Towards improving community pharmacy practice in the United Arab Emirates

Medication use has become complex due to increase in medications available on the market and other advances in medicines and patient management. Pharmacists, given their unique position in the healthcare system and accessibility to communities at large, have a pivotal role in optimising medication therapy and patient safety. Often, they are the patients’ first point of contact with the healthcare system. Accordingly, it is important to strategically ensure optimal pharmacy services. This can be achieved with input from key stakeholders (i.e. pharmacists, patients and physicians). The limited evidence from developing countries shows sub-optimal quality of community pharmacy services and the need for major improvements. Indeed, evidence about community pharmacy services from the key stakeholders’ perspectives in the United Arab Emirates (UAE) remains unknown. Such information is valuable to facilitate development of policies and interventions to optimise community pharmacy services in the UAE context. Therefore, this thesis aimed to characterise current community pharmacy practice in the UAE and propose recommendations for improvement. The research presented in this thesis comprised three phases. Phase one was a survey of the characteristics of community pharmacy practice and the type and frequency of professional services provided through community pharmacies in the UAE. A self-completed questionnaire was delivered by hand to a systematic sample of community pharmacies (n = 700; response rate 49%). Community pharmacists worked long hours (≥ 48 hours/week) and were possibly inadequately trained to provide enhanced pharmacy services. There is no professional pharmacy organisation in the UAE, which may be a barrier to development of services. High turnover of pharmacists was recognised, which could be due to low job satisfaction and poor remuneration. Sub-optimal quality of services was reported. Fewer than one-third (29%) reported they always supplied medication information to patients; most pharmacies (92%) did not routinely keep patient records; and screening and monitoring services were provided by only a small number of pharmacies. Clearly, enhancements in human resource-related conditions and improvements to the professional role of the pharmacist are needed. This phase has, for the first time, documented baseline workforce and service-related information that is critical for future improvement of the community pharmacy practice in the UAE. Phase two was an investigation of patients’ satisfaction with current community pharmacy services and other services that they would be likely to use if they were provided through community pharmacies. A questionnaire was specifically developed and validated for the Arabic context, and was hand delivered to a convenience sample of participants in public places for self-completion (n = 500; response rate 93%). Four dimensions of satisfaction emerged from factor analysis: Information, Relationship, Accessibility and Availability. Low patient satisfaction scores (on a 5-point Likert-type scale: 1 = poor to 5 = excellent) with most services were observed. Patients wanted more information about their medications, self-management and advice on healthy lifestyle (mean±SD = 2.49±1.19). They also requested more personal care, which was considered a measure of trust in the competence of the service provider (mean±SD = 3.05±1.07). Patients were also dissatisfied with the physical characteristics of the pharmacy such as waiting and private areas (mean±SD = 2.80±1.33). Patients would be likely (on a 3-point Likert-type scale: 1 = unlikely to 3 = very likely) to use a wide range of services if provided in the future. This study has, for the first time, provided pivotal information on areas needing improvement from the perspective of patients, and on what could possibly lead to better patient satisfaction and utilisation of the services provided through community pharmacy in the UAE. Phase three utilised a qualitative approach involving 27 one-to-one semi-structured interviews and five focus group discussions among physicians to explore their opinions on pharmacists’ roles in providing primary care services in the community and on collaborating with pharmacists. Emerging themes included: Competency, Business orientation, Territorial control and Service delivery/patient care. There was support for roles that related to the provision of information on medications and their use. Benefits of collaborative care were recognised. Facilitators of success were identified as clear role definition, efficient communication and trust building. Barriers to success included lack of acceptance by both physicians and patients, pharmacists’ competence, and administrative factors. This was the first study to provide valuable insight into pharmacist-physician relationships in the UAE and into what promotes collaboration between them. In working towards improving community pharmacy practice in the UAE, this research is unique in that it has considered the views of the key stakeholders: pharmacists, patients and physicians. This thesis has identified shortcomings in the provision of community pharmacy services which could have negatively affected patient satisfaction and physicians’ perspectives of pharmacists’ roles. Significantly, this thesis has generated crucial recommendations to guide decision making by stakeholders such as policy makers, government authorities and pharmacists with respect to the planning, design and offering of interventional programs that will lead to improvement of community pharmacy practice in the UAE