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Public Perception Regarding Practice, and Barriers towards Pharmacist Counseling in the Community Pharmacy

Suleiman Ibrahim Sharif , Esra Moustafa Mohamed
American Journal of Medical Sciences and Medicine. 2021, 9(2), 43-47. DOI: 10.12691/ajmsm-9-2-2
Received March 03, 2021; Revised April 05, 2021; Accepted April 14, 2021

Abstract

Background: The role of the pharmacist includes an effective informative counseling with the patient. Pharmacists should practice delivery of patient-centered services and patients should know their rights for proper counseling. Objectives: To assess patient’s perception and attitude towards counseling in the community pharmacy. Methods: The cross sectional study employed an anonymous questionnaire with closed ended questions, written in English and Arabic and posted online. Results: Only 362 participants responded within the specified period. The majority (314, 86.7%) of participants were females, age range of 17-24 years (238, 66%), Arabs (354, 98%), and single (234, 64.6%). Participant’s visits to the pharmacy were 2-4 times (120, 33.1%) and > 10 times (107, 29.6%) annually. The main reason of these visits was to obtain medications (248, 68.5%). Large number of participants ask about the dose (278, 77%) and frequency of administration and duration of use (238, 65.7%), while only 91 (25.1%) of participants ask about side effects. Surprisingly, 182 (50.3%) of the participants admitted not asking about side effects. Reasons of participants not asking for information include getting these from the prescribing physician (204, 56.4%) and having earlier experience (175, 48.3%) with the medication. Sources of information were mainly the physician (262, 72.4%) followed by the pharmacist (220, 60.8%). Participants who consult a physician when feeling ill comprised 146 (40.3%) and a few consult the pharmacist (64, 17.7%). Conclusion: In UAE, the usual practice in most community pharmacies is product- rather than patient-centered and such a perception negatively influences patient’s satisfaction with community pharmacy services.

1. Introduction

The role of the pharmacist includes effective informative counseling with the community pharmacy visitors. It has been suggested that the identified challenges engage pharmacy customers in effective communication at the counter entailed a new and extended role for pharmacists in the health care system. 1 Challenges to effective counseling include customer expectations, earlier experience with the medication, shyness to ask, lack of private counseling area, and the busy schedule of the pharmacist. 2, 3, 4 The role of pharmacists in the healthcare system have tremendously evolved and the profession is no longer product-centered, but it became widely practiced as patient-centered. 5, 6 Through patient assessment, disease management, proper consultation, and follow-up, great improvement can be achieved in therapeutic outcomes. Moreover, patient's adherence to medication has been reported to be significantly improved as a result of increased patient satisfaction. 7, 8 Previous reports indicated that consumers may not accept pharmacists’ advice if they had experienced unsatisfactory interaction with the pharmacist. 9, 10 The joint efforts of the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) established standards for quality of pharmacy services. 11 The guidelines stressed pharmacists to understand consumers’ concerns and demands to ensure the quality of pharmaceutical care. Results of a previous study 2 showed a general patient’s satisfaction with the help provided by the community pharmacist. However, the pharmacist needs to fully practice his/her role to the advantage of the patients, and the latter needs to be aware of what to expect and demand from the community pharmacist. The present study aims to explore consumer’s perceptions regarding the pharmaceutical care that community pharmacists in the United Arab Emirates (UAE) provide.

2. Methods

A descriptive cross-sectional study design was carried out at the University of Sharjah-United Arab Emirates from October to December 2020. The study was based on a questionnaire designed and written in both Arabic and English. The questionnaire was pre-piloted for face validity by distributing it to six administrators at the University of Sharjah. Their comments and recommendation were considered in the final version of the questionnaire but their responses were not included in the results. The first part of the questionnaire includes questions on demographic characteristics of the participants including age, gender, ethnicity, profession, and marital status. The second part includes questions on the number of visits to the pharmacy per year, reasons for visiting the pharmacy, type of pharmaceutical products they purchase, and whether they ask on how to use a pharmaceutical device. The third part questioned pharmacy visitors on whether they ask about the indication of their prescribed medication, dose, frequency of administration and duration of use, and possible side effects. In addition, participants were asked about their sources of pharmaceutical information and the reasons for not asking the pharmacist about their medications. Participants were asked about their sources of drug information and who they consult when feeling ill. They were also asked to comment on the pharmaceutical services they receive at the community pharmacy. The surveys (English and Arabic versions) were prepared using ‘Google Forms’: //docs.google.com/forms/u/0/), and then the English version was posted at:

