Attitudes and impediments of the implementation of clinical pharmacy services and pharmaceutical care in Ethiopia: a systematic review
DOI:
https://doi.org/10.18203/issn.2454-2156.IntJSciRep20251779Keywords:
Clinical pharmacy, Pharmaceutical care, Drug therapy problem, Health care professional, Patient careAbstract
Clinical pharmacy services are firmly established in many countries, associated with reduced adverse drug events, medication errors, length of hospital stay, mortality rates, and costs. However, implementation of clinical pharmacy is in its infancy in many developing countries including Ethiopia. The aim of this systematic review was to identify attitudes and factors influencing the implementation of clinical pharmacy services and pharmaceutical care in Ethiopia. A systematic review of published articles was conducted using databases such as PubMed, EMBASE, Scopus and Google scholar. A search was conducted from 01 July 2021 to 11 October 2021. The studies published in peer-reviewed journals in the English language, their full texts available and those done in Ethiopia were included. For this review, eleven articles were accepted and considered. From the included studies, about 52.6% of physicians and half of other health care professionals were of the opinion that pharmacists should concentrate on drug product and patient care should be left to other health care providers. Lack of clearly defined roles and responsibilities for the clinical pharmacists, lack of a support from the hospital management, lack of awareness, hesitance to have clinical pharmacists in the health care team, lack of proper communication and lack of incentives for the service are common factors influencing the implementation of clinical pharmacy services and pharmaceutical care.
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Omar NE, Elazzazy S, Abdallah O, Nashwan AJ, Eltorki Y, Afifi HM, et al. Perceptions and expectations of health care providers towards clinical pharmacy services at a tertiary cancer centre in Qatar. J Oncol Pharm Pract. 2020;26(5). DOI: https://doi.org/10.1177/1078155219882076
Loh P, Chua SS, Karuppannan M. The extent and barriers in providing pharmaceutical care services by community pharmacists in Malaysia: a cross-sectional study. BMC Health Serv Res. 2021;21(822):1-14. DOI: https://doi.org/10.1186/s12913-021-06820-7
Miller RR. History of Clinical Pharmacy and Clinical Pharmacology. J Clin Pharmacol. 1981;21:195-7. DOI: https://doi.org/10.1002/j.1552-4604.1981.tb05699.x
Dinesh K. Upadhyay GSO. Enhancing Quality of Patient-Centered Care Services in Developing Countries: Pharmaceutical Care Approach. Social and Administrative Aspects of Pharmacy in Low- and Middle-Income Countries: Present Challenges and Future Solutions. Elsevier. 2018;311-28. DOI: https://doi.org/10.1016/B978-0-12-811228-1.00019-4
Summers RS, Mackie CA, Gous AGS, Everard M. Developing pharmacy practice A focus on patient care. World Health Organization. 2006. Available at: https://iris.who.int/handle/10665/69399. Accessed on 12 March 2025.
Aljamal MS, Saud A, Alrowili M. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. Int J Med Dev Ctries. 2019;3(3):302-6. DOI: https://doi.org/10.24911/IJMDC.51-1543620246
Franklin BD, van Mil JW. Defining clinical pharmacy and pharmaceutical care. Pharm World Sci. 2005;27(3):137. DOI: https://doi.org/10.1007/s11096-005-7060-4
Hepler CD. Clinical Pharmacy, Pharmaceutical Care, and the Quality of Drug Therapy. J Hum Pharmacol Drug Ther. 2004;24(11):1491-8. DOI: https://doi.org/10.1592/phco.24.16.1491.50950
El Hajj MS, Al-Saeed HS, Khaja M. Qatar pharmacists' understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care. Int J Clin Pharm. 2016;38(2):330-43. DOI: https://doi.org/10.1007/s11096-016-0246-0
Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, et al. US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48(10):923-33. DOI: https://doi.org/10.1097/MLR.0b013e3181e57962
Charrois TL, Zolezzi M, Koshman SL, Pearson G, Makowsky M, Durec T, et al. A systematic review of the evidence for pharmacist care of patients with dyslipidemia. Pharmacotherapy. 2012;32(3):222-33. DOI: https://doi.org/10.1002/j.1875-9114.2012.01022.x
Gregory P. Documenting clinical interventions in community pharmacy: PROMISe III. University of Tasmania. Conference contribution. Available at: https://hdl.handle.net/102.100.100/513087. Accessed on 12 March 2025.
