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 29.888.13 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 29.888.13 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. 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