Iraqi J Pharm Sci, Vol.28(2) 2019 Counseling and pharmacy education programs DOI: https://doi.org/10.31351/vol28iss2pp30-36 30 Perceptions and Attitudes of Community Pharmacists’ towards Patient Counseling and Continuing Pharmacy Education Programs in Iraq Samer I. Mohammed*,1, Elaf B. Dawood** and Iman S. Abaas*** * Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq. **Department of Pharmacology and Toxicology, College of Pharmacy, University of Baghdad, Baghdad, Iraq *** Department of Pharmaceutics, College of Pharmacy, University of Baghdad, Baghdad, Iraq Abstract The pharmacist's role in the community is currently directed towards providing drug information and patient care rather than drug compounding and dispensing. Patient counseling is an essential skill for pharmacists. So as to improve the pharmacist role in the community and enhance the patient's education and counseling skills, many continuing education programs are established. The aim of this study is to assess the perceptions and tendency of community pharmacists in Iraq regarding patients counseling and continuing pharmacists’ educational programs. A cross-sectional survey was performed on a convenience sample of community pharmacists’ from different governorates of Iraq from January 2017 to April 2018. Data were collected using a pretested questionnaire specifically designed from a previous study with some modification to reflect the work nature in Iraq. The majority of pharmacists gave counseling to the patients and spent from one to five minutes in order to dispense a prescription. Approximately (53%) concentrated on the dose of the drug during dispensing more than the duration of use (19%) or drug indication (21%) while approximately half of the patients, on the other hand, asked mainly on the indications of their medications also less than (32%) asked about drug dose. Almost (47%) of participants indicated that attending continuous pharmacist education programs can help them to improve the counseling practice furthermore, the majority of them have an optimistic attitude toward the importance of these programs for the future of their career. Most participants declared that these programs are very rare in Iraq. This study provided a clue that the majority of community pharmacists in Iraq had an optimistic perception towards patients counseling and continuing pharmacy education programs. Keywords: Perceptions, Patients counseling, continuous pharmacy education programs. يف التعليم المستمر للصيادلة وبرامج مريضلل مشورةتقديم ال تجاه صيادلة المجتمع ومواقف تصورات العراق ***و ايمان سعدي عباس ** ، ايالف باسم داود 1*،سامر عماد محمد فرع الصيدلة السريرية ،كلية الصيدلة، جامعة بغداد، بغداد، العراق.* .العراق بغداد، بغداد، جامعة الصيدلة، ،كلية االدوية والسموم فرع** .العراق بغداد، بغداد، جامعة الصيدلة، ،كلية*** فرع الصيدالنيات الخالصة تعتبر لذلك. وتوزيعها األدوية تحضير من بدالً المرضى ورعاية الدوائية المعلومات توفير على حالًيا المجتمع في الصيادلة يركزمعظم مع التواصل مهارات وتعزيز المجتمع في الصيدلي دور تحسين لغرض. للصيادلة أساسية مهارة للدواء االمثل االستخدام عن المريض إرشادات في ةالصيادل وميل تصورات تقييم هو الدراسة هذه من الهدف ان. المستمر التعليم برامج من العديد إنشاء تم ، واإلرشاد التوعية لغرض المريض .بالصيادلة الخاصة المستمر وتقييم برامج التعليم للمرضى المشورة تقديم تجاه العراق باستخدام البيانات جمع تم. 7102 أبريل إلى 7102 يناير من المختلفة العراق محافظات من المجتمع لصيادلة مالئمة عينة على مقطعي مسح إجراء تم .العراق في العمل طبيعة لتعكس التعديالت بعض مع سابقة دراسة من خصيًصا وُصمم اختباره تم استبيان الصيادلة من( ٪ 35) من يقرب ما ركز. دقائق خمس إلى واحدة دقيقة من الطبية الوصفة لصرف وقضوا للمرضى المشورة الصيادلة غالبية أعطى في( ٪ 70) االستخدام من الغرض أو( ٪ 01) للعالج االستخدام مدة من أكثر للمريض العالج صرف أثناء الدواء جرعة عن معلومات اعطاء على ( ٪ 57) أقل وبصورة العالج استخدام من الغرض عن السؤال على رئيسي بشكل المرضى نصف من يقرب ما ركز الصيادلة رأي وحسب حين تحسين يساعدهم في أن يمكن المستمر الصيدلي التعليم برامج حضور أن إلى المشاركين من( ٪ 72) من يقرب ما أشار. الدواء جرعة سألوا عن شاركينالم معظم أعلن كما. المهنية حياتهم لمستقبل البرامج هذه أهمية تجاه متفائل موقف لديهم منهم الغالبية فإن ، ذلك على عالوة المشورة ممارسة .العراق في جدًا نادرة البرامج هذه أن الصيدلي ليمالتع ولبرامج للمرضى المشورة لتقديم ورغبة متفائل تصور لديهم العراق في الصيادلة غالبية أن فكرة الدراسة هذه قدمت الختام في .المستمر المريض ، برامج التعليم المستمر . تصورات ، مشورةالكلمات المفتاحية : 1Corresponding author E-mail: samer.jameel@copharm.uobaghdad.edu.iq Received: 31 / 1 /2019 Accepted: 7/4 /2019 Iraqi Journal of Pharmaceutical Sciences https://doi.org/10.31351/vol28iss2pp30-36 Iraqi J Pharm Sci, Vol.28(2) 2019 Counseling and pharmacy education programs 31 Introduction Most pharmacists in Iraq are working in hospitals and community pharmacies to provide pharmaceutical care services to patients (1). The pharmacist's role in the community has widely changed as a consequence of the expansion in the pharmacy profession worldwide. Nowadays, it is currently directed toward providing drug information and patient care rather than drug compounding and dispensing(2). Patient counseling is regarded as an essential skill for pharmacists to interact positively with patients