ABSTRACT
The objectives of the study were to: explore Nigerian pharmacists’ attitudes towards pharmaceutical care; identify activities of community pharmacists, which are elements of pharmaceutical care in relation to hypertensive patients; conduct antihypertensive medication regimen review; assess the pattern of prescribing and the potential for drug therapy problems; assess patients’ pharmaceutical care expectations as well as the impact of demographic factors, in a university teaching hospital where pharmaceutical care does not yet exist; assess patient satisfaction with current pharmaceutical services using the “ideal referent” model, and to generate data to further evaluate the validity of the updated instrument developed by Larson et al (2002) in a Nigerian practice setting.; and describe an educational intervention designed to enable pharmacists in a Nigerian teaching hospital provide pharmaceutical care, to assess the impact of the intervention on the behavioral pharmaceutical care scale and to develop a documentation format.
The studyemployed cross-sectional observational qualitative methods. Pharmacists and patients were surveyed. Sample characteristics and interval data were gathered on a Likert-type scale. Descriptive statistics on the sample profile and survey items were computed including means, standard deviations and frequency distributions. Varimax rotation with Kaiser normalization and list-wise deletion was employed in principal factor analysis. Student’s t-test and one-way ANOVA were used in inferential statistics.
76% (n = 1005) of the pharmacists indicated willingness to embrace pharmaceutical care and 75% had positive attitudes made up of seven components. Only pharmacists’ professional experience appeared to influence attitudes (p = 0.001). Pharmacists having less experience showed more positive attitudes.
Community pharmacists reported performing some pharmaceutical care activities of patient counseling and patient follow –up evaluation but the core elements of identification of drug therapy problems and documentation were lacking.
The antihypertensive medication regimen review showed that the most frequently encountered drugs were amiloride-hydrochlorothiazide (58%), slow release nifedipine (35%), methyldopa (35%), and propranolol (14%). 40% regimens had adjunct sedative/anxiolytic. There were gender differences, (p < 0.001) for propranolol (31.3 %) in males and diuretics (88.1%) in females. Duplicate therapy with diuretics was common and drug use in the elderly and comorbid conditions did not follow guidelines of the Sixth Report of the Joint National Commission on hypertension.
Some 80 per cent of patients expected the hospital pharmacists to perform activities promoted under pharmaceutical care rubric and expectations were associated with high levels of education (p = 0.01) and low-income levels (p = 0.01).
Overall, current pharmacy services were rated 56.04 ± 24.49, below midpoint (range, 20 to 100). Satisfaction was significantly higher in “friendly explanation” than in “managing therapy” (t p< 0.0001). The educational intervention produced significant differences between pre-intervention and post-intervention self-reported knowledge (p = 0.003), attitudes (p = 0.01), and self-efficacy (p = 0.02).
The positive outcomes of the needs assessment indicated thatthere were opportunities for pharmaceutical care in Nigeria. Teaching pharmaceutical care as a practice model to pharmacists and developing a documentation system enhanced their potentials to implement pharmaceutical care.
