Good pharmacy practice assessment among community pharmacies in Lebanon
Keywords:Pharmacies, Professional Practice, Quality of Health Care, Pharmacists, Pharmaceutical Services, Health Promotion, Goals, Management Audit, World Health Organization, Reference Standards, Lebanon
Objective: This study aims to assess good pharmacy practice (GPP) aspects and compare GPP scores among community pharmacies in Lebanon, using a tool developed jointly by the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) to improve and maintain standards of pharmacy practice.
Methods: Data collection was carried out between July and October 2018 by a team of 10 licensed inspectors who work at the Lebanese Order of Pharmacists (OPL) and visited community pharmacies across Lebanon. The questionnaire was adapted to the Lebanese context and included 109 questions organized under five sections: socio-demographics, Indicator A (data management and data recording), Indicator B (services and health promotion), Indicator C (dispensing, preparation and administration of medicines), and Indicator D (storage and facilities). The value of 75% was considered as the cutoff point for adherence to indicators.
Results: Out of 276 pharmacies visited, a total of 250 (90.58%) pharmacists participated in the study with one pharmacist being interviewed in every pharmacy. Results showed that 18.8% of pharmacists were generally adherents to GPP guidelines (scores above the 75% cutoff): 23.3% were adherent to indicator A, 21.6% to indicator B, 14.8% to indicator C and 13.2% to indicator D. Moreover, comparison of GPP scores across geographical regions revealed a higher adherence among community pharmacists working in the Beirut region compared to the North region, the South region, Mount Lebanon, and the Bekaa.
Conclusions: Our study shows that community pharmacists in Lebanon do not fulfill GPP criteria set by FIP/WHO, and that this poor adherence is a trend across the country’s geographical regions. Therefore, efforts should be made to raise awareness among pharmacists about the necessity to adhere to GPP guidelines and standards, and train them and support them appropriately to reach that goal. This is the first indicator-based comprehensive pilot assessment to evaluate GPP adherence in community pharmacies across Lebanon. Working on the optimization of this assessment tool is also warranted.
World Health Organization. Joint FIP/WHO Guidelines on Good Pharmacy Practice: Standards for quality of pharmacy services. Geneva: WHO; 2011. Available at: https://apps.who.int/medicinedocs/documents/s18676en/s18676en.pdf (accessed Jan 2, 2020).
Farah R, Lahoud N, Salameh P, Saleh N. Antibiotic dispensation by Lebanese pharmacists: a comparison of higher and lower socio-economic levels. J Infect Public Health. 2015;8(1):37-46. https://doi.org/10.1016/j.jiph.2014.07.003
Morrill AM, Abel CA, Januszweski M, Chamberlain B. Community education by advanced pharmacy practice experience students: Increasing electronic cigarette awareness amongst teens. Curr Pharm Teach Learn. 2017;9(6):1147-1150. https://doi.org/10.1016/j.cptl.2017.07.022
Massoud MA, Chami G, Al-Hindi M, Alameddine I. Assessment of Household Disposal of Pharmaceuticals in Lebanon: Management Options to Protect Water Quality and Public Health. Environ Manage. 2016;57(5):1125-1137. https://doi.org/10.1007/s00267-016-0666-6
Sholy L, Gard P, Williams S, MacAdam A. Pharmacist awareness and views towards counterfeit medicine in Lebanon. Int J Pharm Pract. 2018;26(3):273-280. https://doi.org/10.1111/ijpp.12388
El-Jardali F, Fadlallah R, Morsi RZ, Hemadi N, Al-Gibbawi M, Haj M, Khalil S, Saklawi Y, Jamal D, Akl EA. Pharmacists' views and reported practices in relation to a new generic drug substitution policy in Lebanon: a mixed methods study. Implement Sci. 2017;12(1):23. https://doi.org/10.1186/s13012-017-0556-1
Karaoui LR, Deeb ME, Nasser L, Hallit S. Knowledge and practice of patients with diabetes mellitus in Lebanon: a cross-sectional study. BMC Public Health. 2018;18(1):525. https://doi.org/10.1186/s12889-018-5416-7
Domiati S, Sacre H, Lahoud N, Sili G, Salameh P. Knowledge of and readiness for medication therapy management among community pharmacists in Lebanon. Int J Clin Pharm. 2018;40(5):1165-1174. https://doi.org/10.1007/s11096-018-0666-0
Hajj A, Hallit S, Ramia E, Salameh P. Medication safety knowledge, attitudes and practices among community pharmacists in Lebanon. Curr Med Res Opin. 2018;34(1):149-156. https://doi.org/10.1080/03007995.2017.1361916
World Health Organization. Noncommunicable Diseases (NCD) Country Profiles, Lebanon. Available from: https://www.who.int/nmh/countries/2014/lbn_en.pdf (accessed Jan 2, 2020).
