Doctors’ perceptions, expectations and experience regarding the role of pharmacist in hospital settings of Pakistan

Abstract

Background The inclusion of pharmacist in health care system is essential to ensure optimal patient care. However, with the passage of time, pharmacist’s role has transcended from dispensing, compounding and counting of pills, to more sophisticated clinical duties. Objective To evaluate doctors’ experience, perceptions and expectations regarding pharmacists’ role in Pakistani healthcare settings. Setting All tertiary care hospitals across 26 cities of Pakistan. Method A cross-sectional study using a self-administered questionnaire was carried out targeting doctors practising in Pakistan. The survey was conducted from January to April 2018. Chi square (χ2) test was used to analyse responses of doctors regarding pharmacist’s role in the healthcare system of Pakistan. The associations were considered significant at p value less than 0.05. The study was approved by concerned ethical committee. Main outcome measure Doctors’ experience, perceptions and expectations regarding pharmacists’ role. Results A total of 483 questionnaires were received and analysed (response rate; 87.9%). Most participants (67.5%) reported interaction with pharmacists at least once daily, and that was mostly related to drug availability inquiry (73.7%). 86.7% of doctors expected pharmacists to ensure safe and appropriate use of medicines to patients. 87.6% of doctors expected pharmacists to monitor patient’s response to drug therapy (p < 0.05) and 66.5% expected pharmacists to review patient’s medicines as well as discuss possible amendments to therapy (p < 0.05). Besides, most doctors (84.9%) disagreed with the notion of pharmacists prescribing medicine for patients (p < 0.05). Most participants (81.6%) did not want pharmacists to prescribe independently. Conclusion The study highlights that doctors considered pharmacists as drug information specialists, dispensers, educators and counsellors; however, their expectation of pharmacists performing the clinical role and being involved in direct patient care was limited. They negated the idea of prescription intervention and direct involvement of pharmacists in pharmacotherapy plan for patients. It is imparative  to increase doctors’ awareness regarding the role pharmacists could play in Pakistan’s healthcare system. Currently, the clinical role of pharmacists in Pakistan’s healthcare system seems minimal and is seen with scepticism within the community of doctors.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient-centered approach to medication management services. 3rd ed. New York: McGraw-Hill Education, LLC; 2012. ISBN 978-0-07-175638-9.

    Google Scholar 

  2. 2.

    World Health Organization. The role of the pharmacist in self-care and self-medication: report of the 4th WHO Consultative Group on the Role of the Pharmacist. The Hague: World Health Organization; 1998.

    Google Scholar 

  3. 3.

    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.

    CAS  PubMed  Google Scholar 

  4. 4.

    Hepler CD. Pharmaceutical care. Pharm World Sci. 1996;18:233. https://doi.org/10.1007/BF00735965.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Hepler CD. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. Pharmacotherapy. 2004;24(11):1491–8.

    PubMed  Google Scholar 

  6. 6.

    Legislation.Gov.UK. The Medicines for Human Use (Prescribing) (Miscellaneous) Amendments) Order. 2006. No. 915. Retrieved December, 2018. Available from: http://www.legislation.gov.uk/uksi/2006/915/contents/made

  7. 7.

    Naqvi AA, Hassali MA, Naqvi SBS, Aftab MT. Impact of pharmacist educational intervention on disease knowledge, rehabilitation and medication adherence, treatment-induced direct cost, health-related quality of life and satisfaction in patients with rheumatoid arthritis: study protocol for a randomized controlled trial. Trials. 2019;20:488. https://doi.org/10.1186/s13063-019-3540-z.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Matowe L, Abahussain EA, Al-Saffar N, Bihzad SM, Al-Foraih A, Al-Kandery AA. Doctors’ perceptions and expectations of pharmacists’ professional duties in government hospitals in Kuwait. Med Princ Pract. 2006;15(3):185–9.

    CAS  PubMed  Google Scholar 

  9. 9.

    Smith WE, Ray MD, Shannon DM. Doctors’ expectations of pharmacists. Am J Health Syst Pharm. 2002;59(1):50–7.

    PubMed  Google Scholar 

  10. 10.

