See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/318659264
Patient Medication Counseling: A Survey of Knowledge, Attitude and Practice of
Pharmacy Professionals in Gondar, North West Ethiopia
Article · June 2015
CITATIONS
READS
6
2,463
2 authors, including:
Dessalegn Asmelashe
University of South Australia
33 PUBLICATIONS 270 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
Hospital pharmacy View project
Herbal medicine use among pregnant women attending rural health facilities View project
All content following this page was uploaded by Dessalegn Asmelashe on 24 July 2017.
The user has requested enhancement of the downloaded file.
Dessalegn Asmelashe Gelayee et al., J. Sci. Res. Pharm. 2015, 4(2), 74-77
Journal of Scientific Research in Pharmacy
Available online through
www.jsrponline.com
Research Article
ISSN: 2277-9469
Patient Medication Counseling: A Survey of Knowledge, Attitude and Practice of Pharmacy
Professionals in Gondar, North West Ethiopia
Dessalegn Asmelashe Gelayee1*, Mequanent Kassa Birara2
1MSc
in Pharmacology, Ethiopia; 2MSc Pharmacy in Practice, Ethiopia.
Received on: 02-06-2015; Revised and Accepted on: 27-06-2015
ABSTRACT
Background: The ultimate goal of patient counseling is to provide information directed at encouraging the safe and appropriate use of drugs
thereby enhancing therapeutic outcomes.
Objective: To assess the knowledge, attitude and practice of pharmacy professionals in Gondar town towards patient counseling.
Method: This cross-sectional study was conducted on 63 pharmacy professionals working in private and public pharmacy establishments in
Gondar town, North West Ethiopia using a pre-tested, semi structured questionnaire for interview. Data was then analyzed using SPSS version 20.
A p-value of 0.05 was employed for test of significance.
Results: About 42 (66.7%) male and 21 (33.3%) female respondents with a mean age of 29.888.13 years the majority (N=41, 65.1%) of whom
were diploma holders were involved in this study. Thirty five percent of the respondents were able to properly define patient counseling, nearly
half of the respondents assume patient counseling as their professional duty and the majority (84.12%) demonstrated an interest to patient
counseling. Leaflets were the primary sources of information to establish their counseling practice and knowledge gap was identified as the most
important perceived barrier to implement patient counseling.
Conclusion and Recommendation: Even though the respondents in this study demonstrated a good attitude, there are knowledge and practice
gaps that prompt appropriate training on the area of patient counseling.
Keywords: Patient Counseling, Knowledge, Attitude, Practice, Ethiopia.
INTRODUCTION
Worldwide, millions of people visit community
pharmacies every day for their health care needs and pharmacists
are placed at the first point of contact in the health care system due
to their free accessibility and friendly approach. They are readily
available to answer patients concerns and enquire about their
medication and alternative treatments. They are also usually the
final link between the medication and the patient. Therefore they
have the opportunity and responsibility to safeguard the patients’
health and to help ensure the success of the drug therapy by
providing appropriate counseling [1-5].
Patient counseling is defined as providing information
orally or in written form to the patient or his/her representative on
direction of use, advice on side effect, precaution, storage, diet and
life style modification [6]. The ultimate goal is to provide information
directed at encouraging the safe and appropriate use of drugs
thereby enhancing therapeutic outcomes [4]. Pharmacists can
contribute to positive outcomes by educating and counseling
patients to prepare and motivate them to follow their
pharmacotherapeutic regimens and monitoring plans [6]. The
pharmacist-provided counseling is shown to be significantly
effective in improving knowledge, attitude, and practice of patients
toward the disease management in chronic kidney disease patients
[7]. Another study also showed that knowledge of hospitalized
diabetic patients significantly improved following counseling by a
pharmacist [8].
Patient counseling along with drug dispensing form the
core professional activities of pharmacists and these are an integral
part of the quality use of medicines [9]. Patient education and
counseling usually occur at the time prescriptions are dispensed but
*Corresponding author:
Dessalegn Asmelashe Gelayee
MSc in Pharmacology, Ethiopia.
*E-Mail: desefikir@gmail.com
may also be provided as a separate service. The techniques and the
content should be adjusted to meet the specific needs of the patient
and to comply with the policies and procedures [6].
The counseling process properly implemented and
consistently maintained will result in improvement in the patient
understanding about the medication, improve adherence, and also
reduces complications due to non-compliance to treatment [10].
Dispensing is often overlooked by health planners during
the development of health care delivery. It is usually considered of a
secondary importance to diagnosis, procurement, inventory control
and distribution. This oversight is unfortunate, since inappropriate
dispensing can undo many of the benefits of the health care system
[11].
