Abstract: Background and Objective: Hospital pharmacists are the most voluntarily convenient health professionals within their communities. Pharmaceutical care is the provision of drug therapy for the purpose of achieving definite outcomes to improve the patient’s quality of life. Pharmacists play a key role in providing quality health care to patients and use their clinical skill together with practical knowledge to ensure the safe supply and use of medicines by patients and members of public. The practice of pharmaceutical care should be new and updated. Therefore, a cross sectional study was carried out using a self-administered questionnaire on hospital pharmacists regarding their professional, pharmacy store maintenance, communication skills, prescription auditing services, patient education and awareness programs etc. Materials and Methods: A cross sectional study was conducted among the hospital pharmacists working in two urban cities in south India. A sample of 409 hospital pharmacists was selected from urbanised hospitals in these two cities. Data was analyzed using Microsoft Excel 2007. Results: A total number of 106 hospital pharmacies were visited of which 409 hospital pharmacists have responded to the questionnaire. Most of the hospital pharmacists were qualified with a D.Pharm (75%), B.Pharm (22%) and M.Pharm degree (3%). Around 92.2% of the hospital Pharmacists constantly updated their knowledge whereas only 53% wore white coat during work. Regarding pharmacy store maintenance, almost every pharmacist was following the rules and regulations of state pharmacy council except 72.5% were found not following proper storage restrictions for narcotics. Most of the pharmacists counselled patients on medication use, provided customer care services and did not dispense OTC medications frequently while only 55% of them conducted awareness programmes in their hospitals. Almost all the pharmacists handled the prescription correctly with regard to checking date, record maintenance and verifying signature of prescriber. In terms of interaction with other health care professionals, pharmacists maintained good relationship, reported the medication errors and explained the rational use of drugs. With regards to attitude, 72.5% pharmacists agreed that pharmaceutical services are important for selection and safe and effective use of medicines. Conclusion: In this survey hospital pharmacists lacked to meet their professional requirements. Pharmacists should also be consistent in upgrading their knowledge regarding pharmacy, drugs and diseases.
INTRODUCTION
Hospital pharmacists are professional health care experts who advice to provide prescribing, administering, monitoring of medicines and also ensure that medicines are available through procurement, storage, distribution, inventory control and quality assurance1. Hospital pharmacy is considered to be ‘the engine of innovation’ in the pharmaceutical services field, which has become patient oriented together with specialists, compounding and providing drug information2. The hospital pharmacist interacts with prescribers to promote the rational prescribing and use of drugs. They communicate with other fellow pharmacists to gain knowledge and upgrade their expertise on diseases and drugs. They have access to medical records and can influence the selection of drugs, dosage regimens, monitor patient compliance and recognize drug interactions and report adverse drug reactions or events. They also serve as policy makers in drug selection, use of antibiotics and hospital infections committees such as Drug and Therapeutics Committee and Infection Control Committee to prepare the hospital formulary and are also involved in planning and implementation of clinical trials in the hospital3.
In the current scenario, pharmacy profession has undergone change from product oriented to patient oriented practice which is considered as pharmaceutical care4. Pharmaceutical care is the provision of drug therapy to achieve a definite therapeutic outcome that improves the patient’s quality of life5. India possesses a high number of trained pharmacists but their pharmacy training is focused more towards the industrial sector as compared to other sectors. This is due to the demand from the industrial side6. There is a lack of appropriate and good-quality medicines which are the most common problems encountered. Irrational use of drugs and weak regulatory enforcement of drug sales are also serious issues that have to be addressed7.
However, in developing countries such as India, there is a lack of hospital pharmacy services because of the isolation and under recognition of pharmacists as health care professionals. The shortage of trained personnel results in less patient-pharmacist interaction8. To our knowledge, no survey or study has yet been conducted among the hospital pharmacists in Indian urban hospitals. Therefore, the primary objective of this study was to evaluate the perception of hospital pharmacists towards their profession in tertiary care urbanized hospitals.
