Patients’ Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Study Instrument
2.3. Study Setting
2.4. Selection Criteria of Participants
2.5. Inclusion and Exclusion Criteria
2.5.1. Inclusion Criteria
- Patients have visited more than 10 different urban pharmacies.
- Patients have a valid prescription from a registered medical practitioner.
- Patients declare no competing interest to pharmacy owners/staff.
2.5.2. Exclusion Criteria
- Patients with any conflict of interest or any relation to owner of pharmacy.
- Patients visiting pharmacy for over-the-counter (OTC) medicine.
- Patient under the age of 18 years.
2.6. Sampling and Data Collection
2.7. Data Analysis
2.8. Ethics
3. Results
3.1. Current Services
3.1.1. Inappropriate Unhygienic Storage
“The pharmacies shops are not more developed than a local grocery or departmental stores ...... the rakes are broken and uncovered ...... no glass cover of rakes ...... many medicine are kept in big open containers ....... Cattle farming are common here and their dung is spread around ....... How the medicine can pure, safe and efficacious?”(P 4)
“The humming flies welcome the patients ever ...... absence of front glass door ...... presence of dust over the packing and blisters of medicines is common”(P 20)
“The floor of pharmacies in cities are blazing, flat and decorated while in our locality dilapidated and un even floor can be seen”(P 11)
“Medicines are not stored in clean racks, the shops of pharmacy is also not clean well, staff don’t have clean dresses”(P 33)
“My doctor told me insulin without maintenances of cold chain loss their efficacy ...... pharmacy have no refrigerator ...... 18 h electricity breakdown is common in villages ...... no alternative power supply ...... purchasing such medicines from these pharmacies is waste of money ...... I prefer to purchase the my own medicines and eye drops for my mother from city”(P 7)
3.1.2. Having Interest in Patient’s Wellbeing and Counseling
“When patients are not much, provide enough time to discuss disease and therapies in a very polite way ...... in rush to deal other patients, ignore some time ...... in urban pharmacies ignorance is often ...... on request staff of urban pharmacies referred us again to concern doctors”(P 6)
“He is very friendly to me and almost to all patients ...... many time told me about the harm of smoking …... spread of diseases like TB ...... eating habits and importance of regular exercise to control blood pressure and diabetes”(P 1)
“Provides the significant counseling and deals the health queries in a good way”(P 26)
“Medication counseling and instructions regarding wellbeing are significantly provided specially in chronic diseases”(P 31)
3.1.3. Appropriate Referral
“As most of the people in our village are not aware of specialized doctors and their addresses in city ...... finding a proper doctor for a specific disease and approaching to concern doctor is a difficult task for the attendants of patients specially in the case of emergency ....... We contact to the owner of pharmacy for this purpose ....... He manages every thing ...... provide us the exact information”(P 22)
“He referred me to a doctor for my cardiac problem ...... my wife to gynecologist and my son to pediatrician ...... we find these doctors very cooperative and competent ...... this services by him save our time and money”(P 29)
3.1.4. Vaccination Point
“Government vaccinator come to pharmacy ...... people of village are informed prior about the vaccinator visit ...... children and women got free vaccinations according to schedule”(P 26)
“The owner of pharmacy is like a family member of each house ...... contact to head of each family ...... load speaker of mosque is used ...... government vaccinator stay a complete day at the pharmacy ...... people visit for vaccination according to their feasibility”(P 31)
3.1.5 Charging High Prices for Medicines
“Five to ten percent discount is common in urban pharmacies ....... up-to 15% discount can find there due to business competition ...... facilitate patients without request ... having a single pharmacy in villages ...... can’t get any discount even by request. Simply (a business) monopoly”(P 5)
“The prices of medicines are personal description here ...... huge difference of medicines prices in urban and rural pharmacies”(P 12)
“In some cases, the written prices of medicines are much higher than original selling prices. In city, these medicines are available at 1/5th prices of written price e.g., folic acid preparation. But pharmacies in this area charge it as written on pack”(P 8)
“Very high prices of medicines are charged here”(P 34)
3.1.6. Providing Substandard Medicines
“Veterinary medicines are freely decorated in the pharmacies ...... injecting and selling veterinary medicines to human beings without discrimination”(P 9)
“Mostly substandard and counterfeit medicines are sold through rural pharmacies”(P 32)
“Whenever I purchase medicines for myself/family/relative/friend, must check its expiry dates ...... Usually expiry dates are just one to 2 month latter ...... medicines in these pharmacies are near expiry”(P 13)
3.1.7. Unavailability of Medicines
