Self-reported and actual involvement of community pharmacists in patient counseling: a cross-sectional and simulated patient study in Gondar, Ethiopia

Original Research Self-reported and actual involvement of community pharmacists in patient counseling: a cross-sectional and simulated patient study in Gondar, Ethiopia Abdrrahman S. Surur1  , Eyob Getachew2  , Ebsa Teressa3  , Bisrat Hailemeskel4  , Nurahmed S. Getaw5  , Daniel A. Erku6  1BPharm, MSc. Assistant Professor. Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia). 2BPharm. Assistant Lecturer. Department of Pharmacology, School of Pharmacy, College of Mediine and Health Sciences, University of Gondar. Gondar (Ethiopia). 3BPharm. Assistant Lecturer. Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia). 4MS, PharmD, RPh. Associate Professor and Director of Drug Information Services. School of Pharmacy, College of Pharmacy, Nursing, and Allied Health Sciences, Howard University. Washington, DC (United States). 5BPharm, MSc. Senior Lecturer. Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia). 6B.Pharm. Lecturer. Department of Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia). Abstract Background: Community pharmacists play a crucial role in reducing medication related health problems and improving the patient's overall wellbeing. Evidence suggests that community pharmacist led counseling services result in a better clinical and self-reported outcome, including a higher level of satisfaction and quality of life. Objective: This study aims to document self-reported and actual levels of community pharmacists' involvement in the provision of patient counseling and barriers that limit their involvement in such services. Methods: Simulated patient visits and a cross-sectional survey of community pharmacists were employed in Gondar town, Ethiopia between March 15 and May 15, 2016 to observe actual counseling practices and to assess their reported counseling practices respectively. Four different scenarios were developed for the simulated patient visit. A well designed questionnaire and an assessment form were used for the survey and simulated patient visit. Results: In the cross-sectional survey, 84 pharmacists were approached and 78 agreed to participate (92.8 % response rate). Of the respondents, 96.1% agreed/strongly agreed that patient counseling is important and 69.3% strongly agreed that patient counseling should be a professional duty. The most frequent information provided to patients were dosing schedule of drugs, how to take medication, and drug-food interaction. Majority of community pharmacists either strongly agreed (42.1%) or agreed (51.3%) that patients are comfortable towards their counseling practice. A total of 48 simulated visits were conducted and a medicine was dispensed in all visits. In all four scenarios, dosage schedule (100%), how to take medication (97.6%) and drug-food interaction (69.1%) were the most common type of information provided while what to do when dose is missed (100%), contraindication (95.2%) and the importance of compliance or adherence (92.9%) were the most commonly ignored types of information. Conclusions: The present study emphasizes the existing gap in self-reported and actual counseling practices by community pharmacist in Gondar town, Ethiopia. Hence, the ministry of health, local health policy makers and other stakeholders should collaborate to design interventions to improve community pharmacists' dispensing and counseling practice. Keywords Patient Education as Topic; Community Pharmacy Services; Professional Practice; Pharmacies; Pharmacists; Patient Simulation; Surveys and Questionnaires; Ethiopia INTRODUCTION Community pharmacists play an important role in reducing medication related problems and improving patient's overall health status through providing different services including patient counseling.1,2 Patient counseling can be defined as providing either oral or written information to the patient or his/her representative on the direction of use, potential side effects and precautions, storage conditions as well as counseling non-pharmacologic treatments including diet and lifestyle modification.3 It is considered to be a major priority for community pharmacists in modern healthcare settings and is mandated by law and regulations in some countries.4,5,6 In order to reduce medication related problems, a greater emphasis must be placed on pharmacists' patient counseling.5 According to a recent systematic review finding, community pharmacists led counseling services result in a better clinical and self-reported outcome, including a higher level of satisfaction, quality of life, and economic benefits.7 However, the extended role of community pharmacists in developing countries is not satisfactory and their role is largely confined to dispensing of medications and seldom offers patient-oriented services.8,9,10 In Ethiopia, there are more than 650 community pharmacists, which are divided into pharmacy, drug store and rural drug vendors based on the type of medications they are supposed to dispense and the qualification of dispensers.11 Pharmacies are run only by a pharmacist (with qualification of a university degree or above), drug shop run by druggist (with qualification of diploma in pharmacy) and rural drug vendor run by health assistant. Community pharmacists are involved not only in filling prescription but also in self-care. While they are expected to make clear distinction between a minor illness and a more serious condition in order to recommend the appropriate action which includes counseling on non-pharmacologic treatment, or advising to visit a health care practitioner, community pharmacists often fail to adequately assess patients or recommend inappropriate treatment. In Ethiopia, prescription-only medicines are frequently purchased without prescription from community pharmacies.12 This implies that they are often the first and the only health care professionals available for patients before they start drug therapy, both for prescription-only medicines and oral over-the-counter (OTC) medications. Studies conducted elsewhere in the globe forwarded different reasons for dispensing mal-practice which include lack of time and interest, inadequate knowledge, and distance of the community pharmacy from hospital.13 Provision of inadequate patient counseling by the pharmacist may predispose patients to increased risk of adverse drug reaction and fosters the development of drug resistance.12,13 With much smaller numbers, compared to developed countries, community pharmacists in developing countries including Ethiopia tend to focus more on the traditional medication dispensing roles and se (...truncated)