Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases DOI: https://doi.org/10.31351/vol31iss1pp109-118 109 Using Phone Calls to Promote Community Pharmacist Counselling during COVID-19 Pandemic in Baghdad, Iraq Susan Tawfiq Hameed*,1 and Zinah Mudhafar Anwer* *Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq. Abstract Drug consultation is an important part of pharmaceutical care. a mobile phone call or text message can serve as an easy, effective, and implementable alternative to improving medication adherence and clinical outcomes by providing the information needed significantly for people with chronic illnesses like diabetes and hypertension particularly during pandemics like the COVID-19 pandemic. This study aimed to estimate the use of phone calls to promote pharmaceutical counseling and explore the commonest question asked by patients and do the socio-demographic or disease characteristics play any role regarding such questions. A prospective, interventional, clinical study was conducted during the period (from 5th of November 2020 to 21st of February 2021). A total of 246 patients were enrolled in the study. The mean age was 40.93 years (±15.84). The majority were female (62.6%) and age group (35-54) years (44.3%). A total of 507 questions were asked by patients, The researcher provided pharmaceutical consultations in response to 47 % of the question. There were significant associations between socio-demographic characteristics and some of the domains. In conclusion, socio- demographic characteristics influence the type of question asked by patients. Most of the patients got educational advice and some of them were referred to physicians. Key words: Phone counselling, Community Pharmacist. في المجتمع دالنيةإلرشاد الصيا إليصالستخدام المكالمات الهاتفية ا العراق ، في بغداد 19- خالل جائحة كوفيد *مظفر أنور و زينة 1*، توفيق حميدسوزان العراق بغداد، بغداد، جامعة الصيدلة، كلية السريرية، *فرع الصيدلة الخالصة هي جزء مهم من الرعاية الصيدالنية. يمكن أن تكون المكالمة الهاتفية أو الرسائل النصية بمثابة بديل سهل بخصوص الدواءاالستشارة من أمراض وفعال وقابل للتنفيذ لتحسين االلتزام باألدوية والنتائج السريرية من خالل توفير المعلومات الالزمة بشكل كبير لألشخاص الذين يعانون استخدام المكالمات الهاتفية ييمهدفت هذه الدراسة إلى تق .19-كوفيد وارتفاع ضغط الدم خاصة أثناء األوبئة مثل وباءمزمنة مثل مرض السكري مرضية لتعزيز االستشارة الصيدالنية واستكشاف األسئلة األكثر شيوًعا التي يطرحها المرضى وهل تلعب الخصائص االجتماعية والديموغرافية أو ال (. تم تسجيل 2021 شباط 21إلى 2020 تشرين الثاني 5خلية أجريت خالل الفترة )من اق بهذه األسئلة. دراسة سريرية مستقبلية تدأي دور فيما يتعل - 35٪( والفئة العمرية )62.6سنة(. وكانت الغالبية من اإلناث ) 15.84سنة )± 40.93العمر مريضا في الدراسة. كان متوسط 246ما مجموعه . 1وقدمت الباحثة استشارات دوائية المرضى، أسئلة من قبل 507٪(. تم طرح ما مجموعه 44.3( سنة )54 االستشارة الهاتفية ،صيدلي المجتمع الكلمات المفتاحية : Introduction Hypertension (HT) can be defined as a condition in which blood pressure (BP) is elevated to a level likely to lead to adverse consequences. There is no clear-cut blood pressure threshold separating normal blood pressure from high blood pressure(1). Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia and abnormalities in carbohydrate, fat, and protein metabolism(2). Drug consultation is an important part of pharmaceutical care offered by the pharmacist. This service not only promotes optimal medication use, which helps enhance health outcomes, but it also exemplifies an opportunity for pharmacists to hone their professional skills. It is particularly convenient for patients and pharmacists to provide these consultation services via telephone(3). Today, with the technological advances of the past ten years and the broadening of pharmacy services to include direct patient care, mobile phone usage has drastically increased, irrespective of region or country, urban area or rural area, and literacy or illiteracy, evidence suggests that a mobile phone call or text message can serve as an easy, effective, and implementable alternative to improving medication adherence and clinical outcomes by providing the information needed. Counseling by telephone might improve patient counseling(4). 