MATERIALS AND METHODS
A cross sectional survey was conducted on present status and was observed in both outpatient and inpatient departments of hospital pharmacies in urbanized hospitals in the areas of Chennai (Tamil Nadu) and Kadapa (Andhra Pradesh) for a period of 3 months from June-August, 2016. The study participants consisted of hospital pharmacists who gave their informed consent and were working at the hospital during the study period.
A self-administered questionnaire was prepared and validated from the Department of Pharmacy Practice, SRM College of Pharmacy, Kattankulathur, Tamil Nadu. The questionnaire was divided into 7 sections: (i) Demographic details, (ii) Pharmacist profession, (iii) Pharmacy store, (iv) Interaction with patients, (v) Prescription analysis, (vi) Interaction with medical professionals and (vii) Attitude of pharmacists. Reliability test was applied for variables of 20 and reliability of tool was estimated on the basis of Cronbach’s Alpha which was found to be 0.68 (α = 0.68) by using SPSS version 25.
The questionnaire was composed of a total of 7 sections where each of the first to sixth sections comprised of a set of six statements in which respondents were asked to give ‘Yes’ or ‘No’ response whereas in the seventh set, they were asked to indicate the level of agreement using a 5-point Likert scale where 1 = strongly disagree, 2 = disagree, 3 = strongly agree, 4 = agree, 5 = don’t know. This scale was used in order to avoid confusion with neutral responses from the respondents.
The data was entered into and analyzed using Microsoft excel sheet version 2007 and the results were represented using percentage with high percentage indicating good level of significance and low percentage indicating poor level of significance.
RESULTS AND DISCUSSION
In this survey which was conducted in 2 urban hospitals in India, Table 1 represents demographic details. Mean age group of pharmacists was found to be 21-30 years. The gender wise distribution showed male population to be pre-dominant in number as compared to females.
| Table 1: | Demographic details of hospital pharmacists |
| Table 2: | Pharmacist adherence to the pharmacy profession |
| Table 3: | Pharmacy store adhered to the requirement |
| Table 4: | Pharmacists handling the patients |
| Table 5: | Handling of prescription by the pharmacist |
In our study Diploma degree holders shared the highest percentage in degree qualification. The study was carried out in a total number of 106 hospital pharmacies of which 409 hospital pharmacists responded and approximately 17955 patients visited the pharmacies each day.
The hospital pharmacists showed an effective communication with their patients. All the hospital pharmacists had 100% registered licensure certificate to work at the hospital pharmacy, 53% followed proper dress code i.e., a neat white over coat and the remaining 47% did not follow any dress code. About 72.5% of the sample practiced pharmacist’s OATH and 92.2% hospital pharmacists had up to date knowledge regarding banned drugs and new drugs available in the market every year, a small percentage of them (7.8%) lacked up-to-date pharmacy knowledge9. With regards to pharmacy store maintenance, 92.2% of the pharmacy stores were registered under state pharmacy council and 7.8% of pharmacy stores were not registered. About 94.2% of the pharmacy stores followed minimum space regulation of 110 sq.ft to store high number of medicines in wider space and 5.8% of pharmacy stores did not meet the pharmacy store space requirements10. About 94.2% of the pharmacies showed coding and codification regarding dispensing of drugs whereas 5.8% did not any proper codes and codification for dispensing of drugs11. About 88.2% of the pharmacies had adequate space for storage of drugs with proper ventilation, lighting, temperature maintenance in refrigerator, regular inspection and cleanliness outside the premises of the storage facilities which plays a key role in material management of a pharmacy whereas 11.2% of hospital pharmacies were deficit of the above. About 47.5% of the hospital pharmacies followed special storage conditions including packaging and labeling for narcotics, psychiatrics and alcohol preparations, hormonal drugs with proper refrigeration at cold temperatures whereas 72.5% of hospital pharmacies did not meet the above requirements. 100% of the hospital pharmacists had observation regarding the old stock and date of expiry ensuring proper storage and protection of the product quality until expiry12. The results of pharmacist profession and maintenance of pharmacy store in hospital pharmacare shown in Table 2 and 3.
