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ORIGINAL ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 3  |  Page : 197-202

A study on knowledge and practice of dispensing drugs without prescription by pharmacists in Belagavi City


1 Department of Public Health, J. N. Medical College, Belagavi, India
2 Department of Pharmaceutics, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research (KAHER), Belagavi, India
3 Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research (KAHER), Belagavi, India

Date of Submission28-May-2021
Date of Acceptance09-Aug-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Dr. Ashwini Narasannavar
Department of Public Health, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_65_21

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  Abstract 


Background: The pharmacists were trained mainly to dispense medicines only over prescriptions. Despite guidelines, practice of dispensing medicines without prescription has been widely practiced worldwide. The problem and burden of drug resistance are increasing worldwide due to this practice. Objective: The objective of this study is to assess the knowledge and practice of pharmacists on drug dispensing practices without prescription in Belagavi City. Materials and Methods: A cross-sectional study was conducted between January and April 2021 among 80 pharmacists in different areas of Belagavi city. Pharmacists were selected by the simple random technique. Data were collected using the structured questionnaire. The obtained data were tabulated, and the Chi-square test was used to determine the association between the nominal variables. Results: Pharmacists had a good knowledge about laws regarding practice of dispensing without prescription. The practice of dispensing nonover-the-counter drugs without prescription was found to be 32.5% in an average. Pharmacists' fear of losing customers was the primary reason for dispensing without prescription. A significant association was found between knowledge score of pharmacists and job status of pharmacist (P = 0.043*) and location of pharmacy (P = 0.05*). The frequency of dispensing medicines without prescription was found to be significantly associated with age of staffs dispensing (P = 0.04*) and with their education status (P = 0.04*). Conclusion: Pharmacists had an average level of knowledge regarding the practice of dispensing drugs without prescription in India. However, pharmacists tend to dispense medicines without prescription on request of patients.

Keywords: Dispensing, knowledge, practice, prescription


How to cite this article:
Sharma S, Patil S, Narasannavar A, Bhandari R. A study on knowledge and practice of dispensing drugs without prescription by pharmacists in Belagavi City. J Sci Soc 2021;48:197-202

How to cite this URL:
Sharma S, Patil S, Narasannavar A, Bhandari R. A study on knowledge and practice of dispensing drugs without prescription by pharmacists in Belagavi City. J Sci Soc [serial online] 2021 [cited 2022 Jan 18];48:197-202. Available from: https://www.jscisociety.com/text.asp?2021/48/3/197/333851




  Introduction Top


Pharmacists are the key person and a source of linkage between patients and medical personnel. The pharmacist are trained and allowed to dispense drugs only with prescription. Malpractice arises when a professional fails to adequately follow the standards set and properly utilize his/her skills acquired.[1] Over-the-counter (OTC) drugs can be dispensed without prescription but except that, all drugs are to be dispensed with proper doctor's prescription.

Good Pharmacy Practice guidelines for community and hospitals were drafted by the International Pharmaceutical Federation, which was recognized and published by the World Health Organization in 1999,[2] although the guidelines have been drafted the practice of dispensing medicines without prescription has been widely practiced worldwide. Estimation shows that more than 50% of the antibiotics worldwide are sold without a prescription despite the fact that dispensing practice is illegal in most of the countries.[3] The practice is not only going against the rule but widely contributing to the anti-microbial and anti-drug resistance among people.

Dispensing medicines without prescription by registered medical personnel which are required to be given on prescription only is classified as a misconduct by pharmacy practice regulation 2015 in India.[4] The Drug and Cosmetic Act, 1945 also state Schedule “H” drugs are required to be dispensed to any person over prescription only and the practice of dispensing without prescription as illegal.[5]

However, studies conducted in India show a high prevalence of practice despite laws and regulations being implemented. Studies conducted in Bangalore, India, showed the prevalence of practice of dispensing of medicines without prescription ranging from 45% to 67%.[2],[6],[7] Schedule H drugs were found to be commonly dispensed.[2] The practice is common all over India, but no such studies have been conducted in Belagavi city to assess the knowledge and practice of dispensing medicines among pharmacists until today. Thus, this study was conducted to assess the knowledge and practice of dispensing drugs without prescription in Belagavi city.