1Corresponding author E-mail: Susantofiqhameed@gmail.com Received: 21/6/2021 Accepted: 22/8 /2021 Iraqi Journal of Pharmaceutical Science https://doi.org/10.31351/vol31iss1pp109-118 Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 110 The advantages of using phone calls in pharmaceutical services include enhancement of the clinical role for pharmacists significantly for people with chronic illnesses particularly during pandemics (like the COVID-19 pandemic), where many people have various medicines-related concerns(5). Secondly, it increases patients’ awareness about their conditions(6), improved Patient Adherence(7), supporting rational medicines use(8), enhance access to healthcare services in remote and rural communities(9), and lastly, the counseling via telephone ensures greater satisfaction of patients with regard to the pharmacist counseling and time required to obtain medication(10). The main role of community pharmacists during COVID-19 include supporting rational use of medicine, promotion medication adherence, medication review and follow-up, information and communication about COVID-19, and triaging at the community level for suspected COVID-19 cases(11). At the health system level, the implementation of telepharmacy services in hospitals and primary health care centes expanded hours of service, improved the speed of processing of physician medication orders, increased clinical pharmacy services, and cost avoidance(12). Aim of the study 1. To evaluate the use of phone calls to promote pharmaceutical counseling 2. To explore the frequently asked questions by patients about their medications and their relation to their sociodemographic or disease status. Subjects and Method Study type and design This is a prospective, interventional, clinical study, which includes interviewing and enrolling the subjects during the predetermined period of four months (5th of November 2020 to 21st of February 2021). Inclusion criteria Patients with any age who were diagnosed as hypertensive and/or diabetic by their physicians and continue to refill their medications. Exclusion criteria 1. Abnormal cognitive behaviors or unable to understand the questions. 2. Patients asking questions not related to HT or DM. Sampling All patients who received the identification cards through randomly selected sixty pharmacies, social media, or by snowball sampling and met the inclusion criteria were enrolled in the study. Data collection To gather the information from the participants, the researcher used one thousand cards distributed by sixty community pharmacies in Baghdad and through social media groups on (Instagram, Facebook, Whatsup, Telegram, and Viber) with the assistant of the admins of these groups to enroll a larger number of participants. The cards included the phone number of the researcher and types of counseling like laboratory investigation follow-up, treatment follow-up, side effects. A special sheet was prepared in advance to be used to gather the information from the patients via phone call. Its purpose was to acquire detailed information, including socio-demographic data, contact information, disease history, disease characteristics, co-morbidities, treatments being received for the