Posted: April 3rd, 2022

Pharmacy Education in Bangladesh

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Introduction

In Bangladesh, a comparatively small South Asian nation, the pharmacy occupation has been in existence for the final Four a long time. Nevertheless, the occupation remains to be preserving the established order to help pharmaceutical industries. Till now the shelling out and affected person care roles of Bachelor of Pharmacy (BPharm) graduate (A-grade) pharmacists have been non-existent in the healthcare system of Bangladesh¹. In hospital pharmacy settings, B-grade diploma pharmacists dispense, procure, and distribute medicines. A C-grade pharmacist with a Three-month pharmacy certification following a secondary faculty diploma can personal and run a retail pharmacy and dispense medicines.²

Pharmacy training in Bangladesh has been historically based mostly with 95% of the entry-level BPharm curriculum specializing in pharmaceutical science and industry-based programs, producing pharmacists with experience in the areas of pharmaceutical manufacturing, high quality management and assurance, pharmaceutical advertising and marketing, and regulatory affairs. With the worldwide upsurge aimed toward reforming pharmacy training, a number of south Asian nations together with India, Nepal, and Pakistan have launched clinically-oriented PharmD applications to combine the pharmacist into the healthcare system.^3-7 Following the identical pattern, pharmacy colleges in Bangladesh have been restructuring their curricula to incorporate patient-care elements of pharmacy training together with exploring the opportunity of introducing PharmD applications.^{2, 8}

In a latest article, we mentioned the standing of present pharmacy training and the alternatives and challenges related to incorporating PharmD or scientific applications in Bangladesh⁸. One of many main boundaries we recognized is the lack of know-how and consciousness of the significance of the pharmacy occupation amongst healthcare stakeholders and the federal government. Physicians and different healthcare stakeholders of the nation fail to acknowledge the necessary roles of pharmacists in complete healthcare. Physicians’ recognition of the evolving pharmacy occupation and growth of a pharmacist-physician skilled relationship are important in order to combine the pharmacy occupation into affected person care. Research carried out in a number of nations have proven that physicians are receptive to pharmacists-provided shelling out in addition to affected person care companies^9-11. There may be growing proof that pharmacists can play a job in improved and cost-effective method of affected person care and discount in complete drug-related morbidity and mortality^{12, 13}.

As Bangladeshi pharmacy colleges are reforming their curricula to incorporate scientific elements, it’s the proper time to set the stage for future inter-professional collaboration. The altering face of at this time’s healthcare and growing complexity of drug remedy underscores the necessity for sturdy working relationships between pharmacists and physicians in order to supply optimum affected person care. Thus, it is very important assess the data and attitudes of physicians concerning pharmacists’ roles and obligations in healthcare. The target of this research is to find out physicians’ data and perceptions of the pharmacists’ roles in affected person care and pharmacy companies. The survey outcomes will help in initiating a fruitful dialogue with completely different stakeholders in healthcare concerning the evolving adjustments in the pharmacy occupation in Bangladesh.

Strategies

A survey instrument was developed by the investigators, based mostly on earlier literature experiences^{9, 14, 15} of physician-pharmacist collaboration. The survey instrument was reviewed by all investigators and revisions have been made on suggestions. Two investigators of this research are registered pharmacists with experiences in hospital and/or group pharmacy settings. Since, the researchers graduated in pharmacy from Bangladesh, they’re abreast of the previous and current healthcare techniques of the nation. The research obtained exempt standing from the institutional assessment board of West Coast College and Lake Erie Faculty of Osteopathic Medication. The survey collected information on Three domains: physicians’ present consciousness of pharmacy training and occupation in the nation; their perceptions of the longer term roles of pharmacists in affected person care and, lastly, interprofessional collaboration with pharmacists. The survey instrument additionally collected demographic data of the respondents together with age, gender, affiliation and length of follow.

