What Practicing Pharmacists Think About Their Role EJDA=HPD?=Naġ-NAHEIEJ=NUŁj@EJCOBNKI(=N=?DE Pakistan

$33 Short Communication

What practicing pharmacists think about their role EJDA=HPD?=NAġ-NAHEIEJ=NUłJ@EJCOBNKI(=N=?DE Pakistan

Shazia Qasim Jamshed, Muhammad Atif1, Mohammad Jamshed Siddiqui2, Iqbal Azhar3 Departments of Pharmacy Practice and 2Pharmaceutical Chemistry, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, 1Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia, 3Department of Pharmacognosy, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan

Address for correspondence: ABSTRACT Dr. Shazia Qasim Jamshed, Department of Pharmacy Practice, Objective: This study is aimed to explore the understanding of pharmacists International Islamic University Malaysia, about their perceived role in the health care system of Pakistan. Kuantan, 25200, Pahang, Malaysia. E-mail: [email protected] Methods: A 15-item questionnaire, which was devised on the basis of literature survey, was self-administered to a convenience sample of practicing pharmacists in Karachi, Pakistan. The questionnaire constituted components regarding their desired practice setting, expectations concerning their professional function and the opinion on the future of profession. Results: The demographic characteristics highlighted male (47.1%) and female (52.9%) WREHLQHTXDOSURSRUWLRQZLWKPRUHWKDQRIWKHUHVSRQGHQWV\HDUVRIDJH (n = 67; 65.7%). Majority of the respondents hold bachelor degree in pharmacy (n = 82; 80.4%). Majority of the respondents had <5 years experience (n = 70; 68.6%). More than 75% of the respondents worked in hospital settings (n = 80; 78.4%). Majority of the respondents (n = 78; 76.5%) expressed their dissatisfaction towards their role as a pharmacist. Nearly half of the respondents (n = 47; 46.1%) visualized themselves as mere dispensers, while around one-fourth of the respondents (n = 24; 23.5%) perceived themselves as drug information pharmacist. In the context to their education and training as pharmacists, the opinion seems to be divided as half of the respondents expressed satisfaction (n = 46; 45.1%), while the other half showed dissatisfaction (n = 49; 48.0%). More than 90% of the respondents agreed to learn new skills a key to achieve career satisfaction. Conclusion: The pharmacists expressed dissatisfaction about their perceived Key words: Karachi, Pakistan, status in the healthcare system of Pakistan. In order to intensify the feel of practicing pharmacists professionalism, reconceptualization of education and training system is advocated.

INTRODUCTION has been an adjunct to escalating pharmaceutical expenditure, which in turn leads to extra burden on Aging population and expensive medicines are the healthcare expenditure.[4]+HDOWKFDUHZRUNIRUFH KDOOPDUNVRIDQ\KHDOWKFDUHV\VWHPJOREDOO\[1-3]7KH which refers to physicians, pharmacists, nurses, and [5] contributory role of medicaments in population health dentists LVWKHEDFNERQHRIUHVSHFWLYHKHDOWKFDUH system.[6] In order to strengthen the health care system Access this article online the role of pharmacist, in particular, is evolved from Quick Response Code: [7] Website: a dispenser to a counselor and caregiver. Either in developed or developing regions, pharmacists are www.archivepp.com JHQHUDOO\WKHGLUHFWÀUVWSRLQWRIFRQWDFWZLWKWKH [8,9] DOI: patients, thus symbolized as health information custodian expected to give advice ranging from dosage 10.4103/2045-080X.137548 regimen to side-effects, adverse effects, drug-drug

