Counseling Practices of Pharmacists at Medical Stores/Pharmacies in Karachi Pakistan

Introduction: Dispensing medicines means delivering complete knowledge about the medicine being dispensed to that patient. Patient’s counseling regarding their medications play a very important role to achieve the high efficacy and proper constancy on therapy. The aim of the study was to evaluate the counseling practices of pharmacist from customers’ perspective. Methodology: This was a descriptive cross sectional study, conducted among who were selected at random at pharmacies/ medical stores, while purchasing medications for them and/or for their loved ones. The study finally included 365 patients or attendants of the patients. The data obtained were analyzed using appropriate statistical analysis through SPPS version 25. Results: 289 (81.37%) patients were counseled when they purchased antibiotics about the Original Research Article completion of the therapy and to take the doses timely. Only 4 patients were told about missing a dose. Conclusion: There were different results of candidates majority of them were satisfied with on-going pharmacy service but some were not. Candidates also told about the lack of information given by the health care professional /pharmacist prior to dispensing.


INTRODUCTION
Dispensing medicines do not mean giving medicines only, but it includes delivering complete knowledge about the medicine being dispensed to that patient. Research has shown that the majority of the patients don't have knowledge regarding the use of their medication. As seen in Pakistan, where practically half of the nation is uneducated, unawareness and lack of proper patient counseling leads to the failure of positive treatment. Diagnosis and prescribing medicines is the job performed by doctors/physicians only however the majority of them do not consider counseling of patients as a part of their job. So the role of Pharmacists become more significant in such cases. Although, pharmacists are basic units of healthcare system. Unfortunately, their role in Pakistan is found to be very limited. Dispensing of medications gives pharmacists and their employees the chance to converse the medications with patients and consequently play a part, "to the treatment of individuals in order to enhance use of medicines and enhance health outcomes" [1,2].
Proper drug dispensing and counseling is a key component of pharmacy practice. The final link between the patient and medications are pharmacist. A good relationship between pharmacist and patient indicates good outcomes of medication on basis of rational drug use. Pharmacist should also educate patients regarding the name of medication, its frequency, side-effects, duration of treatment, drug food interactions, and drug -drug interactions. A good patient counseling by pharmacists also prevent the chance of adverse drug effects, therapy complications and also improve cost-effective therapy. It also increases patients' satisfaction with the treatment they are getting that eventually help patient to reach their target drug therapy and get maximum therapeutic outcomes [3].
Patient's counseling regarding their medications play a very important role to achieve the high efficacy and proper constancy on therapy. Proper counseling while dispensing antibiotics is essential as they require a full completion of its course of therapy to achieve maximum outcomes otherwise the infection may revert back and it also increases antibiotic resistance [4,5]. Non adherence to the therapy a patient is getting may reduce pharmacotherapy outcomes [6]. Proper counseling of medication regimen increases adherence to the therapy as well as adherence play a great role in managing chronic diseases [7,8,9]. Therapeutic failure and adverse drug reaction occur due to non-compliance of patient to drug therapy. This is part of health care services especially professionals of pharmacy to counsel the patients and improve patients knowledge about medications [10] as proper counseling can increase patient compliance towards the therapy they are receiving [11].
It has been seen that it is possible for the pharmacists to identify and resolve drug related problems conveniently through patient counseling. Patient counseling also motivate the patients to comply with the drug therapy and increase their satisfaction level with pharmaceutical care [12]. Regardless of counseling being so important and beneficial to the society and heath care system and pharmacist having a vast knowledge of medicines, it has been seen all over the world that the patients, the caregivers or the customers that are purchasing the medicines from the pharmacies have least interest in being counseled [13]. The aim of the study was to evaluate the counseling practices of pharmacist from customers' perspective.

METHODOLOGY
This was a descriptive cross sectional study, conducted among who were selected at random at pharmacies/ medical stores, while purchasing medications for themselves and/or for their patients. A self-administered questionnaire was developed and validated after a pilot study among 20 eligible customers. The questionnaire was also peer reviewed and was validated by the team of experts and was proven to consist of satisfied content rationality. Cronbach alpha was calculated as 0.83. After modifications, the final questionnaire was comprised of 15 questions, out of which 2 questions were from demographics, 5 questions were related to the counseling service rendered by the pharmacists at medical stores/ community pharmacies, at the time of purchasing of medicines and the remaining questions were based on the evaluation of various components of counseling process satisfaction pattern using Likert Scale. The study was conducted from December 2020 to January 2021. The sample size for the study was 345 calculated from online source; Open Epi at 95% confidence level. For the safe side 365 participants from 40 pharmacies/ medical stores were included in this study. The data obtained were analyzed using appropriate statistical analysis through SPPS version 25.

RESULTS AND DISCUSSION
The pre validated self-administered questionnaire were received from 400 patients out of which 28 questionnaires were incomplete and 7 were from the age below 18 thus excluded from the study. The study finally included 365 patients or attendants of the patients. Table 1 shows that amongst the participants, majority were males (57.26%) and 61.87% of the participants were from age group of 41-50 years. It is also exhibited that out of 365 patients 297 patients were told about when to take the medicine. 289 (81.37%) patients were counseled when they purchased antibiotics about the completion of the therapy and to take the doses timely. 20.3% patients did not ask any medical

CONCLUSION
The basic aim of this survey was to evaluate the patients' perception regarding practices of pharmacists at community pharmacies/ medical stores. The results showed that majority of the participants were satisfied with on-going pharmacy services but in some cases the results were different and vice versa. Candidates also told about the lack of information given by the health care professional /pharmacist prior to dispensing, they were not informed properly about the indication about the medicines to patients and also lacking to counsel them properly. As majority of candidates were satisfied with Medicine retail outlet services so it is now duty of health care professional to satisfy all the minor problems of consumers too because the core of health care is what input they are putting and what patient is receiving.

CONSENT AND ETHICAL APPROVAL
The study was approved by Ethics Review Committee (ERC) of Ziauddin University and Dr. Ziauddin Hospital with protocol no. 1970220NSPHA. Informed consent was obtained prior to the administration of questionnaire. Participants were also assured about the confidentiality of their identity.