    Bradley CP. The future role of pharmacists in primary care. Br J Gen Pract. 2009;59(569):891–2. https://doi.org/10.3399/bjgp09X473105.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Bhagavathula AS, Sarkar BR, Patel I. Clinical pharmacy practice in developing countries: focus on India and Pakistan. Arch Pharma Pract. 2014;5:91–4.

    Google Scholar 

  12. 12.

    George PP, Molina JA, Cheah J, Chan SC, Lim BP. The evolving role of the community pharmacist in chronic disease management—a literature review. Ann Acad Med Singap. 2010;39(11):861–7.

    PubMed  Google Scholar 

  13. 13.

    Gallagher RM, Gallagher HC. Improving the working relationship between doctors and pharmacists: is inter-professional education the answer? Adv Health Sci Educ. 2012;17(2):247–57.

    Google Scholar 

  14. 14.

    Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Kistnasamy B. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. 2010;376(9756):1923–58.

    Google Scholar 

  15. 15.

    Rosenthal MM, Breault RR, Austin Z, Tsuyuki RT. Pharmacists’ self-perception of their professional role: insights into community pharmacy culture. J Am Pharm Assoc. 2011;51(3):363–8.

    Google Scholar 

  16. 16.

    Khan N, Abbas A, McGarry K, Shahid S. Perceptions and experiences of doctors regarding integration of clinical pharmacists in health practices: a survey of hospitals of Karachi. Int J Allied Med Sci Clin Res. 2014;2(3):222–34.

    Google Scholar 

  17. 17.

    Kassam R, Collins JB, Berkowitz J. Comparison of patients’ expectations and experiences at traditional pharmacies and pharmacies offering enhanced advanced pharmacy practice experiences. Am J Pharm Educ. 2010;74(5):90.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Mann C. Doctors need to give up professional protectionism. BMJ. 2018;361:k1757.

    PubMed  Google Scholar 

  19. 19.

    Atiq MA. Epidemiology of non-communicable diseases in Pakistan: are we on the right track? Pak J Med Dent. 2018;6(4):52–6.

    Google Scholar 

  20. 20.

    Naqvi AA, Naqvi SBS, Zehra F, Verma AK, Usmani S, Badar S, et al. Estimation of the direct cost of poliomyelitis rehabilitation treatment to pakistani patients: a 53-year retrospective study. Appl Health Econ Health Policy. 2018;16(6):871–88. https://doi.org/10.1007/s40258-018-0422-6.

    Article  PubMed  Google Scholar 

  21. 21.

    Naqvi AA, Naqvi SBS, Zehra F, Ahmad R, Ahmad N. The cost of poliomyelitis: lack of cost-of-illness studies on poliomyelitis rehabilitation in Pakistan. Arch Pharm Pract. 2016;7(4):182–4. https://doi.org/10.4103/2045-080X.191988.

    Article  Google Scholar 

  22. 22.

    UK Health Accounts. Office for National Statistics. 2015. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2015. Accessed Dec 2018.

  23. 23.

    World Health Organization (WHO). Health service delivery Pakistan. 2019. http://www.emro.who.int/pak/programmes/service-delivery.html. Accessed Dec 2018.

  24. 24.

    Hassan A, Mahmood K, Buksh HA. Healthcare system of Pakistan. IJARP. 2017;1(4):170–3.

    Google Scholar 

  25. 25.

    Hussain M, Naqvi SBS, Khan MA, Rizvi M, Alam S, Abbas A, et al. Direct cost of treatment of diabetes mellitus type 2 in Pakistan. Int J Pharm Sci. 2014;6:261–4.

    Google Scholar 

  26. 26.

    The Medicines Act 1968. 2019. https://www.legislation.gov.uk/ukpga/1968/67. Accessed Dec 2018.

  27. 27.

    Khan MU. A new paradigm in clinical pharmacy teaching in Pakistan. Am J Pharm Educ. 2011;75(8):166. https://doi.org/10.5688/ajpe758166.

    Article  PubMed  Google Scholar 

  28. 28.

