Posted at 03.10.2018
In Bangladesh, a relatively small Southern Asian country, the pharmacy vocation has been in existence for the last 4 ages. However, the profession is still protecting the status quo to support pharmaceutical industries. Until now the dispensing and patient attention tasks of Bachelor of Pharmacy (BPharm) graduate (A-grade) pharmacists have been non-existent in the medical system of Bangladesh1. In clinic pharmacy adjustments, B-grade diploma pharmacists dispense, procure, and distribute medicines. A C-grade pharmacist with a 3-month pharmacy qualification following a secondary college diploma can own and run a retail pharmacy and dispense medications. 2
Pharmacy education in Bangladesh has been traditionally industry structured with 95% of the entry-level BPharm curriculum focusing on pharmaceutical technology and industry-based classes, creating pharmacists with experience in the areas of pharmaceutical production, quality control and guarantee, pharmaceutical marketing, and regulatory affairs. With the global upsurge targeted at reforming pharmacy education, several south Asian countries including India, Nepal, and Pakistan have launched clinically-oriented PharmD programs to incorporate the pharmacist in to the medical care system. 3-7 Following the same style, pharmacy academic institutions in Bangladesh have been restructuring their curricula to include patient-care the different parts of pharmacy education including discovering the opportunity of presenting PharmD programs. 2, 8
In a recently available article, we reviewed the status of current pharmacy education and the opportunities and challenges associated with incorporating PharmD or professional medical programs in Bangladesh8. Among the major obstacles we recognized is the lack of knowledge and awareness of the value of the pharmacy occupation among health care stakeholders and the federal government. Health professionals and other health care stakeholders of the country fail to realize the important functions of pharmacists in thorough healthcare. Health professionals' reputation of the evolving pharmacy occupation and development of a pharmacist-physician professional relationship are critical to be able to combine the pharmacy career into patient attention. Studies conducted in a number of countries have shown that health professionals are receptive to pharmacists-provided dispensing as well as patient care and attention services9-11. There is certainly increasing information that pharmacists can play a role in increased and cost-effective way of patient good care and decrease in total drug-related morbidity and mortality12, 13.
As Bangladeshi pharmacy colleges are reforming their curricula to add clinical components, it is the right time to set the stage for future inter-professional collaboration. The changing face of today's medical care and increasing difficulty of drug remedy underscores the necessity for strong working human relationships between pharmacists and doctors to be able to provide best patient health care. Thus, it's important to assess the data and behaviour of physicians regarding pharmacists' jobs and responsibilities in healthcare. The aim of this study is to determine medical doctors' knowledge and perceptions of the pharmacists' assignments in patient care and pharmacy services. The survey results will help in initiating a fruitful dialogue with different stakeholders in medical care regarding the evolving changes in the pharmacy career in Bangladesh.
A survey instrument was developed by the investigators, based on past books reports9, 14, 15 of physician-pharmacist collaboration. The survey instrument was analyzed by all investigators and revisions were made on opinions. Two investigators of the study are documented pharmacists with activities in medical center and/or community pharmacy settings. Since, the research workers graduated in pharmacy from Bangladesh, they can be abreast of days gone by and present medical systems of the united states. The study received exempt position from the institutional review board of West Coastline School and Lake Erie College or university of Osteopathic Treatments. The survey collected data on 3 domains: health professionals' current knowing of pharmacy education and vocation in the united states; their perceptions into the future functions of pharmacists in patient health care and, finally, interprofessional cooperation with pharmacists. The review instrument also accumulated demographic information of the respondents including years, gender, affiliation and period of practice.
The participant doctors (n=160) were randomly preferred from Dhaka, the capital city of Bangladesh. The study was implemented by two methods: 1) electronically (n=110) and 2) distributing hardcopies of the study (n=50) by a volunteer in selected clinics and nursing homes. The online review instrument was sent through email that included a web link of the study instrument (Review Monkey). Email addresses of medical doctors were obtained from websites of federal government and private coaching clinics and professional organizations. Ninety percent of the e-mail information was gathered from 3 authorities and 10 private hospitals of Dhaka.
A resume cover letter accompanied the study which explained the purpose of the survey combined with the assurance that involvement will be voluntary and personal information will remain anonymous. Also contained in the cover letter, was information on current fads in global pharmacy education and physician-pharmacist collaborative practice to provide optimum patient care. Physicians were also prepared that medical pharmacy training are being introduced in Bangladeshi pharmacy curricula to get ready pharmacy graduates to work in specialized medical settings with medical doctors and other healthcare professionals.