In the past, it seems that patient counseling has received
little attention in Ethiopia with presumed problems of shortage of
qualified personnel, lack of preparedness of the practicing
pharmacist, and community perception towards practicing
pharmacist [12]. In a study done in Bahir Dar city, Northwest Ethiopia
it was shown that patient counseling practice by pharmacists is
significantly influenced by differences in dispenser work
experiences, type of health facility, level of health facility, patient
load at dispensary and average consultation time [13]. From another
study done in UAE, patients were known to demonstrate poor
attitude towards pharmacy professionals and hence less often visit
pharmacies seeking their advice [14].
According to a study conducted in Gondar, North West
Ethiopia, patient non-compliance was estimated to be 26.1% [15]
while self-medication prevalence was 27.2% in three towns
including Gondar [16].
With the increasing focus on high quality outcome based
service delivery in health care, it is timely for the pharmacy
profession to critically self-examine all the processes to ensure that
their services are of the highest quality from both consumer and
professional standards perspectives. [17]. The purpose of this study is
therefore to determine the knowledge, attitude and extent of patient
medication counseling offered by pharmacy professionals working
in private and public pharmacy professionals in Gondar town.
Journal of Scientific Research in Pharmacy 2015, 4(2)
74-77
Dessalegn Asmelashe Gelayee et al., J. Sci. Res. Pharm. 2015, 4(2), 74-77
METHODOLOGY
This cross-sectional study was done from January to June
2011 on pharmacy professionals working in pharmacy
establishments (both private and public) of Gondar town, North
West Ethiopia which had more than 300,000 people at the time of
the study. About 63 Pharmacy professionals known to dispense
drugs in the study area were interviewed using a pretested semi
structured questionnaire following an ethical clearance from the
School of Pharmacy, College of Medicine and Health Science,
University of Gondar.
The data collected on knowledge, attitude and practice of
pharmacy professionals was cleared, checked for completeness and
entered in to SPSS version 16 for analysis with a p value of 0.05 for
testing significance.
RESULT
Socio-demographic characteristics:
A total of 63 pharmacy professionals dispensing drugs in
government and private pharmacy establishments in Gondar town
were involved in this study of which 42 (66.7%). were males and
21(33.3%) were females . The respondents’ mean age + SD was
29.888.13 years and the majority (N=41, 65.1%) were diploma
holders. See table 1.
Table No. 1: Socio-demography of respondents (Gondar town, North West Ethiopia; 2011)
Age
Sex
Variable
Frequency
Percentage %
20-30
31-40
41-50
45
7
11
71.43
11.11
17.46
22
41
34.9
65.1
Female
Male
Qualification
Degree in pharmacy
Diploma in pharmacy
Knowledge of respondents about patient counseling:
Asked to define patient counseling, 53.97% of
respondents defined it as telling to the patient about dose and
frequency, 34.92% as giving detail information to the patient on
how to use their drugs, dose, adverse effect, life style modification,
storage aspect, contraindication and 11.11% were unable to give a
definition.
About forty three (68.25%), 36 (57.14%), 34 (53.97%)
and 25(39.68%) respondents respectively said patient counseling
by pharmacists should include information on the dose, side effects,
life style modification and storage aspect. Only 17 (26.98%) agreed
to include contraindication, duration, frequency as well as route of
administration.
21
42
33.3
66.7
Regarding the importance of counseling, 47 (74.6%)
respondents said to improve compliance, 17 (26.98%) said to have
professional satisfaction, 11 (17.46%) said patient counseling is
their duty and 10(15.87%) said to improve sales.
Patient counseling was considered as their professional
responsibility by 33 (52.38%) respondents while the rest
30(47.62%) said it is not. On the means of patient counseling
provision, nine out of ten respondents mentioned the face to face
approach. This study also assessed the respondents’ knowledge
regarding what constitutes good patient medication counseling and
accordingly 56 (88.89%) said it consists two way communications,
7(11.11%) said one way communication. See table 2.