    Abbas A. The catch-22 of pharmacy practice in Pakistan’s pharmacy education. Pharmacy. 2014;2(3):202–4. https://doi.org/10.3390/pharmacy2030202.

    Article  Google Scholar 

  29. 29.

    Khan TM. Challenges to pharmacy and pharmacy practice in Pakistan. Australas Med J. 2011;4(4):230–5. https://doi.org/10.4066/AMJ.2011.488.

    Article  PubMed Central  Google Scholar 

  30. 30.

    Naqvi AA. Evolution of clinical pharmacy teaching practices in Pakistan. Arch Pharma Pract. 2016;7:26–7.

    Google Scholar 

  31. 31.

    Pharmacy Council of Pakistan. 2019. http://www.pharmacycouncil.org.pk/. Accessed Dec 2018.

  32. 32.

    Rosenthal M, Austin Z, Tsuyuki RT. Are pharmacists the ultimate barrier to pharmacy practice change? Can Pharm J Rev Pharm Can. 2010;143(1):37–42.

    Google Scholar 

  33. 33.

    Adnan S, Tanwir S, Abbas A, Beg AE, Sabah A, Safdar H, et al. Perception of doctors regarding patient counseling by pharmacist: a blend of quantitative and qualitative insight. Int J Pharm Ther. 2014;5:117–21.

    Google Scholar 

  34. 34.

    Calculator, R. (2014). Raosoft. Retrieved December, 2018. Available from: http://www.raosoft.com/samplesize.html.

  35. 35.

    Total number of doctors/dental surgeons (G.P’s with basic degree only), registered up to 30th June, 2019. Pakistan Medical and Dental Council (PM & DC). 2019. Retrieved July, 2019. http://www.pmdc.org.pk/Statistics/tabid/103/Default.aspx.

  36. 36.

    Waterfield J. Is pharmacy a knowledge-based profession? Am J Pharm Educ. 2010;74(3):50.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Farrell B, Pottie K, Woodend K, Yao V, Dolovich L, Kennie N, et al. Shifts in expectations: evaluating doctors’ perceptions as pharmacists become integrated into family practice. J Interprof Care. 2010;24(1):80–9.

    CAS  PubMed  Google Scholar 

  38. 38.

    Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care. 2010;14(5):174.

    Google Scholar 

  39. 39.

    Azhar S, Hassali M, Ibrahim M. Doctors’ perception and expectations of the role of the pharmacist in Punjab. Pakistan. Trop J Pharm Res. 2010;9(3):205–22.

    Google Scholar 

  40. 40.

    Shekhani SS, Moazam F. The myth of ‘Doctor Brides’. Dawn.com. 2019. https://www.dawn.com/news/1460104. Accessed Dec 2018.

  41. 41.

    Zakaria R. The doctor brides. Dawn.com. 2013. https://www.dawn.com/news/1032070. Accessed Dec 2018.

  42. 42.

    Ilyas F. From ‘doctor brides’ to practicing doctors. The Express Tribune. 2015. https://tribune.com.pk/story/969805/docthers-from-doctor-brides-to-practicing-doctors/. Accessed Dec 2018.

  43. 43.

    Annual Report 2016. Asian Development Bank. https://www.adb.org/sites/default/files/institutional-document/414776/adb-annual-report-2016.pdf. Accessed Dec 2018.

  44. 44.

    The Global Gender Gap Report 2018. World Economic Forum (WEF). http://www3.weforum.org/docs/WEF_GGGR_2018.pdf. Accessed Dec 2018.

  45. 45.

    Afridi FK, Baloch QB, Baloch VQ. Preventing and reversing Pakistan’s medical brain drain through diaspora option and diaspora network. J Postgrad Med Inst. 2016;30(2):115–8.

    Google Scholar 

  46. 46.

    Sheikh A, Abbas Naqvi SH, Sheikh K, Shiraz Naqvi SH. Physician migration at its roots: a study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan. Glob Health. 2012;8:43. https://doi.org/10.1186/1744-8603-8-43.

    Article  Google Scholar 

  47. 47.