https://docs.google.com/forms/d/1Myv6WTsH9YdyByHPM1TCkZoqMFYXQ 2OLwdOOOgth4vc/edit?%20USP=drive%20web.

The Arabic version was posted at:

https://docs.google.com/forms/d/1grBhAlBPIWfs-Ys-BS_Zw74I84sirvHG5szS2kxsn_o/edit.

A thematic analysis approach was applied in this study and a Microsoft Excel 2013 was used for data analysis. Responses in English were encoded and the Arabic responses were translated into English by one of the researchers and revised by another two colleagues then the responses were added to the original English responses to generate a complete thematic framework that integrated all the findings. Comments and recommendations raised by the participants were first reviewed by two researchers and representative samples were considered to avoid duplication. As the study focused mainly on exploration rather than measurement of consumer perceptions, the data is qualitatively represented as frequency and percentages. Ethical approval was obtained from the Ethical Committee of the University of Sharjah, Reference number: REC-19-02- 11-02-S. The purpose of the study was clearly explained to the study participants. Voluntary participation by filling the questionnaire was considered as verbal consent. For the purpose of maintaining confidentiality, a participant's name was not used at the time of data collection. In addition, all other personal information was kept entirely anonymous throughout the study period.

3. Results

The response was quite reasonable as 362 participants responded by completing the questionnaire within the period specified. Table 1 shows the demographics of the participants. The majority (314, 86.7%) were females, within the age range 17-24 years (238, 65.7%), Arabs (354, 98%), single (234, 64.6%), and university students (189, 52.2 %). The number of visits per year is shown in Figure 1, where the highest frequency was 2-4 times (120, 33.1%) and > 10 times (107, 29.6%). Figure 2 demonstrates that the main reasons for visiting the pharmacy. About two-thirds (248, 68.5%) visited the pharmacy to obtain medications. The most frequently purchased medicines are shown in Figure 3. These were in the order of, analgesics (234, 64.6%), cosmetics (157, 43.4%), antitussive syrups (152, 42%), and antibiotics (138, 38.1%). Less than 50% (157, 43.4) of pharmacy visitors purchased cosmetics. Responses of participants to questions on whether they seek information when purchasing a device or medicine are shown in Table 2. A large number (278, 76.8%) of participants asked about the dose and frequency of administration, and duration of use (238, 65.7%) of the medication, but only a few (91, 25.1%) asked about side effects. The main reasons for not asking for information are shown in Table 3. These include getting information from the prescribing physician (204, 56.4%), and having earlier experience with the medicine (175, 48.3%). Sources of information were mainly the physician (262, 72.4%) followed by the pharmacist (220, 60.8%), and when feeling ill, participants consult a physician (146, 40.3%) and a few consult the pharmacist (64, 17.7%). Respondents who self-medicate by using medication available at home comprise (102, 28.2%) participants. The most common comments and recommendations of participants on the delivery of pharmaceutical care by the community pharmacist include;

“The pharmacist must be more proactive, should never dispense medications without a prescription, and should give enough time of voluntarily counseling to patients.”

“An Arabic speaking pharmacist should be available to serve the non-English speaking patient.”

“The pharmacist should engage more in the pharmaceutical care process.”

“The pharmacist should share his knowledge with the patient and show him/her all options.”

“The pharmacist must be sure to suggest the right medicine to a patient who seeks an advice to purchase medication without prescription because sometimes the pharmacist suggests a medicine which is not actually helpful to treat the condition.”