Table No. 2: Knowledge of respondents towards patient counseling (Gondar town, North West Ethiopia; 2011)
Variables
Definition of Patient counseling
telling patients about dose or frequency
telling patient on dose, how to use their drugs, adverse drug effect, life style
modification, drug storage aspect and contraindication
unable to define
Patient counseling by pharmacists should include
dose
adverse effect
storage aspect
life style modification
others (duration, route of administration, frequency of administration)
Importance of patient counseling
to improve compliance and adherence
to have professional satisfactory
to improve sales
to accomplish professional duty
others eg economic impact, avoid drug resistance, to achieve desired out come
Patient counseling is my professional duty
Yes
No
Patient counseling is done
face to face
telephone
internet
by letter
Good patient counseling consists
2 way communication
1 way communication
Attitude of respondents towards patient counseling
In this study, 63(100%) respondents think patient
counseling is important and thus 53(84.12%) are interested in it.
Frequency
Percentage
34
22
53.97
34.92
43
36
25
34
17
68.25
57.14
39.68
53.97
26.98
7
47
17
10
11
9
33
30
56
3
2
2
56
7
11.11
74.60
26.98
15.87
17.46
14.29
52.38
47.62
88.89
4.77
3.17
3.17
88.89
11.11
Related to this, 53(87.3%) respondents think patient counseling
should be professional duty. See table 3
Journal of Scientific Research in Pharmacy 2015, 4(2)
74-77
Dessalegn Asmelashe Gelayee et al., J. Sci. Res. Pharm. 2015, 4(2), 74-77
Table No.3: Attitude of the respondents towards patient counseling (Gondar town, North West Ethiopia; 2011)
Variable
Think patient counseling is important
Yes
No
Interested in patient counseling
Yes
No
Patient counseling should be professional duty
Yes
No
Counseling practice of the respondents:
About sixty (95.24%) respondents claimed to often
practice “patient counseling”; patient counseling defined in their
own context. Those respondents who felt they had been practicing
“patient counseling”
described that they provided patients
information on the dose (N=43, 68.25%), on the adverse drug effect
(N= 36, 57.14%), on storage aspect (N=25, 39.68% ) and on life
style modification (N=34, 53.97%). The counseling practice by
these pharmacy professionals involved two way communication for
some (N=56, 88.89%) and one way communication some others
(N=7, 11.11%). Only 5(7.94%) respondents claimed to practice
patient counseling in a separate room and 22(34.92%) used to ask
their patients after counseling to verify their clients’ understanding.
The respondents rely on different sources of information to
Frequency
Percentage
63
0
100
0
53
10
55
8
84.12
15.88
87.3
12.7
establish their patient counseling practice. Accordingly leaflet was
used by 45(71.43%) while books by the 31(49.21%).
Perceived barriers to implement patient counseling and
their solutions were described by the respondents as follows. The
leading barrier as described by 51(80.95%) was lack of in depth
knowledge on what to counsel and how to counsel patients while
5(7.94%) mentioned lack of time. Another 5(7.94%) respondents
admitted lack of interest by the pharmacy practitioners themselves
had been a challenge to practice patient counseling. To overcome
the above problems, respondents also suggested some possible
solutions such as filling the knowledge gap (N=46, 73.02%),
establishing a separate room dedicated for patient counseling
(N=30, 47.62%) and increasing number of trained pharmacy
professionals (N=28, 44.44%). See table 4
Table No. 4: perceived barriers and the solutions to practice patient counseling (Gondar town, North West Ethiopia; 2011)
a.
b.
c.
d.
a.
b.
c.
d.
Variable
Frequency
Perceived barriers in patient counseling
lack of knowledge of practitioners
51
lack of time of practitioners
5
lack of interest of practitioners
5
absence or in adequacy of counseling guide lines
2
Perceived solutions to overcome the problems`
by filling the knowledge gap on counseling
46
by providing separate room for counseling
30
by increasing number of pharmacists
28
by providing extra money for counseling
4
In this study, males are more knowledgeable than females
(P= 0.044) and for other variables there is no strong evidence of
relationship.
DISCUSSION
It is well documented that safe and effective drug therapy
occurs most frequently when patients are well informed about
medications and their use [4]. Therefore in this study pharmacy
professionals working in the different pharmacy establishments,
both private and public, of Gondar town as drug dispensers were
involved to be assessed for their knowledge, attitude and practice on
patient medication counseling.
According to the American Society of Health-System
Pharmacists, patient counseling is defined as providing information
orally or written form to the patient or his/her representative on
direction of use, advice on side effect, precaution, storage, diet, and
life style modification [6]. However in this study only 34.92%
respondents gave an approximately similar definition reflecting that
majority were lacking a clear idea of this concept. It is also alarming
to encounter an 11.11% respondents being unable to define patient
counseling at all because patient counseling is a task that forms the
core professional activities of pharmacists together with dispensing
[9]. In line with this, the respondent’s knowledge on the content of
patient counseling was very disappointing as only less than half of
them mentioned storage aspects, frequency and duration of
administration as contents of it.
