Systematic Review in Public Perceptions of Pharmacists and Pharmacy Services

            ABSTRACT

            Background: One of the significant and fundamental factor that will in the present days and in the future, in the pharmaceutical industry is a clear comprehension of the public needs, also depicted as the consumers, expectations, and as well as satisfaction. The systematic review will categorically aim establish the perception of the public and patients with the functions and services given by pharmacists and pharmacies.

            Key words

            Pharmacists – are also established as druggists who are professions in health and practices in pharmacy which is a heath science field and bases their focus on effectiveness of the use of medications.

            Pharmacy- is the technique and science which is utilized in dispensing and preparing drugs. This is thus a profession of health sciences which utilizes chemicals with the main purpose of ensuring effectiveness and safety in the utilization of pharmaceutical products.

            Differentiation- is the process of making products distinct from all the other similar products.

            Abbreviations

NHS- National Health Service

CASP0- Critical Appraisal Skills Program

RCTs- Randomized Controlled Trials

            Acknowledgement

            Following, an intensive research period, writing my note of thanks is the completing touch of my thesis. This has been an intense learning period for me both in the research arena and at an individual level. Writing this research has thus made a huge effect on me.  I would therefore, wish to mirror on the individuals who assisted and supported me throughout the whole period.

            First, I would wish to thank all my colleagues from school for their great and lovely collaboration. It would be an ungrateful act to assume thank you supported me because you had too. Your support is well appreciated and it was of great help to me as you were all willing to help me at all times. In particular I would wish  to single out my research professor and supervisor, I want to thank you so much for your reliable  cooperation, support and for the general opportunities that you provided for me to perform my research and also to further my research project.

            Additionally, I would wish to thank my tutors, for offering their valuable knowledge as well as guidance.  Definitely you were great to me because you provided me with the necessary tools which I mostly needed in selecting an accurate direction.  This gave me the power to complete my research thesis without worry as the knowledge and power of working everything out was well exposed.

            Moreover, I wish to thank my parents for their general wise support, counsel as well as the sympathetic ear that they always landed to me. I would not have made it without your support as this is all that I needed during this period.  Finally, I cannot be done without thanking my friends. We did not only offer deliberate support to each other over the issued that we shared as well as findings but we were additionally involved in happy talks in regard to general things in exemption of the papers which made a huge impact based on the generated happiness.

To everyone, I say thank you.

            Funding

            This research did not receive any particular funding grants from agencies in commercial, public or from the profit generating sectors.

            Methods: All relevant articles examining and identified published from January 2000 until December 2015 were searched using various search engine, bibliography searches and authors’ libraries. Studies were included if they: 1) quantitative and qualitative primary research papers, 2) any papers based on public perception of pharmacy services.

            Results and Discussion: Forty percent (10 out of 25) of studies conducted in developed countries while sixty percent (15 out of 25) of studies conducted in developing countries. In both developed and developing countries, 60% (15 out of 25) of studies demonstrated the satisfaction of public perception towered pharmacists’ activities and pharmaceutical services while 40% (10 out of 25) of studies illustrated the dissatisfied of public expectation overlooked pharmacists’ role and pharmacy services.

            Conclusion: The majority of the public in the review had a positive perception regarding the services offered to them by the pharmacist as well as perception towards their profession. It is, therefore, a good suggestion that there is is need to educate the public about the role of pharmacists and the services that should be delivered to improve the patients-pharmacists relationship and develop the pharmacists’ role and the services provided by pharmacies in this manner enhance the fulfillment of clients.

 

1. INTRODUCTION

            Health and life sciences is a critical area, mostly given its connection with the daily lives of people. In that line, Pharmacists have been much about connecting with the individuals in matters relating to their well-being. In a more general perspective, the role of the pharmacists is the role of being as health enhancers. However, the use of pharmaceutical services has been on the rise in the last few decades. The shift experienced has been from a typical view of a pharmacist being mere medication vender to a position where the public now a visions them as doctors. Revisiting the case of the changes of roles in the pharmaceutical environment, it is clear that the public perceives their services in a different point of view.