Ammar W, Kdouh O, Hammoud R, Hamadeh R, Harb H, Ammar Z, Atun R, Christiani D, Zalloua PA. Health system resilience: Lebanon and the Syrian refugee crisis. J Glob Health. 2016;6(2):020704. https://doi.org/10.7189/jogh.06.020704
Alameddine M, Fouad FM, Diaconu K, Jamal Z, Lough G, Witter S, Ager A. Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria. Soc Sci Med. 2019;220:22-30. https://doi.org/10.1016/j.socscimed.2018.10.018
Hunter P. The refugee crisis challenges national health care systems: Countries accepting large numbers of refugees are struggling to meet their health care needs, which range from infectious to chronic diseases to mental illnesses. EMBO Rep. 2016;17(4):492-495. https://doi.org/10.15252/embr.201642171
Lebanese Republic. Law of 1950. The establishment of the Lebanese Order of Pharmacists. http://opl.org.lb/pdf/regulations/qanon.pdf (accessed Jan 2, 2020).
Lebanese Republic. Law 190/2011 related to the mandatory continuing education for pharmacists. http://opl.org.lb/pdf/regulations/190.pdf (accessed Jan 2, 2020).
Hallit S, Sacre H, Hajj A, Sili G, Zeenny RM, Salameh P. Projecting the future size of the Lebanese pharmacy workforce: forecasts until the year 2050. Int J Pharm Pract. 2019;27(6):582-588. https://doi.org/10.1111/ijpp.12564
Bates I, John C, Bruno A, Fu P, Aliabadi S. An analysis of the global pharmacy workforce capacity. Hum Resour Health. 2016;14(1):61. https://doi.org/10.1186/s12960-016-0158-z
Iskandar K, Hallit S, Raad EB, Droubi F, Layoun N, Salameh P. Community pharmacy in Lebanon: A societal perspective. Pharm Pract (Granada). 2017;15(2):893. https://doi.org/10.18549/PharmPract.2017.02.893
Lebanese Republic. Law 367/94 governing the practice of the pharmacy in Lebanon. http://opl.org.lb/pdf/regulations/367.pdf (accessed Jan 2, 2020).
Lebanese Republic. Decree No. 2622/1992: technical specifications and conditions of community pharmacies. https://www.moph.gov.lb/Laws/download_file/1492 (accessed Jan 2, 2020).
Hallit S, Sacre H, Sarkis H, Dalloul N, Jaoude CA, Nahhas Z, Dagher J, Sili G, Salameh P. Good Pharmacy Practice Standardized for Community Pharmacists: The Lebanese Order of Pharmacists Initiative. J Res Pharm Pract. 2019;8(1):29-32. https://doi.org/10.4103/jrpp.JRPP_18_96
Trap B, Hansen EH, Trap R, Kahsay A, Simoyi T, Oteba MO, Remedios V, Everard M. A new indicator based tool for assessing and reporting on good pharmacy practice. Southern Med Review. 2010;3(2).
