Indian Journal of Pharmacology Medknow Publications on behalf of Indian Pharmacological Society ISSN: 0253-7613 EISSN: 1998-3751 Vol. 43, Num. 4, 2011, pp. 381-384

Indian Journal of Pharmacology, Vol. 43, No. 4, July-August, 2011, pp. 381-384

Research Article

Effect of information, education and communication intervention on awareness about rational pharmacy practice in pharmacy students

Kunda Gharpure¹, Vijay Thawani², Smita Sontakke¹, Kiran Chaudhari¹, Mangesh Bankar¹, Rajendra Diwe³

¹ Department of Pharmacology, Government Medical College, Nagpur - 440 003, India
² Department of Pharmacology, VCSGGMSRI, Srinagar, Pauri-Garhwal, Uttarakhand - 246 174, India
³ The Hitavada, Wardha Road, Nagpur - 440 012, India

Correspondence Address: Vijay Thawani Department of Pharmacology, VCSGGMSRI, Srinagar, Pauri-Garhwal, Uttarakhand - 246 174 India vijaythawani@rediffmail.com

Date of Submission: 10-May-2010
Date of Decision: 18-Apr-2011
Date of Acceptance: 25-Apr-2011

Code Number: ph11104

DOI: 10.4103/0253-7613.83105

Abstract

Keywords: Current Index of Medical Specialities; Food and Drug Administration; Fisher′s Exact test; Indian Drug Review; information, education, communication (IEC); knowledge, attitude and practice (KAP); Monthly Index of Medical Specialities; rational use

Introduction

The selection and rational use of medicines (RUM) indicates quality of health service. It has been well recognized that several factors influence the use of medicines by consumers, ^[1] and there is a need to address them to bring about a change towards RUM. One prominent factor which influences RUM is the pharmacist. It is being increasingly felt that the pharmacist has an important role to play in providing information on medicines to patients which complements the information given by the doctors. ^[1] Public health interventions, pharmaceutical care, RUM and effective medicine supply management are crucial components of accessible, sustainable, affordable and equitable health care system. It is clear that pharmacy has an important role to play in the health sector reform process. ^[2] The undergraduate curriculum for doctors, pharmacists and nurses should contain well prepared modules on the rational use of medicines. ^[3] The concept of seven star pharmacists introduced by World Health Organization (WHO) has been adopted by International Pharmaceutical Federation (FIP) in 2000 which published its Statement of Policy on Good Pharmacy Education Practice (GPEP). The GPEP statement provides a conceptual framework for the design, implementation and assessment of contemporary educational programmes. ^[4]

The statement on Good Pharmacy Education Practice attaches the roles of a care giver, decision maker, communicator, manager, lifelong learner, teacher, leader ^[5] and a researcher. ^[6] In view of the global acceptance of the new role of a pharmacist as a pharmaceutical care provider, an extensive curriculum change and restructuring of education is urgently needed. An action plan for 2008-2010 was adopted, which incorporated the top four priorities viz. quality assurance, academic and institutional capacity, competency framework and vision for pharmacy education. ^[7]

A pharmacist is an important link between the physician and the patient. The patients expect the pharmacist to give them detailed information about the use of medicines since the physicians do not always have sufficient time to discuss these details. Even if the patients do get instructions from the doctor, they like to get the reinforcement from the pharmacist. The pharmacy graduates enter myriad service fields like Food and Drug Administration (FDA), research, hospital medical store management, quality control, medical representative or private pharmacy shop. In the race for achieving educational excellence, the basics of moral, ethical practice are lost upon the students of pharmacy. Stress is rarely given on good, rational practice and the duties towards patients. Colleges and schools of pharmacy must employ a variety of valid and reliable assessment measures to collect information about the attainment of desired student learning outcomes throughout the professional degree program. ^[8]

Hence, it was thought appropriate to study the existing awareness about rational pharmacy practice in the students of final year B. Pharm and change in their knowledge, attitude and practice (KAP) after information, education, communication (IEC) intervention.

Objective

The main objective was to study the effect of IEC intervention on the awareness about rational pharmacy practice.

Material and Methods

This was a survey based study using a structured questionnaire for collection of data. The questionnaire comprised of 27 objective questions framed by the investigators and peer reviewed by experts. It was pre tested for clarity and appropriateness with the study objective on five student volunteers who were not part of the study group. The final year students of four degree colleges from Nagpur were contacted through the heads of the respective institutes. The students were informed about the objective of the project and the plan of the study. Those who gave written informed consent to continue through full study (n=147) were enrolled. The participating students were called at the meeting venue on a pre determined date in accordance with their convenience. Collection of base line data was done through a pre tested questionnaire which participants filled without being identified, in presence of investigators. It was emphasized that the performance was in no way connected to their academic career. The answer sheets thus obtained were analyzed for the preparation of educational material for interventional phase.

