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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 1  |  Page : 24-31

Evaluation of counseling services provided by community pharmacists and patients' satisfaction toward their services: A cross-sectional survey from Sudan


1 Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
2 Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan

Date of Submission29-Oct-2020
Date of Decision10-Nov-2020
Date of Acceptance19-Nov-2020
Date of Web Publication13-Jan-2021

Correspondence Address:
Dr. Bashir Alsiddig Yousef
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, Khartoum 11111
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_138_20

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  Abstract 


Background: Patient counseling is an integral part of the pharmacy services provided in community pharmacies, and it can be used as a tool to determine the quality of health care. This study aimed to evaluate the community pharmacists' counseling services and determine patients' satisfaction toward these services. Methodology: This study was a descriptive, community-based cross-sectional study in the Sudanese population from March 2020 to June 2020. One thousand nine participants responded to the questionnaire. A convenience sampling method was used to collect the data. Data were collected using an online predesigned standardized questionnaire and then analyzed using the Statistical Package for the Social Sciences. Results: It was found that most of the participants (78.4%) were from urban areas. The majority of the participants (84.8%) completed their education until the university level, and 82% of the respondents were aged between 18 and 29 years. Females were 57.1%, and 50.5% of the participants work in the medical field. About 60% (59.9%) of them have never been asked if they had an allergy to certain drugs when they visited the pharmacy and 81.6% did not receive any information about what to do if they missed a dose, whereas 71.6% have never been told about the possible side effects of the drugs they are prescribed. The average score of satisfaction among the participants was 18.24 ± 3.953. It was found that 32.1% and 11.8% of the people involved in the study were satisfied and very satisfied with the pharmacist's counseling services, respectively. Chi-square test revealed that opinion/feedback about the pharmacist and his services was significantly associated with gender, residence, and working in the medical field. Conclusion: More than two-thirds of the participants reported positive feedback toward the community pharmacists and their services. Patient satisfaction was significantly associated with gender, residence, and working in the medical field. Opinion/feedback about the pharmacist and his services was significantly associated with gender, residence, and working in the medical field.

Keywords: Community pharmacist, counseling service, patient's satisfaction, Sudan


How to cite this article:
Matar MS, Eljanzoury AM, Musa SI, Abdulwahaab MA, Mustafa AA, Yousef BA, Badi S. Evaluation of counseling services provided by community pharmacists and patients' satisfaction toward their services: A cross-sectional survey from Sudan. Curr Med Issues 2021;19:24-31

How to cite this URL:
Matar MS, Eljanzoury AM, Musa SI, Abdulwahaab MA, Mustafa AA, Yousef BA, Badi S. Evaluation of counseling services provided by community pharmacists and patients' satisfaction toward their services: A cross-sectional survey from Sudan. Curr Med Issues [serial online] 2021 [cited 2021 Jan 16];19:24-31. Available from: https://www.cmijournal.org/text.asp?2021/19/1/24/306937




  Introduction Top


Community pharmacists are an important part of the health-care team and are most accessible to the public.[1] They supply medicines according to a medical prescription or when legally permitted without a prescription.[2] In the last decades, and after implementing pharmaceutical care strategies, community pharmacists have shifted from only product-centered professions to the product- and patient-centered professions.[3],[4] By ensuring proper supply of suitable pharmaceutical products, their activities include counseling patients during dispensing of prescription and nonprescription medications, drug information to health-care providers, patients, the general public, and everyone who participates in medical promotion systems.[5],[6] Therefore, more clinical pharmacy services for the patient's well-being are applied in community pharmacies, such as disease counseling, blood pressure, blood sugar monitoring, and drug information services.[7] In 2011, the WHO and the International Pharmaceutical Federation released Good Pharmacy Practice guidelines that are directed to all countries to achieve many benefits, including high-quality use of medicines as well as economic and rational purposes.[8],[9] Patient counseling is one of the essential services appropriately provided by the community pharmacist, as it promotes patients to adhere well to their medical treatments.[3],[10] Nevertheless, neglecting the patient's perspective in evaluating of clinical care quality may lead to medical therapy failure and wasting of health resources.[11]