Order of Pharmacists of Lebanon. Lebanese Order of Pharmacists website. Available at: www.opl.org.lb (accessed Feb 17, 2019).
Trap B, Kikule K, Vialle-Valentin C, Musoke R, Lajul GO, Hoppenworth K, Konradsen D. First regulatory inspections measuring adherence to Good Pharmacy Practices in the public sector in Uganda: a cross-sectional comparison of performance between supervised and unsupervised facilities. J Pharm Policy Pract. 2016;9:18. https://doi.org/10.1186/s40545-016-0068-4
Mishra P, Pandey CM, Singh U, Gupta A, Sahu C, Keshri A. Descriptive statistics and normality tests for statistical data. Ann Card Anaesth. 2019;22(1):67-72. https://doi.org/10.4103/aca.ACA_157_18
Black N. Quality assurance of medical care. J Public Health Med. 1990;12(2):97-104. https://doi.org/10.1093/oxfordjournals.pubmed.a042538
Baker R, Fraser RC. Development of review criteria: linking guidelines and assessment of quality. BMJ. 1995;311(7001):370-373. https://doi.org/10.1136/bmj.311.7001.370
Lawrence M, Olesen F. Indicators of quality in health care. Eur J Gen Pract. 1997;3(3):103-108. https://doi.org/10.3109/13814789709160336
El Bizri L, Dimassi A. Lebanese community pharmacy: The role of the pharmacist in the health care. Eur J Pharm Med Res. 2019;6(1):149-158.
Order of Pharmacists of Lebanon. The OPL deliverables: Summary of a Mandate Dec 2015-Nov 2018. Available through: http://opl.org.lb/newdesign/pdf/OPL%20Deliverables.pdf (accessed Jan 2, 2020).
El Khoury G, Salameh P. Influenza Vaccination: A Cross-Sectional Survey of Knowledge, Attitude and Practices among the Lebanese Adult Population. Int J Environ Res Public Health. 2015;12(12):15486-15497. https://doi.org/10.3390/ijerph121215000
Saade S, Ghazala F, Farhat A, Hallit S. Attitudes towards continuous professional development: a study of pharmacists in Lebanon. Pharm Pract (Granada). 2018;16(1):1103. https://doi.org/10.18549/PharmPract.2018.01.1103
Zahreddine L, Hallit S, Shakaroun S, Al-Hajje A, Awada S, Lahoud N. Knowledge of pharmacists and parents towards antibiotic use in pediatrics: a cross-sectional study in Lebanon. Pharm Pract (Granada). 2018;16(3):1194. https://doi.org/10.18549/PharmPract.2018.03.1194
Kerr A, Strawbridge J, Kelleher C, Mertens F, Pype P, Deveugele M, Pawlikowska T. How can pharmacists develop patient-pharmacist communication skills? A realist review protocol. Syst Rev. 2017;6(1):14. https://doi.org/10.1186/s13643-016-0396-0
Zeenny R, Wakim S, Kuyumjian YM. Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria. Clin Interv Aging. 2017;12:65-73. https://doi.org/10.2147/CIA.S87564
Kabbara WK, Meski MM, Ramadan WH, Maaliki DS, Salameh P. Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon. Can J Infect Dis Med Microbiol. 2018;2018:7404095. https://doi.org/10.1155/2018/7404095
Cheaito L, Azizi S, Saleh N, Salameh P. Assessment of self-medication in population buying antibiotics in pharmacies: a pilot study from Beirut and its suburbs. Int J Public Health. 2014;59(2):319-327. https://doi.org/10.1007/s00038-013-0493-y
Salameh P, Sacre H, Hallit S, Hajj A. Antibiotic Resistance in Lebanon. Available at: http://resistancecontrol.info/2017/antibiotic-resistance-in-lebanon/ (accessed Jan 2, 2020).
Khalifeh M. Usage Pattern of Drugs that are prescription in France and available OTC in Lebanon: Application on Antibiotics: Université de Bordeaux; 2017.
