Original Article

Community pharmacy practice in Pakistan

Nousheen Aslam, Rabia Bushra, Muhammad Umair Khan
College of Pharmacy, Ziauddin University, Karachi, Pakistan

Address for correspondence: ABSTRACT

Mr. Muhammad Umair Khan,
Ziauddin University, Karachi, Pakistan. Objectives: This study was planned to determine the extent to which the role of a
E‑mail: [email protected] pharmacists is established in community pharmacies in Pakistan and to determine the
need of qualified and experienced pharmacists in provision of healthcare at these medical
stores or so called community pharmacies.
Materials and Methods: A structured questionnaire was distributed to a random sample
of 175 attendants at various medical stores located in different areas of Karachi with a
response rate of 90.28%. Questionnaire consisted of 24 closed ended questions whose
consistency and reliability were determined by Cronbach’s alpha. Statistical analysis
were done using SPSS (v.16.0)
Results: The result shows that the average age of pharmacy attendant lies between 21
and 30 years. Only 9.49% of attendants have professional pharmacy education. It was
noted that only 22.6% check prescriber signature before dispensing prescription, which
is quite a low as compared with standard practice. Interestingly 57.6% attendants think
that presence of qualified pharmacy at medical stores does not make any difference in
the efficacy and the business of medical stores.
Conclusion: This study concludes that the current status of community pharmacy
practice is below par. There is a need to involve more pharmacists at community level
Key words: Community pharmacy, and develop awareness programs to counter patients’ routine drug issues and reducing
pharmacist, healthcare, Pakistan the burden of disease from society.

INTRODUCTION improvements in health outcomes depends on the

workforce levels and quality, accomplishment of
The conventional role of pharmacist is to manufacture desirable results are difficult to achieve without a
and supply medicinal products. Recently, however, competent pharmacy workforce.[2‑4]
there is a significant change in the pharmacy profession
in terms of professional services delivery due to The need for the increase in horizon of the pharmacy
increase in demand of pharmacists.[1] Complexities profession had become inevitable for the past 2
due to increase in range of medicines and poor decades. Various unconventional techniques were
compliance have shifted the focus of pharmacist introduced in this time like medication therapy
toward patient‑centered approach. This situation management (MTM), which provides additional
has made pharmacy discipline to be recognized as an scope for the pharmacy professionals. The pharmacy
equally important profession in the multidisciplinary profession is still lagging behind in developing
team for the provision of health care. Since the countries as compared with developed countries
in a way that the pharmacy professionals have
Access this article online never been considered as a part of health care team
Quick Response Code:
Website: neither by the community nor by the health care
www.archivepp.com
providers.[5]

DOI: In low socio‑economic countries like Pakistan,

10.4103/2045-080X.106259
community pharmacies may be of great value in
terms of providing medicinal services. However,

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 Aslam, et al.: Community pharmacy practice in Pakistan

the standard of these services are criticized and are experience, dispensing routine of the attendants
yet to be answered.[6] Moreover, very little literature at medical stores or functional pharmacies. Their
is available regarding the standard of community knowledge about commonly dispensed drugs,
pharmacy practice in developing countries.[7] influence of different factors on prescribing practice
of the general practitioners in that area and the
Various pharmacy organizations and established willingness to have a qualified pharmacist at their
institutions have already devised a plan for a good medical store were also evaluated.[9]
community practice including the use of safe and
cost effective medicines but only little emphasis has Statistical analysis
been given in this regard in developing countries, All the analyses were carried out using SPSS
which is evident from the fact that only few researches version 16.0 (statistical package for social sciences)
have been carried out in this discipline. This signifies for windows.
the need to shift the focus toward optimum use of
medicines.[8] RESULTS
Community pharmacy is an important aspect of The questionnaire were distributed to 175 participants
the pharmacy profession as it is easily accessible and the response rate was 90.28% (n = 158). A total of
for the society. The major responsibilities of the 96 (60.7%) participants responded in English, whereas
pharmacist are to maintain all ethical requirements 62 (39.2%) responded in Urdu.
regarding the dispensing of medicines. The activities
also involve counseling of patients regarding the Among respondents, 75 (47.4%) were the owners
disease and the medicines. They also remain in of pharmacy and 83 (52.5%) were employees. The
contact with the physician and work as a health age distribution, qualification, and experience of the
care team to facilitate the patient at best. However, respondents are summarized in Table 1. Their practice
the involvement of community pharmacists in such for drug dispensing and distribution, prescriber’s
activities is not well known in Pakistan. This paper practice of prescribing different medicines and the
tries to explore the education, experience and main influence of medical information officers’ visits on
activities undertaken by pharmacists at local medical prescribing practice, the patient’s knowledge about the
stores in Karachi – the metropolitan city of Pakistan.
The study also determines the potential of these Table 1: Characteristics of study participants
functional pharmacies or medical stores to play role Characteristics N %
in contributing to health care provision to local public. Age (years)
15-20 18 11.39
MATERIALS AND METHODS 21-30 69 43.67
31-40 41 25.94
41-50 20 12.65
Study design, setting, and study population
51-60 10 6.32
A cross sectional survey based on representative Qualification
sample of 175 attendants working in different locally Lower secondary 14 8.86
situated medical stores in Karachi was conducted from Secondary 22 13.92
April to September 2010. They were given informed Higher secondary 51 32.27
consent form (ICF) before administration of structured BA 09 5.69
questionnaire. BSc 14 8.86
BCom 3 1.89
Data collection and evaluation BPharm 15 9.49
Dispensing course 25 15.82
A structured questionnaire containing 24 closed
No response 05 3.16
ended questions with 3-4 levels was developed. The Experience (years)
questionnaires were drawn in both English and Urdu ≤1 08 5.06
language. The internal consistency and reliability of 2-5 70 44.30
the questionnaire were determined by Cronbach’s 6-10 41 25.94
alpha and Spearman correlation coefficient. The alpha 11-20 16 10.12
value of 0.942 and P value of 0.970 revealed that 21‑30 08 5.06
the questionnaire is both consistent and reliable. 31‑40 05 3.16
Different variables were evaluated such as education, No response 10 6.32

