HOSPITAL PHARMACISTS' KNOWLEDGE OF PHARMACEUTICAL CARE IN MAIDUGURI, NORTH EASTERN NIGERIA

Headnote

ABSTRACT

The objective of the present study was to assess hospital pharmacists' knowledge of pharmaceutical care. Data were collected from thirty one (31) out of thirty six (36) pharmacists working with the University of Maiduguri Teaching Hospital (UMTH), Federal Neuropsychiatric Hospital (FNPH), and State Specialist Hospital, all in Maiduguri metropolis between January - March, 2012 using a self-administered pre-tested structured, mostly closed ended questionnaire. Pharmaceutical care knowledge was measured on a 30-point scale; Knowledge mean score of 28 was recorded. The study participants had a Mean ± SD of age of 37.48 ± 8.02 years. Majorities (38.7%) of the participants were within the age group of 31-40 years, 58.1% were male, and the highest percentages (45.2%) of the respondents were Pharmacist I. Most (61.3%) of the respondents year(s) of professional experience fell within the range of 1-10 years with a mean + SD of 10.13 ± 7.74 years. The pharmaceutical care knowledge levels were 12.90%, 3.23%, and 83.87% for neutral, negative, and positive Knowledge respectively. However, a significant majority (54.88%) of the respondents with 1-10 years of experience had positive knowledge of pharmaceutical care (P=0.014). The only negative knowledge recorded was among the participants within the range of 21-30 years of experience. Significantly highest proportion (41.94%) of pharmacist I had positive knowledge of pharmaceutical care (P=0.012). The only respondent that had negative knowledge was a principal pharmacist. Furthermore, significant proportion of the respondents with positive knowledge on pharmaceutical care had sourced information about pharmaceutical care through Pharmacist's fellowship programme (29.03%), pharmacy school (19.35%) (P=0.004). In conclusion, this study revealed a high level of positive knowledge among the studied participants.

Keywords: Knowledge; Nigeria; Pharmaceutical care; Pharmacists; Participants.

INTRODUCTION

The health care is facing massive changes worldwide and professionals in the system are having a rethink of their roles. Pharmacy profession has responded to these changes mainly by making pharmaceutical care its philosophy of practice, its mission, its professional mandate and its professional aspiration, and in fact, its measure of quality. Pharmacy profession has transited through different stages in search of value- apothecary, compounding, distribution, clinical pharmacy, and pharmaceutical care.

Pharmaceutical care (PC) is a ground-breaking concept in the practice of pharmacy which emerged in the mid-1970s. Possibly the earliest published use of the term pharmaceutical care was by Brodie in the context of thoughts about drug use control and medication-related services.1,2 Pharmaceutical care is a process of drug therapy management that requires a change in the orientation of traditional professional attitudes and re-engineering of the traditional pharmacy environment.3

Pharmaceutical care is designed to complement existing patient care practices to make drug therapy more effective and safe. This practitioner (Pharmaceutical care Pharmacist) is not intended to replace the physician, the dispensing pharmacist, or any other health care practitioner. Rather, the pharmaceutical care practitioner is a new patient care provider within the health care system.4 The responsibilities associated with drug therapy have become so numerous and complex that the need for a practitioner with this focus has become urgent. The need for this practitioner results from the following reasons:4

1. Multiple practitioners writing prescriptions for a single patient, often without co-ordination and communication.

2. The large number of medications and overwhelming amount of drug information presently available to patients.

3. Patients playing a more active role in the selection and use of medications.

4. An increase in the complexity of drug therapy.

5. An increase in self-care through alternative and complementary medicine.

6. A high level of drug-related morbidity and mortality which results in significant human and financial costs.

The term pharmaceutical care was first defined by Hepler in 1987, he philosophically defined pharmaceutical care as "a covenantal relationship between pharmacist and a patient in which the pharmacists performs drug use control functions (with appropriate knowledge and skill) governed by the commitment and awareness of the patient's interest".5 Pharmaceutical care is a patient-centered practice in which the practitioner assumes responsibility for a patient's drug-related needs and is held accountable for this commitment.6 Pharmaceutical care was also defined by Hepler and Strand as a practice which involves good co-operation between pharmacist and patients, physicians, nurses and other health care providers in the design, implementation and monitoring of pharmacotherapy so as to achieve the desired clinical, humanistic and economic outcomes.7 Pharmaceutical care as espoused by Hepler and Strand has four (4) basic components which are: Social Need; Patient - Centered Care; Caring; Pharmacist Responsibilities.7 Certain elements of structure must be in place to provide quality pharmaceutical care. Some of these elements are:3