            Guirguis et al., (2005) postulates that further studies support the increasing involvement of pharmacists in the broader healthcare setting will demand transitions in behaviour by pharmacists and the general public as a whole. Other researchers continue to show and support that attitudes, beliefs and views made a dominant part of practice as postulated by Jose et al., (2015).  In that case, there was a need to look at the attitudes of consumers on the healthcare setting mostly pharmacists and pharmacy in addressing persons medical needs.

2. OBJECTIVES

            The main objective of the review was to scrutinize and observe the ideas, viewpoints, perspectives, and beliefs of the public concerning pharmacy as a field and pharmacists as having medical roles. This systematic review identified that consumers and the pharmacists do have significant roles and specific responsibilities in their relationship, also depicted as a patient pharmacist professional relationship. It is at this point that the satisfaction of the consumer has been an essential component healthcare service.

3. METHODS

A systematic review of the current research evidence addressed the question ‘What are the public perceptions of pharmacy, pharmacists and pharmacy services?’ using the descriptive analysis method. Three electronic databases used in this review MEDLINE (PubMed), Scopus and the Cochrane Library. They identified all relevant articles published in English from January 2000 until December 2015. The search engine Google Scholar, which provides a broad search of academic articles from sources including theses, books and abstracts used to identify the papers published online that are not identified by the databases.

            SEARCH STRATEGY

            The following combination of search terms used in the search strategy with each database: (“public” OR “consumers” OR “patients” OR “clients” OR “customers” OR “users”) AND (“perception” OR “belief” OR “attitude” OR “view” OR “satisfaction” OR “expectation” OR “opinion”) AND (“pharmacy” OR “pharmacist” OR “pharmaceutical service”) AND (“pharmacist” OR “pharmacists”) AND (“hospital” OR “community).

3.1.   INCLUSION CRITERIA

The inclusion criteria was: quantitative and qualitative primary research papers, papers related to pharmaceutical services perception, papers written in the English language, full text available and human adults studies.

3.2.   STUDY SELECTION AND DATA EXTRACTION

Two techniques were used in examining the articles. First, the author identified, screened articles that retrieved from searching database, and scanning the title and abstract: The headings and conceptual screened adjacent to the enclosure criteria. Studies excluded based on titles, abstracts and removal of duplicates that did not related to the public perception of pharmacists and pharmacy services. Finally, the number of articles used and include in the systematic review was 25 articles in total (figure 1).

 

Figure 1: Study selection process.

Studies were excluded on the bases of abstracts titles and duplicate removal which were not in relation to pharmaceutical.

Articles title and abstract

Articles title and abstract

Relevant Articles title and abstract

Studies were excluded based on text screening.

 

 

 

 

 

 

 

               

 

 

 

1.1.   ASSESSING QUALITY

            To assess the quality of selected articles in this review, papers screened against the appropriate CASP checklist and tools that have been authenticated, in ensuring that the studies evaluated and appraised. There were 10 studies in developed countries assessed and critically appraised based on Critical Appraisal Skills Programme (figure 2) while 15 studies in developing countries assessed and critically appraised based on CASP tools (figure 3).

Figure 2: Quality appraisal of 10 studies in developed countries based on CASP.

Studies Retrieved for Quality Appraisal		Appraisal Criteria
		Was there a clear statement of the aims of the research?	Is a methodology appropriate?	Was the research design appropriate to address the aims of the research?	Was the recruitment strategy appropriate to the aims of the research?	Was the data collected in a way that addressed the research issue?	Has the relationship between researcher and participants been adequately considered?	Have ethical issues been taken into consideration?	Was the data analysis sufficiently rigorous?	Is there a clear statement of findings?	How valuable is the research?
Developed Countries	1.      Abukres 2014
	2.      Bishop 2015
	3.      Cavaco 2005
	4.      Franic 2008
	5.      Kelly 2014
	6.      Kwan 2008
	7.      Latif 2013
	8.      McMillan 2014
	9.      Saramunee 2015
	10.  Wirth 2010

Y= “Yes available” ; N= “Not available” ; V= “Valuable” ; NV= “Not valuable

 

Figure 3: Quality appraisal of 15 studies in developing countries based on CASP).