Avery AJ, Rodgers S, Cantrill JA, Armstrong S, Cresswell K, Eden M, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012;379(9823):1310-9. DOI: https://doi.org/10.1016/S0140-6736(11)61817-5
Al-Eidan FA, McElnay JC, Scott MG, Kearney MP, Corrigan J, McConnell JB. Use of a treatment protocol in the management of community-acquired lower respiratory tract infection. J Antimicrob Chemother. 2000;45(3):387-94. DOI: https://doi.org/10.1093/jac/45.3.387
Savickas V, Foreman E, Ladva A, Bhamra SK, Sharma R, Corlett SA. Pharmacy services and role development in UK general practice: a cross-sectional survey. Int J Pharm Pract. 2021;29(1):37-44. DOI: https://doi.org/10.1111/ijpp.12653
Jebara T, Cunningham S, Maclure K, Awaisu A, Pallivalapila A, Al M, et al. Health ‑ related stakeholders’ perceptions of clinical pharmacy services in Qatar. Int J Clin Pharm. 2021;43(1):107-17. DOI: https://doi.org/10.1007/s11096-020-01114-0
Evan A. Prescribing Authority for Pharmacists: Rules and Regulations by State. GoodRx. 2020. Available at: https://www.goodrx.com/hcp-articles/ pharmacists/prescriber-authority-for-pharmacists?sr sltid=AfmBOoqS4pnzWMkIXZRpVQT3qA0RKjysxd9qd_bYHbdZCoj6AR5Lzsws. Accessed on 12 March 2025.
General Pharmaceutical Council. In practice: Guidance for pharmacist prescribers. 2019. Available at: https://www.jccp.org.uk/ckfinder/userfiles/files/ in-practice-guidance-for-pharmacist-prescribers-november-2019. Accessed on 12 March 2025.
Gerard K, Hons BA, Tinelli M. Valuing the Extended Role of Prescribing Pharmacist in General Practice: Results from a Discrete Choice Experiment. JVAL. 2012;15(5):699-707. DOI: https://doi.org/10.1016/j.jval.2012.02.006
Saadah LM, Khan AH, Azhar S, Sulaiman S, Bashiti IA. Maximizing acceptance of clinical pharmacy recommendations to reduce length of hospital stay in a private hospital from Amman, Jordan. BMC Health Serv Res. 2021;21(937):1-11. DOI: https://doi.org/10.1186/s12913-021-06966-4
Bourne RS, Whiting P, Brown LS, Borthwick M. Pharmacist independent prescribing in critical care: results of a national questionnaire to establish the 2014 UK position. Int J Pharm Pract. 2016;24:104-13. DOI: https://doi.org/10.1111/ijpp.12219
Penm J, Moles R, Wang H, Li Y, Chaar B. Factors Affecting the Implementation of Clinical Pharmacy Services in China. Qual Health Res. 2014;24(3):345-56. DOI: https://doi.org/10.1177/1049732314523680
Al-azzam SI, Shara M, Alzoubi KH, Almahasneh FA, Iflaifel MH. Implementation of clinical pharmacy services at a university hospital in Jordan. Int J Pharm Pract. 2013;21(5):337-40. DOI: https://doi.org/10.1111/ijpp.12009
Hussain A, Ibrahim MI MM. The extended role of community pharmacists in developing countries is largely inclined to dispense medications. Pharm Pr. 2013;11(4):179-84.
Mekonnen AB, Yesuf EA, Odegard PS WS. Pharmacists’ journey to clinical pharmacy practice in Ethiopia: key informants’ perspective. SAGE Open Med. 2013;1. DOI: https://doi.org/10.1177/2050312113502959
Pharmaceuticals Fund and Supply Agency (PFSA) and Systems for Improved Access to Pharmaceuticals and Services (SIAPS). National Assessment on the Implementation Status of Clinical Pharmacy Service at Public Hospitals in Ethiopia. Addis Ababa: PFSA and SIA. 2016. Available at: http://apps.who.int/medicinedocs/docum ents/s22467en/s22467en. Accessed on 12 March 2025.
Mekonnen AB, McLachlan AJ, Brien JE, Mekonnen D AZ. Barriers and facilitators to hospital pharmacists’ engagement in medication safety activities: a qualitative study using the theoretical domains framework. J Pharm Policy Pr. 2018;23(11):2.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):2021. DOI: https://doi.org/10.1136/bmj.n71
Berhane A, Ali E, Odegard P, Suleman S. Physicians’ expectations of clinical pharmacists’ roles in Jimma University Specialized. Int J Pharm Teach Pract. 2013;4(2):571-4.
Nasir BB, Gezahegn GT, Muhammed OS. Degree of physician-pharmacist collaboration and influencing factors in a teaching specialized hospital in Ethiopia. J Interprof Care. 2020;1-7. DOI: https://doi.org/10.1080/13561820.2020.1777953
Fekadu G, Gamachu B, Mengie T, Maqbool M. Knowledge and attitude of health care professional’ s toward s clinical pharmacy services in Nedjo General Hospital, Western Ethiopia. Int J Sci Reports. 2019;5(7):172-80. DOI: https://doi.org/10.18203/issn.2454-2156.IntJSciRep20192798
Pineal Yitbarek, Molla B. Attitude on Clinical Pharmacy Training: The Case of Haramaya University, Ethiopia. Int J Pharma Res Heal Sci. 2014;2(5):367-73.
