Public Health
(1992), 106,231-237
© The Society of Public Health, 1992
The Role of Pharmacists in Patients" Education on Medication A. M. Alkhawajah, BPharm, PhD and A. E. Eferakeya, MD, PhD Department of Pharmacology, College of Medicine, Dammam, Saudi Arabia
The pharmacist, as the last health professional to come into contact with the patient, plays a vital role in patient education on drug use. The objective of this study was to assess the extent of pharmacists' involvement in the education of patients on drug use. Five hundred patients were interviewed. The findings indicated that both physicians and pharmacists explained the use of medication; however, pharmacists (20%) were much clearer in their instructions than physicians (11%). Ninety percent of patients who needed more information on their medicines, besides its frequency of use, did not receive it. Patients were not told about drug adverse reactions (100%), storage conditions (93%), important precautions (91%), drug-food interaction (90%) and preparation of suspensions (64%). Fifty-one respondents had in the past made mistakes in the use of their medications, and in 16% this resulted in serious consequences. Ninety-three prescriptions contained drug-drug interactions, and 97% of these were dispensed unnoticed. Of the patients interviewed, 72% were satisfied with the role of pharmacists in disseminating drug information, 67% would get a refill from them without going to their physicians, and 52% had consulted them for OTC medications. It is concluded that, although there are some deficiencies, pharmacists are providing information on drug usage and patients have confidence in them. They should, therefore, acquire the proper training and communication skills to enable them to provide this service more effectively.
Introduction
The n e e d to p r o v i d e the patient with clear and c o m p l e t e information on the n a m e o f a drug, f r e q u e n c y o f administration, i m p o r t a n t side effects, the types o f f o o d and activities to avoid while taking a drug and labelling have recently b e c o m e a subject d e m a n d i n g awareness. 1-13 L a c k of p r o p e r and clear information on drugs to the patient m a y result in therapeutic failures, 8,9 e c o n o m i c waste and detrimental effects to the patient. 9 I n d e e d patients have ingested a nitroglycerin transdermal patch, 1 and dermatological medications m e a n t for topical application 3 mainly because o f i m p r o p e r and incomplete instructions. While there are data concerning the m a g n i t a d e o f lack o f clear information given on drugs to patients in d e v e l o p e d countries, such data are scanty or even absent in developing countries. If i n f o r m a t i o n on drugs to patients poses a p r o b l e m in d e v e l o p e d countries 12,13 the situation could be chaotic in developing countries w h e r e the level o f e d u c a t i o n is generally lower. T h u s the objective o f this study was to find out the extent to which pharmacists e d u c a t e patients on medications in Saudi A r a b i a .
Correspondence and reprint requests to A. M. Alkhawajah, Department of Pharmacology, College of Medicine, PO Box 2114, Dammam-31451, Saudi Arabia.
A. M. Alkhawajah and A. E. Eferakeya
232
Material and Methods
The study was carried out in the Eastern Province of Saudi Arabia. The Eastern Province has a population of about 1.56 million, 11 Government hospitals and 95 community pharmacy shops. Information was collected through a questionnaire which comprised two parts: the first part was structured to collect demographic information about the pharmacist and the patient; the second part was designed to elicit the extent of the pharmacists' involvement in patient drug education (dissemination of information on how to take prescribed drugs, their side effects, drug-drug interaction, drug-food interactions and instructions on preparation of drug suspensions). The questionnaire was administered by direct interview with the patients just after their medications had been dispensed. Two trained personnel were involved: one monitored the interactions between the pharmacist and the patient and the other administered the questionnaire. The hospitals or pharmacies were randomly selected so as to cover all areas of the Province. An incidental sample of 500 patients from five Government hospitals and 42 community pharmacies was used. Results
The role of the pharmacist in patients' drug education was assessed in 500 patients, 94% (468) of whom were Saudi citizens (Table I). The distribution of the level of education of the patients is shown in Table I; a significant number (432) could read and understand written drug instructions in Arabic. Of the 500 patients interviewed, 83 (17%) had their drugs dispensed in Government hospitals and 418 (83%) from community pharmacies. The 47 pharmacies that were involved in the study were operated by 257 technical personnel, 94% of whom were qualified pharmacists. Most of the pharmacists (98%) spoke both English and Arabic, thus information was given TableI Demographic profile Variable 1. Patients: Age (years) Nationality: Saudi Non-Saudi Level of Education: Illiterate Sixth grade or less Higher than sixth grade 2, Pharmacists: Languages spoken: Arabic only English only Both Qualification: BPharm Pharm. Assistant
No.