HT, DM, or any other medications which are being taken concurrently. During the phone calls, the researcher introduced herself, took verbal consent from patients, and asked a number of questions regarding the patient's disease and management and answered the questions of the patients regarding the disease or previously prescribed treatments. The patient's questions were distributed into twelve domains that were prepared by the researchers and accepted by the scientific committee of the clinical pharmacy department. Domain 1. Related to side effects Domain 2. Related to disease Domain 3. Related to complications of the disease. Domain 4. Related to drug-drug interaction. Domain 5. Taking a drug in relation to food. Domain 6. Drug-food interaction. Domain 7. How to decrease a side effect. Domain 8. How to increase the drug’s action. Domain 9. Warning about dangerous actions while using the drug (smoking, drinking alcohol, driving a car) Domain 10. Storage of drugs (ex. insulin) Domain 11. Use of a substance (herbs, supplements... etc.) Domain 12. Give other consultations like which test is more accurate, home or lab test for DM, which lab data should be done continuously for diabetic patients, mechanism of drug action. The researcher answered the patient’s questions depending on trusted references (Clinical Pharmacy and Therapeutics, 6th Edition and Pharmacotherapy Principles and Practice, 4th edition). If the question was related to pharmaceutical practice, the researcher gave a decision. Still, if the question was related to the physician, the researcher will give advice (suggested recommendations) to the treating physician. The physician's response was studied if it is accepted and adopted, accepted without adapted, rejected. Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 111 Ethical approval The study has been proposed and subsequently approved by the scientific committee of the College of Pharmacy/ Baghdad University. Fully informed consent was obtained from the patients verbally after explaining the aim of the study thoroughly and clearly. All the information and questions were communicated to the patients with honesty and transparency in an objective manner to avoid bias as much as possible. Statistical analysis The collected data were analyzed using Microsoft Excel software, version 2016, and Statistical Package for the Social Sciences (SPSS), version 22. The descriptive analysis focused on frequencies and percentages, while the chi-square test, Fisher's Exact test were utilized to determine the mean differences between groups. A P-value of less than 0.05 was considered statistically significant. Results A total of 246 patients were enrolled in the study. The mean age was 40.93 years (±15.84). The majority were female (62.6%) and age group (35- 54) years (44.3%). More than half (65.5%) had either an intermediate or secondary school degree, as shown in Table 1. All participants had chronic disease (s), Diabetes (75.2%), hypertension (9.8%), or both (15%), as shown in Table 2. Table 1. Sociodemographic characteristics of participants Characteristics N % Gender Female 154 62.6 Male 92 37.4 Age group <15* 13 5.3 15*-24 29 11.8 25-34 38 15.4 35-44 59 24.0 45-54 50 20.3 55-64 45 18.3 ≥65 12 4.9 Education Primary school or less 43 17.4 Intermediate school 70 28.4 Secondary school 68 27.6 College or higher 65 26.4 Occupation Employed (Government employee, self-employee) 100 40.7 unemployed (housewife, out of a job, retired) 146 59.3 Resident Urban 193 78.5 Rural 53 21.5 *The interviewees were conducted with a child parent or an adult guardian/relative. Total N=246. Table 2.Medical characteristics of the patients Regarding to the 507 questions asked