oa Knowledge, Attitude, Perception and Experience of Pharmacist in Qatar Towards Drug Use in Pregnancy: A Cross-Sectional Study

Background

Maternal health refers to the health of women pre-pregnancy, during pregnancy, childbirth and postpartum. Pregnancy is a state of altered physiology and medication use during this period is remarkably challenging. For various reasons medication use during pregnancy cannot be completely avoided however, due to altered drug pharmacokinetics and crossing of placenta many of these drugs could significantly still harm the growing fetus. Pharmacists are medication experts with great knowledge of pharmacology, pharmacokinetics and are trained to apply evidence based clinical knowledge. Although pharmacists are having great potential to modify and optimize drug therapy in pregnancy, current evidence demonstrates they do not actively provide this care and are least interested in doing so.

Objective

The primary objective of the study was to determine the knowledge, perception, attitude and experience of pharmacist in Qatar regarding risk benefits ratio, concerns, advice, and source of information about drug use in pregnancy and secondary objective aimed to correlate knowledge with different variables.

Methods

A prospective cross sectional questionnaire based study was conducted by Women's Hospital pharmacy department for 3 months in 2010 (June – August). A 23-item self-completed anonymous questionnaire was distributed to 400 licensed pharmacists in Qatar including community pharmacists, hospital pharmacists, Primary Health Centers (PHC) and pharmacists working in polyclinics. Five pharmacists from women's hospital were selected to distribute and collect the questionnaire. A convenient sampling technique was used. All licensed pharmacist were included while pharmacy technicians were excluded. Pilot study was conducted on 30 pharmacists (16 community and 14 hospital pharmacists), were almost consistent in terms of answering, except for two questions (concerning knowledge and pharmacists confidence levels while dealing with physicians) which were modified accordingly. The questionnaire was classified into 4 sections: 1) Section 1, about their practice 2) Section 2, about knowledge and perception of medication use in pregnancy 3) Section 3, about pharmacist's level of confidence while dealing with patient and physician 4) Section 4, about source of drug information and certain general statements regarding their beliefs Data was analyzed by SPSS version 17. Descriptive statistics was applied for all the collected variables. Knowledge level of each respondent is determined by ranking their answers based on a scale developed with maximum 28 scores. To see association between Knowledge levels and variables, χ² test was used. P value 0.05 was considered as statistical significant. The study conformed to the ethical principles of Hamad Medical Corporation Research center. Descriptive statistics was applied for all the collected variables.

Results

An overall response rate of 51.75% (207/400) was obtained, and majority (54.1%) of whom were males. The highest percentages of respondents were practicing hospital pharmacists (46.8%), followed by community pharmacist (35.3%) whereas only 13% responded from primary healthcare centers. Most of them had a bachelors' degree (95.7%) in pharmacy. More than 50% of pharmacists responded to have no continuous education or received any CE points in last 12 months. 66% of these respondents reasoned work related issues (time, workload) for not attending these educational activities. 86% of the respondents were aware of the risk and benefits associated with the medication use in pregnancy. Majority (64.7%) of pharmacist possessed ‘average knowledge levels’, 34.3% with ‘good knowledge’ very few (1%) had ‘very good knowledge’. Only 33.3% were comfortable giving advices/counselling to pregnant women. Approximately 89% (strongly agree 39.6% and agree 49.8%) respondents believed they were competent enough to inform pregnant population about their medication where as 1.5% disagreed (strongly disagree 0.5% plus 1% disagree) and around 9% being unsure. Respondents with experience of 5 years and above had better knowledge levels than others. There was a significant positive association between respondents having Continuous Educational activities and their knowledge levels. Respondents who were very comfortable and somewhat comfortable (69.4%) were more knowledgeable than those uncomfortable and somewhat uncomfortable (10.6%). Knowledge of respondents who contacted prescribers with an alternative medication was 79.6% compared to ones who contacted prescribers without an alternative 8.3%. Respondents who agreed and strongly agreed that they were confident enough to advice both physicians (87%) and pregnant patients (91.3%) were more knowledgeable than others.

Conclusion

Our study provided a baseline data regarding knowledge, perception and experience of pharmacist in Qatar regarding drug use in pregnancy. With majority of respondents lacking educational activities, there is an urgent need to stress on the importance of continuous pharmacy education tailored to meet the requirements of specialized areas. Pharmacist should be aware of medications used during pregnancy and should be familiar regarding risks and benefits of the medication used and to provide appropriate drug related information to pregnant women and healthcare professionals taking care of pregnant women.