The participant physicians (n=160) have been randomly chosen from Dhaka, the capital metropolis of Bangladesh. The survey was administered by two strategies: 1) electronically (n=110) and a couple of) distributing hardcopies of the survey (n=50) by a volunteer in chosen clinics and hospitals. The web survey instrument was despatched by e-mail that contained a hyperlink of the survey instrument (Survey Monkey). E mail addresses of physicians have been obtained from web sites of presidency and personal instructing hospitals organizations. Ninety p.c of the e-mail data was collected from Three authorities and 10 non-public hospitals of Dhaka.

A canopy letter accompanied the survey which defined the aim of the survey together with the peace of mind that participation will likely be voluntary and identification will stay nameless. Additionally included in the quilt letter, was data on present traits in world pharmacy training and physician-pharmacist collaborative follow to supply optimum affected person care. Physicians have been additionally knowledgeable that scientific pharmacy programs are being launched in Bangladeshi pharmacy curricula to organize pharmacy graduates to work in scientific settings with physicians and different healthcare professionals.

The survey instrument included 13 questions divided into two sections: i) understanding physicians’ data of pharmacy training and occupation (5 gadgets) and ii) physicians’ perceptions of the longer term roles and obligations of pharmacists in complete affected person care (eight survey gadgets). Objects on the present understandingof the physicians concerning the pharmacy occupation and training have been self-reported as “sure” or “no”. Objects on the notion of pharmacists’ future roles in affected person care and interprofessional collaboration have been self-reported on a five-point Likert scale with 1-very uncomfortable to 5-very comfy. On the finish of the questionnaires, there was a bit for particular person feedback. Knowledge obtained from manually distributed survey have been submitted on-line by one of many investigators. Outcomes from the 2 arms of the survey have been aggregated and analyzed. The Fisher Precise take a look at was used to check the importance of affiliation between the impartial variables (gender and size of medical follow) and the dependent variables (respondents’ degree of consolation). Statistical significance was accepted at a p worth of <zero.05. On the finish of the survey, physicians have been requested to supply total feedback concerning the anticipated roles of pharmacists in affected person care and physician-pharmacists collaborations/relationships. Textual content-based feedback have been collated and thematic Assessment of the content material was carried out.

Outcomes:

Of the 160 questionnaires distributed, 103 contributors accomplished the survey (response charge 67%). The demographic profiles for the contributors are given in Desk 1. Better than two third of the contributors have been male. Greater than 50% of the taking part physicians have been below 30 years of age with 1-Three years of expertise in medical follow. About 75% of the respondents work primarily for personal hospitals/ clinics and 25% in authorities hospitals. Apparently, 95% of the responding physicians are concurrently engaged in non-public follow.

When requested to point their consciousness about pharmacy training and occupation, practically all of the doctor contributors (96%) are conscious of pharmacy as a healthcare occupation. Seventy 9 p.c of the contributors are conscious that pharmacy training in Bangladesh has been considerably expanded. However solely 60% of the respondents knew that pharmacists acquire an A-grade license after profitable completion of a Four-5 yr BPharm diploma program from an accredited college. The contributors acknowledge that pharmacists are educated about medicine (80%) and function dependable sources of drug data (91%).

Responses concerning physicians’ perceptions in direction of the anticipated affected person care roles of pharmacists in Bangladesh and interprofessional collaboration amongst healthcare suppliers are proven in Desk 2. Physicians exhibited a excessive degree of consolation with many of the roles of pharmacists as members of Interprofessional healthcare group. They felt very comfy/comfy with pharmacists procuring, distributing, and shelling out medicines in hospital and group pharmacies (81%); offering training to sufferers/caregivers concerning the secure and acceptable use of prescription medicines (85%); and educating sufferers about well being and wellness, vitamin, and use of OTC medicines and dietary dietary supplements (65%). Physicians are comfy/very comfy with pharmacists detecting and stopping prescription errors (56%), designing pharmacotherapeutic regimens (78%) and monitoring affected person security (80%) and therapeutic outcomes at in-patient settings (62%). Physicians’ consolation degree was discovered to be the bottom with pharmacists recommending physicians various drug remedy or modified drug-therapy routine when therapeutic outcomes weren’t passable (comfy/very comfy, 51% versus uncomfortable/very uncomfortable, 49%).