by the participants, 92 (37.3%) were related to the diseases, 72 (29.3%) were related to complications, and 113 (45.9%) were related to the need for other consultations as shown in Table 3. Characteristics N % Number of medications <4 194 78.9 ≥4 52 21.1 Chronic disease Diabetes 185 75.2 Hypertension 24 9.8 Diabetes and hypertension 37 15.0 Duration of disease Five years 84 34.1 Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 112 Table 3.The domains of the participant questions Questions N % 1. Related to drug side effects 40 16.3 2. Related to diseases 92 37.4 3. Related to complications of the diseases 72 29.3 4. Related to drug-drug interaction 6 2.4 5. Taking a drug in relation to food 28 11.4 6. Drug-food interactions 9 3.7 7. How to decrease drug side effects 41 16.7 8. How to increase the drug’s action 20 8.1 9. Warning about dangerous actions while using the drugs (smoking, drinking alcohol, driving a car) 6 2.4 10. Storage of drugs (ex. insulin) 50 20.3 11. Use of substances (herbs, supplements... etc.) 30 12.2 12. Give other consultations 113 45.9 Total 507 100.0 The pharmacist (researcher) received 507 questions from 246 patients. She provided pharmaceutical consultations in response to 47 % of the questions, consultations and refer in response to 44 % of the questions, while referred patients to physicians in response to 9 % of them as shown in Figure 1. Figure 1. The pharmacist response to patient questions A total of 271 questions were referred to physicians, of those, 92 (34%) accepted the pharmacist recommendations and consulted their physicians as shown in Figure 2. Figure 2. Physician access to pharmacist referral recommendations The physicians accepted and adopted 43.5% of the pharmacist referral recommendations as shown in Figure 3. Figure 3. Physician responses regarding pharmacist- referral recommendations There were no significant associations between the gender and the type of asked questions to the pharmacist (Table 4). Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 113 Table 4.The relationships between the patient gender and the study domains Domains Gender P-value Male Female Domain 1 No 79 (38.3%) 127 (61.7%) 0.484 Yes 13 (32.5%) 27 (67.5%) Domain 2 No 58 (37.7%) 96 (62.3%) 0.912 Yes 34 (37.0%) 58 (63.0%) Domain 3 No 67 (38.5%) 107 (61.5%) 0.577 Yes 25 (34.7%) 47 (65.3%) Domain 4§ No 92(38.3%) 148 (61.7%) 0.060 Yes 0 (0.0%) 6 (100.0%) Domain 5 No 84 (38.5%) 134 (61.5%) 0.305 Yes 8 (28.6%) 20 (71.4%) Domain 6§ No 90 (38.0%) 147 (62.0%) 0.338 Yes 2 (22.2%) 7 (77.8%) Domain 7 No 82 (40.0%) 123 (60.0%) 0.059 Yes 10 (24.4%) 31 (75.6%) Domain 8 No 87 (38.5%) 139 (61.5%) 0.232 Yes 5 (25.0%) 15 (75.0%) Domain 9§ No 89 (37.1%) 151 (62.9%) 0.674 Yes 3 (50.0%) 3 (50.0%) Domain 10 No 69 (35.2%) 127 (64.8%) 0.159 Yes 23 (46.0%) 27 (54.0%) Domain 11 No 77 (35.6%) 139 (64.4%) 0.128 Yes 15 (50.0%) 15 (50.0%) Domain 12 No 53 (39.8%) 80 (60.2%) 0.389 Yes 39 (34.5%) 74 (65.5%) *Significant (P-value <0.05) according to Pearson Chi-Square. § Fisher's Exact Test. Yes ( the patient’s questions fell within this domain). NO (the patient’s questions did not fall within this domain). The level of patient education significantly influenced the patients asking of two domains of the questions (domains 1 and 12) (Table 5). In other words, people with high education (high school/college degree or higher) asked significantly more questions related to domain 1 (about drug side effects) than patients with lower education (Table 5).The employment of the patients had no significant influence on the type of asked questions except in domain 12 (Table 6). Table 5.The relationships between the patient education level and the study domains Domains