications, 2) the KAP towards the complications and 3) health-seeking behavior, barriers to follow-up, stigma and sources of information.Methods:A cross-sectional study was conducted from January to October 2020 enrolling 380 Lebanese patients with diabetes asked about socio-demographic and lifestyle characteristics, medical, therapeutic, supplement, and dietary history, KAP scores, health-seeking behavior, stigma, barriers to compliance, and sources of information.Results:The prevalence of diabetes type II, type I, gestational, and the microvascular complications was 82.23%, 15.65%, 2.12%, and 33.07% respectively. Factors with significant association were: 1) good quality of life (β=-0.03; p=0.005) and presence of microvascular complications (β=3.58; p=0.001) with knowledge score, 2) good quality of life (β=-0.01; p=0.02) and absence of the complications (β=-0.33; p=0.001) with attitude score, 3) advanced age (β=0.01; p=0.01), no metformin (β=-0.39; p=0.005), and low-protein diet (β=0.6; p=0.02) with practice score. Patients visited community pharmacies (41.84%) and clinics (46.32%). Barriers were costs (33.42%) and time (30.53%). Few talked about the complications to the family (19.74%). Sources of information were healthcare workers.Conclusion:Awareness campaigns should be tailored accordingly to retard the microvascular complications.

Concordance between reported medication taking behavior and prescription instructions for patients with chronic obstructive pulmonary disease visiting community pharmacies

BackgroundUnderstanding types and frequency of medication taking discrepancies could help design pharmacist interventions to improve adherence, outcomes, and prescribing. ObjectiveThis study aimed to assess concordance between participants' descriptions of chronic obstructive pulmonary disease (COPD) medication taking behaviors and prescription instructions. MethodsContinued analysis of previously collected data. Dispensing data from 35 community pharmacies identified participants at the age of ≥ 40 years, with ≥ 1 COPD maintenance medication in the past year and self-reported COPD. Participants completed a survey of demographics, corticosteroid/antibiotic drug use, and symptom scores. Participants listed each medication and described medication taking behavior. COPD severity was classified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD categories from exacerbation history and symptoms. Aggregate proportion days covered (PDC) for any 1 maintenance medicine was calculated using 12-month dispensing data. Discrepancies between medication taking and instructions were classified: (1) overuse, (2) underuse, or (3) discontinued by participant (without prescriber knowledge). Descriptive statistics summarized survey results. Chi-square compared discrepancies among long-acting bronchodilators (LABDs), inhaled corticosteroids (ICS), and short-acting bronchodilators (SABDs). ResultsMost participants (N = 709; 27.6% urban, 70.5% rural) were highly symptomatic (GOLD groups B/D = 89.9%) and high risk (groups C/D = 59.2%). Median medication number was 4. Concordance of ICS and LABD taking behavior with prescriber instructions was 80.6% and 81.8%, respectively (P > 0.05). PDC averaged 0.46 ± 0.37; only 28.7% were adherent (i.e., PDC ≥ 0.80). ICS underuse (11.8%) exceeded LABD (5.5%). LABD discontinuation (7.4%) exceeded ICS (2.7%) or SABD (0.6%). SABD overuse (9.3%) exceeded ICS (3.4%) or LABD (4.3%) (P < 0.5 all comparisons). ConclusionAlthough most were highly symptomatic, high risk, and frequently described correct medication taking behavior, overall adherence was very low. Discrepancies included overuse, underuse, and self-discontinuation. Nonadherence and medication taking discrepancies may increase symptoms, exacerbations, and additional medication prescribing. Potential pharmacist strategies include regularly assessing adherence and differentiating intentional versus nonintentional nonadherence to identify and implement patient-specific interventions to encourage medication taking as prescribed.

Pharmaceutical care program for Polymedicated elderly patients visiting Community Pharmacies in UAE during COVID-19 Pandemic: A Study Protocol

Background: The profession of pharmacy nowadays is expanding from dispensing medication to evidence-based, patient-centered approach, in which optimizing pharmacologic therapy is the goal. Community pharmacists can optimize the overall quality of care especially in rural populations where people most of the time can’t afford to visit physician. Pharmacist caring of patients is the new pharmacist’s role. Community pharmacist can motivate patients to adhere to their medications. Medication review and patients’ monitoring contribute to resolve serious problems in health care system. Methods: This study involves four phases. Phase one implies training of community pharmacists. Phase two is quantitative and involves baseline evaluation of recruited patients. Phase three is the interventional phase. It is also quantitative and aims to assess the impact of pharmaceutical care service on elderly patients with polypharmacy in three selected pharmacies in Ajman and Sharjah through Medication Adherence Rating Scale (MARS) questionnaire, and Short Form 36 (SF-36) questionnaire for health status, and quality of life. These two questionnaires will be filled by elderly patients first upon signing consent form, before the pharmacist intervention, and in the two interviews following the intervention. Phase four is qualitative and aims to assess the experience of the participating community pharmacists and explore their perception regarding the pharmaceutical care service through focused group discussion. Discussion: This research is the first to be conducted in United Arab Emirates. Therefore, findings will reveal the possibility and preparedness of pharmacists to perform medication review and patients’ monitoring and follow up. Additionally, due to the unusual circumstances of COVID-19 pandemic, innovative ways will be used to perform such service.