“Pharmacies need to have enough professionals so that they can provide proper counseling.”

“Please do tell us about HOW, WHEN, and WHY to use this drug. Most pharmacists do not tell us and assume we already know and we ignore asking the pharmacist when he/she ignores telling us. Please do not force us to buy expensive cosmetic stuff when you know it is the same as the much cheaper ones just because it is a ‘new brand and I should try it.”

4. Discussion

The present study is the first to assess the perception and attitude of the public towards demanding information about their medications from the community pharmacy. Previous studies focused on the assessment of the level of counseling practiced by pharmacists in community pharmacy settings. The highest frequency (27.6%) of monthly visits to the pharmacy are rather lower than in other countries 4, 12, 13. Our results with less frequent visits to the pharmacy may be attributed to the fact both nationals and residents in UAE enjoy the benefits of health insurance and get their prescription medicines at the hospitals. The order of the most frequently dispensed medication was analgesics, antitussives, antibiotics, and antiallergic agents. In agreement with the results of the Qatar study 4, most of our participants visit the pharmacy to purchase medicines. Like earlier findings in Qatar 4, and Lebanon studies 14, our survey showed public perception and attitude toward community pharmacists in UAE to be poor. This is in contrast to the results of a study in Dubai-UAE where community pharmacists were positively perceived 15. The main focus of pharmaceutical counseling should be the therapeutic indication of the medication, directions for its responsible use, possible adverse effects, and proper storage conditions 16. A large number of our participants are not provided with such information and they ask about the dose of the medication, its frequency of administration, and the duration of therapy. This supports earlier findings in Canada 17, and Pakistan 18. On the other hand, only a few respondents ask the pharmacist about the possible side effects of the medication. Experiencing side effects may lead to discontinuation of medication use. Similarly, pharmacists should inform patients on the appropriate and efficient method of using a medical device. In the present study, less than 50% of our participants ask for information on how to use special devices. It has been reported that among the reasons for the lack of disease control in for example asthma and chronic obstructive pulmonary disease patients is the inappropriate use of inhaler devices leading to worsening of the conditions and risk of increased hospitalization 19, 20, 21. Therefore, is advisable that, whether the patient asks for information, or not, the pharmacist must provide information about the use of special devices. The pharmacist can ask for a demonstration on how the patient uses his/her device even if the patient claims expertise in such a matter. In UAE, the usual practices in most community pharmacies are product-centered, and it is suggested that patient’s satisfaction with community pharmacy services is greatly influenced by such a perception 2. Therefore, the challenge facing both the pharmacist and managers of community pharmacies is to recognize and distinguish between what patients want, and what responsible pharmaceutical care they should receive 22. It has been reported that limited counseling practice maybe a consequence of the business-oriented practice in community pharmacies, or the heavy workload for many community pharmacists. 23 In spite of the fact that almost all (98%) the participants in the present study were Arabs and a large number of them filled in the English version of the questionnaire, a common comment of respondents was to have a pharmacist versatile in the Arabic language to communicate easily and effectively with non-English speaking patients. Participants also recommended the availability of more pharmacists in the pharmacy and a private counseling area which indicates their real need for information on their medication regimen and devices. Respondents in the present study seem aware of what they need as many of them recommended that “The pharmacist should engage more in the pharmaceutical care process” and “should share his/her knowledge with the patient and show him/her all options”. Despite the controversial reports about the impact of the rate of counseling on the level of patient satisfaction 23, 24, 25, it is the duty of the pharmacist to educate patients on the various aspects of their medications. The pressure of working on multiple prescriptions by a single pharmacist in a busy community pharmacy is the main barrier to proper counseling. Patient’s perceived barriers for not asking for information are many including, among others, shyness, language, lack of a counseling room, and time constraint. Availability of a counseling room in community pharmacies is a necessity as it encourages patients to feel more secure to freely ask about important information In the present study, the main reasons for patients not asking for information as expressed by a majority of respondents were receiving information from the prescribing physician, and having earlier experience with the medication. Only very few participants admitted not trusting the pharmacist. It is customary in many countries for the physician image to dominate that of other healthcare providers including the pharmacist. Despite the limitations of the present study such as the small sample size, and the possible recall bias, the results may be utilized by decision-makers to establish national guidelines for counseling in the community pharmacy setting on responsible use of medications pharmaceutical products, and special devices.