The major purpose of patient counseling described by the
respondents in this study was improving patient compliance (N= 47,
74.6%) which is far higher than that reported in a study by Poudel
etal in Nepal (26.36%) [5].This difference might be due to inclusion
of dispensers from the public sector in this study contrary to the
later. This justification is supported by the finding that only 10
(15.87%) respondents of this study considered patient counseling to
serve improving sales while the same purpose was mentioned by
22.73% in the other study.
Percentage
80.95
7.94
7.94
3.17
73.02
47.62
44.44
6.35
The finding that 33(52.3%) respondents believe that
patient counseling is their professional responsibility is higher than
that reported by Poudel etal (31%) [5].The same reason suggested
above might explain this difference as well. However it is similar
with that reported by Ayalew etal [18] in which case 23 (46.94%) of
the dispensers believe that pharmacy professionals are better to
counsel the patients than prescribers.
Nine out of ten respondents of this study identified face to
face communication as the main approach for counseling patients
which probably is a reflection of their usual counseling practice
where clients vist the pharmacy establishments usually at the time
of collecting their drugs.
The importance of counseling patients by pharmacists is
accepted by all respondents in this study while 84.12% of them felt
that counseling should be the professionals’ duty and also they
showed an interest to practice it. These findings will be an input in
designing interventions that target enhanced patient medication
counseling by the pharmacy professionals of both the private and
public sector. Many professional organizations like the Society of
Hospital Pharmacists Australia (SHPA) [19]. The American Society of
Health System Pharmacists (ASHP) [20] have also mentioned that
patient counseling is the responsibility of pharmacists.
The finding that 60 (95.2%) respondents claimed to often
practice “patient counseling” is encouraging but the content of
counseling service need to be explicitly identified. Accordingly most
the respondents in this study often counsel patients on the dose
(N=43, 68.25%) while most of the respondents (N=39, 79.59%) in
Ayalew etal [18] counsel on the duration of regimen. these findings
support each other and indicate that pharmacists in the study areas
often fail to provide even the basic drug regimen specific
information which is vital for successful therapy outcome. The
finding of this study is also consistent with that reported by Zewdie
etal and Demilew W according to which dose is one of the drug
regimen related information delivered by pharmacists [12, 13].
However the proportion of respondents who claimed to
provide patients with information on the storage aspects of
Journal of Scientific Research in Pharmacy 2015, 4(2)
74-77
Dessalegn Asmelashe Gelayee et al., J. Sci. Res. Pharm. 2015, 4(2), 74-77
medicines is low and is in line with that reported by Demilew W [13]
but lower than that reported by Ayalew et’al [18] which probably
reflect an inconsistent dispensing and patient counseling practices
among these pharmacists practicing in the same nation. Thus; the
proper implementation of guidelines on the area of pharmacy
practice need to be monitored by the concerned authority.
According to WHO, dispensers should check whether or
not the information is received as intended and that the patient
understands how to use the information to improve the therapeutic
outcomes [21]. However the respondents’ practice in the current
study is very low (N=22, 34.92%) and is far below than that
reported by Ayalew et’al (N=32, 65.31%) [18]. this too is an alarming
finding in that patient compliance largely depends on how much
they understood information provided to them by the pharmacy
professionals.
Persons involved in drug dispensing require updating
their drug information in order to provide adequate and clear
information on drugs to their patients, other health professionals
and to the general public [22].
Thus respondents in this study primarily relied on leaflet
(N=45, 71.43%) as the sources of information to establish their
patient counseling practice. this is consistent with that reported by
Ayalew et’al (N=32, 65.31%). WHO prohibit use of leaflets as a
source of drug information and promote use of drug information
bulletins due to leaflets contain manipulated information about a
particular drug since they are prepared by drug manufacturing
companies and thus are subjected to bias [21].
The number one perceived barrier to practice patient
counseling was lack of knowledge on what to counsel and how to
counsel as reported by 51(80.95%) of the respondents in this study
and hence they recommend filling this knowledge gap. this barrier
is also identified by 39 (79.59%) respondents in Ayalew etal and 23
(76.7) [18] by Demilew W [13]. thus the finding reflect the need for
provision of training as well as dissemination of information
resources dealing with patient counseling by pharmacists.
REFERENCES:
1. Popovich NG. Ambulatory patient care. In: Gennaro AR
editor Remington, The science and practice of pharmacy,
Mack Publishing Company, Pensylvania, 19th ed, 1995; 2:
1695-1719.