The survey tool included 13 questions split into two sections: i) understanding medical professionals' knowledge of pharmacy education and profession (5 items) and ii) medical doctors' perceptions into the future roles and obligations of pharmacists in complete patient good care (8 study items). Items on the current understandingof the health professionals about the pharmacy career and education were self-reported as "yes" or "no". Items on the belief of pharmacists' future jobs in patient care and attention and interprofessional collaboration were self-reported over a five-point Likert range with 1-very uneasy to 5-very comfortable. By the end of the questionnaires, there is a section for individual comments. Data from manually distributed study were published online by one of the investigators. Results from both forearms of the survey were aggregated and analyzed. The Fisher Exact test was used to test the significance of association between the independent variables (gender and length of medical practice) and the reliant variables (respondents' level of comfort). Statistical relevance was accepted at a p value of <0. 05. At the end of the review, health professionals were asked to provide overall reviews about the expected assignments of pharmacists in patient treatment and physician-pharmacists collaborations/interactions. Text-based comments were collated and thematic examination of the content was performed.
Of the 160 questionnaires allocated, 103 participants completed the survey (response rate 67%). The demographic information for the participants are given in Table 1. Greater than two third of the members were male. More than 50% of the engaging medical doctors were under 30 years with 1-3 years of experience in medical practice. About 75% of the respondents work mainly for private clinics/ clinics and 25% in government hospitals. Interestingly, 95% of the responding medical doctors are concurrently employed in private practice.
When asked to indicate their awareness about pharmacy education and vocation, practically all the medical doctor participants (96%) are aware of pharmacy as a professional medical vocation. Seventy nine percent of the members know that pharmacy education in Bangladesh has been significantly expanded. But only 60% of the respondents knew that pharmacists obtain an A-grade certificate after successful conclusion of a 4-5 yr BPharm level program from an accredited university. The individuals recognize that pharmacists are proficient in drugs (80%) and serve as reliable resources of drug information (91%).
Responses regarding health professionals' perceptions for the anticipated patient health care jobs of pharmacists in Bangladesh and interprofessional cooperation among medical providers are shown in Desk 2. Medical doctors exhibited a high comfortableness with almost all of the tasks of pharmacists as customers of Interprofessional health care team. They felt very comfortable/comfortable with pharmacists procuring, distributing, and dispensing medications in clinic and community pharmacies (81%); providing education to patients/caregivers about the safe and appropriate use of prescription drugs (85%); and educating patients about health and fitness, nutrition, and use of OTC medications and health supplements (65%). Medical professionals are comfortable/very comfortable with pharmacists discovering and preventing prescription problems (56%), creating pharmacotherapeutic regimens (78%) and monitoring patient protection (80%) and healing outcomes at in-patient configurations (62%). Health professionals' comfort level was found to be the lowest with pharmacists recommending physicians alternative drug therapy or improved drug-therapy strategy when therapeutic results were not reasonable (comfortable/very comfortable, 51% versus unpleasant/very uneasy, 49%).
A total of 41 open-ended remarks were noted from a total of 102 respondents and were put through thematic research (Table 3). Most of the comments (26/41) shown upon positive behaviour towards pharmacists' future tasks in patient good care. Medical professionals were supportive to the pharmacists' jobs in dispensing and other professional medical pharmacy services. Several medical doctors commented on the problems of integrating pharmacists into patient care and focused on the proper training and education of pharmacists. They also commented on the value associated with an interprofessional dialogue between medical doctors and pharmacists. One or two responses pertained to the reservations of medical professionals about pharmacists' recommendations to improve prescriptions or drug therapy strategy.
Pharmacy education is innovating from it's original "product-oriented" concentrate towards an inclusive "patient-oriented" concentrate. 16, 17 In developed countries, the focus on specialized medical pharmacy education has enabled pharmacists to provide optimal patient care and attention as participants of interprofessional groups. 16 Using the advancement of pharmacy occupation, especially in the developed nations, pharmacists now provide immediate patient care as part of interprofessional team in a number of practice adjustments.
Although Bangladeshi doctors are aware of pharmacy as a medical care vocation, over 50% did not know that 4-5 many years of analysis towards BPharm level are necessary for pharmacist licensure. It is noteworthy that the amount of private colleges offering BPharm degrees is increasing in the united states. Out of 27 pharmacy schools, 22 are in the capital city. Pharmacy classes are also restructuring their curricula to include scientific pharmacy. 2, 18 The advantages of a clinically-oriented PharmD program in developing countries is a challenging undertaking3, 4 In Bangladesh, the current status of pharmacy practice and the fact that the profession is not well known among administration and other stakeholders in the healthcare area constitute major obstacles to initiation of patient-oriented specialized medical programs. Other problems associated with healthcare insurance plan, physical infrastructure, money, establishment of your construction of inter-professional collaboration, and doctors' identification of the pharmacists' roles in patient good care need to be addressed.
