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Simegn W, Weldegerima B, Endeshaw A, Sisay G, Mohammed A, Wondimsigegn D, Dagne H. Assessment of Community Pharmacy Professionals' Attitude and Perception Towards Ethical Issues in Amhara Region, Ethiopia: A Cross-Sectional Survey 2020. Risk Manag Healthc Policy 2021; 14:4127-4139. [PMID: 34629917 PMCID: PMC8495226 DOI: 10.2147/rmhp.s328328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of this study was to assess the attitude and perception of community pharmacy professionals' towards ethical issues. Methods We have undertaken a cross-sectional study among community pharmacy professionals in three selected towns (Gondar, Bahir Dar, and Debra Markos) of Amhara region in Ethiopia from February to March 2020. All community pharmacy professionals who were giving services during the data collection period were the study population. We used a pretested, semi-structured questionnaire developed from a review of previous study. Epi-info 7.1 was used for data entry, and SPSS version 20 was used for data analysis. Logistic regression was done, and a variable with a p-value < 0.05 with 95% confidence interval was considered to be associated with outcome variable. Results A total of 305 community pharmacy professionals participated in the study with a response rate of 95.3%. About 252 (82.6%) of respondents received education regarding professional ethics. Majority (89.8%) of the participants had ever accessed ethical information at their work site. Only 145 (47.5%) participants had ever recorded ethical issues in their working site. The most common reasons that obstruct to explain ethical issues to customers were shortage of time (85.9%), unavailability of reliable resources (40.0%), and poor ethical knowledge (37.7%). The reporting rate of respondents is less than 50% for most ethical scenarios. Sex, age, educational status, work experience, number of customers per day, working site, information about ethics, and training about ethics were observed to have a significant association with attitude and perception of community pharmacy professionals towards ethical issues. Conclusion Community pharmacy professionals had poor attitude and perception towards ethical issues. Interventions should be devised to uphold ethical awareness of community pharmacy professionals. A large-scale study is also recommended.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Berhanemeskel Weldegerima
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Alem Endeshaw
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Gashaw Sisay
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Abdulwase Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Dawit Wondimsigegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Amhara Region, Ethiopia
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Lambert de Cursay C, Akliouat N, Karamé C, Gagnon-Lépine SJ, Porteils C, Brière AL, Bussières JF. [Evaluation of the ethics of pharmaceutical practice: A literature review]. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:446-456. [PMID: 33309606 DOI: 10.1016/j.pharma.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ethics are at the heart of pharmacy practice. METHOD This is a literature review. The main objective is to carry out a review of studies relating on the evaluation of ethics in pharmacy practice. Documentary research on Pubmed was carried out from 1990 to 2020. All studies relating to pharmaceutical ethics that may be applied to the pharmacy practice in pharmacies or in health establishments and that conducted a qualitative or quantitative evaluation of pharmaceutical ethics (e.g. surveying pharmacists or pharmacy students, using a measurement tool, quantifying or qualifying a perception or behaviour) were included. RESULTS The studies come mainly from Anglo-Saxon countries (29/38). Studies related to pharmacy practice, mainly target pharmacists (n=27) and pharmacy students (n=16), and more often have a quantitative component of (n=28). The main ethical dilemmas observed dealt with emergency oral contraception (EOC), voluntary termination of pregnancy with drugs, euthanasia, commercial practices of the pharmaceutical industry, refusal to dispense a prescription in a broader context and plagiarism or dishonesty in academic settings. CONCLUSION Few studies have been conducted on the review of ethics of pharmacy practices from 1990 to 2020. Pharmacy students and practicing pharmacists are regularly exposed to ethical dilemmas and respond to these dilemmas with due consideration, taking into account six principles, eight values and other factors. Exposure to these dilemmas creates inaction, stress and distress. A few possible solutions have been identified.
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Affiliation(s)
- C Lambert de Cursay
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - N Akliouat
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - C Karamé
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - S-J Gagnon-Lépine
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - C Porteils
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - A-L Brière
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada; Faculté de pharmacie, université de Montréal, Montréal, Québec, Canada.
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Moral reasoning perspectives of community pharmacists in situations of drug shortages. Res Social Adm Pharm 2020; 18:2424-2431. [PMID: 33349586 DOI: 10.1016/j.sapharm.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Drug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists' moral reasoning in situations of drug shortages has not been addressed. OBJECTIVE To explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages. METHOD An electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages. RESULTS Results from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario. CONCLUSION Pharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive.
