Community Pharmacy Practice in the United States and Kenya: Comparision

Do we have it good in America or what? Shejal Parmar PharmD. Candidate, University of Florida, and a recent endocrinology intern spent most of her life in Kenya and she shares her insight into the differences in getting a prescription and what the pharmacist can do for patients.

Community Pharmacy Practice in the United States and Kenya: Comparision
Shejal Parmar PharmD. Candidate, University of Florida

Abstract
Objective: In the United States it has been a trend for pharmacy practice to move away from medicine supply to a focus on patient care. However, there is no indication if this has been the trend in developing countries. Therefore the objective of this study is to compare pharmacy practice in a developing country, Kenya, and United States by identifying similarities and differences in the drug dispensing processes, activities and responsibilities.

Settings: Community pharmacies in Nairobi, Kenya and Tampa, Florida.

Method: The data was gathered using a survey and by direct observation.

Main Outcome Measure: The description and comparison of the pharmacy environment, drug dispensing processes and pharmacist activities in the two places.

Results: The survey results indicate that pharmacy practice is similar in the two countries, however from verbal discussion it is seen that the reasons for the answers supplied for the survey are different. This gives an insight that community pharmacy practice differs greatly between the two different countries.

Conclusion: There are differences between community pharmacy practice in Kenya and United States. Community Pharmacy Practice in the United States seems to be more patient oriented and the practice in Kenya seem to be more economically driven.
           
Introduction
In the United States it has been a trend for pharmacy practice to move away from medicine supply to a focus on patient care. The role of the pharmacist evolved from a compounder and supplier of medicines toward that of a provider of patient care. (1) However, there is no indication if this has been the trend in developing countries. Currently there is little published information on how community pharmacy practice in a developing country compares to that in the United States. Therefore, the objective of this study is to compare pharmacy practice in the developing country, Kenya, and United States by identifying similarities and differences in the drug dispensing processes, activities and responsibilities of the pharmacist. It is expected that the practice is going to be different, however the areas in which it differs needs to be identified.

Methods
A 29-item survey, divided into 4 sections was developed to identify current practices, communication, drug dispensing and pharmacist activities. In addition to the survey direct observation and conversations were also utilized to gather information regarding pharmacy practices. The surveys were taken to various community pharmacies in Nairobi, Kenya as well as in Tampa, Florida. There was no order in which the distribution of the surveys was carried out. All types of community pharmacies were visited including free standing pharmacies and pharmacies located inside grocery stores. With each survey, an introduction and explanation of the purpose of the study was given.

Responses to each of the survey questions were compared between the two countries.

Information from observations and conversations was also noted.

Results
Fifty pharmacies in each if the countries were visited. All hundred pharmacists completed the surveys and provided helped verbal information. Therefore, all 100 surveys were used to obtain results and none were omitted.

Comparison of Community Pharmacy Practice
	Kenya	United States
Services Provided	Mainly Drug Dispensing and Drug Information	Mainly Drug Dispensing, Drug information and Counseling
Patient Profile Tracking	Paper-based	Automated
Controlled medication	All controlled, however able to get	All controlled
Types of medications sold most	Over-the-counter	Prescription medications
Most common over the counter medication	Antibiotics	Pain medications
Most common method of payment	Cash	Insurance co-pay
Medications for which prescriptions are needed	All need prescriptions however able to get them without prescriptions	All need prescriptions
Changing medication orders	Need to consult physician, but can do without consultation	Need to consult physician
Patients going to more than one pharmacy	Yes	Yes
Medication Histories	Not available	Available, electronically
Average satisfaction of amount of time spent with patients	4.48 out of 5	4.74 out of 5
Average satisfaction of information provided on drug use	4.34 out of 5	4.82 out of 5
Average satisfaction of drug interaction counseling	4.14 out of 5	3.98 out of 5
Average satisfaction of overall pharmacy activity	4.74 out of 5	4.68 out of 5
Average satisfaction of education provided to pharmacists	4.6 out of 5	4.98 out of 5
Average satisfaction of allergy information obtained	4.12 out of 5	4.5 out of 5
Average satisfaction of medication history obtained	4.58 out of 5	4.52 out of 5
Average satisfaction of patient understanding	4.62 out of 5	4.74 out of 5
Average satisfaction with number of questions asked by patients	4.74 out of 5	4.48 out of 5
Average satisfaction with quality of medication	5 out of 5	5 out of 5
Average satisfaction with level of regulation	3.32 out of 5	3.42 out of 5
Average satisfaction with the cost of medications	3.16 out of 5	3.2 out of 5
Average hours of day a pharmacist is present at the pharmacy	4-6 hours	Whole day
Average time spent with a patient	5 – 10 min	11 – 15 min
Amount of prescriptions filled in a day	15 – 25	101 – 500
Amount of medications stocked in the pharmacy	< 500	1001 – 2000
Time spent on counseling patients in a week	3 -4 hours	Over 5 hours
Time taken to verify a prescription with a physician	Over 30 min	Over 30 min
Average amount of continuing education hours needed	0 – 5	15 – 30

The survey responses shown indicate that there is not a significant difference that exists in pharmacy practice in Kenya compared to that in the United States. However, from the direct observations and verbal conversations carried out with the pharmacists indicated different reasons for answering survey questions.

