Attitude, perception, willingness, motivation and barriers to practice-based research: A cross-sectional survey of hospital pharmacists in Lahore, Punjab, Pakistan

Background and objectives

Practice-based research (PBR) is of pivotal importance for hospital pharmacists which not only up-grades the profession but also improves the patient care. This study aimed to evaluate the attitude, perception, willingness, motivation and barriers to PBR among hospital pharmacists in Pakistan.

Methods

A descriptive, cross sectional study design was employed. Data were collected between 1^st December, 2017 and 1^st March, 2018 from 130 hospital pharmacists employed in 41 hospitals of Lahore, Pakistan. A survey instrument comprising of six sections was designed to determine the attitude, perception, willingness, motivation and barriers to PBR. Data were analyzed by using Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, version 21.0, Armonk, NY: IBM Corp.). The normality of the data was determined through Shapiro-Wilks and Kolmogorov-Smirnov tests. Independent Samples Mann-Whitney U Test and Independent Samples Kruskal-Wallis Test were carried out to test if there were differences among the characteristics of the hospital pharmacists. Logistic regression analysis was used to figure out the factors associated with attitude, perceptions, willingness and motivation towards PBR. A p-value <0.05 was used for statistical significance of differences.

Results

A total of 141 pharmacists were approached. Among them, 130 responded to the survey (response rate 92%). Out of a maximum score i.e., 5 (100%) the respondents obtained a median score of 4 (IQR = 0) for attitude, perception and motivation towards PBR; whereas, a median score of 4 (IQR = 1) was obtained for willingness thus demonstrating fair positive attitude, good perceptions, increased motivation and willingness towards PBR. The most common barrier limiting the pharmacists’ participation in PBR was lack of time (23.8%) followed by lack of incentives (16.2%) and lack of support (14.6%). Results of the logistic regression analysis revealed that hospital pharmacists practicing in the inpatient settings had 4.56 times more positive attitude towards PBR (OR = 4.56, 95%CI = 1.07─19.42, p-value = 0.040) as compared to those practicing in the outpatient settings. The male hospital pharmacists (OR = 8.86, 95%CI = 1.15–53.74, p-value = 0.017), those practicing in the outpatient (OR = 23.51, 95%CI = 2.04─271.53, p-value = 0.011) and inpatient settings had increased motivation towards PBR (OR = 12.24, 95%CI = 1.61─94.66, p-value = 0.016).

Conclusion

Despite the presence of several barriers, the respondents had fair positive attitude, good perceptions, increased motivation and willingness towards PBR which is a promising finding.

Pharmacists' involvement in and attitudes toward pharmacy practice research: A systematic review of the literature

BACKGROUND

The role of pharmacists in health care has evolved toward patient-centered care. Pharmacy practice-based research is essential to the advancement of practice; however, literature addressing attitudes and involvement of pharmacists in practice research indicates reluctance among them. An account of studies undertaken thus far is warranted.

OBJECTIVE

This systematic review aims to summarize and evaluate the views and attitudes of pharmacists regarding their involvement in pharmacy practice research as well as the barriers and enablers to such research.

METHODS

A systematic review of original studies published mainly in MEDLINE, PubMed, EBSCO, ScienceDirect, ProQuest, and Google Scholar was conducted to identify published studies that report pharmacists' attitudes and involvement in research as well as perceived facilitators and barriers. Data were independently extracted by two reviewers using a standardized data abstraction tool.

RESULTS

Fifteen studies utilizing questionnaire-based surveys, focus groups or interviews were identified and included in the review. The majority of studies (10 of 15) involved community pharmacists, while only 6 involved hospital pharmacists. Studies were mostly conducted in the UK (5 of 15), followed by Australia and Canada (3 of 15 each). Early studies focused on pharmacists' attitudes on practice-based research, but most recently there was attention on practice-based research networks (PBRNs). Pharmacists' awareness, interest and willingness to participate in practice research, their actual involvement in research projects, and positive attitude toward research have increased over time. Pharmacists generally believed that practice-based research was needed for professional development of pharmacy and agreed with the importance of research to support evidence-based practice and to improve the quality of patient care and outcomes. The most commonly reported barriers to participation in research across the reviewed studies were: lack of time and workload; insufficient or lack of funds; and lack of research knowledge, training, mentorship and support.