  Materials and Methods Top


Ethical approval

Ethical approval was obtained from the Ethics Committee of JNMC (Reference No. MDC/DOME/387). Participation in the study was voluntary, and informed consent was taken from the participants before conducting the study.

Study design

A cross-sectional study was conducted during a period of 4 months from January to April 2021 using a prestructured questionnaire among pharmacists in Belagavi City.

Sampling and data collection

Simple random sampling technique was used to select the study participants. The inclusion criteria for this study were pharmacy owners and employees in the pharmacies and those pharmacists who gave consent for the study. Those pharmacies that were closed during the data collection period and where pharmacy assistant or employees were present were excluded from the study.

The sample size for this study was calculated based on a 95% confidence interval, with 5% margin of random error and the expected prevalence of dispensing medicines (assuming 95.8%, derived from a study conducted in Saudi-Arabia).[1] The estimated sample size with an added 30% nonresponse rate was 80 pharmacies.

The pharmacists in the study area were approached and briefed about the study. The risks and benefits of the study were explained in detail. Informed consent was taken from the concerned pharmacists. The data were collected using structured prevalidated questionnaire. The questionnaire contained questions related to sociodemographic characteristics, knowledge, and drug-dispensing practices of the pharmacists.

Statistical analysis

Data were entered and coded in MS Excel and later imported in SPSS version 22.0 software (IBM) for analysis. Rate and proportion were calculated under the descriptive statistics. The Chi-square test was used to observe the association between the variables. P < 0.05 was considered statistically significant.


  Results Top


Sociodemographic characteristics of respondents

Out of 80 participants, maximum participants were male, i.e., (83.8%). Majority of the pharmacists had completed Diploma in Pharmacy (38.8%). Similarly, more than half of the study population had experience of more than 10 years (52.5%). Majority of pharmacies were located in residential area (63.7%). The sociodemographic characteristics of pharmacists are detailed in [Table 1].
Table 1: Sociodemographic characteristics of participants

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Knowledge regarding dispensing drugs without prescription

Majority of pharmacists (82.5%) in the study were aware of the fact that dispensing without prescription is illegal in India. Many of participants (76.3%) had an idea about act regulated in India regarding dispensing drugs without prescription but only 10% could name the act correctly. Similarly, 50% of respondents named the schedule under the act correctly. More than half of pharmacists were aware that dispensing without prescription is a problem in India (76.3%) and was promoting drug resistance (71.3%). Maximum of respondents updated their knowledge by Internet and social media (34.6%).

Practice of dispensing drugs without prescription

Maximum pharmacists were found to be asked to dispense non-OTC drugs without prescription (38.8%). Children (39.4%) are the most restricted group by the pharmacist while dispensing without prescription. Cold and flu (37.5%), body pain (28.1%) and diarrhea and vomiting (16.4%) were the most common conditions for dispensing medicines without prescription. The medicines are dispensed most commonly in Tablet form (45.4%). The causes for dispensing the drugs without prescription are listed in [Table 2] where fear of loosing the customers is the most frequent one. Maximum of pharmacists (47.5%) did not insist on dispensing full course of medicines to patients while dispensing without prescription. More than half of pharmacists claimed that they asked about drug allergies (54.8%) to patients before dispensing medicines. The pharmacists claimed that they counseled the patients about the importance of dosage completion (30.3%), quantity and time intake of drugs (25.2%) and side effects of drugs (25.2%).
Table 2: Reasons for dispensing drugs without prescription