5. Conclusions

The present study indicated that although a majority of participants knew their need for detailed information about their dispensed medications. Pharmacists should provide the professionally expected rational pharmaceutical service as healthcare providers. As such they would contribute to the achievement of the best therapeutic outcomes. National guidelines for counseling on various aspects of medicines and special devices should be established, implemented to the benefit of the patients.

Conflict of Interest

The authors declared no conflict of interest.

Funding

Self-funding.

References

[1]  Kaae, S., Traulsen, J.M., & StigNørgaard, L. (2012). Challenges to counseling customers at the pharmacy counter-Why do they exist? Research in Social and Administrative Pharmacy, 8 (3): 253-57.
In article      View Article  PubMed
 
[2]  El-Sharif, S.I., Alrahman, N.A., Khaled, N., Sayah, N., Gamal, E., & Mohamed, A. (2017). Assessment of patient’s satisfaction with pharmaceutical care services in community pharmacies in the United Arab Emirates. Archives Pharmacy Practice, 8: 22-30.
In article      View Article
 
[3]  Al Laif, F.Z., Ahmad, R., Naqvi, A.A., & Ahmad, N. (2017). Pharmacist Perceived Barriers to Patient Counseling; A Study in Eastern Region of Saudi Arabia. Journal of Pharmaceutical Research International. 19(6): 1-12.
In article      View Article
 
[4]  El Hajj, M.S., Salem, S., & Mansoor, H. (2011). Public's attitudes towards community pharmacy in Qatar: a pilot study. Patient Preference and Adherence, 5:405-422.
In article      View Article  PubMed
 
[5]  Droege, M. (2003). The role of reflective practice in pharmacy. Eduction for Health: Change in Learning & Practice, 16:68-74.
In article      View Article  PubMed
 
[6]  John, C. (2018). The changing role of the pharmacist in the 21st century. The Pharmaceutical Journal, 300 (7909).
In article      
 
[7]  Schommer, J.C., & Kucukarslan, S.N. (1997).Measuring patient satisfaction with pharmaceutical services. American Journal of Health- System Pharmacy, 54: 2721-2732.
In article      
 
[8]  Dang, B.N., Westbrook, R.A., Black, W.C., Rodriguez-Barradas, M.C., & Giordano, T.P. (2013). Examining the link between patient satisfaction and adherence to HIV care: A structural equation model. PLoS One, 8:e54729.
In article      View Article  PubMed
 
[9]  Barnes, J.M., Riedlinger, J.E., McCloskey, W.W., & Montagne, M. (1996). Barriers to compliance with OBRA’90 regulations in community pharmacies. Annals of Pharmacotherapy, 30 (10): 1101-1105.
In article      View Article  PubMed
 
[10]  Barner, J.C., & Bennett, R.W. (1998). Pharmaceutical care certificate program: assessment of pharmacists’ implementation into practice. Journal of the American Pharmacists Association. 39 (3): 362-367.
In article      View Article
 
[11]  International Pharmaceutical Federation/World Health Organization. Good Pharmacy Practice. Joint FIP/WHO Guidelines on GPP: Standard for Quality of Pharmacy Services. WHO: The Hague, the Netherlands; 2012.
In article      
 
[12]  McElnay, J.C., Nicholl, A.J., & Grainger-Rousseau T.J. (1993). The role of the community pharmacist – a survey of public opinion in Northern Ireland. International Journal of Pharmacy Practice, 2: 95-100.
In article      View Article
 