    Naqvi AA, Zehra F, Naqvi SBS, Ahmad R, Ahmad N, Usmani S, et al. Migration trends of pharmacy students of pakistan: a study investigating the factors behind brain drain of pharmacy professionals from Pakistan. Indian J Pharm Educ Res. 2017;51(2):192–206. https://doi.org/10.5530/ijper.51.2.25.

    Article  Google Scholar 

  48. 48.

    Mekonnen AB, McLachlan AJ, Joanne EB. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ open. 2016;6(2):e010003. https://doi.org/10.1136/bmjopen-2015-010003

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    El-Ibiary SY, Yam L, Lee KC. Assessment of burnout and associated risk factors among pharmacy practice faculty in the United States. Am J Pharm Educ. 2017;81(4):75.

    PubMed  PubMed Central  Google Scholar 

  50. 50.

    Naqvi AA, Hassali MA, Shyum Naqvi SBS, Aftab MT, Zehra F, Nadir MN, et al. Assessment of patient satisfaction following pharmacist counselling session by a novel patient satisfaction feedback on counselling questionnaire. JPHSR. 2019;10(2):243–54. https://doi.org/10.1111/jphs.12294.

    Article  Google Scholar 

  51. 51.

    Shah A, Naqvi AA, Ahmad R. The need for providing pharmaceutical care in geriatrics: a case study of diagnostic errors leading to medication-related problems in a patient treatment plan. Arch Pharm Pract. 2016;7:87–94. https://doi.org/10.4103/2045-080X.186173.

    Article  Google Scholar 

  52. 52.

    Fathelrahman A, Ibrahim M, Wertheimer A. Pharmacy practice in developing countries: achievements and challenges. Cambridge: Academic Press; 2016.

    Google Scholar 

  53. 53.

    Azhar S, Hassali MA, Ibrahim MI, Ahmad M, Masood I, Shafie AA. The role of pharmacists in developing countries: the current scenario in Pakistan. Hum Resour Health. 2009;7:54. https://doi.org/10.1186/1478-4491-7-54.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Olsson E, Kälvemark Sporrong S. Pharmacists’ experiences and attitudes regarding generic drugs and generic substitution: two sides of the coin. Int J Pharm Pract. 2012;20(6):377–83.

    PubMed  Google Scholar 

  55. 55.

    Norwood CW, Wright ER. Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: improving clinical decision-making and supporting a pharmacist’s professional judgment. Res Soc Admin Pharm. 2016;12(2):257–66.

    Google Scholar 

  56. 56.

    Spinewine A, Fialová D, Byrne S. The role of the pharmacist in optimizing pharmacotherapy in older people. Drugs Aging. 2012;29(6):495–510.

    PubMed  Google Scholar 

  57. 57.

    Abbas A, Shah A, Khan N, Nasir H, Khan MH. Perceptions of patients’ care givers regarding clinical pharmacists and their practice in a developing country. Int J Pharm Pharm Sci. 2014;7(2):168–73.

    Google Scholar 

  58. 58.

    Abbas A. Evidence based improvements in clinical pharmacy clerkship program in undergraduate pharmacy education: the evidence based improvement (EBI) initiative. Pharmacy. 2014;2(4):270–5. https://doi.org/10.3390/pharmacy2040270.

    Article  Google Scholar 

  59. 59.

    Abbas A, Khan N. Clinical trials involving pharmacists in Pakistan’s healthcare system: a leap from paper to practice. Pharmacy. 2014;2(3):244–7. https://doi.org/10.3390/pharmacy2030244.

    Article  Google Scholar 

Download references

Acknowledgements

We extend our gratitude to all the participants for their contribution in the study. We acknowledge the support of Khan and colleagues from Pakistan in completing the data collection.

Funding

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Nabeel Khan.

Ethics declarations

Conflicts of interest

The Authors declares that they have no conflicts of interest to disclose for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Khan, N., McGarry, K., Naqvi, A.A. et al. Doctors’ perceptions, expectations and experience regarding the role of pharmacist in hospital settings of Pakistan. Int J Clin Pharm 42, 549–566 (2020). https://doi.org/10.1007/s11096-020-00991-9

Download citation

Keywords

  • Doctors
  • Pakistan
  • Pharmacist
  • Pharmacy practice