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DovepressPharmacy students’ attitudes toward pharmaceutical care in QatarStudy aimsTable 1 Respondent sociodemographic characteristicsThe study objectives were to investigate Qatar pharmacystudents’ attitudes toward PC, to identify the factors thatinfluence their attitudes toward PC, and to recognize theirperceived barriers for PC provision in Qatar.CharacteristicMethodsStudy design and participantsQU College of Pharmacy is the only pharmacy degree program in the country. The study objectives were addressedin a cross-sectional survey of pharmacy students at QU College of Pharmacy. Eligible participants were all QU second,third, and fourth professional (final) year pharmacy students(52 female students). First year pharmacy students were notexposed to the concept of PC at the time of survey administration, and as a result, this group of students was excluded.Assessment toolA self-administered survey was used in the study. The studyinvestigators designed the study survey based, in part, onthe standard Pharmaceutical Care Attitudes Survey (PCAS).This survey tool is a validated instrument that measuresstudents’ attitudes toward PC. It was developed in the UnitedStates and has already been used and tested in previous studies in Nigeria, the Kingdom of Saudi Arabia, and the UnitedStates.19,28–31The draft survey was distributed to eight faculty members at QU College of Pharmacy to assess its readabilityand content validity. It was also pretested among a group offour randomly selected pharmacy students at QU College ofPharmacy for clarity, relevance, acceptability, and time tocompletion (ie, face validity). These four students wereexcluded from the final study sample. Refinements weremade as required in terms of language comprehension andquestion organization before distributing the final survey tothe study population.The final structured survey consisted of a total of 11(closed- and open-ended) questions that could be completedwithin 10 minutes. It contained questions that addressed thepharmacy students’ attitudes towards PC based on the PCASsurvey, the students’ sociodemographic characteristics, theirperceived barriers toward PC provision, and their suggestionsto improve their attitudes towards PC. Sociodemographiccharacteristics included age, country of origin, currentprofessional year, marital status, and pharmacy trainingexperience (Table 1).To assess the students’ attitudes towards PC, a fivepoint Likert scale (rating from 1 strongly disagree toTherapeutics and Clinical Risk Management 2014:10Frequency(percentage)Country of origin (N rSomaliaSudanSyriaYemenCurrent professional pharmacy year (N 46)SecondThirdFourMarital status (N 46)UnmarriedMarriedPast training experience in a pharmacyenvironment including SPEP (N 46)YesNoIn case of receiving training: training setting (N 28)Community pharmacyHospital pharmacyAmbulatory clinic pharmacyHospital pharmacy and community pharmacy Hospital pharmacy, community pharmacy,and ambulatory clinic pharmacy3 (7%)6 (13%)1 (1%)5 (11%)6 (13%)3 (7%)10 (22%)2 (4%)2 (4%)3 (7%)3 (7%)2 (4%)20 (44%)12 (26%)14 (30%)45 (98%)1 (2%)28 (61%)18 (39%)5 (18%)5 (18%)3 (11%)3 (11%)12 (42%)Abbreviation: SPEP, structured practical experience in pharmacy.5 strongly agree) was utilized to measure the extent towhich the students agreed with 13 statements related to PC(Tables 2 and 3). These statements were taken directly fromthe PCAS survey and measure three constructs: professional benefit (statements 4, 5, and 7–12), professional duty(statements 1–3), and return on effort (statements 6 and 13).Eleven of the 13 statements were positively worded, and twowere negatively worded (“Time” and “Add Work”): the twonegatively worded items, which relate to return on effort,were reverse scored during analysis so that the more positiveattitudes toward PC would be reflected by higher scores.The barriers that would prevent QU pharmacy studentsfrom providing PC in the future were identified by listing12 possible barriers and by asking the students to indicateon a three-point Likert scale (high, medium, and low) theextent to which each of the listed barriers would impedetheir PC provision in the future. The barriers included:inadequate drug information resources, lack of access to thesubmit your manuscript www.dovepress.comDovepress123

DovepressEl Hajj et alTable 2 Students’ attitudes towards pharmaceutical care per PCAS itemStatementFrequency (percentage)Please indicate your extent of agreement withthe following statements regarding your attitudestowards pharmaceutical care1.  All pharmacists should performpharmaceutical care2.  Primary responsibility of pharmacistsin health care setting should be to preventand solve medication-related problems3.  Pharmacists’ primary responsibility shouldbe to practice pharmaceutical care4.  Pharmacy students can performpharmaceutical care during their clerkship5.  I think the practice of pharmaceuticalcare is valuable6.  Providing pharmaceutical care takestoo much time and efforta7.  I would like to perform pharmaceuticalcare as a pharmacist practitioner8.  Providing pharmaceutical care isprofessionally rewarding9.  