Patient satisfaction is defined as the degree of the patient's positive feeling toward the service according to his experience and expectations.[12] It is one of the main parameters for identifying and assessing the health-care system's quality.[13],[14] Patients' attitudes and satisfaction toward community pharmacy's services are critical as increasing patient satisfaction has been reported to enhance patients' adherence to medications significantly and therefore improve therapeutic outcomes.[15],[16] Many aspects are related and affect patient satisfaction toward pharmacy services, including pharmacy setting, waiting time, consultation privacy, communication skills, dispensing process, availability, and medication storage.[17],[18] Thus, evaluation of patient satisfaction to pharmaceutical care delivery in community pharmacies is essential. It is used as an indicator for monitoring and improving the health-care system's quality.[14],[19],[20]

Worldwide, many reports have evaluated the patient's attitude and satisfaction toward community pharmacy services. In developed countries such as the United States, the United Kingdom, and Canada, people showed positive opinions toward community pharmacy services.[21],[22],[23] However, the perception and satisfaction levels of the public differ in developing countries. To the best of our knowledge, no study was done recently to address the patient's attitude and satisfaction toward community pharmacy services in Sudan. Thus, we conducted this study to assess the community pharmacists' counseling services and evaluate patients' satisfaction with pharmacy services.


  Methodology Top


Study setting

This study was a descriptive, community-based cross-sectional study, which was conducted in the Sudanese population from March 2020 to June 2020. Sudan is an African country that lies in the northeast of the continent. It has 18 states with more than 43.8 million, and Khartoum state is the most populated one.

Inclusion and exclusion criteria

All adult Sudanese citizens above 18 years old from both genders who responded to the questionnaire were included. All respondents who participated in the pilot study were excluded from the study.

Sample size and sampling method

Solvin's equation was used to calculate sample size n = N/1+N(e)2, where n = the sample size, N = total population at target, and e = 0.05 error margin. The estimated sample size was 400 participants, while far more than the estimated samples (1009 participants) responded to the questionnaire. A convenience sampling method was used to collect the data.

Data collection

The data were collected using an online predesigned standardized questionnaire posted on various social media platforms. The questionnaire was pretested by distributing the tool to ten participants initially, and then according to their responses and comments, the final structure was designed. All ten participants were excluded from the study. The questionnaire consisted of three parts – Part A: demographic characteristics of the participants, Part B: questions for assessment of the counseling services provided by the community pharmacists, and Part C: questions for determining patients' satisfaction.

Satisfaction score

We assessed the participants' satisfaction through five-point Likert scale questions in which the responses ranged from strongly disagree to agree strongly. Each strongly disagree response was given 1 point, disagree was given 2 points, neutral was given 3 points, agree response was given 4 points, and each strongly agree response was given 5 points. Then, the total satisfaction score for each participant was obtained by the summation of the points of their responses. The number of questions that assessed the satisfaction in this study was five questions. Hence, the overall satisfaction scores were arranged from 5 to 25. Then, the mean of the satisfaction score was obtained.

Data analysis

Data were analyzed using the computerized program, Statistical Package for the Social Sciences (SPSS), version 20 (IBM, SPSS, Chicago, IL, USA). Results were presented as tables. A Chi-square test was used for cross-tabulation at 0.05 margins of error (P value). Descriptive statistics (frequency tables, median, means, and standard deviation) and inferential statistics (Chi-square test) were performed.

Ethical consideration

Ethical approval was obtained from Omdurman Islamic University, Faculty of Pharmacy (OIU-FP-4/2020). After a clear explanation about the study's purpose, agreement to participate in the study was obtained from each participant by clicking yes in the first question about he/she ready to join in the study before starting the survey.