Bilal AI, Tilahun Z, Beedemariam G, Ayalneh B, Hailemeskel B, Engidawork E. Attitude and satisfaction of health care providers towards clinical pharmacy services in Ethiopia: A post-deployment survey. J Pharm Policy Pract. 2016;9:7. DOI: https://doi.org/10.1186/s40545-016-0058-6
Bilal AI, Tilahun Z, Gebretekle GB, Ayalneh B, Hailemeskel B, Engidawork E. Current status, challenges and the way forward for clinical pharmacy service in Ethiopian public hospitals. BMC Health Serv Res. 2017;17:359. DOI: https://doi.org/10.1186/s12913-017-2305-1
Tadesse E, Melesie G, Alemayehu D. Knowledge and Attitude of Health Professionals Towards Clinical Pharmacy Services in Selected Hospitals in West Shoa Zone, Ethiopia. Biomed Stat Informatics. 2020;5(1):9-13. DOI: https://doi.org/10.11648/j.bsi.20200501.12
Kefale B, Temesgen G. Epidemiology: Open Access Knowledge, Attitudes and Practice of Physicians towards Clinical Pharmacy Services in Ten Public Hospitals in Oromia Regional State. Epidemiol Open Access. 2017;7:5.
Mishore KM, Mekuria AN, Tola A, Ayele Y. Assessment of Knowledge and Attitude among Pharmacists toward Pharmaceutical Care in Eastern Ethiopia. Biomed Res Int. 2020;2020:7. DOI: https://doi.org/10.1155/2020/7657625
Mekonnen AB, McLachlan AJ, Brien JE, Mekonnen D, Abay Z. Barriers and facilitators to hospital pharmacists' engagement in medication safety activities: a qualitative study using the theoretical domains framework. J Pharm Policy Pract. 2018;11:2. DOI: https://doi.org/10.1186/s40545-018-0129-y
Hambisa S, Abie A, Nureye D, Yimam M. Attitudes, Opportunities, and Challenges for Clinical Pharmacy Services in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: Health Care Providers' Perspective. Adv Pharmacol Pharm Sci. 2020;2020:5415290. DOI: https://doi.org/10.1155/2020/5415290
Mehralian G, Rangchian M. Investigation on barriers to pharmaceutical care in community pharmacies: a structural equation model. Int J Clin Pharm. 2014;36:1087-94. DOI: https://doi.org/10.1007/s11096-014-9998-6
Ghazal RM, Nageeb P, Galil A, Ghaleb O, Ahdab A, Saliem II. Barriers to the implementation of Pharmaceutical Care into the UAE Barriers to the implementation of Pharmaceutical Care into the UAE community pharmacies. IOSR J Pharm. 2014;4:5.
Onozato T, Pereira M, Dosea AS, Arau EM. Perceived barriers to the implementation of clinical pharmacy services in a metropolis in Northeast Brazil. PLoS One. 2018;13(10):1-14. DOI: https://doi.org/10.1371/journal.pone.0206115
Vinterflod C, Gustafsson M, Mattsson S, Gallego G. Physicians’ perspectives on clinical pharmacy services in Northern Sweden: a qualitative study. BMC Health Serv Res. 2018;18(35):1-9. DOI: https://doi.org/10.1186/s12913-018-2841-3
Somers A, Paepe P De, Maele G Van. Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital. Dove Press J. 2013;8:703-9. DOI: https://doi.org/10.2147/CIA.S42162
Sánchez M, Mercedes A De. The opportunities and challenges to introduce pharmaceutical care in Cuba. African J Pharm Pharmacol. 2013;7(20):1236-41. DOI: https://doi.org/10.5897/AJPP12.1511
Okonta JM, Okonta E. Barriers to Implementation of Pharmaceutical Care by. J Basic Clin Pharm. 2012;3(2):295-8. DOI: https://doi.org/10.4103/0976-0105.103823
Mmuo C, Adibe MO. Challenges in the Practice of Pharmaceutical Care in National Orthopaedic Hospital Enugu (Nohe). Int J Pharm Sci. 2013;3(3):207-12.
Ezenduka CC, Soni JS, Oparah AC. Limitations to the dynamics of pharmaceutical care practice among community pharmacists in Enugu urban, southeast Nigeria. Integr Pharm Res Pract. 2015;4:49-55. DOI: https://doi.org/10.2147/IPRP.S82911
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