Studies Retrieved for Quality Appraisal		Appraisal Criteria
		Was there a clear statement of the aims of the research?	Is a methodology appropriate?	Was the research design appropriate to address the aims of the research?	Was the recruitment strategy appropriate to the aims of the research?	Was the data collected in a way that addressed the research issue?	Has the relationship between researcher and participants been adequately considered?	Have ethical issues been taken into consideration?	Was the data analysis sufficiently rigorous?	Is there a clear statement of findings?	How valuable is the research?
Developing Countries	1.      Al-Arifi 2012
	2.      Al-Hassan 2009
	3.      Alotaibi 2015
	4.      Bawazir 2004
	5.      Bezverhni 2010
	6.      Catic 2013
	7.      Chen 2012
	8.      El Hajj 2011
	9.      Jayaprakash 2009
	10.  Jin 2014
	11.  Jose 2015
	12.  Oparah 2006
	13.  Rayes 2014
	14.  Saw 2015
	15.  You 2011

Y= “Yes available” ; N= “Not available” ; V= “Valuable” ; NV= “Not valuable”

 

2. RESULT

            The results of the systematic review about Public perception of pharmacists and pharmacy services are developed through quantitative and qualitative research methods in both developed and developing countries. There were a total of 37 studies which evaluate the pharmacists’ role and pharmacy services and met the design criterion; however, 12 articles that equivalent (35%) of these did not report any public perception of pharmacists’ role and pharmacy services thus were not included in the review (figure 1). The outcomes of the research on the attitude of the public on pharmacy attendants and pharmaceutical service in developed and developing counties are obtained through structured, semi-structured or across sectional study techniques.  

2.1.   STUDY DESIGN

            In the study design of the twenty five studies, 32% of studies used to derive the outcomes through qualitative approach while 68 % of studies used to derive the outcomes through quantitative approach. In developed countries, the study design used to derive the outcomes was through 50% of studies quantitative approach, 40% (4 out of 10) of studies qualitative approach and 10% of studies mixed method. In the developing countries, the study design used to derive the outcomes was through eighty percent of studies quantitative and twenty percent (3 out of 15) of studies qualitative approach (figure 4).

2.2.   STUDY AIM

            In the study aim of the twenty five studies, six studies (24%) assess pharmacists’ role and pharmaceutical services, eight studies (32%) evaluate pharmaceutical services as health care provider and eleven studies (44%) evaluate pharmacists as having medical roles. According to the study aim used to assessing pharmacy services and pharmacists’ role, there were 40% of studies conducted in developed countries while 13% of studies in developing countries.

2.3.   PUBLIC SATISFACTION

            The articles outcome was expressed based on the satisfaction, expectation and perception of the customers and patient towered pharmacists’ role and pharmacy services in developed and developing countries. In both developed and developing countries, 60% of studies demonstrated the satisfaction of public perception towered pharmacists’ activities and pharmaceutical services while 40% of studies illustrated the dissatisfied of public expectation overlooked pharmacists’ role and pharmacy services. However, the fulfilment of public expectation towered pharmacists’ role and pharmacy services in developed countries was 40% of studies while 73% of studies in developing showed the public fulfilled. On the other hand, the dissatisfaction of public perception overlooked pharmacists’ role and pharmaceutical services in developed countries was 60% of studies whereas 27% of studies in developing revealed the public dissatisfied.