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interactions etc.[10-12]7KHUROHRISKDUPDFLVWVLQWKH both open-ended and close-ended questions and KHDOWKFDUHV\VWHPRI3DNLVWDQLVLQGLVWLQFW,QRQHRI VWDWHPHQWV7KHVWXG\ZDVFDUULHGRXWRYHUDSHULRG the reviews conducted by Azhar et al. it is stated that of 3 months (March 2009-May 2009). In order to 3DNLVWDQLSKDUPDFLVWVDUHXQFRQYLQFHGDERXWWKHLU evaluate the internal consistency of the response to current specialized role in the healthcare system.[13] In items, Cronbach’s alpha was calculated and therefore the context to that there is a dire need to conduct such found to be 0.65. sort of study, which explores the views of pharmacists about their present professional position in different Data analysis KHDOWKFDUHVHWWLQJV7KHFXUUHQWVWXG\LVRQHVXFK $OOWKHGDWDZHUHHQWHUHGLQWRWKH6WDWLVWLFDO3DFNDJH attempt in this regard, which aimed to explore the for Social Sciences (SPSS Inc. Released 2007. SPSS understanding of practicing pharmacists about their for Windows, Version 16.0. Chicago, SPSS Inc). RZQUROHLQGLIIHUHQWKHDOWKFDUHVHWWLQJVLQ.DUDFKL Descriptive statistics was performed to evaluate the 3DNLVWDQ sociodemographic characteristics of the respondents. ,QRUGHUWRVHHWKHGLVWULEXWLRQRIGDWDVNHZQHVVDQG Objective NXUWRVLVZHUHHYDOXDWHG0RUHRYHULQRUGHUWRREVHUYH 7KHREMHFWLYHRIWKHFXUUHQWVWXG\LVWRH[SORUHWKH the distribution frequency of each variable, data were also understanding of pharmacists about their perceived examined visually by means of generating histograms.[15] UROHLQWKHKHDOWKFDUHV\VWHPRI3DNLVWDQ Chi-square was used to see the association between METHODS variables. A value of P < 0.05 will be considered Study design VLJQLÀFDQW A cross-sectional study was carried out to collect data for this research. A 15-item questionnaire, which RESULTS was devised on the basis of literature survey, was self-administered to a convenience sample of practicing A total of 110 questionnaires returned, and 8 were SKDUPDFLVWV LQ .DUDFKL 3DNLVWDQ 2QH KXQGUHG found to have missing values in demographics and twenty-six questionnaires were distributed via and practice information and, therefore, discarded. personal contacts to different healthcare settings A response rate of 87.3% was achieved. where professionally qualified pharmacists were HPSOR\HG 7KHVH KHDOWKFDUH VHWWLQJV FRPSULVHG Demographic characteristics and practice of Community Pharmacies, Hospital Pharmacies, information and Regulatory Departments at the Government of Of 102 pharmacists, 48 (47.1.3%) were male, while 3DNLVWDQ3URIHVVLRQDOO\TXDOLILHGSKDUPDFLVWVDV 54 (52.9%) respondents were female. Majority of the retailers, wholesalers, and distributors of medicines pharmacists were in the age range `0–30 (n were also included in the study. More than three-fourth of the respondents (n HDUQHG%DFKHORURI3KDUPDF\TXDOLÀFDWLRQ Questionnaire design and development Majority of the respondents had an experience 7KHTXHVWLRQQDLUHZDVIRUPHGRQWKHEDVLVRIJXLGHOLQHV of <10 years (n 6OLJKWO\PRUHWKDQ mentioned by Oppenheim for survey research and three-fourth of the respondents were employed in questionnaire design.[14] Pilot test was performed with hospitals (n ZKHUHDVRQO\YHU\IHZZHUH ten pharmacists. Based on the responses obtained ZRUNLQJLQFRPPXQLW\SKDUPDFLHV n IURPWKHSLORWWHVWLWHPVWKDWODFNHGFOHDUQHVVDQG $ODUJHPDMRULW\RIWKHUHVSRQGHQWVZRUNHGPRUH FRPSUHKHQVLYHQHVVZHUHGHOHWHG7RHQVXUHIDFH WKDQDQDYHUDJHRIKZHHN n YDOLGLW\LWZDVVHQWWRÀYHSKDUPDF\DFDGHPLFV 7KHLUFRPPHQWVZHUHJLYHQGXHFRQVLGHUDWLRQ)LQDO Further details regarding practice information are decision on the inclusion of those items that were RXWOLQHGLQ7DEOH FRQVLGHUHGÀQHVWUHSUHVHQWDWLYHVRIWKHPHDVXULQJ YDULDEOHVZDVWDNHQ Perceived role Majority of the respondents expressed their 7KHTXHVWLRQQDLUHFRQVWLWXWHGFRPSRQHQWVUHJDUGLQJ dissatisfaction toward their role as a pharmacist. their desired practice setting, expectations concerning Slightly fewer than half of the respondents (n their professional function and the opinion on the 46.1%) visualized themselves as mere dispensers, IXWXUHRIWKHSURIHVVLRQ7KHTXHVWLRQQDLUHLQFOXGHG while nearly one-fourth of the respondents (n