%
500 Range 18-57 468 32
94 6
68 190 242 257
14 38 48
2 3 252
0.8 1 98
242 15
94 6
Role o f Pharmacists in Education on Medication
233
directly to the patients and illiteracy (14% of the cases) did not constitute a problem as pharmacists used drawn symbols as well as spoken Arabic language when necessary (Table I). The study showed that both physicians and pharmacists explained the use of medication to all patients (Table II). As to the clarity of explanation on drug usage, 69% of the patients agreed that pharmacists and physicians were equally clear, while 11% thought that physicians were much clearer than pharmacists. On the other hand, 20% felt pharmacists were much clearer than physicians. The methods of explanation were: written (14%), verbal (1%) or both (85%) (Table II). Patients felt that the pharmacists could counsel better if pharmacies were less crowded. Two hundred and ninety (58%) patients said they would consult the pharmacist if they forgot the instructions on how to take their medications, while the remaining 210 (42%) would prefer to contact the physician. Those who would contact pharmacists would do so because of easy communication 142 (49%) and accessibility 136 (47%). On the other hand, 206 (98%) patients who would consult physicians felt that they know much more about medications than pharmacists. Of the 200 patients who needed prescription refill, 134 (67%) would get this from pharmacies without the need to consult physicians. Two hundred and sixty (52%) patients would consult pharmacists for over-the-counter (OTC) medications. Four hundred and fifteen (83%) patients would not bother to ensure, from their doctors, the authenticity of the medicine they bought. However, 385 (77%) would consult their physicians should side effects occur. It was found that in 99% of the cases verbal and label instructions conformed with what was written in the prescriptions (Table II). Furthermore, most of the drugs dispensed (89%) were those prescribed. However, there were 55 cases of substitution as a result of non-availability in the market (23 cases) or in the dispensing pharmacies (32 cases). In 46 cases, substituted drugs had the same generic names while nine had the same therapeutic effect. Pharmacists consulted prescribing physicians in only 13 (24%) of the substitution cases. Patients were not given any additional instructions about their medications apart from how the drug should be taken (Tables II and Ill). Most patients were not given information on drug adverse reactions, storage conditions, certain important precautions such as not driving after taking drugs that induce sedation, drug interaction with food and preparation of suspension from powdered formulation (Table III). Interestingly enough, 27% of the 205 patients who needed to prepare suspensions from solid forms made mistakes when they were asked to describe how to do it. Of the 51 patients who had previously made mistakes in the use of their medications, 16% had resulted in serious consequences necessitating hospital admission. There were also 93 prescriptions containing drug-drug interactions, of which 90 cases were dispensed unnoticed. The pharmacists spent an average of 2.33 minutes (0.5 to 4.0 min.) with the patients to inform them about their medications. As expected, patients understood better, knew more about their medications and had more confidence in the pharmacists when three minutes were spent with them than when the duration was shorter (Tables IV and V). The study revealed that in addition to frequency of administration, all the patients interviewed would like to know more about their medicines. Seventy-two percent of patients were generally satisfied with the way pharmacists educate patients on drug use and 54% felt that they are the right people to perform that function (Table II).
234
A. M. Alkhawa]ah and A. E. Eferakeya Table II
Distribution of some of the survey findings
Item The person who explained medicine use Pharmacist Physician Both Clarity of instructions Pharmacists clearer Physicians clearer Both equally clear Methods of provision of instruction Written Verbal Both Agreement between patients' instruction and prescription orders Agreed Did not agree Conformity between dispensed and prescribed drug Conformed Did not conform Additional instructions besides the frequency of administration Provided Not provided Patients' previous mistakes in the use of medicine Yes No Motivation of patients to have more information about their medications Motivated Not motivated Patients' satisfaction about the way the pharmacists educate the patients in medicine use Satisfied Not satisfied No opinion Opinion of patient regarding who should explain medicine use Pharmacist Physician Do not know
No.
