This study was the first of its kind in Qatar to examine the general public’s attitudes, views, and practices regarding community pharmacy services.
Overall, the study respondents had positive attitudes toward the community pharmacist in Qatar. Forty-five percent of respondents perceived a balance between business and health aspects of pharmacy practices, and only 27% viewed community pharmacists as being more concerned with business matters than health matters.
The majority of respondents were familiar with the different roles and responsibilities of the community pharmacist, with the exception of two pharmaceutical care key elements: monitoring patient drug therapy and performing health screening. More than 70% of respondents disagreed that the pharmacist was expected to monitor the patient’s health progress to ensure safe and effective medication use and that the pharmacist was supposed to perform proper screening and monitoring for specific diseases. This shows the lack of public awareness of the different professional services that the community pharmacist is supposed to provide. This lack of awareness might be from a lack of any chance to evaluate, try, or even use these services since Qatar’s pharmacists have not provided these services before. If the transition to pharmaceutical care is to occur successfully, Qatar’s community pharmacists should make considerable efforts to raise public expectations about their professional role and must demonstrate the potential benefits of extending pharmacists’ contributions to the medication use process beyond ensuring accurate dispensing and providing basic counseling.
Fifty percent of the study respondents rated the physician as their primary source of drug-related information. Furthermore, when asked about the barriers that would prevent them from asking the pharmacist drug-related questions, 45% of patients listed the higher trust in physicians compared with pharmacists as a barrier. The respondents who did not consider the pharmacist as their first choice to answer their drug-related questions may have had unsuccessful experiences in getting such information from pharmacists or may not be aware that the pharmacists are capable of answering their drug-related questions or may feel that pharmacists do not have the necessary expertise to offer this service. In addition, these results emphasize the traditional belief in the physician’s capabilities and skills. This belief is maintained by Qatar’s old health care system, which is governed by physicians. In light of these findings, Qatar’s pharmacists should educate the public on their accessibility, clinical experience, and ability to offer drug informational services and should strive to have a better integration in Qatar’s health care system.
It is interesting to note that the majority of patients desired communication skills, medication knowledge, honesty and professionalism, and understanding of patients’ concerns rather than personal aspects (friendlessness and other characters) as favorite qualities of community pharmacists. Communication skills are important skills that community pharmacists should master. Whether counseling patients or communicating with other health care professionals, pharmacists use their communication skills daily. Effective pharmacist communication is essential to establish an ongoing pharmacist–patient relationship, and to improve medication use by patients.16
In addition to communication skills, to embrace the philosophy of pharmaceutical care and to ensure optimal patient outcomes, the pharmacist should have enough therapeutic experience and judgment and should be willing to address patients’ needs and concerns.
Most study participants (91%) said that they would seek the pharmacists’ advice before the physicians in the case of a minor illness. In comparison, the majority of the public in Jordan (63%) and in Northern Ireland (67%) reported that they would not hesitate to ask the pharmacist for advice, especially if the condition was not serious enough to see a doctor.12
This is promising in terms of advancing the community pharmacist’s role in Qatar. Community pharmacists in Qatar are ideally positioned to serve as a public health resource to diagnose and treat minor ailments. This can help free general practitioners’ time to concentrate on more serious illnesses.
The majority of the public (52%) visited the community pharmacy at least once a month. This correlates well with the frequency of community pharmacy visits cited in studies carried out in Jordan (67.4%), Northern Ireland (67.7%), Malta (70.8%), and the United Kingdom (74.6%).12
The percentage (93%) reported in our study for patients visiting the community pharmacy to obtain over-the-counter medications was higher than that reported in Jordan (50.3%), Malta (23.3%), and the United Kingdom (11.3%).12
This is explained by the high number of medications available over the counter in Qatar, despite their classification as prescription medications in other countries.19
Given the high potential for the misuse and abuse of these medications, Qatar’s community pharmacists should have a primary responsibility in promoting the safe, proper, and effective use of medications by Qatar’s public.