Archives of Pharmacy Practice y Vol. 5 y Issue 3 y Jul-Sep 2014 133 Jamshed, et al.: Role of practicing pharmacists in Karachi

23.5%) perceived them as drug information Table 1: Demographic characteristics of pharmacists pharmacist. Characteristics Frequency (%) Age range Education and training 20-30 67 (65.7) In the context to their education and training as 31-40 22 (21.6) pharmacists, the opinion seems to be divided as half of 41-50 13 (12.7) the respondents expressed satisfaction (n Gender while the other half showed dissatisfaction (n Male 48 (47.1) 48%). More than 90% of the respondents agreed to Female 54 (52.9) OHDUQQHZVNLOOVDNH\WRDFKLHYHFDUHHUJRDOV n %DVLFTXDOL¿FDWLRQ 93.1%) and career satisfaction (n 7KHVH Bachelor of Pharmacy 82 (80.4) Master of Pharmacy 9 (8.8) responses showed significance with respect to Doctor of Philosophy 2 (2.0) practice setting. Hospital pharmacists showed more Doctor of Pharmacy 9 (8.8) inclination when compared to other respondents Experience ZRUNLQJLQGLIIHUHQWSUDFWLFHVHWWLQJV7KHGHWDLOHG 1-5 70 (68.6) LQIRUPDWLRQLVJLYHQLQ7DEOH 6-10 15 (14.7) >10 17 (16.7) Interestingly, a large majority of the practicing Average h/week pharmacists (both from hospital and community 1-45 36 (35.3) settings) showed their ignorance about essential drug >45 66 (64.7) list and/or essential drug concept (n 61-90 20 (9.7) Slightly fewer than half of the respondents (n >90 4 (1.9) ZHUHIRXQGWREHNQRZOHGJHDEOHDERXWUDWLRQDO Practice setting Hospital 80 (78.5) drug use. Regulatory pharmacists expressed their Community 11 (10.8) NQRZLQJQHVVDERXWHVVHQWLDOGUXJOLVWDQGRUHVVHQWLDO Regulatory 8 (7.8) drug concept as well as rational drug use. Retail/wholesaler 3 (2.9) DISCUSSION Table 2: Opinion of pharmacist with respect to their Pharmacists are considered to be major contributors training and education in improving public health by giving advice on Items Responses (n (%)) P value medicine use to ensure responsible self-care, promote Yes No Age Gender Practice setting medication adherence as well as encourage healthy $UH\RXVDWLV¿HG 46 (45.1) 49 (48.0) 0.589 0.325 0.821 life-styles through appropriate health education with your training?* [16] strategies. ,Q3DNLVWDQWKHUROHRISKDUPDFLVW Whether education 47 (46.1) 55 (53.9) 0.750 0.123 0.345 whether in the community or hospital needs to be has enabled you to established.[13]7KLVH[SORUDWRU\VWXG\ZDVGHVLJQHG work independently? Whether learning new 95 (93.1) 7 (6.9) 0.325 0.145 0.025 WR VHHN WKH RSLQLRQ RI SUDFWLFLQJ SKDUPDFLVWV skills are a key to about their own role in the health care system. achieve career goals? In the current study proportion of respondents Whether learning new 95 (93.1) 7 (6.9) 0.590 0.134 0.028 IURPFRPPXQLW\SKDUPDF\VHWWLQJLVSUHIHUDEO\ skills are a key to ORZ 7KLV LV LQ DFFRUGDQFH ZLWK WKH SUHYLRXV career satisfaction? Do you feel 63 (62.0) 39 (38.0) 0.812 0.567 0.021 study by Butt et al. (2005) in which only 22% of competent enough to the respondents were qualified pharmacists in be a patient educator? community pharmacies.[17],Q3DNLVWDQWKHVFHQDULRRI Do you feel trained 43 (42.4) 59 (58.6) 0.135 0.456 0.001 SURIHVVLRQDOO\TXDOLÀHGSKDUPDFLVWVLQFRPPXQLW\ enough to do PRUHWKDQ¿OOLQJ pharmacies is not different from other neighboring prescription? [18] countries. 7KLVLVSUREDEO\GXHWRVWULQJHQWVDODU\ Do you feel the need 90 (88.0) 12 (12.0) 0.245 0.190 0.003 structure[18] less motivation to join community to provide point settings[17] DQG DV ZHOO DV ZRUNIRUFH PLJUDWLRQ of care testing? Do you feel 43 (42.4) 55 (53.9) 0.132 0.124 0.001 3DNLVWDQ LV RQH RI WKRVH GHYHORSLQJ HFRQRPLHV competent enough to which have a very large number of pharmacies counsel the patient?* WKDQSKDUPDFLVWVLQ3DNLVWDQDQGDURXQGWZRWKLUG *Missing values in that item