%
0 0 500
0 0 100
98 55 347
20 11 69
70 5 425
14 1 85
495 5
99 1
445 55
89 11
50 450
10 90
51 449
10 90
500 0
100 0
360 50 90
72 10 18
270 205 25
54 41 5
Discussion and Conclusion It is just as i m p o r t a n t to p r o v i d e a p a t i e n t with c o m p l e t e a n d c l e a r i n f o r m a t i o n o n drugs in a l a n g u a g e t h e p a t i e n t u n d e r s t a n d s , as it is to p r o v i d e the d r u g itself. A p h a r m a c y is no l o n g e r c o n s i d e r e d s i m p l y a p l a c e w h e r e a p a t i e n t g o e s to get m e d i c i n e s to cure his illness. It is also a c e n t r e for i n f o r m a t i o n o n m e d i c i n e s as well as a h e a l t h service. P h a r m a c i s t s a r e a m o n g t h e m o s t easily accessible h e a l t h c a r e p r o f e s s i o n a l s , a n d since t h e y are the last p e r s o n s in t h e h e a l t h c a r e t e a m to c o m e into c o n t a c t with p a t i e n t s t h e y s h o u l d p l a y a vital r o l e in t h e e d u c a t i o n o f p a t i e n t s o n d r u g use.
Role o f Pharmacists in Education on Medication Table l l I
235
Distribution of patients where pharmacists did/did not give information to the patient Yes
Item Side effects: causes gastric irritation or dizziness, etc. Storage condition Precautions: causes sleep, do not drive, etc. Interaction with food Preparation of suspensions
No
Total*
No.
(%)
No.
(%)
0
(0)
500
(100)
500
10 15 17 74
(7) (9) (10) (36)
135 148 151 131
(93) (91) (90) (64)
145 163 168 205
Yes = information was given. No = information was not given. *Total number of cases in which patient needed to be given information.
Table IV
Influence of length of time* on patient's understanding of medication instructions and confidence in the pharmacist N u m b e r of respondents 1 minute
Questions Did you understand the pharmacist's instructions? D o you k n o w how to mix your medicine? H a v e you e v e r consulted the pharmacist for O T C drugs? A r e you satisfied with the pharmacist's explanation of the use of drugs?
3 minutes
Yes
No
Yes
No
90 23 53
10 30 48
163 103 85
13 10 90
48
13
153
3
*Time pharmacist spent with patient.
TableV
Influence of length of time pharmacist spent with patients on patient's reliance on pharmacist's service Number of respondents 1 minute
Questions If you noticed side effects who would you consult? In your opinion who should explain the use of drugs? Who do you consult when you forget your drug instruction? Who do you go to first when you need a refill? Pharm = Pharmacist; Phys = Physician.
3 minutes
Phys.
Pharm.
Phys.
Pharm.
95 48 68 35
5 53 33 65
140 80 70 70
35 95 105 105
236
A. M. Alkhawajah and A. E. Eferakeya
The results of this study indicate that patients received information concerning their drug regimen from both physicians and pharmacists. However, the explanation by the pharmacist was much clearer to the patient. The reasons for this are probably because the pharmacists had the time and the patients also had more access to pharmacists for clarification. However, the average time the pharmacists spent with the patient to explain their medication use was only 2.33 rain. Some patients were not too happy about the length of time spent with them as they were more satisfied when the pharmacist spent longer explaining the use of their medications. It is also evident from the findings of this study that patients were not receiving complete information on their medicines, since in 90% of the cases in which patients needed to be given more information on their medicines, besides the frequency of administration, they did not receive it. It is uncertain why the pharmacists did not provide complete information. As indicated above, lack of time might be one of the reasons. Additionally, lack of motivation or technical knowledge could have also contributed; however, these factors were not evaluated in this study. These findings agree with a recent F D A report in which 70% of patients in the USA said that neither physicians nor pharmacists informed them about precautions and side effects of their medications. 12,13 The necessity for patients to get complete information concerning their medication cannot be overemphasized, as some patients have mistakenly swallowed transdermal drug patches and topical medications.l,3 In the current study, 27% who were not told how a suspension is prepared from the powdered medication made mistakes in describing how to do so. In addition, 10% had in the past made mistakes in the use of medications with detrimental consequences. The study also indicated that all of our patients were eager to learn more about their medications. This is in contrast to the study from the USA where 96% of patients were not motivated to ask questions about their medications, t2'13 The patients here seem to have confidence in their pharmacists as 72% of them were satisfied about the role of the pharmacist in disseminating drug information. Furthermore, they had consulted the pharmacist for O T C medications and felt the pharmacist to be the one who should educate patients on drug-related matters. In conclusion, patient education on medications is an area of service that needs revamping and there is an increasing need for this service. This study has pointed out some deficiencies in the field of providing and explaining drug instructions. There is no doubt that pharmacists, with their scientific and professional background as well as their location, are well placed to disseminate information on medicines. They should therefore acquire the proper training and communication skills to enable them play that role more actively.