CONCLUSIONS

Pharmacists recognize the value of research in advancing pharmacy practice and indicate their willingness to be involved in independent research and in PBRNs. Lack of time, training and support were identified as the greatest limitations to participation in practice research. These findings have important implications on promoting research capacity building through the development of PBRNs involving academic and pharmacy practitioners as well as informal research training programs.

Hospital pharmacists' self-evaluation of their competence and confidence in conducting pharmacy practice research

Objectives: Research is essential to the advancement of pharmacy practice and healthcare. Pharmacists have a pivotal role to play in this strategy. However, there is a paucity of data about hospital pharmacists’ competence and ability in conducting health-related research. This study primarily aims to determine the research demographics of hospital pharmacists in Qatar and to assess the pharmacists’ perceptions of their competence and confidence to conduct research.

Methods: A multi-centered survey using a 70-item piloted questionnaire was conducted among a randomly selected sample of pharmacists practicing at seven Hamad Medical Corporation-managed hospitals. Both descriptive and inferential statistical analyses were applied using IBM-SPSS® version 20.

Key findings: A total of 120 participants responded to the survey (67% response rate). About 70% of the participants did not have any previous research experience. At least 20% of the respondents self-reported inadequate competence and/or confidence in developing research protocols, critically appraising the literature, undertaking and applying appropriate statistical techniques, and interpreting research findings. The level of education along with the current hospital of practice had significant effects on pharmacists’ self-assessed competence (p < 0.05). Overall, 85% of the participants were interested in pursuing postgraduate studies or research-related training.

Conclusions: A large proportion of hospital pharmacists in Qatar self-assessed themselves as having deficiencies in several domains of research process or competencies, although they recognized the value of research in advancing pharmacy practice. These findings have important implications for developing informal research training programs and promoting the pursuit of formal postgraduate programs to bridge the knowledge gaps found among hospital-practicing pharmacists.

Anti-inflammatory, anti-lipid peroxidative, antioxidant and membrane stabilizing activities of hydroalcoholic extract of Terminalia chebula fruits

CONTEXT

Arthritis is inflammation of one or more joints. Terminalia chebula Retz. (Combretaceae) fruit is mentioned in Ayurveda as useful in treating arthritic disorders.

OBJECTIVE

This work was undertaken to evaluate the anti-inflammatory, antioxidant, anti-lipid peroxidative and membrane-stabilizing effects of hydroalcoholic extract of Terminalia chebula fruits and also to establish a possible association between them.

MATERIALS AND METHODS

In vivo anti-inflammatory activity of T. chebula fruit extract at different doses ranged from 50 to 500 mg/kg, p.o. was evaluated against carrageenin-induced inflammation in rats. Human erythrocyte hemolytic assay was used for in vitro anti-inflammatory activity testing with 50 to 500 µg/ml fruit extract. Antioxidant potential of test fruit extract (10 to 100 µg/ml) was evaluated using TBARS and DPPH methods. The fruit extract was standardized for total phenolic content using Folin-Ciocalteu method.

RESULTS

The standardized extract at 250 mg/kg, p.o. dose caused 69.96% reduction in carrageenin-induced rat paw edema and demonstrated 96.72% protective effect on human RBC membrane stability. Besides, T. chebula fruit extract significantly reduced the in vivo formation of TBARS in carrageenin-induced rat liver with IC50 94.96 mg/kg, p.o. and also in vitro radical scavenging activities in DPPH assay method with IC50 42.14 µg/ml. The standardized extract contains phenolics 118.5 mg gallic acid equivalent/g of extract.

DISCUSSION AND CONCLUSION

These promising findings support the traditional use of T. chebula fruits in the treatment of arthritic disorders and suggest that radical quenching may be one of the mechanisms for its anti-inflammatory activity.