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Fino LB, Basheti IA, Chaar BB. Exploring Ethical Pharmacy Practice in Jordan. SCIENCE AND ENGINEERING ETHICS 2020; 26:2809-2834. [PMID: 32533448 DOI: 10.1007/s11948-020-00231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists' practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists' personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists' understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists' literacy in professional ethics.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: A case of driver with breakthrough seizures. Epilepsy Behav 2020; 102:106703. [PMID: 31786471 DOI: 10.1016/j.yebeh.2019.106703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The present study was conducted among pharmacy students to use an 8-step systematic approach to facilitate discussions, deliberations, and decision-making on what to do when facing a dilemma of a patient with epilepsy who drives while having breakthrough seizures. METHODS A hypothetical case was developed using the 12-tips for developing dilemma case-based assessments in health education. A mixed method was used in this study. A serial group discussions based on the nominal group technique (NGT) method were applied. A thorough review of the literature and interviews with key experts in the domain (n = 12) were conducted to obtain pertinent data to inform discussions, deliberations, and decision-making. The analytic hierarchy process (AHP) was used to pairwise compare countervailing arguments and alternative courses of action. RESULTS In this study, 3 nominal groups were held, and for each 3, discussion rounds were conducted. A total of 27 panelists took part in the nominal groups. Compared with other alternative courses of action, significantly higher weight scores (p-value < 0.001) were given to the course action, "the pharmacist could counsel/educate the patient on the dangers/risks of driving while experiencing breakthrough seizures, inform the patient to refrain from driving in this period, and make a shared decision with the patient to refrain from driving in this period and inform the state authorities". CONCLUSION This study demonstrates that the 8-step approach when combined with the AHP can be a handy method in facilitating decision-making while addressing and resolving ethical/legal/professional dilemmas in daily healthcare practice.
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Kruijtbosch M, Göttgens-Jansen W, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Moral reasoning among Dutch community pharmacists: testing the applicability of the Australian Professional Ethics in Pharmacy test. Int J Clin Pharm 2019; 41:1323-1331. [PMID: 31254151 PMCID: PMC6800840 DOI: 10.1007/s11096-019-00869-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Background Moral reasoning competency is essential in healthcare practice, especially in situations of moral dilemmas when a professional has to choose a morally justifiable action among several suboptimal action options. The Australian Professional Ethics in Pharmacy test (PEP test) measures moral reasoning among pharmacists. In Australia three levels of moral reasoning (schemas) were measured (1) business orientation (2) rules and regulations, and (3) patient rights (i.e. most advanced schema). Objective To test the applicability of the PEP test to pharmacists working in the Netherlands. Setting Dutch community pharmacy. Methods The PEP test consists of 36 statements (items) accompanying 3 moral dilemma scenarios. It was translated into Dutch and completed by 390 pharmacists. Principle component analysis (PCA) was used to investigate construct validity and Cronbach's Alpha was used to indicate internal consistency of the Dutch version of the PEP test. The eligible grouped statements and perceived possible moral reasoning schemas were compared to the Australian findings. Main outcome measure Moral reasoning schemas. Results The PCA analysis resulted in 3 components (i.e. possible moral reasoning schemas) that together accounted 27% variance in the data. The statements that represented the moral reasoning schemas 'business orientation' and 'rules and regulations' were somewhat similar when comparing these with the statements that represented these schemas in the PEP test study. The most advanced moral reasoning schema identified in Dutch pharmacists contained different statements compared to the statements that represented that schema among Australian pharmacists. This schema was labelled 'professional ethics'. Conclusion The PEP test needs further adaptation to the Dutch pharmacy practice context: especially the statements that should reflect the most advanced moral reasoning schema, need more accurate representations of professional pharmacy ethics that guide pharmacists in the Netherlands. Moral reasoning tests for a specific professional setting or country should be developed and adapted by experts who share the same professional values and practice as the respondents.
