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The Provision of Pharmaceutical Care in Oman: Practice and Perceived Facilitators and Barriers to Implementation

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The Provision of Pharmaceutical Care in Oman: Practice and Perceived Facilitators and Barriers to Implementation THE PROVISION OF PHARMACEUTICAL CARE IN OMAN: PRACTICE AND PERCEIVED FACILITATORS AND BARRIERS TO IMPLEMENTATION by Awatif Al Abdullatif A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Pharmaceutical Sciences University of Toronto © Copyright by Awatif Al Abdullatif (2014) ABSTRACT The Provision of Pharmaceutical Care in Oman: Practice and Perceived Facilitators and Barriers to Implementation Awatif Al Abdullatif Doctor of Philosophy Department of Pharmaceutical Sciences University of Toronto 2014 Objectives: The study purpose was to determine the extent of the implementation of pharmaceutical care (PC) in Oman and factors affecting its implementation. Methods: A cross-sectional mail survey of all practicing pharmacists in Oman based on the Theory of Planned Behavior (TPB) was conducted. The survey instrument was informed by a focus group study to identify behavioral, normative, and control beliefs amongst pharmacists in three practice settings: inpatient, outpatient, and community pharmacy. Results: The survey useable response rate was 61.2%. Participants provided PC activities between ‘sometimes’ and ‘most of the time’; however, provision of advanced PC activities was limited. Provision of PC did not significantly differ across inpatient, outpatient, and community settings. Clinical knowledge, communication skills, pharmacist time, and adequate staffing were common facilitators across practice settings; worry about responsibility and culturally-based gender issues regarding patient care were common barriers. While having a private counseling area, and access to patient records and to drug information databases were facilitators identified in the public sector, their absence was a barrier in community pharmacies. Reimbursement was the main barrier in the private sector. Country of origin was significantly related to pharmacists’ ii beliefs about providing PC; specifically, Omani pharmacists had significantly different behavioral, normative, and control beliefs than their South Asian counterparts. All constructs of the TPB (attitude, subjective norm, and perceived behavioral control) were significant predictors of intention to provide PC, but the added construct—past behavior recency was not. The overall variance explained in intention was 43%. Of the two predictors of behavior in the TPB model, only perceived behavioral control was significant; intention was not. The explained variance in PC behavior was 13.0%. Conclusions: This is the first study to examine the implementation of PC in Oman. The findings of this study will inform the development of strategies for advancing PC practice, a mandate of Ministry of Health and the pharmacy profession in Oman. The TPB was useful for explaining pharmacists’ intention to provide PC; however, a longitudinal study is recommended to test its predictive validity for PC behavior. iii ACKNOWLEDGEMENTS I would like to express my gratitude to all of those who have helped me accomplish my studies and this insurmountable venture. Firstly, I would like to thank Dr. Linda MacKeigan, for it was under her guidance and wisdom, without which this thesis would not have been possible. She continued to stand by me and offer continuous feedback to ensure the quality of work delivered is of a high calibre. I also extend my utmost thanks to the members of the Advisory Committee; Dr. Joan Marshman and Dr. Rhonda Cockerill. Their addition of perspective and sage advice enabled me to further improve the quality of my work. Similarly, I would like to thank H.E. Minister of Manpower Mohamed Al Bakri, and former Minister of Manpower H.E. Juma Ali, for making all of this possible in the first place by granting me this scholarship. Additional thanks goes to the Site Advisory Committee in Oman that consisted of Mrs. Sawsan Ahmed Jaffer, Dr. Ibrahim Al Zakwani, Mrs. Jehan Alfanna, Mr. Qasim Al Riyami, Dr. Bryan Gunn, Mr. Osama Babiker, and Mr. Bakool Mehta. Their support in providing me with the information and data necessary was pivotal to my research. I am also very thankful to the funding agencies that helped me finance my expenses and allowed me to carry out the necessary set ups to conduct my research; namely, the Ministry of Manpower, Oman, Muscat pharmacy for sponsoring the survey study, and Oman Pharmaceutical Products (OPP) for sponsoring the focus group study. Along with every venture, there come several points in time where we require additional moral support and motivation to continue soldiering on. For those moments, I take this opportunity to iv express my indebted gratefulness to my son Mohammed, who provided invaluable psychological and technical support, siblings (Alya, Adla, Afaf, Shabir, and Qasim), and nieces (Jannat, Basmala, and Bushra) in Oman, whose prayers, hospitality, and continuous support will forever be remembered. I also thank Nedzad, my colleague and another student under Dr. MacKeigan, who also advised me throughout the whole process and assisted me whenever possible. Additional thanks to Awsaf, Hussain, Shahzad, Maryam, Shoroog, Ivana, and Fatima for continuously acting as a supportive family and always sought to help me in every way possible. I also thank my friends in Oman for their support; Amal Jalal, Faten Ajeena, Hala Makharita, Dr. Laila Emara, Dr. Bassem Elmenshawi, and Tahera Abdul Sattar. A special thanks, as well, to Dr. Dena Taylor from the University of Toronto and Mr. Chris Corcoran from the Higher College of Technology for their final editing, and to all the staff in the Pharmacy Department of the Higher College of Technology, Finally, I would like to thank the participants of my research, for it was through them that I received the data necessary to conduct my analysis. Above all, I thank God, the most gracious, the most merciful for being blessed with all I mentioned earlier, and to all of you, I dedicate my work. The author acknowledges that she was an employee of the Ministry of Health from 1989 – 2005, that is, until two years before the thesis work. v TABLE OF CONTENTS ABSTRACT .................................................................................................................................... ii ACKNOWLEDGEMENTS ........................................................................................................... iv TABLE OF CONTENTS ............................................................................................................... vi LIST OF TABLES ........................................................................................................................ xii LIST OF FIGURES ...................................................................................................................... xv LIST OF APPENDICES .............................................................................................................. xvi LIST OF ABBREVIATIONS ..................................................................................................... xvii GLOSSARY OF TERMS .......................................................................................................... xviii CHAPTER ONE: INTRODUCTION ............................................................................................. 1 1. Health Care System in Oman ................................................................................................. 1 2. Pharmacy Practice in Oman ................................................................................................... 3 3. Study Rationale ...................................................................................................................... 6 4. Theoretical Framework .......................................................................................................... 6 5. Study Goal and Objectives ..................................................................................................... 7 CHAPTER TWO: LITERATURE REVIEW ................................................................................. 9 Section I: Patient-Focused Care Models .................................................................................... 9 1. Clinical Pharmacy............................................................................................................ 10 2. Pharmaceutical Care ........................................................................................................ 10 3. Medication Therapy Management ................................................................................... 12 4. Relationship among Clinical Pharmacy, Pharmaceutical Care, and MTM ..................... 13 5. Summary of Relationships amongst the Three Models ................................................... 14 Section II: Pharmaceutical Care in the Arabian Gulf Region .................................................. 14 1. Summary of Studies on Pharmaceutical Care in the Arabian Gulf Region ..................... 21 Section III: Barriers to and Facilitators of Pharmaceutical Care Globally .............................. 22 1. Individual Factors ............................................................................................................ 23 1.1. Pharmacist-Related Factors ..................................................................................... 23 1.1.1. Awareness and Understanding of the Concept of Pharmaceutical Care .......... 23 1.1.2. Competency ...................................................................................................... 24 1.1.3. Personality
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