|Year : 2018 | Volume
| Issue : 4 | Page : 226-231
Study on the perception of staff and students of a university on community pharmacy practice in Ipoh, Perak, Malaysia
Allan Mathews1, Abul Kalam Azad2, Syed A Abbas3, Farid Z Bin Che Rose4, A B M Helal Uddin2
1 Faculty of Pharmacy, Quest International University Perak, Malaysia
2 Faculty of Pharmacy, International Islamic University Malaysia (IIUM), 25200 Kuantan, Pahang, Malaysia
3 Faculty of Pharmacy, Quest International University Perak, Kuantan, Pahang, Malaysia
4 Faculty of Integrative Sciences and Technology, Quest International University Perak, Malaysia
|Date of Web Publication||23-Nov-2018|
A B M Helal Uddin
Department of Pharmaceutical Chemistry, Faculty of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: In Malaysia, community pharmacies play an important and vital role in both urban and rural areas with approximately 30% of 12,000 registered pharmacists with annual retention certificate practicing in community pharmacies. The main objective of this study was to find the perception of respondents on the value and necessity of pharmacists. Materials and Methods: The questionnaire was divided into two sections: the first section assessed the visits to community pharmacies, purpose, interaction with pharmacy staffs, professional fee, and improvements to pharmacy practices; the second section evaluated the characteristics of respondents including an e-consent form. Data were analyzed using the Statistical Package for the Social Sciences software (version 11.5).Results: The highest number of respondents (66.1%) consulted with the pharmacists for cough and cold, 33.1% for gastric and stomach ailments, and 28.9% for diarrhea and constipation. Only 34% of cases were handled by the pharmacists, whereas 52.1% by the sales assistant. Approximately 88.5% showed satisfaction with the counseling provided. A total of 46.3% did not know whom they dealt with, whereas 51.2% wanted personal attention of the pharmacists instead of the sales assistants. However, 66.9% of respondents preferred to a private consultation room. Records of only 32.2% of respondents were secured by the pharmacies, whereas 42.1% showed interest to pay a professional fee. Moreover, 83.3% agreed the fee of RM5 only, whereas 20.8% agreed to RM10. Among the respondents, majority agreed to pay a fee willingly, but approximately 30% stayed neutral. Conclusion: There is a need for the community pharmacists to play vital roles firsthand at the front desk to serve the patients professionally instead of handing over the responsibilities to the sales assistant.
Keywords: Community pharmacy practice, counseling, pharmacist, pharmacy, respondents
|How to cite this article:|
Mathews A, Azad AK, Abbas SA, Bin Che Rose FZ, Helal Uddin A B. Study on the perception of staff and students of a university on community pharmacy practice in Ipoh, Perak, Malaysia. J Pharm Bioall Sci 2018;10:226-31
|How to cite this URL:|
Mathews A, Azad AK, Abbas SA, Bin Che Rose FZ, Helal Uddin A B. Study on the perception of staff and students of a university on community pharmacy practice in Ipoh, Perak, Malaysia. J Pharm Bioall Sci [serial online] 2018 [cited 2018 Dec 15];10:226-31. Available from: http://www.jpbsonline.org/text.asp?2018/10/4/226/245911
| Introduction|| |
In Malaysia, community pharmacies play an important and vital role in both urban and rural areas with approximately 30% of the 12,000 registered pharmacists with annual retention certificate practicing in community pharmacies in Malaysia; there is a separation of functions from the private to public sector where only medical practitioners are allowed to prescribe and dispense medications. Medicines in Malaysia fall under the two categories of either controlled medicines (scheduled poisons) or over-the-counter (OTC) medicines. OTC medicines are those that are freely available at any outlet such as provision shops or supermarkets. Controlled medicines can be subdivided into those requiring a prescription if it is to be dispensed at the community pharmacy or can be supplied as a “dispensed medicine” by the community pharmacist. Dispensed medicine (Group C) is defined in the Poisons Act 1952 as a medicine supplied by a registered medical practitioner, dentist, or veterinary surgeon or supplied for the purpose of the medical, dental, or animal treatment by a licensed pharmacist on the premises specified in the license.