[13]  Al-Wazaify, M., Matowe, L., Albsoul-Younes, A., & Al-Omran, O.A. (2006). Pharmacy education in Jordan, Saudi Arabia, and Kuwait. American Journal of Pharmacy Education, 70(1):18.
In article      View Article  PubMed
 
[14]  Iskandar, K., Hallit, S., Bou Raad, E., Droubi, F., y Layoun, N., & Salameh, P. (2017). Community pharmacy in Lebanon: A societal perspective. Pharmacy Practice, 15(2): 893.
In article      View Article  PubMed
 
[15]  Rayes, I.K., Hassali, M.A., & Abduelkarem, A.R. (2014). A qualitative study exploring public perceptions on the role of community pharmacists in Dubai. Pharmacy Practice (Granada), 12(1):363.
In article      View Article  PubMed
 
[16]  Cms, Centers for Medicare and Medicaid Services – 2011. Medicare Part D Medication Therapy Management (MTM) Programs. 2011.
In article      
 
[17]  Nair, K., Dolovich, L., Cassels, A., McCormack, J., Levine, M., Gray, J., et al.(2002). What patients want to know about their medications? Focus group study of patient and clinician perspectives. Canadian Family Physician, 48(1): 104-110.
In article      
 
[18]  Saqib, A., Atif, M., Ikram, R., Riaz, F., Abubakar, M., & Scahill, S. (2018) Factors affecting patients’ knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan. PLoS One, 13(6): e0197482.
In article      View Article  PubMed
 
[19]  Melani, A.S., Bonavia, M., Cilenti, V., Cinti, C., Lodi, M., Martucci, P., et al. (2011). Inhaler mishandling remains common in real life and is associated with reduced disease control. Respiratory Medicine, 105(6): 930-938.
In article      View Article  PubMed
 
[20]  Lindgren, S., Bake, B., & Larsson, S. (1987). Clinical consequences of inadequate inhalation technique in asthma therapy. European Journal of Respiratory Diseases, 70(2): 93-98.
In article      
 
[21]  Rahim, A., Abuduli, M., & Ahmed, Z. (2013) Non-compliance with inhaled corticosteroid (ICS) among asthma patients in Yazd city, Iran. Malaysian Journal of Public Health Medicine, 13: 77-87.
In article      
 
[22]  Kassam, R., Collins, J.B., & Berkowitz, J. (2012). Patient satisfaction with pharmaceutical care delivery in community pharmacies. Patient Preference and Adherence, 6: 337-348.
In article      View Article  PubMed
 
[23]  Alrasheedy A.A., Hassali, M.A., Wong, Z.Y., Aljadhey, H., AL-Tamimi, S. K., & Saleem, F. (2017). Pharmaceutical policy in Saudi Arabia. In: Babar Z, editor. Pharmaceutical Policy in Countries with Developing Healthcare Systems: Adis Cham, 329-347.
In article      View Article
 
[24]  Cleland, E. (2013). Stub it Out: Alarming smoking statistics emerge on UAE youths. The National; 2013. Available: http://www.thenational.ae/uae/health/stub-it-out-alarming-smoking-statistics-emerge-on-uae-youths. [Accessed Nov. 26, 2020].
In article      
 
[25]  Bultman, D.C., & Svarstad, B.L. (2002). Effects of pharmacist monitoring on patient satisfaction with antidepressant medication therapy. Journal of American Pharmacists Association, 42:36-43.
In article      View Article  PubMed
 
[26]  Singhal, P.K., Gupchup, G.V., Raisch, D.W., Schommer, J. C., & Holdsworth, M. T. (2002). Impact of pharmacists’ directive guidance behaviors on patient satisfaction. Journal of American Pharmacists Association, 42: 407-12.
In article      View Article  PubMed
 

Published with license by Science and Education Publishing, Copyright © 2021 Suleiman Ibrahim Sharif and Esra Moustafa Mohamed