“The medicines of common illness like fever, flue, cough and diarrhea can obtain in a single visit .............. the medicines for other diseases need multiple visits or a visit to city”(P 14)
“Required medicines or a suitable substitute are arranged ...... a prior intimation, ensures the availability of formula milk for babies”(P 18)
“All medicines are not available every time .......... 1–3 days prior request is needed to get exact dose and dosage of cardiac and diabetic medicines .......... alternative (herbal and homeopathic) medicines are abundant in pharmacy”(P 21)
“I need epilepsy medicine for my son ....... pharmacy is on the way to my work place ....... I inform the owner 2 days ago and he manages medicines at the time”(P 3)
“Only few medicines are available that are used in their quackery practices ....... most medicines of multinational companies are rare”(P 32)
“Medicines of chronic diseases of my routine treatment can be get after 1 or 2 days—prior information to owner of pharmacy”(P 10)
3.1.8. Inept Dispensing
“In many cases the prescribed dose of drug is not available ...... high or low doses are dispensed .......... advice to break a single tablet or take 2 tablets”(P 19)
“Different dosage forms are dispensed rather than prescribed/required like omeprazole tablets instead of its sachet”(P 16)
“Usually biological/therapeutic equal medicines are dispensed to fulfill a prescription. Mostly these are replaced by some cheap medicines”(P 1)
“Only yellow colored dispensing envelope is used ...... medicines from a large container are poured and provided ...... patient is don’t know name of dispensed medicine”(P 7)
“Sometime, medicines are dispensed by underage school students”(P 9)
3.1.9. Inadequate Staffing with Poor Knowledge
“At every visit a new employ is seen ...... no concept of permanent staff ...... students of schools at evening come to learn this business …... these students cleans the store and sometime dispense the medicines”(P 9)
“Only owner is doing all duties ...... don’t have any other employ”(P 15)
“No staff member and owner of pharmacy have education more than 10 years of formal schooling”(P 21)
“The owners/staff of pharmacies provide misinformation about the use of medicines ...... many time doctor asked “Who told you this wrong information about disease/ medicine use” ...... have very poor scientific knowledge ...... don’t have any technical diploma”(P 17)
3.1.10. On-call Services Provide Medicines
“At night, villagers don’t have any other health facilities ...... mobile numbers of owner is given at board to contact in emergency ...... almost all the population of community avail this facility”(P 12)
“Its blessing, pharmacy remain open in public holidays or festivals …... if pharmacy is close, make a contact through mobile ....... owner never refuse our request of medicines”(P 1)
3.1.11. Limited Free Extended Pharmacy Services
“Weighing machine, body thermometer, blood pressure equipments at pharmacy are totally free for all....... provide the facility of blood pressure measuring at pharmacy and home”(P 6)
“I can’t afford personal gluco-meter ...... this device is available at pharmacy ...... my blood glucose level is monitored easily ......... only the cost of strips is charged ...... helpful to manage my glucose”(P 10)
3.1.12. Arrangement of Medical Camps
“Consultant physician come to pharmacy on weekly basis ....... patients who can’t afford travelling cost or can’t afford travelling due to poor health conditions, get health services at door steps”(P 24)
“Eye camps are usually organized by ophthalmologists or some individuals on charity basis at rural pharmacy ....... patients get the free of cost medicines and advices”(P 27)
“Free medical camps at pharmacies are occasionally organized ....... helpful for underprivileged population of rural areas”(P 30)
3.1.13. At Home Medical Services
“We don’t have any hospital here ........ no doctor is available ......... in any illness, we just call to pharmacy owner ...... he is available at cell every time ....... he visits for patient check up at home ...... advices the medicines up-to his competencies or guide for further steps for patient care ...... in our locality it is helpful for family health specially for women”(P 23)
“In many minor ailments like diarrhea, fever, cough and flue …... we contact him through cell .... tell him the patients conditions and he send us the medicine at home …... some time he come to check the patients at home”(P 28)
3.1.14. First Aid Point
“In our daily life, during working in field …... for minor injury pharmacies provide the first aid and necessary medicine”(P 25)
“Provision of on time first aid by pharmacy, saves the many lives”(P 26)
“Satisfactory first aid facilities are provided by pharmacies …... suitable for the people of every field of life”(P 31)
3.1.15. Limited Working Hours
“The working hours of pharmacy is ranged between sunrise and sunset regardless of summer and winter”(P 2)
“In unexpected weather condition like rain, medicines can’t be obtain ....... faraway urban pharmacy is last resort ...... owner itself belongs a faraway river side village”(P 10).