There is a need for better integration of pharmacists into the public health-care system because the Poisons Act allows the Malaysian community pharmacists to prescribe a large number of controlled medicines including drugs designated for diabetes, asthma, skin, eye, ear, nose, pain, central nervous system disorders, cough and cold as well as oral contraceptives. Almost all respondents of the surveys carried out in Malaysia viewed Class C Poisons (as scheduled in the Poisons Act 1952) as dispensed medicines suitable for substitutions. Analyzing the pattern of non-prescribed medicines purchased by the consumers in Malaysia from community pharmacies showed that 39.6% purchased scheduled poisons, 45.5% unscheduled poisons, and 12.5% traditional and complementary medicines.
If the separation of dispensing is implemented, 77.5% of general medical practitioners in Malaysia may jump to work closely with the community pharmacists monitoring patients’ pharmacotherapeutic outcomes. Majority of community pharmacists in Malaysia (>70%) were still focusing on counseling for nutritional supplements, cough, cold, and diabetic medications as well as providing screening tests for blood pressure and sugar levels. It is a common scenario for many community pharmacies in Malaysia to sell all sorts of consumer items some of which are not related to health care, whereas a discerning public would even question the lack of proper dress code for the pharmacists. The objective of this study was to gauge the consumer’s perception of community pharmacy practice in an university in a major city in Malaysia.
| Materials and Methods|| |
This was a cross-sectional survey using a self-completed anonymous e-questionnaire.
This study was carried out among 400 staff and students of a tertiary university in Ipoh, Malaysia.
The survey subjects were predetermined with some inclusion criteria such as age (≥15 years), university staffs and students, both genders with good command in English language, and good physical and mental health.
In this survey, the respondents who were ≤15 years, not mentally and physically fit, unable to understand the questionnaire or not good enough in English, and not students or staffs of the university were excluded.
The questionnaire of this survey was distributed to 400 respondents who met the inclusion criteria of the study. However, only 121 respondents participated and completed the questionnaire successfully.
The final questionnaire consisted of 22 questions that were divided into two sections (I and II). Section I: It assessed the visits of respondents to a community pharmacy, purpose of visits, and the interaction with pharmacy staffs including community pharmacists, professional fee, and improvements of community pharmacy practices. Section II: It evaluated the characteristics of respondents, which involved an e-consent form that was required to be filled completely at the end of the questionnaire.
The project and design of survey questionnaire were approved by the university research committee. The privacy of the respondents was strictly maintained and kept confidential throughout the study. The participants reflected a cross-sectional population of students and administrative and academic staffs of a university in Perak of Ipoh in Malaysia. The selection of two different sample populations was to essentially reflect the income from lower to higher range.
Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) software of version 20.0, IBM, Armonk, NY, USA. Frequency and cross tabulation were used for descriptive analysis. Chi-square statistics was used to investigate the differences in the respondents’ answers between the different groups of respondents (gender, age, and employment position). The difference was considered statistically significant when P value was ≤0.05. Odds ratios were calculated for variables that showed significant differences based on chi-square analysis. Reliability of the questionnaire was based on Cronbach’s alpha, with a value of ≥0.70 taken as an indication of high reliability.
All the participated respondents were required to fill the e-consent form before responding to the survey questionnaire.
| Results|| |
A total of 400 questionnaires were distributed during the period of data collection but only 121 respondents (30.25%) answered the questionnaire completely. The reliability test was applied to all variables that could give a Cronbach’s alpha value of ≥0.72.
| Focus Groups Discussion|| |
Common perception of the four groups
All the groups agreed that community pharmacies are essential for the health-care system and should be easily accessible with no waiting time and should have a variety of brands of medicines for choice. The administration group noted that they should have no professional fee.
There was a consensus about the need of improvement in the professionalism aspect of the community pharmacist so that they could be easily recognizable.
All the groups agreed that a counseling fee should be imposed for certain specific circumstances that need consultation of pharmacists to decide which particular controlled medicines is required for a patient.