  Results Top


Sudanese people who participated in the study were 1009; 82% of them were between 18 and 29 years of age. Females represented 57.1%, and most of the participants (78.4%) were from urban areas. Married participants represented 84.8%, and 84.8% completed their education until the university level. Half of the participants (50.5%) work in the medical field. Forty-six percent of the participants reported that they spend about 5 min when they visit a pharmacy. About 17% of the participants reported that they have chronic diseases; of them, 42% had asthma [Table 1].
Table 1: Sociodemographic characteristics and clinical data of the participant (n=1009)

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Among the 1009 participants who filled the questionnaire, 54.7% were never asked if they were taking any regular medications, while 59.9% were never asked about any history of drug allergy. 81.6% did not receive any information about what to do if they missed a dose, and 71.6% have never been told about the possible side effects of the drugs they were prescribed [Table 2].
Table 2: Responses to counseling services provided by the community pharmacists (n=1009)

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The average score of satisfaction among the participants was 18.24 ± 3.953. People who were satisfied with pharmacist's counseling services represented 32.1%, and 46.5% thought that the pharmacist's information is useful, and 70.1% of the participants described the pharmacist they go to as “experienced and confident.” When asked about the possible barriers that prevented pharmacists from providing adequate information about the drugs, 46% felt that it was due to the pharmacist's lack of interest, while 32.8% felt it was due to the pharmacist's lack of knowledge. Seventy percent of the participants reported that the pharmacist is experienced and confident [Table 3].
Table 3: Satisfaction of patients and co-patients toward services provided by the community pharmacists (n=1009)

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When an independent-samples t-test and one-way ANOVA test were done to compare the means of overall satisfaction score among different variables of the participants, we found a significant difference between the means of satisfaction score among different groups of gender, residence, presence of chronic diseases, the place the participants go first when they need medical consultation, age, and educational level of the participants [Table 4].
Table 4: Comparing the means of overall satisfaction score among different variables of the participants (n=1009)

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The results of the Chi-square test revealed that the participants' opinion/feedback toward the pharmacists' services had a statistically significant association with gender, residence, working in the medical field, the first place the participants go when they need medical consultation, and counseling time (P = 0.001, 0.021, 0.036, 0, and 0.046, respectively). Furthermore, the logistic regression test [Table 5] revealed that females had more positive feedback regarding the pharmacist services than males by 1.6 times (confidence interval [CI], 1.176–2.101; P = 0.002), and those who work in the medical field were more likely to have positive feedback by 1.3 times than their counterparts who did not work. Even though the result was statistically insignificant (CI: 0.974–1.739, P = 0.075), those living in the urban areas were more likely to have positive feedback by 1.4 times than others who lived in the rural areas (CI: 1.008–1.954, P = 0.045). Furthermore, participants who reported that the pharmacy's counseling time is more than 10 min were more likely to have positive feedback by 1.3 times than those who spent just 2 min in the pharmacy (CI: 0.714–2.462, P = 0.372). Participants who consulted by the pharmacists about medications and other medical conditions were more likely to have positive feedback toward pharmacists' services by four times than those who consulted the Internet or other sources (CI: 2.034–7.507, P = 0.000).
Table 5: Predicting patient's opinion/feedback toward pharmacists services using binary logistic regression test (n=1009)

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  Discussion Top


Community pharmacists have a more significant role in improving patients' quality of life and enhancing health-care outcomes.[3] Thus, conducting studies to assess the pharmacists' services, such as counseling services, and studying the level of patient satisfaction toward these services can improve the health-care system's quality.[20],[24] In the current study, most participants (82%) were between 18 and 29 years, and 84.8% of the respondents had a university educational level; half of them were of medical background. These high percentages of the younger population and well-educated participants may be due to the use of an online-administered questionnaire in this survey, which is more accessible for these population sectors. Furthermore, due to limited Internet access in many Sudan regions, participants who were found to live in the urban areas represented 84.8%.