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 Aslam, et al.: Community pharmacy practice in Pakistan

medicines, which they buy from these medical store, in the practices of the different countries, despite of the
and other variables are presented as percent responses guidelines given by World Health Organization (WHO)
to different levels in Table 2. While perception of regarding the role of pharmacist in clinical settings.[10]
pharmacists against different practices of community
pharmacy is presented in Table 3. This paper has tried to explore practices in community
pharmacies in Karachi. The results have revealed
Interesting results were obtained when respondents some important points regarding the standard of
were asked about having pharmacist in their practice in the most populated city of Pakistan. The
pharmacies. 57.6% responded that it will not make any most striking point was among all the pharmacy
difference in the overall practice in their pharmacies attendants; only 15 (9.49%) were pharmacist. This
[Figure 1]. The study participants also revealed again is totally ignoring the guidelines provided by
that antibiotics (95.9%) and multivitamins (94.55%) WHO that a legally qualified licensed pharmacist
were among the most common drugs dispensed at must be present at a operational pharmacy.[10]
community pharmacies in Pakistan [Figure 2].
This study observed the responses of pharmacy
DISCUSSION attendants for various activities and it was found
that 86.7% respondents agreed that the handwriting
Pharmacy is an important discipline that carries the of prescribers does not make any legibility problem
responsibilities of providing rational cost effective to them. However, 81% of these respondents were
medicines to patients. The profession of pharmacy unable to understand the prescription orders written
is well established across the globe especially in the by doctors other than their area. This figure brought
developed countries. However, still some variations exist into light an interesting fact that the dispensing

Figure 1: Percent response of the respondents to have a pharmacist Figure 2: Most commonly dispensed drugs at community pharmacies
at their community pharmacies

Table 2: Percent responses to each level of different activities

Questions No. of No Yes Often Very often No
respondents response n % n % n % n %
Check name and age of patient on prescription 142 16 26 18.3 46 32 † † 70 49
Check prescriber’s sign on the prescription order 137 21 31 22.6 44 32.1 † † 62 45.2
People come to tell about any adverse drug event 140 18 11 7.8 49 35 † † 80 57.1
Prescribers write the reason for medication on prescription order 145 13 13 8.9 60 41.3 † † 72 49.6
Prescribers’ handwriting is easy to understand 158 00 137 86.7 8 5.06 8 5.06 5 3.16
They dispense drugs without prescription 158 00 150 94.9 8 5.06 00 00 00 00
They face problems of sound alike/look alike drugs 150 8 73 48.6 39 26 † † 38 25.3
They dispense drugs without prescription 158 00 62 39.2 60 37.9 † † 36 22.7
They can dispense drugs by generic name 150 8 47 31.3 28 18.6 52 34.6 23 15.3
Prescribers prescribe medicines according to the locality of practice 148 10 101 68.2 39 26.3 † † 8 5.4
Patients know which drug they are using and for which purpose 155 3 33 21.2 47 30.3 † † 75 48.3
Visits of medical information officers affect prescribing practice 148 10 106 71.6 23 15.5 † † 10 6.7
They use computers at their medical stores 153 5 36 23.5 8 5.2 3 1.96 106 69.2
They dispense alternate drugs 150 8 26 17.3 54 36 31 20.6 39 26

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 Aslam, et al.: Community pharmacy practice in Pakistan