A complete of 41 open-ended feedback have been recorded from a complete of 102 respondents and have been subjected to thematic Assessment (Desk Three). Many of the feedback (26/41) mirrored upon constructive attitudes in direction of pharmacists’ future roles in affected person care. Physicians have been supportive to the pharmacists’ roles in shelling out and different scientific pharmacy companies. A number of physicians commented on the challenges of integrating pharmacists into affected person care and targeted on the correct coaching and training of pharmacists. Additionally they commented on the significance of an interprofessional dialogue between physicians and pharmacists. A couple of feedback pertained to the reservations of physicians about pharmacists’ suggestions to alter prescriptions or drug remedy routine.

Dialogue:

Pharmacy training is evolving from it’s unique “product-oriented” focus in direction of an inclusive “patient-oriented” focus.^{16, 17} In developed nations, the emphasis on scientific pharmacy training has enabled pharmacists to supply optimum affected person care as members of interprofessional groups.¹⁶ With the evolution of pharmacy occupation, particularly in the developed nations, pharmacists now present direct affected person care as part of interprofessional group in a wide range of follow settings.

Though Bangladeshi physicians are conscious of pharmacy as a healthcare occupation, over 50% didn’t know that Four-5 years of research in direction of BPharm diploma are required for pharmacist licensure. It’s noteworthy that the variety of non-public universities providing BPharm levels is growing in the nation. Out of 27 pharmacy colleges, 22 are in the capital metropolis. Pharmacy colleges are additionally restructuring their curricula to incorporate scientific pharmacy.^2,18 The introduction of a clinically-oriented PharmD program in growing nations is a difficult endeavor^{3, 4} In Bangladesh, the present standing of pharmacy follow and the truth that the occupation just isn’t nicely acknowledged amongst authorities and different stakeholders in the healthcare area represent main boundaries to initiation of patient-oriented scientific applications. Different challenges related to healthcare coverage, bodily infrastructure, monetary sources, institution of a framework of inter-professional collaboration, and physicians’ recognition of the pharmacists’ roles in affected person care must be addressed.

It’s encouraging that physicians in Bangladesh gave the impression to be comfy with pharmacists shelling out prescription orders, detecting and stopping prescription errors, checking opposed results and drug-drug interactions, and offering affected person training. There may be documented proof that the combination of pharmacists to interdisciplinary healthcare groups improves well being and security outcomes for sufferers, decreases morbidity and mortality attributable to medication-related issues, decreases healthcare prices, and improves high quality of care.^{11-13, 19} In a latest pharmacy-based managed trial, Vinks et. al. confirmed that group pharmacists play important roles in lowering the prevalence of drug-related issues in aged sufferers.^{20, 21}

Irrational prescribing, medicine errors, and poly pharmacy have change into a serious well being drawback globally.^22-25 Equally, in Bangladesh, irrational prescribing of medicines and drugs errors are frequent in each healthcare setting. Superfluous prescribing of antimicrobials is widespread and results in emergence of antibiotic-resistant strains and remedy failure²⁶. In a latest research, Paul et al. have reported extremely prevalent prescription errors in a personal hospital in Bangladesh.²⁷ Plenty of components similar to lack of medical professionalism²⁸, curricular hole²⁹ and insufficient coaching in pharmacology and therapeutics^30-34, aggressive promotion of pharmaceutical merchandise, and illegal contract between docs and pharmaceutical industries ³⁵ contribute to the persevering with disaster of irrational prescribing traits in the nation. As well as, Bangladeshi healthcare supply techniques severely undergo from corruption, poor administration, scarcity of correctly educated well being professionals, and lack of accountability³⁶. There may be little or no technique for amassing statistics on medicine errors and its prevention to make sure affected person security. Within the final decade there was an upsurge of personal hospitals together with a number of world-class company hospitals which, for the primary time, are emphasizing high quality management, affected person security requirements, and privateness practices ³⁶. The systemic methods for medicine administration, together with integration of pharmacists into healthcare group by the Apollo Hospitals Dhaka, probably the most distinguished hospital in Dhaka, are noteworthy. The hospital claims that the present charge of medicine error has dropped to 2.45%, the place the US benchmark is 5%.³⁷It’s anticipated that the Apollo Hospitals is usually a mannequin for different hospitals in the nation in the popularity of pharmacists’ roles in affected person care and security.