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RIWKHSKDUPDF\ZRUNIRUFHFRPSULVHRISKDUPDF\ regulatory settings agreed that the profession of technicians rather than professionally qualified pharmacy needs more recognition as pharmacists are pharmacists.[19] In the current study, the ratio of male “professional experts” on medicine-related issues. to female community pharmacists is more or less More or less, similar suggestions were given by Aslam the same, which is contrary to the previous studies et al.[23]LQWKHEDFNGURSRIFRPPXQLW\SKDUPDF\ GRQHLQFRPPXQLW\SKDUPDFLHVLQ3DNLVWDQ[17,20] SUDFWLFHLQ3DNLVWDQ In the current study, a very large percentage of FRPPXQLW\SKDUPDFLVWVPHUHO\LGHQWLÀHGWKHPVHOYHV In the current study, an appreciable number of as drug dispenser. It is imperative on the part of the pharmacists expressed their desire to learn new government to provide funds to freshly graduated VNLOOV7KLVLVLQFRQFRUGDQFHZLWKWKHVWXG\GRQH pharmacists for opening community pharmacies. by McDonough and Bennett in which pharmacy 7KLVLQWXUQZLOOLPSURYHWKHVWDWXVRISKDUPDFLVW preceptors realized that pharmacists should be as “indispensable healthcare professional” in the JLYHQ RSSRUWXQLWLHV WR OHDUQ QHZ VNLOOV VXFK DV eyes of the public when compared to hospital or communication.[24] industrial pharmacists. Moreover, the recent concept RIUHWDLOSKDUPDF\FKDLQVLQ3DNLVWDQLVDZHOFRPH CONCLUSION move. Although the evolution of retail pharmacy FKDLQVLVDVORZSURFHVVLQ3DNLVWDQVWLOOIDFLOLW\OLNH 7KHSKDUPDFLVWVH[SUHVVHGGLVVDWLVIDFWLRQDERXWWKHLU computerization of prescription order processing SHUFHLYHGUROHLQWKHKHDOWKFDUHV\VWHPRI3DNLVWDQ generally at retail pharmacy chains may provide the In order to intensify the feel of professionalism, possibility to the pharmacists to expand their role reconceptualization of education and training system IURPGLVSHQVLQJWRUHYLHZLQJPHGLFDWLRQSURÀOLQJ is advocated. counseling, offering cost-effective alternatives, and even, also store management. Limitations of the study /LNHDQ\RWKHUVWXG\WKLVVWXG\GUDZVDWWHQWLRQ Pharmacists are generally employed by the to some of the unavoidable constraints of research JRYHUQPHQWDOVRWRPDLQWDLQFKHFNDQGEDODQFHRQ approach that have been adopted. WKHUHJXODWRU\IUDPHZRUNIRUSURYLGLQJHIILFLHQW safeguard for medicines-consuming public. In terms 7KHFXUUHQWVWXG\LVXQDEOHWRDGGUHVVWKHRSLQLRQV RIWKHLUUROHDVDGHFLVLRQPDNHUDOOWKHUHJXODWRU\ of academic and industrial pharmacists about their pharmacists expressed satisfaction towards their SHUFHLYHGUROHLQWKHKHDOWKFDUHV\VWHPRI3DNLVWDQ PDQDJHULDOSRVLWLRQV7KLVLVOLQHZLWKWKHUHYLHZE\ Moreover, the current study was executed in only Azhar et alZKLFKVWDWHGWKDWWKHUROHRI3DNLVWDQL RQHFLW\RI3DNLVWDQZLWKDVPDOOVDPSOHVL]HDQG pharmacist is more focused toward management therefore, the generalization to other regions of rather than customer or patient oriented.[13] 3DNLVWDQLVQRWSRVVLEOH

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