Education level P- value College or higher High school Middle school Primary or less Domain 1 No 49 ) 23.8% ( 54 )26.2% ( 64 )31.1% ( 39 )8.9% ( 0.032 * Yes 16 )40.0% ( 14 ) 35.0% ( 6)15.0% ( 4 )10.0% ( Domain 2 No 40 (26.0%) 44 (28.6%) 43 (27.9%) 27 (17.5%) 0.977 Yes 25 (27.2%) 24 (26.1%) 27 (29.3%) 16 (17.4%) Domain 3 No 43 (24.7%) 34 (19.5%) 45 (25.9%) 34 (19.5%) 0.205 Yes 22 (30.6%) 9 (12.5%) 25 (34.7%) 9 (12.5%) Domain 4§ No 64 (26.7%) 67 (27.9%) 69 (28.8%) 40 (16.7%) 0.211 Yes 1 (16.7) 1 (16.7%) 1 (16.7%) 3 (50.0%) Domain 5§ No 52 (23.9) 64 (29.4%) 63 (28.9%) 39 (17.9%) 0.085 Yes 13 (46.4%) 4 (14.3%) 7 (25.0%) 4 (14.3%) Domain 6§ No 60 (25.3%) 67 (28.3%) 69 (29.1%) 41 (17.3%) 0.169 Yes 5 (55.6%) 1 (11.1%) 1 (11.1%) 2 (22.2%) Domain 7 No 49 (23.9%) 58 (28.3%) 62 (30.2%) 36 (17.6%) 0.209 Yes 16 (39.0%) 10 (24.4%) 8 (19.5%) 7 (17.1) Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 114 Continued table 5. *Significant P-value <0.05 according to Pearson Chi-Square. § Fisher's Exact Test. Yes ( the patient’s questions fell within this domain). NO (the patient’s questions did not fall within this domain) Table 6. The relationships between the patient employment status and the study domains Domains Employed P-value Yes Count (%) No Count (%) Domain 1 No 80 (38.8%) 126 (61.2%) 0.188 Yes 20 (50.0%) 20 (50.0%) Domain 2 No 66 (42.9%) 88 (57.1%) 0.362 Yes 34 (37.0%) 58 (63.0%) Domain 3 No 74 (42.5%) 100 (57.5%) 0.351 Yes 26 (36.1%) 46 (63.9%) Domain 4§ No 98 (40.8%) 142 (59.2%) 0.712 Yes 2 (33.3%) 4 (66.7%) Domain 5 No 88 (40.4%) 130 (59.6%) 0.801 Yes 12 (42.9%) 16 (57.1%) Domain 6§ No 94 (39.7%) 143 (60.3%) 0.105 Yes 6 (66.7%) 3 (33.3%) Domain 7 No 84 (41.0%) 121 (59.0%) 0.816 Yes 16 (39.0%) 25 (61.0%) Domain 8 No 93 (41.2%) 133 (58.8%) 0.591 Yes 7 (35.0%) 13 (65.0%) Domain 9§ No 99 (41.3%) 141 (58.8%) 0.226 Yes 1 (16.7%) 5 (83.3%) Domain 10 No 84 (42.9%) 112 (57.1%) 0.163 Yes 16 (32.0%) 34 (68.0%) Domain 11 No 85 (39.4%) 131 (60.6%) 0.266 Yes 15 (50.0%) 15 (50.0%) Domain 12 No 67 (50.4%) 66 (49.6%) 0.001* Yes 33 (29.2%) 80 (70.8%) *Significant (P-value <0.05) according to Pearson Chi-Square. § Fisher's Exact Test. Yes ( the patient’s questions fell within this domain). NO (the patient’s questions did not fall within this domain). Domains Education level P-value College or higher High school Middle school Primary or less 65 (28.8%) 39 (17.3%) 0.954 Yes 6 (30%) 5 (25%) 5 (25%) 4 (20%) Domain 9§ No 65 27.1% 66 27.5% 66 (27.5%) 43 (17.9%) 0.134 Yes 0 (0.0%) 2 (33.3%) 4 (66.7%) 0 (0.0%) Domain 10 No 54 (27.6%) 56 (28.6%) 55 (28.1%) 31 (15.8%) 0.504 Yes 11 (22.0%) 12 (24.0%) 15 (30.0%) 12 (24.0%) Domain 11 No 55 (25.5%) 62 (28.7%) 60 (27.8%) 39 (18.1%) 0.581 Yes 10 (33.3%) 6 (20.0%) 10 (33.3%) 4 (13.3%) Domain 12 No 47 (35.3%) 31 (23.3%) 30 (22.6%) 25 (18.8%) .002* Yes 18 (15.9%) 37 (32.7%) 40 (35.4%) 18 (15.9%) Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 115 The number of scheduled medications significantly influences two types of question domains (no. 3 & 9). Patients with polypharmacy (≥ 4 medications) had a significantly higher number of questions related to “the warning about dangerous actions while using the drugs” compared to patients taking a smaller number of medications (< 4) (Table 7). Table 7. The relationships between the number of scheduled medications and the study domains Domains Number of medications P-value < 4 Count (%) ≥ 4 Count (%) Domain 1 No 164 (79.6%) 42 (20.4%) 0.513 Yes 30 (75.0%) 10 (25.0%) Domain 2 No 120 (77.9%) 34 (22.1%) 0.640 Yes 74 (80.4%) 18 (19.6%) Domain 3 No 144 (82.8%) 30 (17.2%) 0.020* Yes 50 (69.4%) 22 (30.6%) Domain 4§ No 191 (79.6%) 49 (20.4%) 0.080 Yes 3 (50.0%) 3 (50.0%) Domain 5 No 175 (80.3%) 43 (19.7%) 0.130 Yes 19 (67.9%) 9 (32.1%) Domain 6§ No 187 (78.9%) 50 (21.1%) 0.935 Yes 7 (77.8%) 2 (22.2%) Domain 7 No 165 (80.5%) 40 (19.5%) 0.162 Yes 29 (70.7%) 12 (29.3%) Domain 8§ No 180 (79.6%) 46 (20.4%) 0.389 Yes 14 (70.0%) 6 (30.0%) Domain 9§ No 193 (80.4%) 47 (19.6%) 0.002* Yes 1 (16.7%) 5 (83.3%) Domain 10 No 153 (78.1%) 43 (21.9%) 0.543 Yes 41 (82.0%) 9 (18.0%) Domain 11 No 170 (78.7%) 46 (21.3%) 0.871 Yes 24 (80.0%) 76 (20.0%) Domain 12 No 109 (82.0%) 24 (18.0%) 0.197 Yes 85 (75.2%) 28 (24.8%) § Fisher's Exact Test. Yes ( the patient’s questions fell within this domain). NO (the patient’s questions did not fall within this domain). Patients with DM had a significantly higher number of questions of six domains (3,4,5,6, 10 & 12) compared to patients with hypertension or hypertension and DM. These six domains included questions related to complications of the diseases, drug-drug interaction, taking a drug in relation to food, drug-food interactions, drug storage, and other consultations (Table 8). Table 8. The relationships between the patient chronic disease type and the study domains Domains Chronic Disease Type P-value DM Count (%) HT Count (%) DM & HT Count (%) Domain 1 No 160 (77.7%) 18 (8.7%) 28 (13.6%) 0.126 Yes 25 (62.5%) 6 (15.0%) 9 (22.5%) Domain 2 No 115 (74.7%) 17 (11.0%) 22 (14.3%) 0.649 Yes 70 (76.1%) 7 (7.6%) 15 (16.3%) Domain 3§ No 130 (74.7%) 22 (12.6%) 22 (12.6%) 0.025* Yes 55 (76.4%) 2 (2.8%) 15 (20.8%) Domain 4§ No 185 (77.1%) 21 (8.8%) 34 (14.2%) 0.000* Yes 0 (0.0%) 3 (50.0%) 3 (50.0%) Domain 5§ No 168 (77.1%) 22 (10.1%) 28 (12.8%) 0.041* Yes 17 (60.7%) 2 (7.1%) 9 (32.1%0 *Significant (P-value <0.05) according to Pearson Chi-Square. § Fisher's Exact Test. DM=d=Diabetes Mellitus; HT=Hypertension. Yes ( the patient’s questions fell within this domain). NO (the patient’s questions did not fall within this domain). Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 116 Continued table 8. *Significant (P-value <0.05) according to Pearson Chi-Square. § Fisher's Exact Test. DM=d=Diabetes Mellitus; HT=Hypertension. Yes ( the patient’s questions fell within this domain). NO (the patient’s questions did not fall within this domain). Discussion The use of information and telecommunication technologies has expanded rapidly, which strongly influences healthcare delivery in many countries(13). To our best knowledge, this is the first study to assess the use of phone calls in pharmaceutical counseling during COVID-19 in Iraq. Most of the participants were female, identical results were obtained in other studies in the united states 2018(14) and Iran 2012(15). In contrast, males were predominant in Al-blooshi et al. study in the United Arab Emirate(UAE) 2020(16). Many explanations related to these results as females are more worry about their diseases and complications, Mark et al found that diabetic women were substantially more concerned about weight increase, which was linked to the majority of the negative outcomes including lower self-rated health, poorer psychological well-being, poorer reported regimen adherence, and more diabetes-related distress(17) Another study postulated that men appeared to underestimate problems related to diabetes more than women. They were less concerned about long-term consequences and hypoglycemia (18), in agreement with this postulation, Elke found that 24% of the participant men and 23% of the participant females reported non-adherence to anti-diabetic medication(19). This might explain the predominant female participation in this study and most other similar studies as women have a higher desire to know more about their disease, treatment, and complications. The largest age group was (35-44), in