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Affiliation(s)
- M Kruijtbosch
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE, Leiden, The Netherlands. .,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.
| | - W Göttgens-Jansen
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 120, ELG, 6500 HB, Nijmegen, The Netherlands
| | - A Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
| | - E van Leeuwen
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 120, ELG, 6500 HB, Nijmegen, The Netherlands
| | - M L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
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Hattingh HL, King MA, Hope DL, George E. Pharmacy ethical reasoning: a comparison of Australian pharmacists and interns. Int J Clin Pharm 2019; 41:1085-1098. [PMID: 31093939 DOI: 10.1007/s11096-019-00815-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
Abstract
Background Ethical reasoning informs decision making and professional judgement, is guided by codes of ethics and conduct, and requires navigation through a regulatory framework. Ethical reasoning should evolve throughout the pharmacy internship year and prepare interns for independent practice. Objective To explore the ethical reasoning and processes of Australian pharmacists and pharmacy interns. Setting Queensland community pharmacists and interns. Method A survey to determine use of resources to guide ethical decisions, management of ethical dilemmas, and exposure to potential practice privacy breaches. Participants were recruited at pharmacy intern training events, a pharmacist education session and through telephone contact of randomised community pharmacies. Main outcome measure Comparison between pharmacist and intern responses using 5-point Likert scales, listings and prioritising. Results In total 218 completed surveys were analysed: 121 pharmacy interns and 97 pharmacists. The Code of Ethics was identified as the resource most frequently consulted when faced with ethical dilemmas. Interns were more likely to consult legislation and regulatory authorities whereas pharmacists with colleagues. Responses to ethical vignette scenarios and exposure to privacy breaches varied between interns and pharmacists, with some scenarios revealing significant differences. Most participants had been exposed to a variety of potential privacy breaches in practice. Conclusion Interns focussed on legislation and guidelines when presented with hypothetical ethical dilemmas. In contrast to this positivist approach, pharmacists reported using a social constructionist approach with peers as a reference. Pharmacists avoided ethical scenario options that required complex management. Interns reported more exposure to potential practice privacy breaches.
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Affiliation(s)
- H Laetitia Hattingh
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia. .,Quality Use of Medicines Network, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.
| | - Michelle A King
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Quality Use of Medicines Network, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia
| | - Denise L Hope
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Quality Use of Medicines Network, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia
| | - Elizabeth George
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia
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Al-Qudah RA, Tuza O, Tawfiek H, Chaar B, Basheti IA. Community pharmacy ethical practice in Jordan: assessing attitude, needs and barriers. Pharm Pract (Granada) 2019; 17:1386. [PMID: 31015876 PMCID: PMC6463417 DOI: 10.18549/pharmpract.2019.1.1386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Having a local code of ethics, based on moral obligations and virtues, known
to all practicing pharmacists is important in order to guide them in
relationships with patients, health professionals, and society. Objective: To investigate pharmacists’ attitude and barriers towards applying the
ethical principles published by the Jordanian Pharmacists Association in the
Jordanian code of ethics. Methods: The study objectives were addressed in a cross-sectional study completed by a
convenience sample of community pharmacists, in both cities; Amman and Irbid
A questionnaire was used to achieve the study objective. The questionnaire
was developed and validated, investigating pharmacists’
socio-demographic and practice characteristics, perceived attitude toward
certain practice scenarios, and perceived barriers towards applying the
locally published ethical principles while dealing with their patients. The
questionnaire was self-completed by pharmacists between January and August
2017. Collected data was analyzed using SPSS version 21. Descriptive
statistics and parametric tests were used with p<0.05 set a priori as
significant. Results: Seven hundred and four pharmacists (Amman n=486; Irbid n=218) responded to
the questionnaire, providing completely answered questionnaires with a
response rates of 69.4% in Amman and 99.6% in Irbid.
Pharmacists from both cities revealed that they use the Internet as their
main resource to obtain ethical information when they need it, to help them
deal with their patients (34.0% from Amman and 31.5% from
Irbid). More pharmacists in Amman (57.0%) had access to resources
regarding ethical information at their practice sites compared to
pharmacists in Irbid (24.0%). Significant differences in attitude was
found between pharmacists practicing in both cities, as significantly less
pharmacists from Amman (37.8%) declared that they would sell a
medication for an unreported indication according to national and
international guidelines, if recommended by the consultant, compared to
pharmacists from Irbid (77.7%, p<0.001). Conclusions: Despite having ethical guidance from the Jordanian Pharmacists Association,
the majority of pharmacists in Jordan do not use this resource; instead,
most choose to access ethical guidance on-line. Pharmacists from the
capital, Amman, reported to adhere more with the guidelines when selling a
medication for an unreported indication compared to pharmacists from the
smaller city, Irbid. Results of this study call for more actions from the
authorities in the country responsible for setting and enforcing the
pharmaceutical Code of Ethics.
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Affiliation(s)
- Rajaa A Al-Qudah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Omar Tuza
- Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Haneen Tawfiek
- Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Betty Chaar
- Faculty of Pharmacy, University of Sydney. Sydney (Australia).
| | - Iman A Basheti
- Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences Private University. Amman (Jordan).
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