A qualitative study exploring physicians’ perceptions on the role of community pharmacists in Dubai

Ibrahim K. Rayes dr.ibrahimrayes@gmail.com

Ajman University of Science and Technology, United Arab Emirates

Abduelmula R. Abduelkarem karem1961@hotmail.com

University of Sharjah, (United Arab Emirates

Pharmaceutical care has passed through three major redefinitions over the last two decades.1 The medicine preparation era was replaced by the dispensing era which was, over a period of time, overtaken by the clinical pharmacy movement.2 Most recently, pharmaceutical care has adopted a new set of assumptions, concepts, and values that have made the pharmacy practice patient-centered rather than merely product-oriented.3,4,5

Pharmacists among other healthcare providers have an important role in health service delivery because of their knowledge and location close to patients, so that they are sometimes the first line of responding.6 This interaction between patients and pharmacists has been extensively studied in many developed countries and values like patient satisfaction and perception of public regarding the role of pharmacists with pharmaceutical care type or with specific disease management services were thoroughly assessed.7,8,9,10 However, these values are often not generalizable to developing countries such as the Middle East where the first priority is still traditional pharmacy practice.11 As a reason to the shift in the type and quality of pharmaceutical services offered to patients, the interaction between community pharmacists and physicians has also enhanced.12,13

In general, communication between pharmacists and physicians is both interesting and problematic because each party’s professional identity is at stake when the two professionals interact.14 Recently the pharmacy profession has expanded significantly in terms of professional services delivery and now it has been recognized as an important profession in the multidisciplinary provision of healthcare. It should be mentioned that some physicians feel that pharmacists are attempting to expand their clinical roles, so topics of optimal drug selection and use have become contested ground where the two professions seek to establish their autonomy and assert their authority over decisions about drugs and drug use. Since these tasks were perceived the sole responsibility of physicians, recent attempts to establish pharmacists’ legitimate authority may be seen by some physicians as unwelcome encroachments.15

In the United Arab Emirates (UAE), the health care system is well developed and the facilities are predominantly Governmental, offering their services to all citizens. However, outside the secondary care sector the majority of patients obtain their medication from the growing number of private community pharmacies. Despite the fact that pharmacy practice in community pharmacies in the Gulf area, such as within the UAE, has shown some improvement during the last 15 years, it has not yet fully gained the trust of the public or indeed of health professionals. This would appear to be due to several reasons, including a perceived lack of professionalism on the part of pharmacists by public and health professionals, commercial pressure on community pharmacies, and a lack of enforcement of the regulations governing pharmacy practice within both the community and in hospital settings.16 However, this does not appear to be the case within some of the developed countries, where the notion of pharmacists prescribing medications and their involvement in patient care seems to been much more readily acceptable to the population and to doctors. This is most likely due to the perception of pharmacists in those countries as senior health professionals.17

There had not been any research to measure the perceptions of physicians on the role of community pharmacists in Dubai. For this reason, the aim of this study is to explore the opinions of physicians operating within the boundaries of Dubai on the significance of professional interaction among the two professions.

Semi-structured interviews were used to collect data in this research after extensive literature review and depending on a survey done in Pakistan.18 Application of previously validated instruments to address pharmacy practice issues was found to be useful to ensure instrument validity and reliability.19

The participants were physicians recruited using Dubai health authority (DHA) physicians’ list that was adopted as sampling frame. The sample of 12 physicians was randomly selected via a predetermined numbering system from a current list of approximately 88 (7 male, 5 female) physicians registered to provide their services in government and private hospitals as well as private clinics of the city of Dubai, UAE. The study took place between May 10, 2013 and June 11, 2013. The appointed research team experts managed arrangements for the time and place of interviews during the initial contact and obtained written consents from the participants prior to each interview.

The interviews mainly focus on physicians’ perception on the role of community pharmacists and their willingness to collaborate with them. Furthermore, the research team gathered information regarding their experience of working with community pharmacists in their respective positions. Probing questions were used where necessary by the research team and the participants were given freedom to express their views at the end of the interview session. Each interview was conducted by the researcher at the place and time convenient for the physicians and lasted approximately twenty to thirty minutes. The research team conducted all the interviews in English, audio taped and transcribed verbatim. The authors verified transcripts for their accuracy by listening to the tapes. Then, analyzed the transcripts line by line, which were read repeatedly and thematically analyzed for its content.20 From the analysis, saturation of data was reached after 12 interviews with no new themes emerging in the last two interviews. This study was approved by the Ajman University of Science and Technology Human Research Ethics Committee in the UAE.

Twelve interviews were conducted by the research team. Among the participants seven were male while five were female. Demographic characteristics of respondents are shown in Table 1.