comparing to another study, (15-25) years were the largest age group in a similar study in the Kingdom of Saudi Arabia 2015(20). Unemployed, those with intermediate school graduation and patients with monthly income less than one million IQD constituted the largest part of the sample. In contrast, most participants in another study in UAE 2020 were employed with college graduates (16). In terms of the estimated family monthly income, over two- fifths of the sample (41.7%) reported the lowest monthly income, of which less than 5000 Saudi Riyal (1,333 US$) was observed in another study in the Kingdom of Saudi Arabia, 2015(20), this agreement with the current study results. The low cost of phone counseling and its availability at home may be the reason behind these results. About one-fifth of the participants lived in the urban areas, this is related to the area where the study was done, and the urban people are more aware about the use of phone calls in medical and specifically pharmaceutical consultations. The most frequently asked questions were related to domain12 (related to other consultations like which test is more accurate, home or lab test for DM), which lab data should be done continuously for diabetic patients, mechanism of drug action). As postulated by other studies, most Iraqi diabetic and hypertensive patients have good knowledge about their conditions, that the major parts of the current study participant asked about more advanced issues of their disease. Esraa et al revealed that the majority of the patients had strong beliefs in the necessity of anti-diabetic treatment for controlling their illness(21), In Erbil, A study was done there revealed most diabetic participants had acceptable to good knowledge(22). Another study was done in Baghdad revealed that hypertensive patients in our Domains Chronic Disease Type P-value DM Count (%) HT Count (%) DM & HT Count (%) DM Count (%) Domain 6§ No 185 (78.1%) 20 (8.4%) 32 (13.5%) 0.000* Yes 0 (0.0%) 4 (44.4%) 5 (55.6%) Domain 7§ No 156 (76.1%) 18 (8.8%) 31 (15.1%) 0.513 Yes 29 (70.7%) 6 (14.6%) 6 (14.6%) Domain 8§ No 171 (75.7%) 22 (9.7%) 33 (14.6%) 0.804 Yes 14 (70.0%) 2 (10.0%) 4 (20.0%) Domain 9§ No 182 (75.8%) 24 (10.0%) 34 (14.2%) 0.070 Yes 3 (50.0%) 0 (0.0%) 3 (50.0%0 Domain 10§ No 142 (72.4%) 24 (12.2%) 30 (15.3%) 0.028* Yes 43 (86.0%) 0 (0.0%) 7 (14.0%) Domain 11§ No 162 (75.0%) 21 (9.7%) 33 (15.3%) 0.962 Yes 23 (76.7%) 3 (10.0%) 4 (13.3%) Domain 12§ No 100 (75.2%) 19 (14.3%) 14 (10.5%) 0.007* Yes 85 (75.2%) 5 (4.4%) 23 (20.4%) Iraqi J Pharm Sci, Vol.31(1) 2022 Using phone calls for pharmaceutical counseling for chronic diseases 117 community have relatively good knowledge and attitude(23). Conclusion In conclusion, socio-demographic characteristics influence the type of question asked by patients, most questions related to consultation regarding the mechanism of drug action or laboratory diagnosis and questions about the disease. Most patients got educational advice and some of them were referred to physicians. Most patients got education and advice regarding their questions to resolve their conditions, increase the awareness of the patients about their disease, and adhere to treatment without the need to direct pharmaceutical counseling which is an important issue during the pandemic especially for old age with multiple comorbidities. Recommendations Activating and expanding the role of the community pharmacist by strengthening the pharmacy consultation service via the phone or the Internet, which will have a positive impact on the health of the community during pandemics, especially for those with chronic diseases. References 1. 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