3.1.16. Promoting Quackery
“Owner behaves like a doctor ...... prefer patients must get his advice for medication, directly ...... sometime he advices patient for their medication change ...... also change the prescribed medicines with cheap substitutes ...... attitude is much better to patients seeking direct medication advice”(P 5)
“The owner of pharmacy claims “same medicines are advised by him and doctor”.......... pay much intention to the patient without prescription ......... found variation in the prices of same medicine according to prescription nature ... higher prices on another doctor prescription and lower on his direct advice”(P 17)
3.2. Suggestions
3.2.1. Scheduling Non-marginal Pricing
“At the time of price decision, government authorities must consider the rural, underprivileged population of rural areas. The actual selling prices must printed on pack”(P 12)
“Most of rural population is not aware of this difference between written prices and actual retail prices ....... margin between these prices should minimize”(P 8)
3.2.2. Developing Informative Services
“In rural areas the social media is not commonly used ....... lacks of public health awareness in communities .... accesses to health care is limited ......... pharmacy owner can effectively promote campaigns related to health promotion and to control the prevalence of infectious disease like currently Congo virus prevention campaign”(P 18)
“The available literature about medication use, life style modification for many chronic diseases like diabetes, hypertension is helpful ......... such a literature is rare in rural pharmacies ...... Similar to urban pharmacies, posters and brochure at sale counters will be helpful for the well being of rural population”(P 10)
3.2.3. Urgent Need of New Legislation and Implementation
“The authorities should define the working time for pharmacies in rural areas and ensure it by enforcement”(P 2)
“The concern officers authorities didn’t approve pharmacies with improper infrastructure”(P 4).
3.2.4. Proper Vigilance by Officials
“Only officials and government authorities can improve the pharmacy services in rural areas ...... faraway areas are neglected by them .......... pharmacies of countryside are rarely visited”(P 19)
“In the cities there is the chance of visits by high officials. Therefore, officers of low ranks are much attentive ......... pharmacies and health services of are rural areas unnoticed by staff and authorities ...... vigilance system in villages should strengthen”(P 15)
“Pharmacies in villages are death house ...... need more vigilance and strict control ... government and authorities must pay immediate intentions”(P 32)
4. Discussion
5. Conclusions
6. Limitations
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | Category | Frequency | (%) |
---|---|---|---|
Age | 18–30 | 4 | 11.8 |
31–40 | 8 | 23.5 | |
41–50 | 13 | 38.2 | |
<50 | 9 | 26.5 | |
Gender | Male | 34 | 100 |
Female | 0 | 0 | |
Education status | Below or matriculation | 11 | 32.4 |
Intermediate | 9 | 26.5 | |
Bachelor | 5 | 14.7 | |
Master | 7 | 20.5 | |
Higher | 2 | 5.9 | |
Monthly income in Pakistani rupees (PkR) | 15,001–30,000 | 19 | 55.9 |
30,001–45,000 | 7 | 20.6 | |
45,001–60,000 | 8 | 23.5 | |
Disease (for which participant visited pharmacy) * | Cardiac diseases | 1 | 2.9 |
Diabetes mellitus | 5 | 14.7 | |
Gastrointestinal diseases | 4 | 11.8 | |
Orthopaedic problems | 8 | 23.5 | |
Respiratory infections | 9 | 26.5 | |
Urinary tract infections | 4 | 11.8 | |
Other | 3 | 8.8 |
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Share and Cite
Aziz, M.M.; Jiang, M.; Masood, I.; Chang, J.; Zhu, S.; Raza, M.A.; Ji, W.; Yang, C.; Fang, Y. Patients’ Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan. Int. J. Environ. Res. Public Health 2019, 16, 143. https://doi.org/10.3390/ijerph16010143
Aziz MM, Jiang M, Masood I, Chang J, Zhu S, Raza MA, Ji W, Yang C, Fang Y. Patients’ Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan. International Journal of Environmental Research and Public Health. 2019; 16(1):143. https://doi.org/10.3390/ijerph16010143
Chicago/Turabian StyleAziz, Muhammad Majid, Minghuan Jiang, Imran Masood, Jie Chang, Shan Zhu, Muhammad Ali Raza, Wenjing Ji, Caijun Yang, and Yu Fang. 2019. "Patients’ Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan" International Journal of Environmental Research and Public Health 16, no. 1: 143. https://doi.org/10.3390/ijerph16010143