When carrying out the observations and conversations, questions were asked regarding the reasoning for an answer and information regarding regulation and pharmacy practice was asked.

Most pharmacists Kenya indicated that even though prescription medications needed a prescription in order to be dispensed, the rules could be bent. Patients were able to get medications without prescription if they were able to afford them. This included medications controlled medications. For medications such as antibiotics, in Kenya prescriptions were often not needed. In cases where patients were unable to afford the medications, pharmacists in Kenya were able to switch to a different medication without consulting a physician. Most pharmacists express that this was done because it would take too long for the physician to get back to them.

In Kenya, when a patient walks into the pharmacy, they usually just ask what medication they need and assume that the physician had verified the allergies and looked at their medications for drug-drug interactions. The pharmacist usually does not verify this information. This is in contrast to the United States where a prescription is required in order to obtain a prescription medication, a physicians authorization would be needed to change a medication, and allergies and medication histories are taken from patients when they visit the pharmacy.

When comparing the satisfaction rates of pharmacists in the two different countries, they were based on different reasons. In Kenya, the pharmacists were satisfied with the amount of time spent with patients, giving patients drug information and counseling, and obtaining allergy and medication histories because they feel that the more time they spend on a patient the less the time they will have for serving another patient. Whereas the pharmacist is the United States stated that they feel like they don’t have enough time to spend talking to patients. This was especially true for the busier pharmacies.

The pharmacists in Kenya need a diploma in order to run a pharmacy. Usually once the pharmacy is opened by a pharmacist, staff is employed to run the pharmacy on a regular basis. The pharmacist is available at the pharmacy on an average of 4 to 6 hours. Whereas, in the United States a pharmacy cannot be open without a pharmacist. In Kenya, once you are a pharmacist there is no requirement for continuing education unless the pharmacist takes the initiative themselves.

Discussion
Pharmacy practice is expected to be different in developing countries compared to the United States. In many cases it may be the case that a pharmacist is not available at the pharmacy to ensure that quality products and services are rendered. The level of training pharmacists receive in developing countries is less that that received in the United States. This may play a role in the type of care and services that are provided to patients. In Kenya, pharmacies are run on an economic perspective. Patients are viewed as customers, as long as they can pay for the goods, they are able to receive them. This economic drive is as seen in the pharmacists serving the patients. The pharmacists feel like they should get a customer what they need and move on to the next customer in order to increase the sales of the pharmacies. Most of the community pharmacies in Kenya are independently owned.

Regarding responsibilities as a pharmacist, the regulatory authority of pharmacy in Kenya is the Pharmacy and Poisons Board. However, the board does not enforce its rules and regulations.
This makes it easier for pharmacists to bend rules in order to increase sales at their pharmacy.

Conclusion
Pharmacy practice differs greatly between the two different countries. In the United States, community pharmacy practice is geared towards patient care, whereas in Kenya pharmacy practice is economically driven. Major improvements need to be made in order to change the focus of pharmacy practice in Kenya. There are guidelines available from the International Pharmaceutical Federation that can help developing countries to evolve their pharmacy practice to be geared towards patient care.

References:

1. Wiedenmayer K, Summers RS, Mackle CA, et al. Developing Pharmacy Practice A Focus  On Patient Care. 2006. World Health Organization. Accessed: November 25th 2007. Available from: https://www.who.int/medicines/publications/WHO_PSM_PAR_2006.5.pdf
2. The role of the pharmacist in the health care system. Preparing the future pharmacist: Curricular development. Report of a third WHO Consultative Group on the role of the pharmacist, Vancouver, Canada, 27–29 August 1997. Geneva: World Health Organization; 1997. WHO/PHARM/97/599. Available at: https://www.who.int/medicinedocs/
3. International Pharmaceutical Federation. Good Pharmacy Practice in Developing countries. Accessed November 28th 2007. Available From: https://www.fip.org/files/fip/Statements/latest/Dossier%20003%20total.PDF
4. Pharmacy and Poisons Board. Ministry of Health, Kenya. Accessed on November 28th 2007. Available from: https://www.pharmacyboardkenya.org/