A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan

Background In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan. Methods A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings. Conclusion Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan

Audit report: Baseline health facility assessment of quality assurance for malaria diagnosis in existing government hospital laboratories in Sokoto State, Nigeria

Background: Quality laboratory services are needed to direct reasonable malaria case management through malaria microscopy and rapid diagnostic test. This study assessed the existing diagnostic capacities including laboratory structures and systems, human resource, skills and competences, using the standardized WHO/NMEP EQA assessment tool. Methodology: Data were collected by an assessment team using a standardized assessment instrument/checklist drawn from WHO/NMEP assessment tool and analyzed with Open Data Kit (ODK) and Open-source suite of tools on Android mobile devices from September 3-11, 2020. The use of ODK allowed data to be collated offline where internet services were poor or unavailable and uploaded thereafter. Results: Of the 24 laboratory facilities assessed, diagnostic services on malaria are routinely done with combined malaria rapid diagnostic test (mRDT) and microscopy at 17 (65.0%) laboratories, microscopy only at 7 (27.0%)laboratories, while only mRDT was performed in 1 (3.8%) laboratory due to lack of functional microscopes, supplies, or trained personnel in microscopy. In the 24 facilities providing laboratory services, 16 (63.0 %) had one of the staff received basic malaria microscopy and mRDT training in the year prior to the assessment, and 23 (96.0%) of the laboratories had at least one functional electric binocular microscope. None of the laboratory had a good structured quality assurance/quality control procedure or standard operating procedures for either microscopy or mRDT. Conclusion: There were gaps in laboratory services due to lack of well-established quality control framework and ineffective communication system, which could have substantial impacts on the quality and accessibility of malaria diagnosis. These issues can be addressed by improving laboratory services.   French title: Évaluation de base par les établissements de santé de l'assurance qualité pour le diagnostic du paludisme dans les laboratoires hospitaliers gouvernementaux existants dans l'État de Sokoto, au Nigéria Contexte: Des services de laboratoire de qualité sont nécessaires pour diriger une prise en charge raisonnable des cas de paludisme grâce à la microscopie du paludisme et au test de diagnostic rapide. Cette étude a évalué les capacités de diagnostic existantes, y compris les structures et les systèmes de laboratoire, les ressources humaines, les aptitudes et les compétences, à l'aide de l'outil d'évaluation EQA standardisé de l'OMS/NMEP. Méthodologie: Les données ont été collectées par une équipe d'évaluation à l'aide d'un instrument d'évaluation/liste de contrôle standardisée tirée de l'outil d'évaluation de l'OMS/NMEP et analysées avec Open Data Kit (ODK) et une suite d'outils open source sur les appareils mobiles Android du 3 au 11 septembre 2020 L'utilisation d'ODK a permis de rassembler les données hors ligne lorsque les services Internet étaient médiocres ou indisponibles et de les télécharger par la suite. Résultats: Sur les 24 établissements de laboratoire évalués, les services de diagnostic du paludisme sont systématiquement effectués avec un test de diagnostic rapide du paludisme combiné (mRDT) et une microscopie dans 17 laboratoires (65,0%), la microscopie uniquement dans 7 laboratoires (27,0%), tandis que seul le mRDT a été effectué. dans 1 (3,8%) laboratoire en raison du manque de microscopes fonctionnels, de fournitures ou de personnel qualifié en microscopie. Dans les 24 établissements fournissant des services de laboratoire, 16 (63,0 %) avaient un membre du personnel ayant reçu une formation de base en microscopie du paludisme et mRDT au cours de l'année précédant l'évaluation, et 23 (96,0%) des laboratoires avaient au moins un microscope binoculaire électrique fonctionnel. Aucun des laboratoires ne disposait d'une bonne procédure structurée d'assurance qualité/contrôle qualité ou de modes opératoires normalisés pour la microscopie ou le mRDT. Conclusion: Il y avait des lacunes dans les services de laboratoire en raison de l'absence d'un cadre de contrôle de la qualité bien établi et d'un système de communication inefficace, ce qui pourrait avoir des impacts substantiels sur la qualité et l'accessibilité du diagnostic du paludisme. Ces problèmes peuvent être résolus en améliorant les services de laboratoire

Nurses' perceptions, involvement, confidence and perceived barriers towards antimicrobial stewardship program in Pakistan : findings from a multi-center, cross-sectional study

Purpose: Antimicrobial resistance (AMR) is leading to greater therapeutic cost, length of hospital stays, adverse events, morbidity and mortality. Hospital-based antimicrobial stewardship programs (ASPs) engaging physicians, pharmacists, microbiologists and nurses are considered as effective way to ensure appropriate use of antimicrobial agents. The aims of our study were to assess nurses’ perception, involvement, confidence and barriers towards hospital-based ASPs, and use the findings to provide future guidance. Methods: A web-based, cross-sectional study was conducted among the nurses serving at eleven hospitals of Punjab province of Pakistan during a period of two months (December 2021-January 2022). Data were collected using a validated self-administered questionnaire. All data were analyzed using SPSS version 22. Results: A total of 583 nurses participated in the study (response rate = 77.7%). All the participants were female staff nurses and 86% had a minimum of 3 years of working experience. The overall median score on the perception towards ASPs among the nurses was 18 (IQR: 16, 19) on a 0 to 20 scale whereas median score on the involvement in ASPs was 18 (IQR: 15, 37) on a 0 to 64 scale. Median perception and involvement score were statistically significantly differed by age (p < 0.001) and years of experience (p < 0.001). The overall median score on the confidence to perform ASP activities was 22 (IQR: 14, 24) on a 0 to 28 scale. Lack of knowledge, insufficient support from administration, and heavy workload were found to be the common barriers to perform ASP. Conclusion: Our study concluded that Pakistani nurses have positive perception but limited involvement in ASPs. Moreover, they are confident to perform ASP besides many barriers