Characteristics of respondents
[Table 1] shows the characteristics of participants: 52.9% of respondents were between 15 and 24 years of age group and it reflects more or less that 60.3% of respondents were students and 39.7% were from other professions, including 26.4% from the academic field. Female respondents outnumbered the male by 57% to 43%.
|Table 1: Demographic characteristics of respondents who took part in this study|
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[Table 1] also shows the demographic characteristics of respondents who took part in this survey study.
Frequency of visits to pharmacy
Sixty-two percent of respondents hardly visited a community pharmacy, 31.4% visited only 1–2 times a month, whereas 58.7% also visited the same pharmacy. A total of 50% of nonstudents stated that they rarely visited (<1 time) a pharmacy compared to 70% of students.
Purpose of visit to pharmacy
In a multi-answer response, it was found that 73.6% of respondents visited a pharmacy to purchase only health-care products, whereas 33.1% visited to only seek consultation and treatment, 27.3% to get a prescription medicine from the dispensary, but only 11.6% brought medicines obtained from another outlet (e.g., hospital or clinic) to be counseled. Interestingly, 21.6% visited a pharmacy to only compare prices.
Consultation and treatment
It was found that approximately 66.1% of respondents consulted the pharmacists for cough and cold, 33.1% for gastric and stomach ailments, and 28.9% for diarrhea and constipation. Only 34% of cases were handled by the pharmacists, whereas majority of the cases (i.e., 52.1%) were handled by the sales assistants.
Approximately 33.9% of respondents stated that they were served by the pharmacists, 61.1% of them appreciated the pharmacists and their good or excellent knowledge of service, whereas 22.3% had only satisfactory level of perception on the services provided. Moreover, only 4.1% of respondents noted that the knowledge of the pharmacists was unexpected and 88.5% were satisfied with the counseling services provided, but 46.3% of them did not know who the pharmacist was. Approximately 51.2% of the respondents wanted to have personal attention of the pharmacists rather than that of the sales assistants. Only 32.2% of respondents believed the pharmacists to be one of the most important factors when a pharmacy is chosen.
[Table 2] shows the responses of respondents about pharmacists and their services in Ipoh of Malaysia.
Privacy in the pharmacy
Only a small number of respondents (9.1%) argued about the existing level of privacy protection among the pharmacies that they had visited. However, a great number of respondents (66.9%) suggested to have a private consultation room so that their privacy was highly protected and kept confidential.
Approximately 32.2% of respondents mentioned that their records were well maintained by the pharmacies during their visits.
[Table 3] shows the chi-square test results for the association between perception of services and age, gender, and employment.
|Table 3: Chi-square analysis results for the association between perception of pharmacist service with age, gender, and employment|
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Among the patients who sought consultation and treatment, 42.1% of them noted that the community pharmacists should be paid with a professional fee, which was opposed by 36.4%, whereas 21.5% were neutral. Approximately 52.9% who answered positively stated that the remuneration should be based on the time involved, whereas the remaining wanted it to be a fixed amount. A fixed amount of fee between the range of RM5 and RM10 was suggested by 83.3%, whereas 20.8% proposed more than RM10. The main reasons given by those who opposed the idea of paying a professional fee were that “there should be no extra fee in a pharmacy shop” (31.8%) and “it is just a product purchase” (28.9%). Only 4.5% reasoned that the pharmacists they visited were professionals. Patients (38%) who brought medicines from elsewhere and came for counseling only have shown willingness to pay the fee as against the 33.1% who opposed the idea and 28.9% who kept neutral.
Approximately 61% of the respondents supported the idea of paying the fee for the reason that “the pharmacist is a professional,” whereas 63% reasoned that “the pharmacist uses his time and knowledge” and 45.7% stated that “the pharmacists are the most knowledgeable on medications.”
Medicines brought to pharmacy for counseling
The main reasons for the patients to bring medications that were obtained from another clinic or hospital to the community pharmacists for counseling were free services (36.4%), regular availability of the pharmacists (24.8%), and the lack of explanation by clinics and hospitals (22.3%).
Suggested improvements to community pharmacies
Improvements suggested include to have a private consultation area/room (66.9%), personal/direct attention of the pharmacists instead of the sales assistants (51.2%), professionalism of the pharmacists (52.1%), well-maintained records (49.6%), and drastic reduction of waiting time (40.5%).