Intervention 1

Analysis of the existing knowledge from the pre test questionnaire formed the basis for framing IEC intervention. A triad of methods was used to impart IEC. Seven informative articles were accordingly prepared for publication in a leading local English news paper. These were written in a manner that even general public would find the information of importance in their use of medicines. The participants were reminded via Short Message Service (SMS) on their mobiles, on the day when each article appeared in the news daily. Each time a copy of the article was also pasted in the respective college notice board. Announcement about this was also made in the classrooms to reinforce the message to read them, through the elected student leaders of the respective colleges.

Intervention 2

After a period of one month of publication of the last article of the series, a half day interactive session was arranged, which was attended by 121 participants only. The 26 absentees were dropped from the study. Posters were displayed on the do′s and dont′s of rational pharmacy practice at the venue. In addition there were six power point presentations on topics relating to various aspects of RUM which reinforced the published articles in greater detail. On the same day after the lecture series, the participants (n=121) were given a repeat test using the same questionnaire which was used earlier for the base line data collection.

Comparison of the pre and post intervention data was done by Fischer′s Exact test and Chi square test wherever applicable using Graph Pad Prism version 5.01. P value less than 0.05 was considered statistically significant.

Results

It was seen that after IEC intervention there was an increased awareness about direct to consumer advertising (DTCA) (P < 0.005), off label use (P < 0.05), schedules of medicines, Monthly Index of Medical Specialities (MIMS), Current Index of Medical Specialities (CIMS), Indian Drug Review (IDR), and pharmacovigilance. Knowledge about storage temperatures for medicines, and expiry dates was adequate in pre as well as post intervention phase [Table - 1].

It was seen that false notions about the need of medicine for every illness, side effects of over the counter (OTC) medicines (P < 0.05), adverse drug reactions (ADRs) of Ayurvedic preparations (P < 0.001) changed after intervention for the better. Base less ideas about brand verses generic quality, newer and costly medicines, injections, and fixed dose combinations (FDCs), were routed out after intervention. Influence of literacy levels, advertising through mass media on rational medicine use and importance of pharmacovigilance, was well recognized in the post intervention phase. The attitudinal change was observed regarding recheck of prescription with the prescribing physician in case of doubt (P < 0.05), lodging of complaint to FDA for quality check when concern was expressed by the patient or was detected by the pharmacist, and issue of medicines on repeat prescriptions.

Questions with multiple choice responses relating to attitude and practices

Outlook towards patients′ suffering was changed for the better as evidenced from more number of respondents opting to give free medicines to a poor patient and selling only the full course of the essential medicine when a patient could not purchase all prescribed medicines. There was increased awareness of duties as seen by more respondents willing to give more information to the patients about medicine use. The concept of essential medicine list (EML) and national medicine list (NML) was cleared to a greater extent after intervention. The importance of various influencing factors on medicine use was understood as is seen from pre and post intervention data in [Figure - 1]. The students identified the advertisements and the pharmacists as key influences on medicine use. The importance of the cost and family influence was ranked lower in post intervention finding [Table - 2].

[Figure - 2] shows pre and post intervention attitude towards importance given to different aspects which a sales person should consider while detailing a physician. In the post intervention phase, the ranking of cost and the gifts took a backseat as compared to the detailing about adverse drug reactions [Table - 3].

The opinion on reasons for decline in health care quality was not changed to any extent.

Discussion

Over the years, the pharmacists′ role has changed from that of a compounder and dispenser to one of medicine therapy manager. The skills and attitude which pharmacists need to master for this new role, affords challenges. Our students still have fixed ideas regarding practice of pharmacy profession. Much has not been done to change these. The young, budding pharmacists during student life are the right target for bringing about the desired change. It is found that the students are usually receptive to any educational intervention. However since the time chosen for the intervention clashed with some internal examinations, all enrolled students could not complete the study.

The results of subjective questions in this study are indicative of the difficulty in changing attitude of the students. Ranking given to influences of several factors on medicine use is more of the idealistic nature and not what is seen in factual situation. Similarly the ranking for medicine promotional information also seems to be highly subjective. It should be borne in mind that these responses are of the student community when they do not have hands on experience.

So far very few studies relate to assessment of curriculum and the impact of this on the attitude and practice of rational pharmacy. A computer assisted program to analyze problem solving and critical thinking skills has been described. ^[9] In yet another study a survey of final year students by self completion questionnaire was undertaken to evaluate the teaching and learning process. The survey concluded that development of knowledge, skills and attitudes framework for pharmacy undergraduate education is necessary. ^[10]

From this study, it is seen that development of knowledge and attitude can be achieved by intervention at a stage when the students are ready to enter the profession. Incorporation of this knowledge in the final year curriculum would surely improve the KAP of students. Since this study was found helpful to change the knowledge, attitude and practice (KAP), it can be replicated to include a wider base of students. A strategic objective of FIP plan called "2020 Vision", in addition to working to advance pharmacy practice and the pharmaceutical sciences, is to increase the organization′s role in reforming pharmacy and pharmaceutical sciences education. Rational practice must be imbibed at the student level itself so that when they enter a profession they carry a good message with them regarding the nobility of the profession.

Conclusion

This study shows that the planned IEC intervention, according to needs, when sincerely implemented in stages, can definitely affect the KAP of the pharmacy students.

References

Copyright 2011 - Indian Journal of Pharmacology

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