I feel that the pharmaceutical care is the rightdirection for the provision to be headed10.  I feel that pharmaceutical care movementwould benefit pharmacists11.  I feel that pharmaceutical care movementwill improve patient health12.  I feel that practicing pharmaceutical carewill benefit my professional pharmacycareer as a pharmacy practitioner13.  Providing pharmaceutical care is notworth the additional workload thatit places on the lydisagree24 (52%)18 (39%)4 (9%)0 (0%)0 (0%)29 (63%)17 (37%)0 (0%)0 (0%)0 (0%)17 (37%)18 (39%)10 (22%)0 (0%)1 (2%)15 (32%)32 (50%)4 (9%)1 (2%)3 (7%)31 (67%)15 (33%)0 (0%)0 (0%)0 (0%)10 (22%)25 (54%)9 (20%)0 (0%)2 (4%)26 (57%)18 (39%)2 (4%)0 (0%)0 (0%)26 (56%)17 (37%)3 (7%)0 (0%)0 (0%)26 (56%)16 (35%)4 (9%)0 (0%)0 (0%)27 (59%)17 (37%)2 (4%)0 (0%)0 (0%)32 (70%)14 (30%)0 (0%)0 (0%)0 (0%)30 (65%)15 (33%)1 (2%)0 (0%)0 (0%)2 (4%)4 (9%)6 (13%)13 (28%)21 (46%)Mean SD(95% CI)Median(IQR)4.43 0.65(4.24–4.63)4.63 0.49(4.48–4.76)5 (4–5)4.11 0.82(3.87–4.33)4.04 0.94(3.74–4.30)4.67 0.47(4.52–4.80)2.06 0.77(1.85–2.30)4.52 0.59(4.35–4.70)4.5 0.62(4.30–4.67)4.48 0.66(4.28–4.67)4.54 0.58(4.37–4.72)4.69 0.46(4.56–4.83)4.63 0.53(4.48–4.78)4 (3.75–5)3.85 1.07(0.77–1.28)4 (3–5)5 (4–5)4 (4–5)5 (4–5)2 (2–2.25)5 (4–5)5 (4–5)5 (4–5)5 (4–5)5 (4–5)5 (4–5)Note: aReversed score for negatively worded item.Abbreviations: CI, confidence interval; IQR, interquartile range; PCAS, Pharmaceutical Care Attitudes Survey; SD standard deviation.patient medical record in the pharmacy, lack of therapeuticsknowledge, lack of understanding PC, inadequate trainingin PC, lack of workplace for counseling in the pharmacy,inadequate technology in the pharmacy, time constraints,and other barriers (Table 4).The survey was started with the definition of “pharmaceutical care”: “Pharmaceutical care is a patient centeredTable 3 Students’ attitudes towards pharmaceutical care perPCAS scaleScaleMean SDMinimumscoreMaximumscoreRangeProfessional dutyProfessional benefitReturn on effort13.17 1.6536.08 3.685.91 1.5310282154095127Abbreviations: PCAS, Pharmaceutical Care Attitudes Survey; SD standard deviation.124submit your manuscript www.dovepress.comDovepresspractice in which the practitioner assumes responsibility forpatients’ drug-related needs and is held accountable for thiscommitment.”1Survey implementation and confidentialityThe survey was conducted using the Web-based commerciallyavailable survey software, SurveyMonkey (SurveyMonkey,Palo Alto, CA, USA).32Web-based surveys are efficient and convenient alternatives to the more traditional methods of data collection. Theyassure short timeframe for collection of responses and aretime and cost saving. Furthermore, they permit anonymity,in addition to rapid and effective data analysis.33An email, containing an Internet link to the survey, wassent to all eligible participants. The participants submittedTherapeutics and Clinical Risk Management 2014:10

DovepressPharmacy students’ attitudes toward pharmaceutical care in QatarTable 4 Students’ perceived barriers for PC provisionBarrierTable 5 Statistically significant correlation between studentscharacteristics and their attitudes toward pharmaceutical careaFrequency (percentage)To what extent would each ofthe following barriers preventyou from providing PC whenyou become a pharmacist in thefuture?Inadequate drug informationresources in the pharmacyLack of access to the patientmedical record in the pharmacyLack of therapeutics knowledgeLack of understandingof pharmaceutical careInadequate trainingin pharmaceutical careLack of workplace forcounseling in the pharmacyInadequate technologyin the pharmacyLack of self confidenceTime constraintsPoor image of pharmacist’srole in societyInability to deal with adifferent genderReligious constraintsHighextentModerateextentLowextent25 (55%)14 (30%)7 (15%)35 (76%)11 (24%)0 (0%)18 (39%)17 (37%)11 (24%)9 (20%)17 (37%)20 (43%)16 (35%)14 (30%)16 (35%)20 (44%)19 (41%)7 (15%)20 (43.5%)20 (43.5%)6 (13%)15 (33%)24 (53%)23 (50%)12 (26%)17 (38%)14 (30%)19 (41%)4 (9%)9 (20%)11 (24%)6 (13%)29 (63%)7 (15%)3 (7%)36 (78%)Abbreviation: PC, pharmaceutical care.the survey online. A reminder was sent via email to alleligible participants 2 weeks after the initial email wassent. After 4 weeks of data collection, the survey was closed,and the data were entered into the online survey software.To minimize any potential for bias and to protect participant confidentiality, the survey was anonymously completed;no participant identification information was recorded bythe investigators.Professional year versus“Primary responsibility ofpharmacists in health care settingshould be to prevent and solvemedication-related problems”Professional year versus“I think the practice ofpharmaceutical care is valuable”Professional year versus “I feel thatpharmaceutical care movementwill improve patient health”Professional year versus “I feel thatpracticing pharmaceutical care willbenefit my professional pharmacycareer as a pharmacy practitioner”Weeks of practical experienceversus “Primary responsibility ofpharmacists in health care settingshould be to prevent and solvemedication-related