Table 1
Physicians’ demographic data

Thematic content analysis yielded four major themes: 1) Pharmacist as a healthcare professional in physician minds. 2) Psychological perceptions towards pharmacists. 3) Willingness to collaborate with pharmacists. 4) Separation of prescribing from dispensing in Dubai.

Recently, community pharmacists have become closer to patients as their profession changed its approach and mutated to a better contribution with public rather than being merely product centered.22 This resulted into enhancing the cooperation between pharmacists and physicians and the ability to discuss matters related to accelerating patients’ cure process.23,24

In developed countries, studies showed that physicians accepted the extended role of community pharmacists.25,26 Other studies investigated physicians’ perceptions regarding the role of community pharmacists showed that they do support and acknowledge pharmacists’ role but overall, they do not know what to expect from pharmacists.27,28

Possibility of interpersonal conflicts might flourish due to increased frequency of contact and collaboration with other individuals and this is what is occasionally occurring between pharmacists and physicians.29 Few studies have shown negative experiences from physicians when dealing with pharmacists. It was reported that some pharmacists have been involved in dispensing alternatives without prior permission instead of prescribed medicines.30 When it comes to clinical pharmacists, the perception of physicians is different as there are studies which showed very favorable attitude towards the clinical pharmacists’ role with some concerns from transferring some responsibilities to clinical pharmacists.31,32,33

In the context of developing countries, the situation of pharmacy practice varies from one country to another. In a neighbor country like Qatar, a study had shown that physicians had less comfort and expectations of patient-oriented pharmacist roles but were not threatened to learn more about these capabilities or explore enhanced collaboration in patient care.34 In case of UAE, pharmacy profession is in an advanced stage of its development in terms of pharmaceutical care. During recent years in Dubai, many advancement points had helped pharmacists to play greater role in patients’ healthcare. Some of them were developing many new and up-to-date rules and regulations by DHA which controls licensing procedures for all medical professionals and organizations. In addition, competition level was dramatically increased in Dubai because of the entry of huge multinational and domestic pharmacy chains which are spending plenty of their financial resources on training their pharmacists, advertisements, and fancy decorations in their pharmacies. These points combined forced community pharmacists in Dubai to enhance services provided in order to win competition and grant a higher market share.

Therefore, contact of community pharmacists in Dubai with physicians was increased due to the above points. To understand the perception of physicians practicing in Dubai regarding their recent experience of community pharmacists and pharmacy services provided by them and their future expectation is very critical. This will help to develop strategies for better services provided to patients in the future due to elevated collaboration level between pharmacists and physicians. Similar studies were conducted in developed countries.35,36,37

Although all the informants who participated in this research agreed that the pharmacists are very important members for any healthcare setting, but more than half of them (n=7) defined community pharmacists as medical professionals responsible only of dispensing medicines.

Pharmaceutical care is a worldwide accepted mission of pharmacy profession, which cannot be fulfilled without proper collaboration with other healthcare professionals to practice rational drug usage.30 Interviewers extracted this point from the informants who almost agreed (n=11) on this concept. However, seven physicians had sort of doubt about the current scenario of pharmacy practice in Dubai in regards to pharmacists interfering with some of their duties and responsibilities. Due to the previous point, five of them added that they look at community pharmacists in Dubai as business people. In a recent study; the same concept was discovered in Qatar.38

A contradictory perception was extracted by the respondents stated that they are willing to work hand in hand with community pharmacists. This theoretical and comprehensive perception was only applied by four respondents in their daily medicine practice in Dubai.

Among the two professions, their respective knowledge and expertise demand separation of medicine and pharmacy into two independent but correlated professions.39,40 In many developing countries and some developed countries, the separation of prescribing from dispensing is not common due to insufficient pharmacy services coverage, increased drug accessibility and availability for the physicians’ patients and for financial gain.41 This situation is popular among physicians in many Asian countries where they both prescribe and dispense drugs, earning profits that vary with the types and amount of drugs dispensed.21,42 The situation in the UAE in general and Dubai in particular is totally different compared to some developing countries facing the problem of lack of separation between prescribing and dispensing as there are strict rules and regulations by MOH and DHA which hinder physicians from providing pharmacy services in their clinics.

This study was the first of its kind to explore the perception of physicians on the role of community pharmacists in Dubai. It can be concluded from the results extracted that physicians in Dubai found receptive to the expanding role of the community pharmacists as well as considering them drug information source. However, these expectations do not match with their daily experience as the community pharmacists are not providing quality range of clinically focused pharmacy services rather they perceive pharmacists product-oriented. Although they are expecting broad range of services from community pharmacists, but they are sometimes appearing less comfortable with pharmacists’ provision of direct patient care.