Table 3: Perception of pharmacist against different important causes of dispensing errors the major
practices in community pharmacy one being the poor, often unreadable, handwriting
Perception N % response of prescribers.[11]
What do the dispensers do when there is no
signature of prescriber on the prescription Interestingly, 44.93% of the attendants dispense
I return back the prescription 114 72.15
drugs even if they cannot understand prescriber’s
I dispense the medicines in any way 5 3.16
handwriting and 45% are sure that they dispense the
It does not make any difference 21 13.29
No response 18 11.39
correct drug. Similarly, only few respondents (11.39%)
What do the dispensers do when diagnosis
told that they return back the prescription in the
is not written on the prescription? case if it does not contain prescriber’s signature.
What do the dispensers do when there is no 3 1.9 An alarming fact was that 95% sell drugs without
signature of prescriber on the prescription prescriptions, which factually can lead to the
I return back the prescription 126 79.7
misuse of drugs in our society. We were told by
I dispense the medicines in any way 24 15.19
49.6% respondents that doctors do not indicate the
It does not make any difference 5 3.16
No response 3 1.9
reason of medications on prescription and only 1.9%
What do the dispensers do when return back such prescriptions. They also told that
writing of prescriber is illegible? they do not consider it important to be written on
I return back the prescription 82 51.9 the prescription for dispensing from community
I dispense the medicines in any way 71 44.93 pharmacy.
No response 5 3.16
When the writing of prescriber is illegible
then the dispenser is sure that he is
Expectedly, 57.6% pharmacy attendants think that
dispensing correct medicines the presence of a pharmacist will not make any
100% Correct 71 45 difference in the community pharmacy operation
75% Correct 49 31 and it can be better run by nonpharmacists. Nearly
50% Correct 32 20.2 8.86% think that if pharmacists would be hired
No response 6 3.8 in the medical stores then they will dominate the
They recognize drugs by
nonpharmacists. They were of opinion that presence
Manufacturing company 71 45
of pharmacist does not make any difference to the
Packing 63 39.8
Appearance (as pink tablet, red capsule, etc.) 19 12.02
sale of community pharmacy. Only 26% were of the
Category (e.g., cardiovascular drug, analgesic) 00 00 idea that a pharmacist can improve the efficiency of
No response 5 3.16 work at community pharmacy because he has more
The purpose of computer at medical store* knowledge about drugs and drug management and
It serves as an accessory 3 9.5 he can counsel patients at community pharmacy,
It eases my work 11 31.64 which can also be source of escalation in the business
It helps marinating inventory 13 36.11 of medical stores. In Pakistan, the overall structure
It attracts the customers 2 6.32 of health care system is not well developed and is
It helps in patient education 00 00
associated with confounding factors like economic
Rationale behind dispensing an alternative
drug to the prescribed one** crises, social insecurities, gender insensitvity, limited
More costly, so that I can earn more 00 00 resources, and also due to restricted role of pharmacist
Cheaper so that the patient can afford easily 73 65.76 in health care setting.[12] The scope of community
More effective than the drug 8 7.2 pharmacy can be evolutionized in collaboration with
which was prescribed government and the society by employing more and
Shortage of prescribed drug 28 25.2 more qualified pharmacist and create awareness
at my medical store
The alternate drug is near to expiry date 00 00
programs to make people understand the role of
No response 2 1.8 pharmacist in community settings and how they can
*36 medical stores had computers, **111 dispensers dispense alternative drugs bring fresh waves of health and knowlegne in the
society.[13,14]
person or pharmacist at community pharmacies
or the medical stores in Karachi are familiar with Moreover, 57% attendants specified that their
the prescribers’ handwriting of their areas. The customers do not inform them about any adverse drug
finding is supported by a Danish study conducted event occurred after the use of drug. Only 7.8% (all of
in 2007 where the authors analyzed self‑reports them were pharmacists) of them informed that their
of community pharmacies and identified four customers tell them about any adverse drug event.

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 Aslam, et al.: Community pharmacy practice in Pakistan

Since there are no guildelines available regarding only 23.5% use computers with a belief that it eases
the use of patient medical record and reports of their work and helps in maintenance of inventory.
adverse drug event, the information provided are No respondent considered it as a source of patient
of no use neither for phamracist not for the patients. education. Various softwares are available, which can
This can be seen in view of Mcpherson and Fonatane be used for maintaing records and providing patient
who reported that Pateint Centered Care (PCC) is education. There is a need to train pharmacy attendants
acheieved by maintaing and regular updating of on these softwares so that they can play much needed
pateint health reords, counselling sessions for disease role in providing maximum benefits to the patient.
and medicines, and adverse drug events.[15‑17] These type of services are more important in rural
areas because of the scarcity of health professionals
Another important feature of this study revelaed in those areas.[25‑31]
that visits of medical information officers of various
pharmaceutical companies to doctors influence their
CONCLUSION
prescribing practice. Nearly 71.6% respondents
informed that these medical officers also visit The important conclusion that can be drawn from
pharmacy for their drug products. This explains this study is that the community pharmacy practice
how the respondents can dispense the drugs even if in Pakistan is well below par. This situation can
they do not understand the handwriting of physician. be overcome by hiring more pharmacists for the
Rogers conducted a study to evaluate the factors supervision of community pharmacy. Other
affecting prescribing of doctors in a hospital setting health‑care staff must be qualified enough to counter
and in general practice. He found out that general day to day problems. Much emphasis must be given
practitioners (GPs) often work alone or with just a on pharmacist–physician collaboration for extracting
few colleagues, and pharmaceutical representatives maximum benefits from the therapy. Proper record
may represent the main opportunities to encounter must be maintained and encouragement should be
‘change agents’.[18] given for the use of technology for the betterment of
society.
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