problems”Weeks of practical experienceversus “Pharmacy students canperform pharmaceutical careduring their clerkship”Weeks of practical experienceversus “I think the practice ofpharmaceutical care is valuable”Weeks of practical experienceversus “I feel that pharmaceuticalcare movement will improvepatient health”Weeks of practical experienceversus “I feel that practicingpharmaceutical care will benefitmy professional pharmacy careeras a pharmacy practitioner”F(Spearman’srho)P-values 0.4120.005-0.3270.03Note: aOnly statistically significant correlations between student characteristics andtheir pharmaceutical care attitudes are included in this table.Data analysisOnline survey data were downloaded to an Excel (MicrosoftCorporation, Redmond, WA, USA) spreadsheet, andimported into SPSS (IBM Corporation, Armonk, NY, USA)software, version 18, for descriptive and inferential analysis.Association of the sociodemographic characteristics of therespondents with their attitudes toward PC was determinedusing Spearman’s rho test. Association was considered statistically significant when P was ,0.05.Incomplete surveys were included in the analysis ifthey contained basic demographic information and partialresponses to some of the questions. Accordingly, the numberof respondents for each question varied.Therapeutics and Clinical Risk Management 2014:10The mean, standard deviation, median, interquartilerange, and percentage frequency for each of the PCAS itemswas determined (Table 2). The mean, standard deviation,and range for the three separate constructs were determined(Table 3). The score for each scale of the PCAS was calculated by adding the five Likert scores (1–5) of the relateditems: professional benefit, items 4, 5, and 7–12; professional duty, items 1–3; return on effort, items 6 and 13.Scores above 3.5 were interpreted to be positive responses.The highest possible score for professional benefit was40, and 8 was the lowest; the highest possible score forprofessional duty was 15, and 3 was the lowest; and thesubmit your manuscript www.dovepress.comDovepress125

DovepressEl Hajj et alhighest possible score for return on effort was 10, and 2was the lowest.Students’ perceived barriersfor PC provisionEthical considerationsHighly perceived barriers for PC provision included lackof access to the patients’ medical records in the pharmacy(76% of respondents), inadequate drug information sources inthe pharmacy (55%), time constraints (53%), and poor imageof the pharmacist’s role in society (50%) (Table 4).When asked about the changes in pharmacy curriculumthat should be made to further enhance their attitudes towardPC, most respondents suggested increasing the number ofPC exercises in the professional skills course series (78% ofrespondents) and in the SPEP Program (74%).Participation in the study did not pose any risk to participantsand was voluntary. Pharmacy students who completed thesurvey were considered to have given the consent for participation in the study. The study procedures and instrumentswere exempted from full ethics review by the QU InstitutionalReview Board.ResultsOver the 4-week study period, of the 52 students, 46 completed the survey (achieved overall response rate was 88%).Response rate was 100% for second-year students, 86% forthird-year students, and 77% for fourth-year students.Students’ sociodemographiccharacteristicsThe sociodemographic characteristics of respondents aresummarized in Table 1. Most respondents were coming fromone of four countries: Palestine, Jordan, Egypt, and Iraq(59%). Respondents were aged between 19 and 24 years, witha mean age of 21 years standard deviation of 1.33 years.The average number of weeks of training for respondentswas 9 weeks standard deviation of 6 weeks.Students’ attitudes toward PCQU pharmacy students’ attitudes toward each PC item arepresented in Table 2. Overall, the students had very positiveattitudes toward PC provision. All respondents agreed that theprimary responsibility of pharmacists in the health care settingshould be to prevent and solve medication-related problems,that the practice of PC is valuable, and that the PC movementwill improve patient health. However, 76% of respondentsbelieved that providing PC takes too much time and effort.The mean standard deviation scores on the PCAS scalesare summarized in Table 3. An assessment of influence ofsociodemographic characteristics of the respondents on theirattitudes toward PC is presented in Table 5.Professional year and practical experience duration wereinversely significantly associated with four and five statements, respectively, out of the 13 PCAS statements, includingthe statements related to the value of PC and its benefit inimproving patient health and pharmacy practitioners’ careers.No statistically significant correlations existed between othersociodemographic characteristics and students’ attitudestoward PC.126submit your manuscript www.dovepress.comDovepressDiscussionThis study is the first of its kind to assess the attitudes ofQatar pharmacy students toward PC. Overall, students inthis study had high positive attitudes toward PC. There areother, but few