As has been reported in different parts of the world, the main reason for using any particular pharmacy in our study was pharmacy location.12
Several issues of concern related to current community pharmacy services in Qatar were raised in this study. Only 34% of respondents agreed that the pharmacist provided them with thorough medication counseling and encouraged them to ask questions when getting their prescription medications. This may indicate that Qatar’s community pharmacists are dispensing prescription medications presuming that the patients are already well informed about their health conditions and about their medications. One of the important aspects of pharmaceutical care is counseling patients regarding their medications. Pharmacist-provided medication counseling is vital for improving medication use and achieving desired outcomes. Community pharmacists in several countries such as Canada and the United States are required to provide patient education when dispensing prescription medications.23
This is not true for Qatar.
Accessibility is one of the benefits that community pharmacies have over other health care settings. Qatar’s community pharmacists are not using this benefit to their advantage by increasing their contact time with patients. Only 37% of respondents agreed that the pharmacist gave them enough time to discuss their problem and listened to them carefully. This can be attributable to two possible reasons: lack of personnel in the pharmacy and lack of time. The majority of Qatar’s community pharmacies are staffed by only one pharmacist and one pharmacy technician at any particular shift. Lack of time is also perceived by Qatar’s pharmacists as a barrier for the provision of cognitive services including breast cancer health promotion and smoking cessation counseling.25
Thus, in order for Qatar’s pharmacists to spend enough time with their patients, more pharmacy technicians need to be hired and better delineation should exist between the role of pharmacy technicians and that of pharmacists. If pharmacists are less involved in medication dispensing, they will have more time for patient centered pharmacy activities.
The third issue that was raised in the study was privacy in the pharmacy. Only 35% of respondents agreed that privacy concerning prescriptions was maintained by the pharmacist. Furthermore, 50% stated that lack of privacy in the pharmacy was a barrier to seek the community pharmacist’s help. This can be due to the lack of a private area for consultation in the majority of community pharmacies in Qatar as shown in a recent study completed by QU College of Pharmacy.27
The last issue was the pharmacist’s knowledge and ability to answer questions. Only 37% of the public agreed that Qatar’s pharmacists were knowledgeable enough and were always ready to answer questions. This can be related to several factors. The first factor is that Qatar’s community pharmacists are coming from diverse pharmacy curricula. These curricula may not adequately prepare their graduates to take the role of pharmaceutical care providers. Another factor is that continuous pharmacy education was never offered to Qatar’s community pharmacists until QU College of Pharmacy established the first national continuing professional pharmacy development (CPPD) program in 2008. To implement pharmaceutical care in community pharmacies in Qatar, efforts should be exerted to identify the educational needs of Qatar’s community pharmacists. Accordingly, the QU College of Pharmacy CPPD program in collaboration with Qatar’s Supreme Council of Health would design educational activities that address the community pharmacists’ inadequate knowledge, competencies, and skills.
The study participants responded positively regarding new community pharmacy services. Interestingly, 81% supported the introduction of diagnostic and screening services. These services are essential for the development of pharmaceutical care practice in community pharmacies in Qatar. With the aid of diagnostic blood monitoring devices, pharmacists would be able to offer disease management programs for patients suffering from diabetes, dyslipidemia, and other diseases. Many studies have demonstrated that these pharmacist-delivered programs can improve patient outcomes.4
This study had several limitations. The survey instrument used in the study was not evaluated for its reliability in Qatar. However, many of the survey questions were designed based on a previous survey done and tested for reliability and validity in Saudi Arabia. Qatar is very close to Saudi Arabia geographically and in terms of population characteristics. Therefore, we do not believe that this limitation was a real barrier, especially as our study was a pilot study only and was exploratory in nature. In addition, due to the nature of the direct questioning method, collected information may differ to some extent from that obtained in, for example, a mail survey, where the respondents would have more time to answer any given question. Our study was also limited by its small sample size, which may not properly represent Qatar’s population. The percentage of Qataris in the study participants was not representative of that in the general population. Furthermore, younger respondents and those with higher educational levels were overrepresented, and elderly patients were underrepresented.28
Thus, generalization of the study results to all Qatar’s public should be made carefully.