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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Suleiman Ibrahim Sharif, Esra Moustafa Mohamed. Public Perception Regarding Practice, and Barriers towards Pharmacist Counseling in the Community Pharmacy. American Journal of Medical Sciences and Medicine. Vol. 9, No. 2, 2021, pp 43-47. http://pubs.sciepub.com/ajmsm/9/2/2
MLA Style
Sharif, Suleiman Ibrahim, and Esra Moustafa Mohamed. "Public Perception Regarding Practice, and Barriers towards Pharmacist Counseling in the Community Pharmacy." American Journal of Medical Sciences and Medicine 9.2 (2021): 43-47.
APA Style
Sharif, S. I. , & Mohamed, E. M. (2021). Public Perception Regarding Practice, and Barriers towards Pharmacist Counseling in the Community Pharmacy. American Journal of Medical Sciences and Medicine, 9(2), 43-47.
Chicago Style
Sharif, Suleiman Ibrahim, and Esra Moustafa Mohamed. "Public Perception Regarding Practice, and Barriers towards Pharmacist Counseling in the Community Pharmacy." American Journal of Medical Sciences and Medicine 9, no. 2 (2021): 43-47.
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  • Table 2. Responses of participants to questions on whether they seek information when purchasing a device or a prescription drug
[1]  Kaae, S., Traulsen, J.M., & StigNørgaard, L. (2012). Challenges to counseling customers at the pharmacy counter-Why do they exist? Research in Social and Administrative Pharmacy, 8 (3): 253-57.
In article      View Article  PubMed
 
[2]  El-Sharif, S.I., Alrahman, N.A., Khaled, N., Sayah, N., Gamal, E., & Mohamed, A. (2017). Assessment of patient’s satisfaction with pharmaceutical care services in community pharmacies in the United Arab Emirates. Archives Pharmacy Practice, 8: 22-30.
In article      View Article
 
[3]  Al Laif, F.Z., Ahmad, R., Naqvi, A.A., & Ahmad, N. (2017). Pharmacist Perceived Barriers to Patient Counseling; A Study in Eastern Region of Saudi Arabia. Journal of Pharmaceutical Research International. 19(6): 1-12.
In article      View Article
 
[4]  El Hajj, M.S., Salem, S., & Mansoor, H. (2011). Public's attitudes towards community pharmacy in Qatar: a pilot study. Patient Preference and Adherence, 5:405-422.
In article      View Article  PubMed
 
[5]  Droege, M. (2003). The role of reflective practice in pharmacy. Eduction for Health: Change in Learning & Practice, 16:68-74.
In article      View Article  PubMed
 
[6]  John, C. (2018). The changing role of the pharmacist in the 21st century. The Pharmaceutical Journal, 300 (7909).
In article      
 
[7]  Schommer, J.C., & Kucukarslan, S.N. (1997).Measuring patient satisfaction with pharmaceutical services. American Journal of Health- System Pharmacy, 54: 2721-2732.
In article      
 
[8]  Dang, B.N., Westbrook, R.A., Black, W.C., Rodriguez-Barradas, M.C., & Giordano, T.P. (2013). Examining the link between patient satisfaction and adherence to HIV care: A structural equation model. PLoS One, 8:e54729.
In article      View Article  PubMed
 
[9]  Barnes, J.M., Riedlinger, J.E., McCloskey, W.W., & Montagne, M. (1996). Barriers to compliance with OBRA’90 regulations in community pharmacies. Annals of Pharmacotherapy, 30 (10): 1101-1105.
In article      View Article  PubMed
 
[10]  Barner, J.C., & Bennett, R.W. (1998). Pharmaceutical care certificate program: assessment of pharmacists’ implementation into practice. Journal of the American Pharmacists Association. 39 (3): 362-367.
In article      View Article
 
[11]  International Pharmaceutical Federation/World Health Organization. Good Pharmacy Practice. Joint FIP/WHO Guidelines on GPP: Standard for Quality of Pharmacy Services. WHO: The Hague, the Netherlands; 2012.
In article      
 