Acknowledgements The authors would like to thank Dr E. B. Larbi of the Department of Pharmacology, for reviewing the manuscript and for his valuable comments. Thanks also to Mr A. Al-Ali and Mr S. Toni for their help in the administration of the questionnaire, and to Mr S. Haq for secretarial help.
References 1. Bakris, G. (1988). It may seem obvious to you: giving medication instructions to patients. Journal of the American Medical Association, 260(9), 1243.
Role of Pharmacists in Education on Medication
237
2. Hermann, F. (1973). The out patient prescription label as a source of medication errors. American Journal of Hospital Pharmacology, 30, 155-159. 3. Huntley, A. C. (1984). Oral ingestion of potassium permanganate or aluminum acetate in two patients. Archives of Dermatology, 120, 1363-1365. 4. Linkewich, J. A., Catalano, R. B. & Flack, H. L. (1974). The effect of packaging and instruction on outpatient compliance with medication regimen. Drug Intelligence and Clinical Pharmacy, 8, 10-15. 5. MacDermott, G. M. (1988). It may seem obvious to you: giving medication instructions to patients (letter to the editor). Journal of the American Medical Association, 260(9), 1243-1244. 6. Macdonald, E. T., Macdonald, J. B. & Phoenix, M. (1977). Improving drug compliance after hospital discharge. British Medical Journal, 2, 618-621. 7. Malahy, B. (1966). The effect of instruction and labelling on the number of medication errors made by patients at home. American Journal of Hospital Pharmacology, 23, 283-292. 8. Michaux, M. W. (1961). Side effects, resistance and dosage deviations in psychiatric outpatients treated with tranquilizers. Journal of Nervous and Mental Disease, 133, 203-212. 9. Stewart, R. B. & Cluff, I. E. (1972). A review of medication errors and compliance in ambulant patients. Clinical Pharmacology and Therapeutics, 13,463-468. 10. Wandless, I. & Davie, J. W. (1977). Can drug compliance in the elderly be improved? British Medical Journal, l, 359-361. 11. Witkowski, J. (1988). Compliance: The dermatologic patient, bTternational Journal of Dermatology, 27(9), 608-611. 12. World Health Organization. (1987). Essential Drugs Monitor, No. 5, p. 8. 13. World Health Organization. (1988). Essential Drugs Monitor, No. 6, p. 15.
(1992), 106,231-237
© The Society of Public Health, 1992
The Role of Pharmacists in Patients" Education on Medication A. M. Alkhawajah, BPharm, PhD and A. E. Eferakeya, MD, PhD Department of Pharmacology, College of Medicine, Dammam, Saudi Arabia
The pharmacist, as the last health professional to come into contact with the patient, plays a vital role in patient education on drug use. The objective of this study was to assess the extent of pharmacists' involvement in the education of patients on drug use. Five hundred patients were interviewed. The findings indicated that both physicians and pharmacists explained the use of medication; however, pharmacists (20%) were much clearer in their instructions than physicians (11%). Ninety percent of patients who needed more information on their medicines, besides its frequency of use, did not receive it. Patients were not told about drug adverse reactions (100%), storage conditions (93%), important precautions (91%), drug-food interaction (90%) and preparation of suspensions (64%). Fifty-one respondents had in the past made mistakes in the use of their medications, and in 16% this resulted in serious consequences. Ninety-three prescriptions contained drug-drug interactions, and 97% of these were dispensed unnoticed. Of the patients interviewed, 72% were satisfied with the role of pharmacists in disseminating drug information, 67% would get a refill from them without going to their physicians, and 52% had consulted them for OTC medications. It is concluded that, although there are some deficiencies, pharmacists are providing information on drug usage and patients have confidence in them. They should, therefore, acquire the proper training and communication skills to enable them to provide this service more effectively.