besides in many countries, it is mandatory (3) Although doctors are regarded as the first source of information about the medicines for the patients nevertheless most doctors rarely assess patients understanding when giving medications information despite the importance of doing this (4). This is in opposition to the pharmacists where they actively asses the response of patients which results in an increase in patient adherence, satisfaction as well as decreases in the number of medicines prescribed, medication-related problems and the cost of medication (5). In order to improve the pharmacist’s role in the community and enhance the patient's education and counseling skills, many continuing education programs are established. The term “continuing education” has been defined as “organized learning experiences and activities in which (health care professionals) engage after they have completed entry-level academic education and training. These experiences are designed to promote the continuous development of the skills, attitudes, and knowledge needed to maintain proficiency, provide quality service or products, respond to patient needs, and keep abreast of change”(6). Patients counseling and many pharmacy practices can be well improved when pharmacists participate in various continuous educational programs (7). Although the number of pharmacists in Iraq is greatly increased as a result of an increase in the number of Pharmacy Colleges in the last two decades (8), however, there is a very limited number of continuing pharmacy education programs which does not reflect the dramatic changes in the pharmacy profession in Iraq. The purpose of this study is to assess the attitudes of community pharmacists in Iraq concerning patients counseling and identifies the major obstacles they faced which prevent them from providing effective counseling. Furthermore, the study also evaluates the perceptions and tendency of Iraqi pharmacists to participate in continuing pharmacists’ educational programs. Subjects and Methods A cross-sectional survey performed on a convenience sample of community pharmacists at community pharmacies in different governorates of Iraq from January 2017 to April 2018. Data was collected using a pretested questionnaire specifically designed from a previous study with some modification to reflect the work nature in Iraq (9). The questionnaire consisted of 16 questions. The first 4 questions were collected the demographic data of community pharmacists, followed by 6 questions which related to the attitude toward patients counseling and the obstacles that face the pharmacist during counseling. While the last 6 used to measure the perception of community pharmacists towards continuing pharmacy education programs. Three questions formatted and scored on four-point (1-4) Likert scale with anchor words (Strongly agree to strongly disagree) to measure the opinion of pharmacists about continuous pharmacy education. The study was validated by the Scientific and Ethical Committee in the College of Pharmacy, University of Baghdad. Verbal consent was obtained from all participants included in the study. The authors informed the participants about the purpose of the study at the beginning of each interview. Meanwhile, the respondents were informed that their participation was voluntary. Statistical analysis Statistical analysis was performed using the Statistical Package for Social Sciences software version 16 (SPSS v. 16). Pharmacists’ responses were presented as frequencies and percentages. Perception of community pharmacists towards patients counseling and continuing pharmacy education program was analyzed through a scaling method. Results In order to evaluate the perception of Iraqi pharmacist toward patient counseling and their attitude for the continuous pharmacists’ education program, a convenient sample of 263 community pharmacists from different governorates of Iraq participated in this survey. The demographic data of all participants are shown in table 1. Iraqi J Pharm Sci, Vol.28(2) 2019 Counseling and pharmacy education programs 32 Table 1. Demographic data for participants (n=263) Categories Demographic items Female Male Sex No. (%) 172(65.39) 91(34.60) More than 45 years 36-45years 25-35 years Less than 25 years Age in years No. (%) 9(3.42) 31(11.78) 127(48.28) 96(36.50) More than 10 years 6-10 years 2-5years Less than 2 years Work experience in years No. (%) 33(12.54) 30(11.40) 77(29.27) 123(46.76) More than 16 hours 11-16hours 8-10hours Less than 8 hours No. of working hr.at pharmacy 0(0) 12(4.56) 26(9.88) 225(85.55) More than half of the pharmacists spent from one to five minutes in order to dispense a prescription and about (39%) consumed from five to ten minutes and only less than (3%) take more than 10 minutes to dispense prescriptions as shown in table 2. Table 2. Time required to dispense a prescription (n=263). Time spent in dispensing prescription No. (%) Less than one minute 20(7.60) 1-5 minutes 134(50.95) 5-10 minutes 102(38.78) More than 10 minutes 7(2.66) More than half of the participants stated that they always provide consultation when dispensing any prescription