Bangladeshi physicians are comfy with upcoming pharmacists’ monitoring and optimization of drug remedy. That is according to a survey research in the United Arab Emirates which confirmed that almost all of taking part physicians (92%) supported the scientific pharmacists’ roles⁹. Nevertheless, physicians in Qatar¹⁴, Kuwait³⁸, Pakistan¹⁵, and Sudan³⁹ have been discovered to be extra comfy with pharmacists’ roles carefully linked with drug merchandise than obligations related to monitoring and optimization of affected person outcomes or recommending drug remedy for sufferers. In Montreal, Canada, a physician-pharmacist collaborative care mannequin confirmed higher patient-care outcomes the place pharmacists ordered diagnostic checks and optimized medicine dosages. Nevertheless, the notion of physicians was unfavorable to the success of this mannequin as they felt unsecured and threatened by the increasing roles of pharmacists.⁴⁰

Integrating pharmacists into shelling out and scientific pharmacy companies in Bangladesh will symbolize a milestone. Subsequently, it’s time for Bangladeshi pharmacy group to begin constructing interprofessional relationships with physicians, establishing communication channels, growing mutual respect, and understanding one another’s obligations. The outcomes of the present research can function a foundational method in direction of the interprofessional relationship between pharmacists and physicians. Physicians’ perceptions and data of pharmacy occupation have direct implications on the present pharmacy training reform in Bangladesh. Physicians demonstrated constructive perspective in direction of future pharmacists’ involvement in affected person care. They emphasised the optimum degree of scientific training and coaching for the pharmacists to carry out scientific companies. Furthermore, a number of physicians acknowledged that communication and dialogue between them and pharmacists are inevitable for higher affected person care. On this context, we suggest curricular and non-curricular approaches to develop the tradition of interprofessional collaboration (Determine 1). As now we have mentioned in our earlier article⁸, Bangladeshi pharmacy educators must revisit the curriculum to include optimum didactic and experiential scientific programs, incorporate efficient communication, professionalism, and ethics into curriculum. As well as, the idea of interprofessional training and follow must be included early in the curriculum. Plenty of methods could be utilized by extra-curricular actions at completely different ranges involving skilled associations, establishments, and college students. At skilled affiliation degree, a channel of communication should be developed to provoke skilled dialogue. Upon institution of communication, physicians and pharmacists could be invited as audio system in one another’s skilled conferences. These initiatives will provide the chance of recognizing one another’s experiences, experience and competence in affected person care. At establishment degree, collaboration between medical and pharmacy faculty schools in instructing and analysis, and joint seminars/workshops on scientific areas of curiosity will improve appreciation and recognition of the roles of interdisciplinary colleagues. As well as, alternatives could also be created for organizing well being festivals, workshops, seminars, and group outreach actions involving each pharmacy and medical college students. Because the authorities controls the key well being advantages for its citizen, educating the federal government officers concerning the constructive impacts of pharmacists on total healthcare ought to be an necessary consideration for leaders of the occupation.

In abstract, Bangladeshi physicians possess favorable attitudes in direction of accepting pharmacists in the healthcare area. It’s essential for pharmacy educators and leaders to start a dialog with the federal government in order to increase the roles of pharmacists, undertake related adjustments in well being coverage, and set up inter-professional healthcare groups.