AbstractThere are significant challenges faced by the healthcare system of Saudi Arabia like the prevalence of chronic illnesses, escalating healthcare expenses, and inadequate delivery and governance of healthcare services. The Saudi government has prepared a healthcare transformation in line with vision 2030 of the country to overcome these challenges. One of the main attributes of this plan is to privatize healthcare services by promoting public-private partnerships. The Ministry of Health (MOH) of Saudi Arabia has started implementing the first phase of the transformation plan by outsourcing the procurement, warehousing, dispensing, and distribution of all medicines to community pharmacies under the Wasfaty programme. As a result, all e-prescriptions are now dispensed from enrolled community pharmacies, instead of outpatient pharmacies of primary and secondary healthcare institutions.
This new development in the healthcare setup of Saudi Arabia has brought community pharmacy practice to the forefront of public healthcare in the country. Published studies in Saudi Arabia showed that healthcare consumers and professionals expect community pharmacy practice in Saudi Arabia to be at par with the developed world. Therefore, now with an expected increase in revenues and direct patient involvement, community pharmacy practices in Saudi Arabia need to come out of their traditional dispensing-only practices and are expected to contribute toward the achievement of the healthcare transformation initiatives by delivering patient-centred pharmaceutical care.
Prompted by limited large-scale qualitative and quantitative research conducted in Saudi Arabia, this research aimed to investigate patient-centred care practices in community pharmacies and how the practice can contribute to public health and assist the MOH in achieving its healthcare goals for the year 2030.
This study starts with conducting a systematic review of the literature to explore the current practices, roles, knowledge, and attitudes of community pharmacists. PRISMA guidelines were used to prepare and report the systematic review. Twenty-four studies were chosen and included in the systematic review following the inclusion criteria. Based on its findings, a mixed methods study was planned. In the first phase of the study, a semi-structured interview guide was developed to record the opinions of stakeholders directly or indirectly involved in the policy and practice of community pharmacy. The interviews were conducted with fifteen stakeholders who consented to take part in the qualitative study. The interviews were focused on identifying facilitators, drivers, barriers, and motivators for a change in traditional community pharmacy practice in Saudi Arabia toward a practice, focused on patient-centred care. The qualitative findings were explained through the development and analysis of key themes and sub-themes. In the second phase of the mixed methods study, a quantitative study was planned. A questionnaire was developed and validated based on the findings of the
systematic review and the qualitative analysis. The calculated sample size with a 95% confidence interval and a 5% margin of error was found to be 367 community pharmacists. However, 301 community pharmacists completed the nationwide cross-sectional survey showing a response rate of 82%. The survey was conducted to evaluate community pharmacist’s knowledge, attitude, and practices to conduct patient-centred care and to identify capacity gaps and barriers. The last part of this project was to conduct a pre-and posteducational intervention study to understand the impact of an education and training session on the knowledge and attitudes of community pharmacists. A sample size of 52 community
pharmacists with a 90% confidence interval and a 10% margin of error was calculated by Epi info online software. Forty community pharmacists attended the educational session, showing a response rate of 77%.
The findings of the systematic review highlighted that the majority of published studies showed inadequate and inefficient knowledge, attitudes and practices of community pharmacists toward a wide variety of patient-centred care services. In the qualitative study findings, the stakeholders identified loopholes in the policies of MOH governing the community pharmacy practice, administrative, technical, and social barriers and inadequacy of quality professional development and training programmes for community pharmacists. These findings were validated by the results of the cross-sectional survey, which emphasized national-level skills and knowledge development programmes of community pharmacists, a
centralized remuneration structure in offering pharmacist-led clinical services, and better management of administrative and technical challenges faced by community pharmacies. In addition, both qualitative and quantitative analysis suggests that a multifactorial strategy is needed to streamline the uniform practice structure in Saudi Arabia on models like developed countries.
Utilizing different methodologies in this PhD project extends the author’s knowledge and understanding of the policies and practices of community pharmacy in Saudi Arabia, its expanding role in the healthcare transformation plan of the country and its potential to be a part of a broader primary healthcare setup to achieve objectives of the healthcare transformation plan of Saudi Arabia. This study, the first of its kind in Saudi Arabia, has resulted in a comprehensive review of the pieces of evidence to bring about a change of practice in community pharmacy, highlighted challenges, and barriers to a successful change, and identified motivators, facilitators and drivers of the change process.
|Date of Award||1 Dec 2022|
|Supervisor||Zaheer Babar (Main Supervisor) & Barbara Conway (Co-Supervisor)|