1. Knowledge, skill, and function of personnel

2. Systems for data collection, documentation, and transfer of information

3. Efficient work flow processes

4. References, resources and equipment

5. Communication skills

6. Commitment to quality improvement and assessment.

Pharmaceutical care involves the process of identifying potential and actual drug related problems, resolving actual drug related problems and preventing drug related problems.7 The goal of Pharmaceutical care is to optimize the patient's health-related quality of life, and achieve positive clinical outcomes, within realistic economic expenditures. To achieve this goal, the following must be accomplished:4

A. A professional/therapeutic relationship must be established and maintained.

B. Patient-specific medical/medication information must be collected, organized, recorded, and maintained.

C. Patient-specific medical/medication information must be evaluated and a drug therapy plan developed mutually with the patient.

D. The pharmacist assures that the patient has all supplies, information and knowledge necessary to carry out the drug therapy plan.

E. The pharmacist reviews, monitors, and modifies the therapeutic plan as necessary and appropriate assuring positive outcomes, in concert with the patient and healthcare team.

Pharmaceutical care is the crucial philosophy and mission of pharmacy practice. Understanding and knowledge of this philosophy must precede efforts to implement pharmaceutical care, which merits the highest priority in all practice settings.8 Some studies on pharmaceutical care have been carried out in Nigeria. A study9 that evaluated pharmaceutical care documentation among pharmacists practicing in the South-Western states of Nigeria was conducted by Suleiman et al, in 2012. A study10 carried out in Ogun State assessed the attitude, perception and practice of pharmacists towards pharmaceutical care implementation. However, a study11 that identified practice standards that can be effectively applied in the implementation of pharmaceutical care in Nigeria was done in Benin City, South-Southern Nigeria. Exploration of Nigerian pharmacists' attitudes towards pharmaceutical care was undertaken by Oparah et al, in 2005 and revealed that Nigerian pharmacists indicated willingness to implement pharmaceutical care but expressed major concerns about their knowledge, professional skills, and pharmacy layout.12 Lastly, a study13 that examined pharmacists' roles in optimizing pharmaceutical care for HIV/AIDS patients was carried out in Maiduguri, North- Eastern Nigeria. None of these studies dwelt on the evaluation of pharmaceutical care knowledge among hospital pharmacists. Moreover, studies on pharmacists' knowledge of pharmaceutical care are scarce, hence the need for the present study. We undertook the study in Maiduguri, Borno state, North-Eastern Nigeria, a sub-region which to the best of our knowledge has not been evaluated in terms of pharmaceutical care knowledge among hospital pharmacists. The objective of the study therefore, was to assess the hospital pharmacists' knowledge of pharmaceutical care as a step towards full implementation of pharmaceutical care in Nigerian hospitals.

MATERIALS AND METHODS

Setting

The study was a prospective multi-centered study that involved 3 hospitals- two tertiary hospitals and one secondary hospital.The study was conducted at the Pharmacy departments of the University of Maiduguri Teaching Hospital (UMTH) - a tertiary hospital located along Bama road, Maiduguri. UMTH is a 530 bed facility spread over 17 wards; serving a population of over 20 million in the North-Eastern sub-region of the country, comprising six states (Borno, Yobe, Adamawa, Taraba, Bauchi and Gombe) as well as sizeable number across the borders of Cameroon, Chad and Niger Republics; Federal Neuropsychiatric Hospital (FNPH), a tertiary hospital situated few kilometers away from Baga Road Maiduguri; and State Specialist Hospital (SSH), a secondary health care institution situated along Shehu Laminu way. It is owned by Borno state government, and the second largest hospital in Maiduguri metropolis. Maiduguri in Borno state of Nigeria lies between latitude 1150 N and longitude 1350 E with an altitude of 345 meters above sea level and shares borders with three (3) West Africa countries namely Chad, Niger and Cameroun, whose indigenes often reside and trade in Maiduguri. The vegetation falls under the Sahel zone of West Africa. It is a semi-arid region with a short period of rainfall.