Preference for a pharmacy
Approximately 32.9% of the respondents agreed that the pharmacist was the driving factor for them to prefer a particular pharmacy, whereas 33.9% stated it was because of lower price and discount, and 28.9% stated it was due to location.
[Table 4] shows the chi-square analysis results of age, sex, and employment status of the respondents.
|Table 4: Chi-square analysis report of age, sex, and employment status of respondents|
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| Discussion|| |
In 2016, 3,094 community pharmacists registered in Malaysia in a total population of approximately 31 million, giving a community pharmacist/population ratio of 1:10,000 with the concentration mainly in the urban centers.,, This comparison is similar to that of the UK.
Approximately one-third (33.3%) of the visits were for seeking consultation and treatment for a variety of ailments including cough and cold, gastrointestinal and musculoskeletal disorders, contraception, skin, and diabetes. However, only one-third of these patients were attended by a pharmacist, though the pharmacist is expected to attend to every patient under the legal definition of a dispensed medicine and the community pharmacist. The current findings also suggested that the patients preferred to see the pharmacists rather than the sales assistants. This is one of the areas that the community pharmacists can focus on and develop to apply their knowledge and skills that they have obtained from their 6 years of university, internship, and compulsory service training in Malaysia.
Pharmacists were positively viewed by the public when the majority of them were acknowledging the knowledge and skills of the pharmacists. The current findings appeared to be in line with the discussions carried out among the focus group discussions in terms of professional outlook and fee and personal attention by the pharmacist and also privacy issue in the pharmacy.
The community pharmacists in Malaysia need to focus on the Blue Ocean Strategy in community pharmacy practices (i.e., empowering of law on dispensed medicines in the Poisons Act). A community pharmacy practice model can be created with proper consultation, documentation, and patient compliance. Having a practice model in place, a professional fee could also be imposed as the practice would move away from a product-oriented to patient-orientated one. Community pharmacy evolved along with the setup of a retail outlet just as other retail outlets that sell nonmedical products, but the difference is that it is meant for selling only medicines and other health-care products. With time, community pharmacists have been venturing out of the health-care products ranging from cosmetics to sweets or candies, and so on. Urgent studies need to be carried out to find the reasons behind this as it diminishes professionalism in pharmacy practices. In general, the public has negative opinions on the pharmacists about degrading to such a level completely, which does not adhere to their professional training.
This study indicated that the privacy protection level needs to be upgraded in community pharmacies that aligned with the Pharmaceutical Services Division of the Ministry of Health, Malaysia, which has comprehensive guidelines for community pharmacy practices including the layout of the premises, private consultation, dress code, documentation, equipment, premise hygiene, responding to symptoms, and dispensing of prescriptions. The guidelines have addressed a number of areas of concern, some of which are revealed in this study including privacy protection, the need for direct pharmacist–patient contact, and professionalism of the pharmacists.
The worldwide trend for pharmacy practices is toward more involvement of the pharmacists in direct health-care systems, especially in patient compliance., Malaysian community pharmacists can make a start by moving away from just being retailers of medicines to providers of pharmaceutical care, bringing value to the health-care system as well as to the profession they are involved with. When this value would be instituted, patients may feel more safe and comfortable with the patient care including the imposition of professional fees. The majority of respondents in this study agree that the pharmacists deserve to be paid a professional fee.
In conclusion, the pharmacist needs to come to the forefront and be a recognizable professional in the community pharmacy practices. A patient should be going to a community pharmacy to consult with the pharmacists on prescription medicines and not merely just to buy either controlled or OTC medicines.
| Suggestion for Improvement|| |
The four areas highlighted through the analysis of the respondents’ answers in this study are as follows: the need for privacy protection, professional outlook, patient–pharmacist direct interaction (not sales assistants), and price standardization and suspension of non-health-care products from the community pharmacies.
Financial support and sponsorship
This study was supported by the Research Management Centre, International Islamic University Malaysia (EDW-B130620947 and RIGS-162920456) and the Ministry of Education, Malaysia (RACE1400140020).
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]