Assessment of pharmacy practice in community pharmacies in Rwanda

Abstract

ABSTRACT Background: A vast majority of community pharmacists are concentrated in the cities of Rwanda. There is a wide gap between urban and rural dwellers when it comes to accessing pharmacy practice. Currently pharmacy professionalism is becoming more patient centered. Therefore, community pharmacies should improve the quality of their practice as aiming at meeting good pharmacy practice guidelines. Objective: The objective of this research study was to assess pharmacy practice in community pharmacies in Rwanda. Methods: A cross-sectional descriptive and analytical study of community pharmacies located in Rwanda was conducted from February to June 2017. A total of 150 out of 245 community pharmacies were randomly selected. The data were collected by using a tool developed and tested by Birna Trup et al in 2010; it composed of 34 pharmacy practices (PP) indicators that cover five components of pharmacy practice: system, storage, services, dispensing and rational drug use. The results were analyzed by using excel and SPSS version 20, and ANOVA was used to analysis if there were true differences between strata (provinces and Kigali city), where the values of p<0.05 was considered as significant Results: Regarding the system,80.7% (n=121) of pharmacies surveyed have computer but more than half of community pharmacy operation activities are not computerized such as stock management 54.5%(n=66), prescription recording 66.1% (n=80) and for patient medication profile99.2%(n=120). 72.78 %( n=109) of pharmacies didn‘t has a formalized stock management system. In storage, 72.7% (n=109) of pharmacies didn‘t acceptable, hygienic, and functioning hand washing facilities. 77.3% (n=116) pharmacies didn‘t monitors the temperature of storage room. A poor 71.2 %( n=42) pharmacies didn‘t record the temperature of the refrigerator among those with a functioning system for cold storage. 98.7% (n=148), 98.0% (n=147), 30.0% (n=45) of pharmacies didn‘t labeled opened bottles with opening date, didn‘t have procedure for disposal of expired medicines and didn‘t compliant to FEFO respectively. In service only 2.0% (n=3) 0.0% (n=0), of pharmacies work 24hours in normal working and weekend day respectively. 8.7% (n=13) of pharmacies didn‘t have responsible pharmacist on the day of visit, 48.7% (n=73) of pharmacies use unqualified staffs to be in direct contact with patient/clients during community pharmacy operations. 88.0% (n=132) of pharmacies have premises that didn‘t guaranty the patient/client privacy during dispensing process, and community pharmacies intervention as a point of care testing and participating in health promotion activities is still low in all most all community pharmacies surveyed. In dispensing, An overall poor access to paper based health information resources by dispenser/pharmacy staffs was observed in most community pharmacies, dispensing envelope and spatula or spoon were the most usable material and equipment by all most all pharmacies, however their quality and hygiene remain uncertain. The average dispensing time was above 61 seconds in most pharmacies surveyed. 91.3 %( n=137) of pharmacies didn‘t have appropriate dispensing procedures. Poor professional collaboration with different health prescribers was observed in most community pharmacies. Rational use of medicine, Patient leaflets was available as the main source of patient information in 95.3% (n=143) of pharmacies. 78.9% (n=1184); 67.9 % (n=1019) and 62.6 (n=939) of patients/clients riving the community pharmacy didn‘t know the frequency, the cause and other necessary information of their medicines respectively. All medicine bought/received by patient from community pharmacies surveyed weren‘t 100% conform to good labeling practice (not adequately labeled with Quantity85.7% (n=1286), Expiry date92.4% (n=1386), Dose73.5% (1102);, Patient name 93.6% (n=1404) and Facility name99.0% (n=1485).Dispensing antibiotics without prescription was a common bad practice in 95.3 %( n=143) community pharmacies surveyed in Rwanda. Conclusion: The majority of the community pharmacies operated privately in Rwanda was not meeting good pharmacy practice guidelines. This implies the lower quality of pharmacy practice in community pharmacy in Rwanda. Therefore, trainings of pharmacy staffs, application of code of Ethics, developing and implementing community pharmacy practice standards under its corresponding scope of practice and regular supervisory visits are recommended for the improvement community pharmacy practice in Rwanda.