Factors affecting patients’ knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan

Abstract

BackgroundPatients’ knowledge about their prescribed medicines is one of the most important antecedents of successful therapy. Poor knowledge about medicines can lead to serious consequences such as non-adherence and misunderstanding of the significance of adverse events. The objective of this study is to understand the factors that are responsible for a patients’ lack of knowledge regarding their medicines, by taking the perspective of the patient as well as that of healthcare professionals. Much of the work in this area has been undertaken in the setting of developed or semi-developed countries, and there is a scarcity of information from developing nations such as Pakistan.MethodsThis was a large qualitative study set in the hospital outpatient environment in a teaching hospital in the Punjab province of Pakistan. Data were collected from dialogue with patients (n = 19) and healthcare providers (n = 16) i.e., doctors and dispensers (where a dispenser is a person who merely dispenses medicines; i.e. is not a pharmacist) through in-depth semi-structured interviews. Patients having limited knowledge about their dispensed medicines were assessed using a checklist. The healthcare providers were recruited through a convenience sampling strategy, based on their availability and willingness to participate in the study. Based on the objectives of the study, a pilot tested interview protocol was developed, and used to conduct the interviews. The sample size was controlled by using saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis.ResultsThe analysis of data yielded 31 categories (patients = 19, healthcare professionals = 12), 10 subthemes and three themes. The major themes were healthcare professional-related factors, patient-related factors and system-related factors. The health professional related subthemes included: behaviour and attitude and professional liabilities and liaison. The patient related subthemes included: eagerness of the patients and lack of understanding and misconception. The system-related factors included: patients with special needs, perceived role of the pharmacist, prescription and medicines, and staff workload.ConclusionHealthcare professional related, patient related and system related factors have a significant influence on patients’ knowledge about dispensed medicines. The non-professional behaviour of doctors, increased staff workload, inadequate time and attention provided by healthcare professionals to patients, illiteracy of patients, lack of specialized labelling on medicines for illiterate patients and absence of pharmacists at the hospital, were the major concerns identified in this study. The study points to a need for appropriate patient education and counselling with regards medicines, improved coordination between hospital staff, and provision of some basic system-related facilities which are pivotal for enhancing patients’ knowledge and adherence to their tr...

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“…Findings of the present study support several studies that have shown that effective communication between patients and physicians is important for patients to understand their disease state and to fully understand and appreciate the need for medication and medication adherence 6,[15][16][17] . The high communication effectiveness can, therefore, be the reason why a majority of the patients had a high level of prescription awareness.…”

“…It is equally important to note that effective communication between patients and physicians is key for patients to understand both their disease state and prescribed medication 4,[15][16][17] . Although medication knowledge and thus medication adherence begins with prescribing clinicians 15,18,19 , it is not known whether prescribing clinicians explain prescriptions to patients with cardiovascular disease in developing countries such as Kenya.…”

Why is Pakistan vulnerable to COVID‐19 associated morbidity and mortality? A scoping review

“…67 Although, commendably, specific budget is earmarked by the government with the help of international funding for activities concerning COVID-19 control and prevention, but the prevailing mismanagement at lower hierarchy level 55 and biased distribution practices may endanger these efforts. 68…”

“…Human resources for healthcare are identified as one of the core building blocks of a health system and workforce crisis are one of the major obstacles to the quality healthcare. 68 According to the WHO, the overall Pakistani health sector is confronted with an imbalance in the number, expertise and distribution of healthcare professionals and insufficient allotment of resources across various levels of healthcare. 69 Currently, one physician is available to serve every 963 persons in Pakistan.…”

“…80,81 Similarly, a previous study reported that healthcare professionals had suboptimal knowledge of preventive methods (72%) and diagnostic techniques (59%) and other aspects of MERS infection since advanced training and continued medical education were not mandatory in Pakistan. 68 Likewise, Khan et al has recently reported that front-line healthcare workers were not well aware of the COVID-19 related strategies for the prevention and control of infection, and were not prepared for the alarming situation in the country. 82 Beside this, poor collaboration among all the healthcare professionals, such as physicians, clinical microbiologist, pharmacists and nurses 83 is other well-known factor that undermines infection control efforts.…”