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There was a significant association found between knowledge score of pharmacists and Job status of pharmacist and location of pharmacy. Commercial located pharmacist have good knowledge score than residential area pharmacist as shown in [Table 3]. Similarly, there was also a significant association found between the frequency of medicines dispensed without prescription by pharmacists and age and education status of pharmacist Dispensing practices of drugs without prescription is decreasing with increasing qualification as shown in [Table 4]. A significant association was found between the medicine dispensing practices and the pharmacy ownership [Table 5]. There is also seen a significant association between the job status of pharmacist and the counseling practice of pharmacists before dispensing without prescription [Table 6]. Antibiotics are most common drugs dispensed without prescription followed by analgesics the antacids as shown in [Figure 1].
Table 3: Association between sociodemographic variables and knowledge score

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Table 4: Association between sociodemographic variables and frequency of dispensing medicines

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Table 5: Association between pharmacy ownership and dispensing practices

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Table 6: Association between sociodemographic factors and counseling done

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Figure 1: Drugs commonly dispensed without prescription

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  Discussion Top


Sociodemographic profile

In the present study, the participants were in the age group of 20–60 years. Maximum number of pharmacists belonged to 40 years and above. A study conducted in Syria comprised of participants in the age group of 28–55 years.[8] A similar study conducted in Zambia showed majority of participants to be in the age group of 25–35 years.[9] Another study conducted in Sri lanka showed the maximum participants to be in the age group of 30–39 years.[10]

According to gender distribution, maximum participants 67 (83.8%) were male in this study. Similarly, a study conducted in Syria also showed 92 male participants which was more in comparison to female participants.[8] A similar study conducted in Sri Lanka also showed 64.9% male participants in the study and remaining were females.[10] This can explain that male population are found to be more in pharmacists in the many parts of the world.

In the present study, most of the pharmacists, i.e., 52.5% had a work experience of more than 10 years, which is similar to a study conducted in Syria where 45% participants had a work experience of more than 10 years. In contrast to this, a study conducted in Zambia had majority 53% of participants with a work experience of more than 5 years.[6],[9]

According to the job status, in this study, maximum of the participants, i.e., 55% were owner of the pharmacy. In contrast to this, study in Zambia had maximum participants, i.e., 55% to be pharmacy technologists. Another study conducted in Sri Lanka also comprised 60.8% employees in the study.[9],[10]

In the present study, maximum of the participants 38.3% had a degree of diploma in pharmacy in contrast to a study conducted in Hyderabad participants with an ordinary degree were maximum, i.e., (43.3%).[11]

Knowledge regarding dispensing drugs without prescription

In the present study, 82.5% pharmacists thought dispensing medicines without prescription is illegal in India. Similarly, 76.3% of pharmacist were aware about the law against dispensing medicines without prescription in India. This level of awareness can explain the dispensing practice in Bengaluru being on an average, i.e., (45%). In contrast to this, a similar study conducted in Saudi-Arabia showed 70.5% participants were not aware about the law in their country.[3]

Majority of the pharmacists, i.e., 71.3% agreed that inappropriate dispensing promoted drug resistance. Similarly, a study conducted in Saudi Arabia also showed that a vast majority, i.e., 85.2% were aware that the practice contributed in developing resistance. In contrast to the above studies, a qualitative study conducted in Syria showed that most of the pharmacists did not agree that the practice posed any problem.[3],[8]

In the present study, 50% of participants could name the Schedule correctly as Schedule H. A similar study was conducted in Bangalore which showed that 50.5% participants were aware about the Schedule H.[2]

In the present study, maximum of the participants, i.e., 34.6% keep their knowledge updated through Internet and social media while in a similar cross-sectional study conducted in North-west Ethiopia, the pharmacists were found to update their knowledge frequently by leaflets. In contrast, in a study conducted in Nepal, 28% of pharmacists had not studied and sources to keep their knowledge updated.[12],[13]

Practice of dispensing drugs without prescription

In the present study, the practice of dispensing non-OTC drugs without prescription was found to be 32.5% in an average. Similar studies conducted in Bangalore, India showed the practice of dispensing Schedule H drugs to be ranging from 45% to 55%.[2],[6]