Figure 4: study design, aim and finding of 25 studies included in the systematic review

 

Table 1: systematic review for the 25 studies

Developed Countries
No.	Publication details	Country	Study aims	Study design and participant details	Key findings	Public perception of pharmacy and pharmacists	Comments on key findings    and study limitations
1						The CD model portrays a high degree of acceptance from its users. The importance of model is that it could facilitate the process of supply of medication to the sick persons. Negative consequences alleviation may result due to therapy interruption.
2							The restriction for the success of this model is on the basis that there lack a coordinated approach to health care. There is a need for patient education on the pharmaceutical services’ importance.
3							Localised qualitative study therefore no knowledge of prevalence of perceptions; findings should not be extrapolated to the Portuguese population. Minimum involvement in therapeutic process; pharmacists need to genuinely and effective response might improve public image.
4					Approximately half of the study respondents were unfamiliar about pharmaceutical care term after they asked for the meaning of this term. In case of pharmacies’ services and practices, the majority of respondents observed their pharmacist fill their prescriptions and check it for accuracy and safety.
No.	Publication details	Country	Study aims	Study design and participant details	Key findings	Public perception of pharmacy and pharmacists	Comments on key findings    and study limitations
5	Kelly DV, Young S, Phillips L, Clark D. Patient attitudes regarding the role of the pharmacist and interest in expanded pharmacist services. Canadian Pharmacists Journal : CPJ = Revue des pharmaciens du Canada : RPC. Jul 2014;147(4):239-247.
6	Kwan D, Boon HS, Hirschkorn K, et al. Exploring consumer and pharmacist views on the professional role of the pharmacist with respect to natural health products: a study of focus groups. BMC Complementary And Alternative Medicine. 2008;8:40.
7							Need for inter-professional culture change and visible collaboration. Success of future services based on public understanding or pharmacist’s role, perceived hierarchy of health services & patients’ experiences.
8	McMillan SS, Kelly F, Sav A, King MA, Whitty JA, Wheeler AJ. Consumer and carer views of Australian community pharmacy practice: Awareness, experiences and expectations. Journal of Pharmaceutical Health Services Research. 2014;5(1):29-36.
No.	Publication details	Country	Study aims	Study design and participant details	Key findings	Public perception of pharmacy and pharmacists	Comments on key findings    and study limitations
9							The public is interested in taking up pharmacy community fitness services, and barriers must be considered in uptake of services increase. A limitation in the study is generalisation of the findings to the wider inhabitants could be inadequate and the community attractiveness for those that the interviewer helped.
10	Wirth F, Tabone F, Azzopardi LM, Gauci M, Zarb-Adami M, Serracino-Inglott A. Consumer perception of the community pharmacist and community pharmacy services in Malta. Journal of Pharmaceutical Health Services Research. 2010;1(4):189-194
Developing Countries
No.	Publication details	Country	Study aims	Study design and participant details	Key findings	Public perception of pharmacy and pharmacists	Comments on key findings    and study limitations
11							To progress the patient happiness health care givers, it is appropriate to have a single pharmacist in every community. Additionally pharmacists are required to provide adequate information to patients.
No.	Publication details	Country	Study aims	Study design and participant details	Key findings	Public perception of pharmacy and pharmacists	Comments on key findings    and study limitations
12	Al-Hassan MI. A survey on consumer need and opinion about the community pharmacists in Riyadh, Saudi Arabia. Journal of Medical Sciences. 2009;9(1):36-40
13					72% of consumers think that pharmacists are not committed to dispense medications with prescription. Almost half of the consumers (48%) feel embarrassed when they speak with the pharmacist regarding their health. A large number of the consumers (48%) believed that pharmacists in community pharmacies did not give enough counselling about their medications.
14							The act of creating a private area for discussion served as a real instrument of seeking confidential health matters in the pharmacy. The limitation is that the pharmacists have been omitted whereas they could give out essential information on service provision.
15							There is big gap between expected and provided information about medicines. There are no major barriers in implementing pharmaceutical services but pharmacists are not very optimistic about this.
16							The pharmacy industry has the opportunity to grow based on this research.
No.	Publication details	Country	Study aims	Study design and participant details	Key findings	Public perception of pharmacy and pharmacists	Comments on key findings    and study limitations
17						A majority of respondent’s held low pharmacists perception.  But the information would be used in developing better relationships.
18			Evaluate the perception of the community on pharmacist’s roles by establishing their general views as well as satisfaction.
19							Making attendance to continue education program a mandatory for the renewal of licence for pharmacists. The public should be educated on the role of pharmacists to know what to expect from them. A limitation of the study is that the views expressed may not be generalized for large population of Bangalore as the study conduct only in northern of Bangalore.
20							The public should be educated on the role of pharmacists in the health care systems based on the manner of improving pharmaceutical services. A limitation of the study is that the results cannot be generalised for only 3 cities out of 4 were involved.
No.	Publication details	Country	Study aims	Study design and participant details	Key findings	Public perception of pharmacy and pharmacists	Comments on key findings    and study limitations
21	Jose J, Al Shukili MN, Jimmy B. Public's perception and satisfaction on the roles and services provided by pharmacists - Cross sectional survey in Sultanate of Oman. Saudi Pharmaceutical Journal : SPJ : Nov 2015;23(6):635-641.
22	Oparah AC, Kikanme LC. Consumer satisfaction with community pharmacies in Warri, Nigeria. Research in Social and Administrative Pharmacy. 2006;2(4):499-511.
23	Rayes IK, Hassali MA, Abduelkarem AR. A qualitative study exploring public perceptions on the role of community pharmacists in Dubai. Pharmacy Practice 2014;12(1):363.
24	Saw PS, Nissen LM, Freeman C, Wong PS, Mak V. Health care consumers’ perspectives on pharmacist integration into private general practitioner clinics in Malaysia: A qualitative study. Patient Preference and Adherence.2015;9: 467-477.
25							Awareness should be created on how patients can perform self-care on themselves. Initiatives should be developed to enhance pharmacy care. The issue was the description of self-care performance being inadequate.