Saleh S, Abou Samra C, Jleilaty S, Constantin J, El Arnaout N, Dimassi H, Al-Bittar D. Perceptions and behaviors of patients and pharmacists towards generic drug substitution in Lebanon. Int J Clin Pharm. 2017;39(5):1101-1109. https://doi.org/10.1007/s11096-017-0509-4
Massoud MA, Mokbel M, Alawieh S, Yassin N. Towards improved governance for sustainable solid waste management in Lebanon: Centralised vs decentralised approaches. Waste Manag Res. 2019;37(7):686-697. https://doi.org/10.1177/0734242X19836705
Maamari O, Brandam C, Lteif R, Salameh D. Health Care Waste generation rates and patterns: The case of Lebanon. Waste Manag. 2015;43:550-554.
Lebanese Ministry of Public Health. Guidelines on Good Storage and Distribution Practices of Pharmaceutical Products in Lebanon. Version 3, 2014. Available at: https://www.moph.gov.lb/userfiles/files/HealthCareSystem/Pharmaceuticals/QualityAssuranceofPharmaceuticalProducts/Guidelines-GSDPLebanon(English).pdf (accessed Jan 2, 2020).
Hallit S, Zeenny RM, Sili G, Salameh P. Situation analysis of community pharmacy owners in Lebanon. Pharm Pract (Granada). 2017;15(1):853. https://doi.org/10.18549/PharmPract.2017.01.853
Semegn S, Alemkere G. Assessment of client satisfaction with pharmacist services at outpatient pharmacy of Tikur Anbessa Specialized Hospital. PLoS One. 2019;14(10):e0224400. https://doi.org/10.1371/journal.pone.0224400
Surur AS, Getachew E, Teressa E, Hailemeskel B, Getaw NS, Erku DA. Self-reported and actual involvement of community pharmacists in patient counseling: a cross-sectional and simulated patient study in Gondar, Ethiopia. Pharm Pract (Granada). 2017;15(1):890. https://doi.org/10.18549/PharmPract.2017.01.890
Schumock GT, Butler MG, Meek PD, Vermeulen LC, Arondekar BV, Bauman JL; 2002 Task Force on Economic Evaluation of Clinical Pharmacy Services of the American College of Clinical Pharmacy. Evidence of the economic benefit of clinical pharmacy services: 1996-2000. Pharmacotherapy. 2003;23(1):113-132. https://doi.org/10.1592/phco.22.214.171.124910
Canadian Pharmacists Association. A review of pharmacy services in Canada and the health and economic evidence. Ottawa, ON: CPA; 2016.
Chuc NT, Larsson M, Do NT, Diwan VK, Tomson GB, Falkenberg T. Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. J Clin Epidemiol. 2002;55(11):1148-1155. https://doi.org/10.1016/s0895-4356(02)00458-4
World Health Organization. The legal and regulatory framework for community pharmacies in the WHO European Region. Available at: https://apps.who.int/iris/bitstream/handle/10665/326394/9789289054249-eng.pdf?sequence=1&isAllowed=y (accessed Jan 2, 2020).
Phillips KA, Luft HS. The policy implications of using hospital and physician volumes as "indicators" of quality of care in a changing health care environment. Int J Qual Health Care. 1997;9(5):341-348. https://doi.org/10.1093/intqhc/9.5.341
Tran VD, Dorofeeva VV, Loskutova EE. Development and validation of a scale to measure the quality of patient medication counseling using Rasch model. Pharm Pract (Granada). 2018;16(4):1327. https://doi.org/10.18549/PharmPract.2018.04.1327
Central Administration of Statistics. Household Expenditure, 2012. Available at: http://www.cas.gov.lb/index.php/demographic-and-social-en/householdexpenditure-en (accessed Jan 2, 2020).
How to Cite
Copyright (c) 2020 Pharmacy Practice and the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.