Among the disease condition in which medicines is dispensed most commonly, cold and flu (37.5%) was found in the present study. The disease condition was found to be same in a study conducted in Saudi Arabia 68.4% were dispensed for Cold and flu in the study.[3]

In contrast to this, a study for Pakistan showed the antibiotic dispensing was the highest for wound infection (21%) and for urinary tract infection (61%) in a study from Lebanon.[10],[14]

About counseling the patient's on importance of dosage completion, 30.3% of the pharmacists in this study agreed that they counsel patients. Similar to this, 88.9% of pharmacists in Saudi Arabia and 38% of pharmacists in Nepal claimed that they counsel the patients well about the importance of dosage completion.

Furthermore, a study conducted in Lebanon also found out the counseling on dosage instructions to be 96%.[3],[13],[14]

In the present study, majority, i.e., 47.5% of pharmacists did not dispense or insist to dispense full course of medicines to patients which was similar to a study conducted in Nepal, where dispensing a reduced quantity of medicines was observed, i.e., 73%.[13]

The most common reasons for dispensing medicines without prescription in the present study were fear of losing customer (17.1%), regular customer (15.8%), and patient's in affordability (15.1%). Similar reasons were found to be stated by pharmacists in Vietnam, Syria, and New Zealand. Another common reason stated studies from Lebanon and Saudi Arabia was patient's unwillingness to visit doctors.[3],[8],[15],[16]

Association between variables

In the present study, the frequency of dispensing medicines without prescription was found to be significantly associated with age of staffs dispensing (P = 0.04) and with their education status (P = 0.046). Similar association was found in a study in Nepal which showed a significant association between dispensing practice and age of dispensing staffs (P < 0.043).[13] The study also showed association among dispensing practice and work experience (P < 0.001) but no such association was seen in the present study.

A significant association was found in this study regarding to knowledge score and job status of pharmacists (P = 0.021). Similar results were found in a study from Pakistan which showed that knowledge of legal aspects of antibiotic dispensing was found to be significant higher among pharmacists than among assistants (P = 0.003).[10]

The legal and regulatory framework for the pharmacists includes licensed pharmacist requirements in the pharmacy including ownership requirements and government should provide supervision of the pharmacy on illegal dispensing of the drugs. Continuing education on community pharmacists is required to update their knowledge on the recent updates on the legal and regulatory aspects. Continuing education helps the pharmacists to improve the practice of dispensing of the drugs which will prevent medication errors including fatal adverse drug reactions.[17]

Limitation

There are three key limitations to this study. First, the sample size of the study was taken less due to COVID-19 pandemic and restrictions on movements. Second, the results cannot be generalized to everyone as the sample size is less and the study was conducted only in Belagavi City. Finally, as the study was conducted on dispensing practice without prescription, which is illegal, the pharmacists were found to be hesitant to provide proper information in many cases.


  Conclusion Top


The study showed that the pharmacists had an average level of knowledge (66.3%) regarding the legal aspects and dispensing practice of medicines. The practice of dispensing medicines without prescription was found in an average frequency (32%). Although pharmacists had updated knowledge about laws and acts in India about the dispensing, the practice of dispensing without prescription was found to be present commonly. For this, timely inspection of pharmacies by the concerned authorities and timely knowledge update of pharmacies regarding legal aspects and drug resistance can be done.

Acknowledgment

The authors are thankful to all the pharmacists who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Soumya R, Devarashetty V, Jayanthi CR, Sushma M. Drug dispensing practices at pharmacies in Bengaluru: A cross-sectional study. Indian J Pharmacol 2016;48:360-4.  Back to cited text no. 2
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Hadi MA, Karami NA, Al-Muwalid AS, Al-Otabi A, Al-Subahi E, Bamomen A, et al. Community pharmacists' knowledge, attitude, and practices towards dispensing antibiotics without prescription (DAwP): A cross-sectional survey in Makkah province, Saudi Arabia. Int J Infect Dis 2016;47:95-100.  Back to cited text no. 3
    
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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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