as shown in table 3. Table 3. Attitude to offer consultation for patients while dispensing medication (n=263). Frequency No. (%) Always 140(53.23) Frequently 95(36.12) Occasionally 25(9.50) Rarely 3(1.14) The higher percentages of pharmacists (53%) concentrated on the dose of the drug during dispensing more than the duration of use (19%) or drug indication (21%) or even other information like the main side effects, drug interaction if present and the best time to take the medication which only explained by less than (7%) of pharmacists, on the other hand, nearly half of the patients asked mainly on the indications of their medications and less than (32%) asked about the dose of the drug (Figure1). Figure 1.Variance in motivation about the consultation between pharmacists and patients as pharmacists stated (n=263). The higher percentage of the patients listened carefully to the consultation about their medication and only less than (3%) do not interact with the pharmacist well during the consultation process as shown in table 4. Table 4. Degree of attention of the patients to the medical consultation as pharmacists stated (n=263). Frequency No. (%) Always 106(40.30) Frequently 104(39.54) Occasionally 46(17.49) Rarely 7(2.66) Many participants demonstrated that absence of patient's interest in addition to the insufficient time in pharmacy is the main obstacles that face them during the consultation process (Table5). Iraqi J Pharm Sci, Vol.28(2) 2019 Counseling and pharmacy education programs 33 Table 5. Obstacles encountered the pharmacists concerning providing medical consultation (n=263). Problems No. (%) Lack of Time 84(31.93) Insufficient knowledge and information 42(15.96) Lack of patient’s interest 120(45.62) Other 17(6.46) Approximately (47%) of participants indicated that attending continuous pharmacist education programs can help them to improve the counseling practice. Likewise, the availability of specific area for counseling is essential according to (32%) of participants. Only about (17%) consider that increase the number of pharmacists in one pharmacy can help. Other answers given by some pharmacists indicated that all these explanations are crucial to improve the counseling practice in addition to promoting public awareness about the importance of pharmacist’s instructions as shown in table 6. Table 6. Pharmacists view regarding solving the obstacles concerned in providing medical consultation (n=263). Strategies No. (%) By increasing pharmacists in pharmacy 44(16.73) Attendance of continuous pharmacist education programs 124(47.14) Specify special areas for providing consultation 84(31.93) Other 11(4.18) Only less than (5%) of participants said that continuous pharmacist education programs available for them while more than half of the participants cleared that these programs rarely reach to Iraqi pharmacists as shown in table 7. Table 7. Accessibility of continuous pharmacist education programs for Iraqi pharmacists (n=263). Regarding pharmacists’ opinion about continuing education programs and the need to establish these programs in Iraq, the result in fig.2 showed an optimistic attitude of most pharmacists toward the importance of these programs for improving pharmacists’ information in addition to providing them with the latest scientific issues and the development of pharmacy career. More than (90%) of the contributors strongly agree or agree to launch these programs in Iraq and no one of the contributors strongly disagrees with such programs as shown in figure.2. Figure 2. Pharmacists’ opinion about continuing education programs (n=263). The degree of interest in attending continuous education programs for pharmacists is very high as seen in table 8 and only less than (3%) of the participants refuse to attend these programs. Table 8. The degree of interest in attending continuous pharmacist education programs (n=263). Response No. (%) Frequently 125(47.52) Occasionally 106(40.30) Rarely 26(9.88) Never 6(2.28) Discussion According to previous studies, pharmacists were regarded as an easily accessible source of health care which emphases on the role of pharmacists to give the patients accurate information about their medication (10,11). Although work experience for most of the participants were less than two years nevertheless, the greater proportion of participant displayed a high tendency for counseling and attending continuing pharmacy education programs. Time in community pharmacy could affect the time and quality of counseling (12). According to this study, the number of working hours for the higher percentages of pharmacies was less than 8 hours and this limited time may affect the Response No. (%) Frequently 13(4.94) Occasionally 67(25.47) Rarely 151(57.41) Do not reach at all 32(12.16) Iraqi J Pharm Sci, Vol.28(2) 2019 Counseling and pharmacy education programs 34 time provided for counseling and this clearly appeared in the previous study in Saudi Arabia which showed that most of the working hours (75%) in the pharmacies spent on dispensing and stocking and only (25%) provided for counseling (13). In the present study, more than half of the participant spent