Quality of dispensing of controlled medicines among community pharmacies in Rwanda.

Abstract

Background: Above 50% of all medicines dispensing procedures in developing countries are inadequate. Lack of knowledge or lack of professionalism among medicines dispensers may result in poor quality of controlled medicines dispensing. Objectives: The main objective of this study was to evaluate the quality of dispensing of controlled medicines among community pharmacies and the level of knowledge of dispensers on those medicines. Methodology: This study was a cross sectional descriptive study which used both quantitative and qualitative approaches. The study population was formed by 245 community pharmacies, from which a sample of 150 pharmacies was drawn using a random sampling. Data collection was done using a self administered questionnaire containing both open and closed ended questions and through interview. Quantitative data were analyzed using SPSS version 18.0. The chi square test (2) was performed to test the association between the experience of dispensers and their knowledge on controlled medicines at 5% level of significance (=0.05). Qualitative analysis was done using six steps of thematic analysis as it was suggested by Braun and Clarke in 2006. Findings: Of all research participants, 79.2% were male, 91.3% being pharmacists and their average working experience in dispensing medicines was 4.2 years. Controlled medicines were handled by 98% of sampled community pharmacies. Only 42.9% of all visited pharmacies had SOPs for controlled medicines dispensing and 96.6% of them had adequate cupboards for the storage of those medicines. 89.3% of community pharmacies were allowing both pharmacists and nurses to dispense controlled medicines to clients. It was found that during the checking of prescriptions for controlled medicines, the refill date was only interesting only 1.4% of all the respondents. The partial dispensing and the oral authorization for refilling prescriptions of controlled medicine were done by dispensers in order help patients reducing unneeded expenses. It was found that 96% of dispensers were writing only the directions for use during the labeling of controlled medicines to be dispensed. All respondents (100%) reported to counsel patients on controlled medicines use. The causes which were declining dispensers from dispensing controlled medicines to patients included prescriptions and patients related problems. Records about dispensed controlled medicine were found in 86.4% of visited community pharmacies and 82.8% of them were keeping those records for a period equal or exceeding 2 years. All community pharmacies were not reporting information concerning controlled medicines to any institution. Research findings showed that 47.3% of dispensers knew clearly the definition of controlled medicines but 9.4 % were able to clearly discuss different schedules of those medicines. Only, 2% of respondents reported to have attended trainings on controlled medicines in their career. Inferential analysis showed that there was no statistically significant association between the working experience of dispensers and their knowledge on controlled medicines. Conclusion: Some activities recommended in dispensing controlled medicines were inappropriately performed to ensure quality of controlled medicine dispensing in all community pharmacies that are found in Rwanda.