Data collection process

Prior to the commencement of the study, ethical clearance were obtained from the Ethics and Research Committee of the UMTH and the heads of pharmacy departments of FNPH and SSH due to lack of constituted Ethics and Research Committees in the two hospitals. Furthermore, verbal informed consent was obtained from the participants before the commencement of the study. Data were collected from thirty one (31) out of thirty six (36) pharmacists working with the three hospitals between January - March, 2012 using a self-administered pre-tested structured, mostly closed ended questionnaire. The questionnaire was structured into two sections: the first section was designed to gather demographic information. The second section was to ascertain knowledge of pharmaceutical care, and was however designed mostly using a 2-point Likert response format consisting of Yes and No, True and False options, and a few open ended questions.

Data Analysis

Statistical Package for Social Sciences (SPSS) version 16.0 for windows® was used for analysis. For the 2-point Likert scale used, a mark of two (2) was awarded for Yes or True, one (1) for No or False when they are expected and vice visa, and zero (0) for no response. Knowledge items were aggregated fifteen (15) structured questions on pharmaceutical care. A mean score of 28 was obtained, and the mean score was used to assess knowledge. Knowledge scores of 28-30 were considered positive knowledge, while 1-27 were considered negative knowledge, and zero (0) was considered neutral. Chi square test (X2) was used to determine the level of significance and a P-value of ≤ 0.05 was considered statistically significant.

RESULTS AND DISCUSSION

Out 33 questionnaires distributed, 31 filled questionnaires were retrieved from the consented participants giving a response rate of 93.94%.

Demographics

The Mean ± SD age of the studied population was 37.48 ± 8.02 years with the least age of 22 years and 57 years being the maximum age. Majority (38.7%) of the participants were within the age group of 31-40 years (Table 1). This is in agreement with the finding of another study.9 With respect to rank, the highest percentages (45.2%) of the respondents were Pharmacist I, followed by senior pharmacist and 3.2% each was an Assistant Director of Pharmaceutical Services (ADPS), and consultant pharmacist respectively (Table 1). With regard to pharmacists' years of experience, the Mean ± SD of year of experience was 10.13 ± 7.74 years, with 2 and 30years respectively in the least and highest years of professional experience of which most (61.3%) of the respondents fell within 1-10 years of professional experience (Table 1).

This finding is consistent with the findings of studies 9, 10 done in Ogun State and South- western States of Nigeria, and inconsistent with the finding of a study14 conducted in Belgium on clinical pharmacy practice which showed that the highest proportion of respondents had experience greater than 10 years. The highest percentages (58.1%) of the respondents were male, while (25.8%) were female. This finding is in line with the findings of studies10,15 conducted in Ogun State of Nigeria and Ghana where the highest proportions of the respondents were male respectively. On the contrary, the finding of this study is inconsistent with that of studies9,16 conducted on in South- western States of Nigeria, and United Arab Emirate which showed the highest proportion of the respondents as female respectively.

Participant's Knowledge of Pharmaceutical Care

A significant proportion (83.87%) of the participants had positive knowledge of pharmaceutical care (Figure 1). The finding of this study has shown as expected that pharmacists should have positive knowledge of pharmaceutical care, in order to achieve definite outcomes that improve patient quality of life. This is in agreement with the finding of a study10 done in Ogun State which revealed that 96.2% of the pharmacists were aware about pharmaceutical care. Another similar study17 conducted in china that investigated pharmacist's knowledge of Adverse Drug Reaction (ADR) showed that hospital pharmacists in a northern region of China had a reasonable knowledge of and positive attitudes towards pharmacovigilance which is an aspect of pharmaceutical care.

Distribution of Participants' Knowledge by Hospital of practice

Most of the respondents across the three hospitals had positive knowledge of pharmaceutical care with only 3.23% of the respondent having negative knowledge in UMTH (Figure 2). There was no significant association between hospital of practice and knowledge.