It is encouraging that medical doctors in Bangladesh appeared to be more comfortable with pharmacists dispensing prescription requests, detecting and stopping prescription errors, checking out undesireable effects and drug-drug relationships, and providing patient education. There exists documented evidence that the integration of pharmacists to interdisciplinary medical care teams improves health and safety benefits for patients, reduces morbidity and mortality due to medication-related problems, diminishes professional medical costs, and increases quality of treatment. 11-13, 19 In a recently available pharmacy-based controlled trial, Vinks et. al. confirmed that community pharmacists play critical tasks in minimizing the event of drug-related problems in elderly patients. 20, 21
Irrational prescribing, medication problems, and poly pharmacy have grown to be a major health problem globally. 22-25 In the same way, in Bangladesh, irrational prescribing of medications and medication problems are common in every healthcare environment. Superfluous prescribing of antimicrobials is widespread and leads to emergence of antibiotic-resistant strains and treatment failure26. In a recent study, Paul et al. have reported highly widespread prescription mistakes in a private medical center in Bangladesh. 27 Several factors such as insufficient medical professionalism28, curricular gap29 and insufficient trained in pharmacology and therapeutics30-34, competitive promotion of pharmaceutical products, and unlawful contract between doctors and pharmaceutical market sectors 35 donate to the continuing turmoil of irrational prescribing developments in the country. Furthermore, Bangladeshi professional medical delivery systems significantly suffer from problem, poor management, shortage of properly trained health professionals, and insufficient accountability36. You can find little if any technique for collecting statistics on medication errors and its prevention to ensure patient protection. Within the last decade there has been an upsurge of private hospitals including several world-class corporate clinics which, for the very first time, are emphasizing quality control, patient security standards, and level of privacy routines 36. The systemic approaches for medication management, including integration of pharmacists into health care team by the Apollo Nursing homes Dhaka, the most visible hospital in Dhaka, are noteworthy. The hospital claims that the existing rate of medication error has fallen to 2. 45%, where the US benchmark is 5%. 37It is expected that the Apollo Clinics can be a model for other clinics in the united states in the popularity of pharmacists' assignments in patient care and safe practices.
Bangladeshi medical professionals are more comfortable with upcoming pharmacists' monitoring and search engine optimization of drug therapy. This is consistent with a review study in the United Arab Emirates which revealed that the majority of participating physicians (92%) supported the scientific pharmacists' roles9. However, doctors in Qatar14, Kuwait38, Pakistan15, and Sudan39 were found to be more more comfortable with pharmacists' roles strongly linked with medication products than obligations associated with monitoring and search engine optimization of patient results or recommending medicine remedy for patients. In Montreal, Canada, a physician-pharmacist collaborative good care model exhibited better patient-care final results where pharmacists ordered diagnostic exams and optimized medication dosages. However, the notion of medical doctors was unfavorable to the success of this model as they thought unsecured and threatened by the extending tasks of pharmacists. 40
Integrating pharmacists into dispensing and clinical pharmacy services in Bangladesh will symbolize a milestone. Therefore, its about time for Bangladeshi pharmacy community to start building interprofessional connections with physicians, establishing communication channels, producing mutual admiration, and understanding each other's tasks. The results of the existing study can provide as a foundational procedure to the interprofessional relationship between pharmacists and doctors. Health professionals' perceptions and understanding of pharmacy vocation have direct implications on the current pharmacy education reform in Bangladesh. Physicians demonstrated good attitude towards future pharmacists' engagement in patient care and attention. They emphasized the perfect level of specialized medical education and training for the pharmacists to perform clinical services. Furthermore, several physicians recognized that communication and dialogue between them and pharmacists are inescapable for better patient care. In this framework, we propose curricular and non-curricular methods to develop the culture of interprofessional cooperation (Amount 1). As we've discussed inside our previous article8, Bangladeshi pharmacy educators need to revisit the curriculum to incorporate optimum didactic and experiential professional medical programs, incorporate effective communication, professionalism and reliability, and ethics into curriculum. In addition, the concept of interprofessional education and practice needs to be incorporated early in the curriculum. A number of strategies can be employed through extra-curricular activities at different levels affecting professional associations, companies, and students. At professional relationship level, a channel of communication must be developed to initiate professional dialogue. Upon establishment of communication, health professionals and pharmacists can be asked as loudspeakers in each other's professional meetings. These initiatives will offer the ability of knowing each other's experience, know-how and competence in patient care. At establishment level, collaboration between medical and pharmacy college faculties in coaching and research, and joint workshops/workshops on professional medical regions of interest increase appreciation and acknowledgement of the roles of interdisciplinary acquaintances. In addition, opportunities may be designed for arranging health fairs, workshops, seminars, and community outreach activities concerning both pharmacy and medical students. Because the government controls the major health benefits for its citizen, educating the federal government representatives about the positive influences of pharmacists on overall professional medical should be an important consideration for leaders of the vocation.
In brief summary, Bangladeshi physicians have got favorable attitudes towards accepting pharmacists in the medical arena. It is very important for pharmacy teachers and market leaders to begin a dialog with the government to be able to broaden the assignments of pharmacists, adopt relevant changes in health insurance plan, and build inter-professional healthcare groups.