Introduction
The n e e d to p r o v i d e the patient with clear and c o m p l e t e information on the n a m e o f a drug, f r e q u e n c y o f administration, i m p o r t a n t side effects, the types o f f o o d and activities to avoid while taking a drug and labelling have recently b e c o m e a subject d e m a n d i n g awareness. 1-13 L a c k of p r o p e r and clear information on drugs to the patient m a y result in therapeutic failures, 8,9 e c o n o m i c waste and detrimental effects to the patient. 9 I n d e e d patients have ingested a nitroglycerin transdermal patch, 1 and dermatological medications m e a n t for topical application 3 mainly because o f i m p r o p e r and incomplete instructions. While there are data concerning the m a g n i t a d e o f lack o f clear information given on drugs to patients in d e v e l o p e d countries, such data are scanty or even absent in developing countries. If i n f o r m a t i o n on drugs to patients poses a p r o b l e m in d e v e l o p e d countries 12,13 the situation could be chaotic in developing countries w h e r e the level o f e d u c a t i o n is generally lower. T h u s the objective o f this study was to find out the extent to which pharmacists e d u c a t e patients on medications in Saudi A r a b i a .
Correspondence and reprint requests to A. M. Alkhawajah, Department of Pharmacology, College of Medicine, PO Box 2114, Dammam-31451, Saudi Arabia.
A. M. Alkhawajah and A. E. Eferakeya
232
Material and Methods
The study was carried out in the Eastern Province of Saudi Arabia. The Eastern Province has a population of about 1.56 million, 11 Government hospitals and 95 community pharmacy shops. Information was collected through a questionnaire which comprised two parts: the first part was structured to collect demographic information about the pharmacist and the patient; the second part was designed to elicit the extent of the pharmacists' involvement in patient drug education (dissemination of information on how to take prescribed drugs, their side effects, drug-drug interaction, drug-food interactions and instructions on preparation of drug suspensions). The questionnaire was administered by direct interview with the patients just after their medications had been dispensed. Two trained personnel were involved: one monitored the interactions between the pharmacist and the patient and the other administered the questionnaire. The hospitals or pharmacies were randomly selected so as to cover all areas of the Province. An incidental sample of 500 patients from five Government hospitals and 42 community pharmacies was used. Results
The role of the pharmacist in patients' drug education was assessed in 500 patients, 94% (468) of whom were Saudi citizens (Table I). The distribution of the level of education of the patients is shown in Table I; a significant number (432) could read and understand written drug instructions in Arabic. Of the 500 patients interviewed, 83 (17%) had their drugs dispensed in Government hospitals and 418 (83%) from community pharmacies. The 47 pharmacies that were involved in the study were operated by 257 technical personnel, 94% of whom were qualified pharmacists. Most of the pharmacists (98%) spoke both English and Arabic, thus information was given TableI Demographic profile Variable 1. Patients: Age (years) Nationality: Saudi Non-Saudi Level of Education: Illiterate Sixth grade or less Higher than sixth grade 2, Pharmacists: Languages spoken: Arabic only English only Both Qualification: BPharm Pharm. Assistant
No.