studies describing pharmacy student attitudestoward PC. Both American and Saudi pharmacy studentsindicate favorable positive attitudes toward PC and agreethat that all pharmacists should perform PC.29,31 Althoughour curriculum does not include a separate course on PC,this did not appear to be essential to nurture the students’positive attitudes.Data in our study suggest that participants who have morepractical experience have less positive attitudes toward PC.Professional pharmacy year is another contributing factor.Participants who are early in their professional years havehigher positive attitudes toward PC. This is not unexpectedfor Qatar pharmacy students. It is plausible that those studentswho have completed more clerkships realize the possiblemismatch between what is taught at QU College of Pharmacyand how pharmacists practice in Qatar. The pharmacy sitesused for clinical clerkships are not yet offering PC services.As a result, our students are not able to observe the incorporation of PC into routine pharmacy practice.One of the basic ways by which a new behavior is gainedis through observation of other people’s behavior and theoutcomes for them.34 Therefore, if pharmacy students areexposed to training in which the pharmacy practice is mostlypassive, they are not likely to assume an active practice inwhich complete PC is provided. This highlights the need tohave pharmacy experiential training sites that are designed toprepare Qatar pharmacy students for PC practice. These sitesshould offer the students the chance to see the integrationof PC into pharmacy practice. The question comes up abouthow to change the current pharmacy training sites to activelypromote PC. There are several ways to answer this question.Therapeutics and Clinical Risk Management 2014:10

DovepressOne way is to offer workshops to pharmacy preceptors tobe role model pharmacists who can demonstrate and teachexemplary PC practice. These workshops can be preparedand delivered by the QU College of Pharmacy ContinuingPharmacy Professional Development program. These workshops should include a mix of knowledge and interactiveskill development sessions with follow-up application at thepreceptor practice site.In addition to preceptor training, pharmacy studentsshould be afforded the opportunity to provide PC directlyto actual patients under observation of experienced preceptors as an integral portion of their training experience. Thestudents should be engaged in the entire patient care processfrom initial assessment through documentation to follow-upevaluation. Students can then review their own performancewith their pharmacy preceptors to determine their commandof the PC concept. The major goals of these interactions areto help students develop patient assessment, care planningand evaluation skills, and to teach them the importance ofdeveloping an appreciation for the significant role they canplay as pharmacists.The top perceived barrier for PC provision is lack ofaccess to patient medical records in the pharmacy. Difficultyin accessing patients’ clinical and laboratory data has alsobeen reported as a barrier for PC provision in communitypharmacies worldwide.12,35 PC is a multifaceted processthat involves identifying, preventing, and resolving drugtherapy problems. Associated with this process is the deliveryof proper pharmaceutical services, which include obtainingpatient history, evaluating laboratory data, and reviewingpatient records.22 In Qatar, patients’ medical and medicationinformation is only available in hospitals and health careclinics. This emphasizes the need for having patient medicalrecords in Qatar pharmacies to provide an opportunity fordeveloping a scope of PC.Another of the students’ perceived barriers for PC provision is the poor image of the pharmacist role in Qatar’ssociety. Expanding scope of pharmacy practice in Qatarnecessitates positive public attitudes and views. One surveyof a small sample of the general population in Qatar foundthat “the public has a poor understanding of the pharmacist’srole in regards to monitoring drug therapy, performinghealth screening, and providing drug information.”36 This isunfortunate, as many studies have demonstrated the effectiveness of pharmacist delivered PC services with regard toclinical, humanistic, and economic outcomes in differentdisease conditions.37–39 More initiatives must be executed toeducate Qatar’s population about the importance of PC andTherapeutics and Clinical Risk Management 2014:10Pharmacy students’ attitudes toward pharmaceutical care in Qatarto promote the pharmacist’s role through media campaignsand increased support from Qatar’s Supreme Council ofHealth.The students also identified lack of time as an impedimentin the delivery of PC. This barrier has also been reported inprevious studies among pharmaci

pharmacy practice in Qatar focuses mainly on medication dispensing, and PC is still in its infancy.26 In an effort to support the training of local graduates and improve pharmacy practice, in 2007, the college of pharmacy was established at the only national institution in the country, Qatar University (QU).24 QU College of