2. Kumud K, Farai C , Suryawadi S. Role of dispensers in
promoting rational drug use, Ensuring good dispensing
practice, 1996; 11(3): 1-21.
3. Beardsley R. Oral patient counseling by pharmacists;
proceeding of the national symposium on oral counseling by
pharmacist about prescription medicines, 1997; 19-21.
4. Palaian S, Kchhetri A, Probhu M, Rajan S, Shan kar PS. Role
of pharmacists in counseling diabetes patients, The Internet
Journal of Pharmacology, 2005; 4 (1).
5. Poudel A, Khanal S, Alam K, Palaian S. Perception of
Nepalese community pharmacists
towards patient
counseling and continuing pharmacy education program: A
multicentric study, Journal of Clinical and Diagnostic
Research, 2009; 3: 1408-1413.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
American Society of Health-System Pharmacists. ASHP
guidelines on pharmacist-conducted patient education and
counseling, Am. J. Health Syst. Pharm., 1997; 54(4): 431434.
Ghimirey A , Sapkota B , Shrestha S , Basnet N , Shankar RP ,
Sapkota S. Evaluation of pharmacist counseling in improving
knowledge, attitude, and practice in chronic kidney disease
patients, SAGE Open Medicine, 2013.
Palaian S, Acharya LD, Rao PGM, Shankar PR, Nair NM, Nair
NP. Knowledge, attitude and practice outcomes: evaluating
the impact of counseling in hospitalized diabetic patients in
India, P&T, 2006; 31(7): 383-400.
G M Pterson, MSH Wu, JK Bergin. Pharmacists’ attitudes
towards dispensing errors: their causes and prevention,
Journal of Clinical Pharmacy and Therapeutics, 1999; 24:
57-71.
Melanic J. Pharmacists talking with patients, A Guide to
patient counseling, 2nd edn, 2007; 68-72.
Kumud K. Farai C. Suryawadi S. Role of dispensers in
promoting rational drug use, Ensuring good dispensing
practice, 1996; 11(3): 1-21.
Zewdie D, Jorge Y, Gebre Mariam T. A preliminary
assessment of outpatient counseling in four referral
Hospitals of Addis Ababa, Ethiop. Pharm. J., 1999; 17: 44-50.
Demilew W. Patient counseling at dispensing of medicines in
health care facility outpatient pharmacies of Bahir Dar city,
Northwest Ethiopia, Science Journal of Public Health, 2014;
2(2): 126-134.
Akshar AS, Metwaly Z, Shamssain M. Patients’ Perceptions of
Community Pharmacy Practice in UAE: An Overview, IOSR
Journal of Pharmacy, 2014; 4(11): 8-14.
Abula T. Patient non-compliance with therapeutic regimens
and the factors of non-compliance in Gondar, Ethiop. J.
Health Dev., 2000; 14(1): 1-6.
Abula T, Worku A. Self-medication in three towns of
Northwest Ethiopia, Ethiop. J. Health Dev., 2001; 1(15): 2530.
G M Pterson, MSH Wu, JK Bergin. Pharmacists’ attitudes
towards dispensing errors: their causes and prevention,
Journal of Clinical Pharmacy and Therapeutics, 1999; 24:
57-71.
Ayalew E, Seid Y, Agalu A. Knowledge, attitude and practice
of patient medication counseling among drug dispensers in
Mekele town, Northern Ethiopia, Int. Res. J. Pharm.
Pharmacol., 2014; 4(2): 28-34.
Dooley M, Lyall H, Galbraith K et al. SHPA Standards of
practice for Clinical Pharmacy, In SHPA practice standards
and definitions: 1996; 2-11.
ASHP guidelines on pharmacistconducted patient education
andcounseling, Am. J. Health Sys. Pharm., 1997; 54: 431-34.
WHO. Promoting rational use of medicines core components
WHO policy perspective on medicines. Geneva; 2002; 1-6.
FMHACA/Ethiopia. Manual for Medicines Good Dispensing
Practice; 2nd edn, 2012.
How to cite this article:
Dessalegn Asmelashe Gelayee, Mequanent Kassa Birara: Patient Medication Counseling: A Survey of Knowledge, Attitude and
Practice of Pharmacy Professionals in Gondar, North West Ethiopia, J. Sci. Res. Phar., 2015; 4(2): 74-77.
Conflict of interest: The authors have declared that no conflict of interest exists.
Source of support: Nil
Journal of Scientific Research in Pharmacy 2015, 4(2)
View publication stats
74-77