%
500 Range 18-57 468 32
94 6
68 190 242 257
14 38 48
2 3 252
0.8 1 98
242 15
94 6
Role o f Pharmacists in Education on Medication
233
directly to the patients and illiteracy (14% of the cases) did not constitute a problem as pharmacists used drawn symbols as well as spoken Arabic language when necessary (Table I). The study showed that both physicians and pharmacists explained the use of medication to all patients (Table II). As to the clarity of explanation on drug usage, 69% of the patients agreed that pharmacists and physicians were equally clear, while 11% thought that physicians were much clearer than pharmacists. On the other hand, 20% felt pharmacists were much clearer than physicians. The methods of explanation were: written (14%), verbal (1%) or both (85%) (Table II). Patients felt that the pharmacists could counsel better if pharmacies were less crowded. Two hundred and ninety (58%) patients said they would consult the pharmacist if they forgot the instructions on how to take their medications, while the remaining 210 (42%) would prefer to contact the physician. Those who would contact pharmacists would do so because of easy communication 142 (49%) and accessibility 136 (47%). On the other hand, 206 (98%) patients who would consult physicians felt that they know much more about medications than pharmacists. Of the 200 patients who needed prescription refill, 134 (67%) would get this from pharmacies without the need to consult physicians. Two hundred and sixty (52%) patients would consult pharmacists for over-the-counter (OTC) medications. Four hundred and fifteen (83%) patients would not bother to ensure, from their doctors, the authenticity of the medicine they bought. However, 385 (77%) would consult their physicians should side effects occur. It was found that in 99% of the cases verbal and label instructions conformed with what was written in the prescriptions (Table II). Furthermore, most of the drugs dispensed (89%) were those prescribed. However, there were 55 cases of substitution as a result of non-availability in the market (23 cases) or in the dispensing pharmacies (32 cases). In 46 cases, substituted drugs had the same generic names while nine had the same therapeutic effect. Pharmacists consulted prescribing physicians in only 13 (24%) of the substitution cases. Patients were not given any additional instructions about their medications apart from how the drug should be taken (Tables II and Ill). Most patients were not given information on drug adverse reactions, storage conditions, certain important precautions such as not driving after taking drugs that induce sedation, drug interaction with food and preparation of suspension from powdered formulation (Table III). Interestingly enough, 27% of the 205 patients who needed to prepare suspensions from solid forms made mistakes when they were asked to describe how to do it. Of the 51 patients who had previously made mistakes in the use of their medications, 16% had resulted in serious consequences necessitating hospital admission. There were also 93 prescriptions containing drug-drug interactions, of which 90 cases were dispensed unnoticed. The pharmacists spent an average of 2.33 minutes (0.5 to 4.0 min.) with the patients to inform them about their medications. As expected, patients understood better, knew more about their medications and had more confidence in the pharmacists when three minutes were spent with them than when the duration was shorter (Tables IV and V). The study revealed that in addition to frequency of administration, all the patients interviewed would like to know more about their medicines. Seventy-two percent of patients were generally satisfied with the way pharmacists educate patients on drug use and 54% felt that they are the right people to perform that function (Table II).
234
A. M. Alkhawa]ah and A. E. Eferakeya Table II
Distribution of some of the survey findings
Item The person who explained medicine use Pharmacist Physician Both Clarity of instructions Pharmacists clearer Physicians clearer Both equally clear Methods of provision of instruction Written Verbal Both Agreement between patients' instruction and prescription orders Agreed Did not agree Conformity between dispensed and prescribed drug Conformed Did not conform Additional instructions besides the frequency of administration Provided Not provided Patients' previous mistakes in the use of medicine Yes No Motivation of patients to have more information about their medications Motivated Not motivated Patients' satisfaction about the way the pharmacists educate the patients in medicine use Satisfied Not satisfied No opinion Opinion of patient regarding who should explain medicine use Pharmacist Physician Do not know
No.
%
0 0 500
0 0 100
98 55 347
20 11 69
70 5 425
14 1 85
495 5
99 1
445 55
89 11
50 450
10 90
51 449
10 90
500 0
100 0
360 50 90
72 10 18
270 205 25
54 41 5
Discussion and Conclusion It is just as i m p o r t a n t to p r o v i d e a p a t i e n t with c o m p l e t e a n d c l e a r i n f o r m a t i o n o n drugs in a l a n g u a g e t h e p a t i e n t u n d e r s t a n d s , as it is to p r o v i d e the d r u g itself. A p h a r m a c y is no l o n g e r c o n s i d e r e d s i m p l y a p l a c e w h e r e a p a t i e n t g o e s to get m e d i c i n e s to cure his illness. It is also a c e n t r e for i n f o r m a t i o n o n m e d i c i n e s as well as a h e a l t h service. P h a r m a c i s t s a r e a m o n g t h e m o s t easily accessible h e a l t h c a r e p r o f e s s i o n a l s , a n d since t h e y are the last p e r s o n s in t h e h e a l t h c a r e t e a m to c o m e into c o n t a c t with p a t i e n t s t h e y s h o u l d p l a y a vital r o l e in t h e e d u c a t i o n o f p a t i e n t s o n d r u g use.