According to pharmacists handling the patients and prescriptions as per Drugs and Cosmetics Act 1948, all the hospital pharmacists contributed their 100% on counseling and advising patients on his/her medications regarding the dosage, dose, route of administration, usage and rational use of drugs to promote suitable, effective, safe and convenient use of medicines9,13. About 84.4% of hospital pharmacists provided their 24 h customer care services including the delivery of drugs to indoor and outdoor patients and patients felt comfortable by the friendly gestures and ambiences when they visited the stores while the remaining 15.6% had not provided 24 h service9. Only 11.7% of the pharmacists dispensed OTC medications to patients in need and 88.3% did dispense any OTC drugs13,14. Around 55% of hospital pharmacists conducted awareness programs on influenza vaccination, smoking cessation and patient care whereas 45% did not conduct any such programs15. About 84.4% of the hospital pharmacists handed the bills on time where as 15.6% could not dispense it on time due to lack of personnel and heavy working hours16. The details of patient handling by the pharmacist are shown in Table 4.
According to Drugs and Cosmetics Act 1948, 100% of the hospital pharmacists in our study checked the date of prescription while dispensing, kept the records of prescriptions, refill prescriptions noted dispensing date either in document or computer feeding. 25.5% of them changed the drug when the prescribed drug was not available at the pharmacy while 74.5% did not dispense any alternative drug17. About 98% of the hospital pharmacists checked the signature of the doctor while dispensing and drugs were not dispensed if prescription was unavailable, whereas 2% did not check for prescriber’s signature18. The details of pharmacists handling the prescription are shown in Table 5.
| Fig. 1: | Pharmacist’s attitude towards their profession |
| Table 6: | Pharmacist’s approach with other health care professionals |
Regarding the hospital pharmacist practice towards his profession, 100% of the hospital pharmacists maintained good relation and effective communication with health care professionals regarding the errors, drug availability. All of the hospital pharmacists contributed their duty towards reporting of prescription errors effectively to the medical staff and ensuring that the right patient receives the right medicine in the correct dose, form, frequency and route9. About 90% of the hospital pharmacists discussed with the medical professional regarding the safety if they identified harmful signs and symptoms, drug-drug interactions and handled the patients to health care professional regarding the rational use of drugs mostly on OTC drugs and antibiotics, whereas 10% failed to discuss19. Table 6 showed the details of pharmacists’ practice towards their profession.
The attitude of pharmacists was surveyed by a questionnaire which noted that 72.5% of the pharmacists strongly agreed that pharmaceutical services were important during the selection of medication and that it should be effective, safe and convenient and 25.5% agreed and 2% were not aware of those20. Around 51% of the subjects strongly agreed that they follow code of ethics and 45% agreed where as 4% were not aware of ethics21. Around 42% of the subjects strongly agreed, 57% agreed and 1% strongly disagreed that conducing health education to public and health care unit provides patient care and health benefits22. As of dispensing OTC medications, 45% of the subjects strongly disagreed, 39% disagreed and 10% agreed that it was safe whereas 6% were not aware of it13. Around 23% of the subjects strongly agreed and 76% agreed that rational use of medicines or drug therapy is beneficial to patient’s care whereas 1% were not aware of it23. The details of pharmacists attitude towards their profession was shown in Fig. 1.
CONCLUSION
In our survey, it discovered that hospital pharmacists felt short of meeting their professional requirements. Pharmacists must see that all the conditions required for his store are met properly. They must not change the prescribed drugs without a proper consultation from the prescribers. Pharmacists must constantly update their knowledge regarding pharmacy, drugs and diseases. As provision of pharmaceutical care is an important responsibility of pharmacists, they need to conduct awareness programs, deliver information about the importance of diseases and drug therapy management services.
SIGNIFICANCE STATEMENT
This study discovered the strengths and the lacunae in the practice of hospital pharmacists that is beneficial for other pharmacists who are practicing in their respective hospitals around the world so that they recognize and follow proper standards of pharmacy profession and fill in the short comings thus rendering improved patient care. This study will help the researchers to uncover the critical areas of pharmacist’s profession in the health sector, where the pharmacists has major role in health sector that many researchers were not able to explore.
ACKNOWLEDGMENT
We would like to thank Prof. K.S. Lakshmi, Dean, SRM College of Pharmacy for her kind support throughout the study.