[12]  McElnay, J.C., Nicholl, A.J., & Grainger-Rousseau T.J. (1993). The role of the community pharmacist – a survey of public opinion in Northern Ireland. International Journal of Pharmacy Practice, 2: 95-100.
In article      View Article
 
[13]  Al-Wazaify, M., Matowe, L., Albsoul-Younes, A., & Al-Omran, O.A. (2006). Pharmacy education in Jordan, Saudi Arabia, and Kuwait. American Journal of Pharmacy Education, 70(1):18.
In article      View Article  PubMed
 
[14]  Iskandar, K., Hallit, S., Bou Raad, E., Droubi, F., y Layoun, N., & Salameh, P. (2017). Community pharmacy in Lebanon: A societal perspective. Pharmacy Practice, 15(2): 893.
In article      View Article  PubMed
 
[15]  Rayes, I.K., Hassali, M.A., & Abduelkarem, A.R. (2014). A qualitative study exploring public perceptions on the role of community pharmacists in Dubai. Pharmacy Practice (Granada), 12(1):363.
In article      View Article  PubMed
 
[16]  Cms, Centers for Medicare and Medicaid Services – 2011. Medicare Part D Medication Therapy Management (MTM) Programs. 2011.
In article      
 
[17]  Nair, K., Dolovich, L., Cassels, A., McCormack, J., Levine, M., Gray, J., et al.(2002). What patients want to know about their medications? Focus group study of patient and clinician perspectives. Canadian Family Physician, 48(1): 104-110.
In article      
 
[18]  Saqib, A., Atif, M., Ikram, R., Riaz, F., Abubakar, M., & Scahill, S. (2018) Factors affecting patients’ knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan. PLoS One, 13(6): e0197482.
In article      View Article  PubMed
 
[19]  Melani, A.S., Bonavia, M., Cilenti, V., Cinti, C., Lodi, M., Martucci, P., et al. (2011). Inhaler mishandling remains common in real life and is associated with reduced disease control. Respiratory Medicine, 105(6): 930-938.
In article      View Article  PubMed
 
[20]  Lindgren, S., Bake, B., & Larsson, S. (1987). Clinical consequences of inadequate inhalation technique in asthma therapy. European Journal of Respiratory Diseases, 70(2): 93-98.
In article      
 
[21]  Rahim, A., Abuduli, M., & Ahmed, Z. (2013) Non-compliance with inhaled corticosteroid (ICS) among asthma patients in Yazd city, Iran. Malaysian Journal of Public Health Medicine, 13: 77-87.
In article      
 
[22]  Kassam, R., Collins, J.B., & Berkowitz, J. (2012). Patient satisfaction with pharmaceutical care delivery in community pharmacies. Patient Preference and Adherence, 6: 337-348.
In article      View Article  PubMed
 
[23]  Alrasheedy A.A., Hassali, M.A., Wong, Z.Y., Aljadhey, H., AL-Tamimi, S. K., & Saleem, F. (2017). Pharmaceutical policy in Saudi Arabia. In: Babar Z, editor. Pharmaceutical Policy in Countries with Developing Healthcare Systems: Adis Cham, 329-347.
In article      View Article
 
[24]  Cleland, E. (2013). Stub it Out: Alarming smoking statistics emerge on UAE youths. The National; 2013. Available: http://www.thenational.ae/uae/health/stub-it-out-alarming-smoking-statistics-emerge-on-uae-youths. [Accessed Nov. 26, 2020].
In article      
 
[25]  Bultman, D.C., & Svarstad, B.L. (2002). Effects of pharmacist monitoring on patient satisfaction with antidepressant medication therapy. Journal of American Pharmacists Association, 42:36-43.
In article      View Article  PubMed
 
[26]  Singhal, P.K., Gupchup, G.V., Raisch, D.W., Schommer, J. C., & Holdsworth, M. T. (2002). Impact of pharmacists’ directive guidance behaviors on patient satisfaction. Journal of American Pharmacists Association, 42: 407-12.
In article      View Article  PubMed