Role o f Pharmacists in Education on Medication Table l l I
235
Distribution of patients where pharmacists did/did not give information to the patient Yes
Item Side effects: causes gastric irritation or dizziness, etc. Storage condition Precautions: causes sleep, do not drive, etc. Interaction with food Preparation of suspensions
No
Total*
No.
(%)
No.
(%)
0
(0)
500
(100)
500
10 15 17 74
(7) (9) (10) (36)
135 148 151 131
(93) (91) (90) (64)
145 163 168 205
Yes = information was given. No = information was not given. *Total number of cases in which patient needed to be given information.
Table IV
Influence of length of time* on patient's understanding of medication instructions and confidence in the pharmacist N u m b e r of respondents 1 minute
Questions Did you understand the pharmacist's instructions? D o you k n o w how to mix your medicine? H a v e you e v e r consulted the pharmacist for O T C drugs? A r e you satisfied with the pharmacist's explanation of the use of drugs?
3 minutes
Yes
No
Yes
No
90 23 53
10 30 48
163 103 85
13 10 90
48
13
153
3
*Time pharmacist spent with patient.
TableV
Influence of length of time pharmacist spent with patients on patient's reliance on pharmacist's service Number of respondents 1 minute
Questions If you noticed side effects who would you consult? In your opinion who should explain the use of drugs? Who do you consult when you forget your drug instruction? Who do you go to first when you need a refill? Pharm = Pharmacist; Phys = Physician.
3 minutes
Phys.
Pharm.
Phys.
Pharm.
95 48 68 35
5 53 33 65
140 80 70 70
35 95 105 105
236
A. M. Alkhawajah and A. E. Eferakeya
The results of this study indicate that patients received information concerning their drug regimen from both physicians and pharmacists. However, the explanation by the pharmacist was much clearer to the patient. The reasons for this are probably because the pharmacists had the time and the patients also had more access to pharmacists for clarification. However, the average time the pharmacists spent with the patient to explain their medication use was only 2.33 rain. Some patients were not too happy about the length of time spent with them as they were more satisfied when the pharmacist spent longer explaining the use of their medications. It is also evident from the findings of this study that patients were not receiving complete information on their medicines, since in 90% of the cases in which patients needed to be given more information on their medicines, besides the frequency of administration, they did not receive it. It is uncertain why the pharmacists did not provide complete information. As indicated above, lack of time might be one of the reasons. Additionally, lack of motivation or technical knowledge could have also contributed; however, these factors were not evaluated in this study. These findings agree with a recent F D A report in which 70% of patients in the USA said that neither physicians nor pharmacists informed them about precautions and side effects of their medications. 12,13 The necessity for patients to get complete information concerning their medication cannot be overemphasized, as some patients have mistakenly swallowed transdermal drug patches and topical medications.l,3 In the current study, 27% who were not told how a suspension is prepared from the powdered medication made mistakes in describing how to do so. In addition, 10% had in the past made mistakes in the use of medications with detrimental consequences. The study also indicated that all of our patients were eager to learn more about their medications. This is in contrast to the study from the USA where 96% of patients were not motivated to ask questions about their medications, t2'13 The patients here seem to have confidence in their pharmacists as 72% of them were satisfied about the role of the pharmacist in disseminating drug information. Furthermore, they had consulted the pharmacist for O T C medications and felt the pharmacist to be the one who should educate patients on drug-related matters. In conclusion, patient education on medications is an area of service that needs revamping and there is an increasing need for this service. This study has pointed out some deficiencies in the field of providing and explaining drug instructions. There is no doubt that pharmacists, with their scientific and professional background as well as their location, are well placed to disseminate information on medicines. They should therefore acquire the proper training and communication skills to enable them play that role more actively.
Acknowledgements The authors would like to thank Dr E. B. Larbi of the Department of Pharmacology, for reviewing the manuscript and for his valuable comments. Thanks also to Mr A. Al-Ali and Mr S. Toni for their help in the administration of the questionnaire, and to Mr S. Haq for secretarial help.
References 1. Bakris, G. (1988). It may seem obvious to you: giving medication instructions to patients. Journal of the American Medical Association, 260(9), 1243.
Role of Pharmacists in Education on Medication
237
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