Distribution of Participants' Knowledge by Gender

Majority (45.16%) of the male respondents had positive knowledge of pharmaceutical care while 3.23% had negative knowledge. Similarly, 22.58% of the female respondents had positive pharmaceutical care knowledge while none had negative knowledge (Figure 3). Despite this high proportion of male respondents with positive knowledge, gender was not significantly associated with knowledge of pharmaceutical care.

Distribution of Participants' Knowledge by Year(s) of Professional practice

Most (54.88%) of the respondents with 1-10 years of professional experience had positive knowledge of pharmaceutical care, followed by those with 11-20 years of experience. The only negative knowledge recorded was among the participants within the range of 21 - 30 years of practice (Figure 4). There was a statistically significant association between years of practice and pharmaceutical care knowledge. The association may be due to the highest number of the studied participants within the range of 1 - 10 years of professional experience. Nevertheless, as the year of experience increases most Nigerian hospital pharmacists relent in knowledge acquisition and consequently become redundant to the extent that most of them would not be able to explain their work schedules or their contributions to the health care system. However, some that have work schedules turn out to be inventory managing pharmacists as a result of brain drain syndrome in clinical knowledge including pharmaceutical care knowledge.

Distribution of Participants' Knowledge by Rank

Higher proportion (41.94%) of the respondents that had positive knowledge of pharmaceutical care are pharmacist I, followed by senior pharmacists (22.58%). Only 3.23% of the respondents had negative knowledge and was a principal pharmacist. There was a statistically significant association in this distribution (Figure 5). This finding is in line with that of a study14 conducted in Belgium where chief pharmacists had low knowledge of clinical pharmacy than other pharmacists.

Distribution of Participants' Knowledge Categories by the Sources of Information on Pharmaceutical Care

Significant proportion of the respondents with positive knowledge of pharmaceutical care sourced information about pharmaceutical care through Pharmacists fellowship programme (29.03%); pharmacy schools (19.35%) while 3.23% with negative knowledge sourced pharmaceutical care information from professional journals/newspapers (Figure 6).

There was a statistically significant association between the sources of information about pharmaceutical care and knowledge (P=0.004). This is not in concordance with the finding of another study10 which showed that majority (61.0%) of the participants learnt about pharmaceutical care from pharmacy schools, followed by journals (52.5%). The implication of the finding of this study is that pharmacist's fellowship programme and Pharmacy schools are good avenues to impart pharmaceutical care knowledge to pharmacists.

Therefore, the older pharmacists that graduated before the inclusion of pharmaceutical care in the pharmacy curriculum who cannot go back to pharmacy schools for postgraduate studies in clinical pharmacy should utilize the fellowship programme to gain pharmaceutical care knowledge. On the other hand, pharmacists that were taught pharmaceutical care in their undergraduate days should endeavour to benefit from the synergy between Pharmacists fellowship programme and post graduate programmes in clinical pharmacy to constantly update and increase their knowledge base in pharmaceutical care.

This approach will go a long way in equipping Nigerian hospital pharmacists with the requisite knowledge to be able to provide pharmaceutical care to patients against all odds.

Study Limitation

Limitations worth of mentioning are the use of self-reporting questionnaires which only rely on the honesty of those reporting them, and the cross-sectional nature of the study creates difficulties in ascertaining casualty. Scarcity of data on the evaluation of knowledge of pharmaceutical care among hospital pharmacists was another limitation.

CONCLUSION

The study concluded that pharmacists in the studied areas have good knowledge of pharmaceutical care. Knowledge without the corresponding action is limiting, therefore we recommend that Nigerian hospital pharmacists should match their pharmaceutical care knowledge with actions in their various hospital of practice. Finally, let these actions drive the implementation of pharmaceutical care in the Nigerian hospitals to the fullest.

ACKNOWLEDGEMENTS

We wish to express our profound gratitude to the participants, head of pharmacy departments and the management of University of Maiduguri Teaching Hospital (UMTH), Federal Neuropsychiatric Hospital (FNPH), and State specialist Hospital (SSH), all in Maiduguri metropolis, Borno state, Nigeria for their immense support during the data collection processes. We appreciate Mrs. Glory Ogechi Okoro for her technical and moral support in the course of this work.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

References

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