from (1-5) minutes with each patient to dispense a prescription. This result is similar to the previous study performed in Nepalese which indicates that the majority of pharmacists took from (1-5 ) minutes for dispensing a prescription (10), another study which assessed the Turkish community pharmacists' view about pharmaceutical care practice in Turkey, indicated only a small percentages ( 22.5% ) take more than 6 minutes to counsel patients (14). Counseling of pharmacist is essential to enhance the patient’s adherence with his medications (14). Furthermore, the World Health Organization (WHO) Good Pharmacy Practice Guidelines also suggest that the pharmacist should provide counseling (15).The best outstanding finding of this survey was that most Iraqi pharmacists have a great tendency towards patients counseling. The greater proportions of the participants said that they regularly provide consultation when dispensing any prescription. Similarly, two other studies (16,17) in different countries indicated that the pharmacists always provide counseling to their patients. During counseling, the higher percentages of participants focus on the dose of the drug than on the duration of use and to a lesser extent on indications or even other information. On the other hand, nearly half of the patients prefer to ask mainly on the indications of their medications. In contrast, a previous study in India stated that 17% of the pharmacists give some basic information about the product and its usage method (18). Regarding patients’ questions during counseling, the results of the present study are different from the results of a previous study in Nepal where most patients asked about the cost of the medication more than other things such as the dose or the duration of use (10). Although the greatest proportion of the participants concluded that most patients were listening well to their counseling nevertheless, the major obstacle that faced them and reduced the effectiveness of the consultation process was a lack in some patients’ interest. This made them cancel the counseling or decrease the given information. The result is similar to another study in Northwest China where the lack of patient acceptance of pharmaceutical care lead to ineffective communication between patients and pharmacists (19).Lack of time and insufficient knowledge also can affect the counseling according to other participants in the present study that is similar to many other results in previous studies (14,20,21). Attendance of continuous pharmacist’s education programs was regarded as the main strategy to solve the problem of weak counseling according to the higher proportion of the participants. The previous result was predictable as improving the knowledge of the pharmacists can assist them to improve the counseling process in a timely manner. A comparable result was mentioned in a previous study conducted in Turkey(14) which concluded that continuous education programs would be an important approach to enhance pharmaceutical care and counseling. Continuous education program for the pharmacist is an effective method to improve all pharmacists knowledge after graduation (22). Unfortunately, these programs are very rare and not accessible for the majority of pharmacists in Iraq according to the suggestion of more than (57%) of participants in this study. This problem is not only in Iraq but also in many other countries in the Middle East(23,24). This study reveals a high attitude toward attending continuous educational programs and a promising opinion of most Iraqi pharmacists about continuing education programs. The higher percentages declared that these programs can improve pharmacists’ information, in addition, to provide them with the latest scientific issues and can play a vital role in the development of pharmacy career. More than (90%) of the contributors strongly agree or agree to launch these programs in Iraq. The great attitude of pharmacists to this program was in line with several former studies (22, 25- 26). Conclusion This study provided a clue that the majority of community pharmacists in Iraq had an optimistic perception towards patients counseling and continuing pharmacy education programs. In addition to that, most of them showed a great tendency to contribute effectively in these programs which are absent or very rare in Iraq to improve their career and reduce the barriers toward a good effective counseling. Ethical statement The study and the questionnaire were validated by the local Scientific and Ethical Committee in the College of Pharmacy, University of Baghdad. 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Opinion of hospital pharmacy practitioners toward the Continuing Pharmacy Education program: a study from a tertiary care hospital in central Nepal. Integrated pharmacy research & practice. 2017;6:157. Baghdad Iraqi Journal Pharmaceutical Sciences by bijps is licensed under a Creative Commons Attribution 4.0 International License. Copyrights© 2015 College of Pharmacy - University of Baghdad. http://bijps.uobaghdad.edu.iq/index.php/bijps.com http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/