 

3. DISCUSSION

            The level of relevance attached to pharmacy and pharmacists seems unexpectedly not in tandem with the global acceptance and usage of health services when an evaluation is made to determine the perception people in developed and developing nations have regarding pharmacists’ role and pharmacy services. Key objectives of this paper are to help improving the pharmacists’ role and pharmacy services, the patients-pharmacists relationship, and the overall healthcare systems. The question is what are the public perceptions of pharmacy, pharmacists and pharmacy services?

            In the developed countries the percentages of qualitative and quantitative studies were almost equal.  They assessed public perception by statistical and psychological methods to cover their whole perception. However, 80% of the studies were quantitative and 20% qualitative in terms of the developing countries. There is a possibility that the quantitative methods are higher in developing countries due to illiteracy and the rapid rhythm of life for the population (Al-Arifi, 2012).

            It is important to understand that some developed countries may have proper health care system but may have lack proper channels to administer the services (Latif, Boardman, & Pollock, 2013; Saramunee et al., 2015). In the developing countries, the satisfaction levels were high (73%) due to the pharmacists quality services.Interaction created leads to the build-up of the new opinions which in the long run is crucial in promoting the quality of the service provision.

3.1.   STRENGTH AND LIMITATION

            The main strength of this systematic review is the first review conducted in field of public perception of pharmacists and pharmacy services nationwide. However, the differentiation from country to others in health care system, education level of resident, public culture and status of life may consider as limitation.

4. CONCLUSION

            The systematic review demonstrates public perception on pharmacists and pharmacy services across the globe. It has reveals the majority of public had positives perception regarding the services offered to them by the pharmacists as well as perception towered their profession although suggests that steps and initiatives to improve clinical skills and social relationships. Satisfaction, on the other hand, comes to the act pharmacies embracing new actions which make the services better such as the counselling. Lastly, the case on the expectation as highlighted on the paper is connected with a factor of attitude. Therefore, there is dire need for public awareness that seek to educate populations on different aspects of pharmacist roles and functions. This type of research would provide a solid foundation for future research in professional or stockholder perception of pharmacists and pharmacy services.