There are many determinants to measure the pharmacy services' satisfaction, including convenient opening time and communication, pharmacy location, and availability of trusted and confident pharmacists.[23],[25],[26] Patient counseling is a critical satisfaction domain that promotes patients to adhere to their medical treatments.[3] Nevertheless, neglecting the patient's perspective in evaluating clinical care quality may lead to failure of medical therapy and wasting of health resources.[27] Patients' perception toward counseling service can be evaluated by many questions regarding frequency and duration of usage, storage conditions, allergies, side effects, drug interactions, counseling time, and privacy. In the present study, as shown in Table 2, participants showed different responses to these questions.

Regarding people's satisfaction toward the community pharmacy services, only 32.1% of the participants were satisfied with the community pharmacist's counseling services. The pharmacist's main counseling point is giving drug information to patients about drug usage, administration, dosage, side effects, storage, and drug–drug and drug–food interactions.[28] Around half of people were currently satisfied with the information provided and how to give this information by the community pharmacist. Interestingly, we found that 70.1% of the participants thought that community pharmacists are experienced and confident. The findings of the current study indicated that the Sudanese population's overall satisfaction was average, which is similar to that provided by Nigerian and Ethiopian people.[29],[30] However, a study in Spain showed a high level of satisfaction toward community pharmacy services.[31]

Many barriers and obstacles may prevent community pharmacists from providing proper counseling services to patients, including privacy during counseling, language, communication skills, unclear explanation concerning medical use, adverse effects, storage of medication, and rapid dispensing.[32],[33] In the present study, around 45% and 32% of the participants thought that the pharmacist's lack of interest or the lack of knowledge is the main reason for giving proper medical advice. However, around 45% of them believed that the pharmacy's overcrowdedness is the main barrier to receiving an appropriate counseling service.

Furthermore, our study showed that females were more satisfied with the community pharmacist services than males. This may be due to the high proportions of female community pharmacists in Sudan. Therefore, girls feel better interacting with them than male pharmacists. These findings are in contrast to that from India, in which we found that males are highly satisfied compared to females.[34] On the other hand, due to the ease of interaction between pharmacists and other health-care professionals, people working in the medical field had better satisfaction feedback than other workers. Moreover, people who lived in urban areas were more likely to have positive feedback than those who lived in rural areas. This may be explained by most of the pharmacies in rural areas in Sudan managed by pharmacy assistants instead of pharmacists, which affect the quality of the provided services. On the other hand, participants who spent longer counseling time reported that they have better satisfaction; the same result was shown with those who firstly consult the pharmacists about medications and other medical conditions.

The current study has some notable limitations. First, the study was carried out using the convenient sampling technique; therefore, the subjective selection bias is not avoidable, which can affect the study's internal validity. Furthermore, the study took place during the coronavirus pandemic. Thus, an online survey was used. In this regard, the study was not fully representative, as some areas in Sudan have Internet connection problems that may limit the questionnaires' distribution. The third limitation is the limited number of questions to assess satisfaction to other determinants rather than patient counseling. Therefore, further future studies with more detailed and updated items are urgently required to deal with all domains of patient satisfaction and the barriers and obstacles for providing better services in the community pharmacy.


  Conclusion Top


More than two-thirds of the participants reported positive feedback and opinion toward the community pharmacists and their services. The patient satisfaction level was significantly associated with gender, residence, working in the medical field, the first place the participants go when they need medical consultation, and counseling time. Moreover, the quality of counseling services is generally required to be improved by organizing continuing education programs for community pharmacists.

Research Quality and Ethics Statement

The authors of this manuscript declare that this scientific work complies with reporting quality, formatting and reproducibility guidelines set forth by the EQUATOR Network. The authors also attest that this clinical investigation was determined to require Institutional Review Board / Ethics Committee review, and the corresponding protocol / approval number is IRB minute number OIU-FP-4/2020. We also certify that we have not plagiarized the contents in this submission and have done a Plagiarism Check.

Acknowledgments

We do appreciate all participants for their voluntary participation in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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