Community pharmacy ethical practice in Jordan: assessing attitude, needs and barriers
Background: Having a local code of ethics, based on moral obligations and virtues, known to all practicing pharmacists is important in order to guide them in relationships with patients, health professionals, and society.
Objective: To investigate pharmacists’ attitude and barriers towards applying the ethical principles published by the Jordanian Pharmacists Association in the Jordanian code of ethics.
Methods: The study objectives were addressed in a cross-sectional study completed by a convenience sample of community pharmacists, in both cities; Amman and Irbid A questionnaire was used to achieve the study objective. The questionnaire was developed and validated, investigating pharmacists’ socio-demographic and practice characteristics, perceived attitude toward certain practice scenarios, and perceived barriers towards applying the locally published ethical principles while dealing with their patients. The questionnaire was self-completed by pharmacists between January and August 2017. Collected data was analyzed using SPSS version 21. Descriptive statistics and parametric tests were used with p<0.05 set a priori as significant.
Results: Seven hundred and four pharmacists (Amman n=486; Irbid n=218) responded to the questionnaire, providing completely answered questionnaires with a response rates of 69.4% in Amman and 99.6% in Irbid. Pharmacists from both cities revealed that they use the Internet as their main resource to obtain ethical information when they need it, to help them deal with their patients (34.0% from Amman and 31.5% from Irbid). More pharmacists in Amman (57.0%) had access to resources regarding ethical information at their practice sites compared to pharmacists in Irbid (24.0%). Significant differences in attitude was found between pharmacists practicing in both cities, as significantly less pharmacists from Amman (37.8%) declared that they would sell a medication for an unreported indication according to national and international guidelines, if recommended by the consultant, compared to pharmacists from Irbid (77.7%, p<0.001).
Conclusions: Despite having ethical guidance from the Jordanian Pharmacists Association, the majority of pharmacists in Jordan do not use this resource; instead, most choose to access ethical guidance on-line. Pharmacists from the capital, Amman, reported to adhere more with the guidelines when selling a medication for an unreported indication compared to pharmacists from the smaller city, Irbid. Results of this study call for more actions from the authorities in the country responsible for setting and enforcing the pharmaceutical Code of Ethics.
Robert A. Buerki LDV. Ethical responsibility in pharmacy practice. Madison, Wisconsin: American Institute of the History of Pharmacy; 2002.
Astbury JL, Gallagher CT. Development and validation of a questionnaire to measure moral distress in community pharmacists. Int J Clin Pharm. 2017;39(1):156-164. https://dx.doi.org/10.1007/s11096-016-0413-3
Kruijtbosch M, Göttgens-Jansen W, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Moral dilemmas of community pharmacists: a narrative study. Int J Clin Pharm. 2018;40(1):74-83. https://dx.doi.org/10.1007/s11096-017-0561-0
Jordan Pharmacists Association. Pharmacy Code of Ethics; 2017. Available at: http://jpa.org.jo (accessed Oct 6, 2018).
American Pharmacists Association. Code of Ethics for Pharmacists', adopted by the membership of the American Pharmacists Association; 1994 [Available at: http://www.pharmacist.com/code-ethics (accessed Oct 6, 2018).
Royal Pharmaceutical Society of Great Britain. Medicines, ethics and practice guide. London: Pharmaceutical Press; 2018.
The Pharmaceutical Society of Australia. Code of Professional Conduct; 1998. Available at: http://www.psa.org.au/site.php?id=628 (accessed Oct 6, 2018).
Chaar BB, Brien J, Krass I. Professional ethics in pharmacy practice: developing a psychometric measure of moral reasoning. Pharm World Sci. 2009;31(4):439-449. https://dx.doi.org/10.1007/s11096-009-9292-1
Cooper R. Ethical problems and their resolution amongst UK community pharmacists: a qualitative study. London: University of Nottingham; 2007.
Cooper RJ, Bissell P, Wingfield J. A new prescription for empirical ethics research in pharmacy: a critical review of the literature. J Med Ethics. 2007;33(2):82-86. https://dx.doi.org/10.1136/jme.2005.015297
Vukovic Rodriguez J, Juricic Z. Perceptions and attitudes of community pharmacists toward professional ethics and ethical dilemmas in the workplace. Res Social Adm Pharm. 2018;14(5):441-450. https://dx.doi.org/10.1016/j.sapharm.2017.05.010
Kruijtbosch M, Göttgens-Jansen W, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Moral dilemmas reflect professional core values of pharmacists in community pharmacy. Int J Pharm Pract. 2019;27(2):140-148. https://dx.doi.org/10.1111/ijpp.12490
Dessing RP. Ethics applied to pharmacy practice. Pharm World Sci. 2000;22(1):10-16.
Barreda Hernández D, Mulet Alberola A, González Bermejo D, Soler Company E. The reason for having a code of pharmaceutical ethics: Spanish pharmacists code of ethics. Farm Hosp. 2017;41(3):401-409. https://dx.doi.org/10.7399/fh.2017.41.3.10611
Dessing RP, Flameling J. Ethics in pharmacy: a new definition of responsibility. Pharm World Sci. 2003;25(1):3-10
Resnik DB, Ranelli PL, Resnik SP. The conflict between ethics and business in community pharmacy: what about patient counseling? J Bus Ethics. 2000;28(2):179-186.
Al-Arifi MN. Community pharmacist perception and attitude toward ethical issues at community pharmacy setting in central Saudi Arabia. Saudi Pharm J. 2014;22(4):315-325. https://dx.doi.org/10.1016/j.jsps.2013.08.003
Cooper RJ, Bissell P, Wingfield J. Dilemmas in dispensing, problems in practice? Ethical issues and law in UK community pharmacy. Clin Ethics. 2007;2(2):103-108. https://dx.doi.org/10.1258/2F147775007781029564
Kogut SJ, Goldstein E, Charbonneau C, Jackson A, Patry G. Improving medication management after a hospitalization with pharmacist home visits and electronic personal health records: an observational study. Drug Healthc Patient Saf. 2014;6:1-6. https://dx.doi.org/10.2147/DHPS.S56574
Australian Department of Health. Medication management reviews 2014. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/medication_management_reviews.htm (accessed Oct 6, 2018).
Nazer LH, Tuffaha H. Health Care and Pharmacy Practice in Jordan. Can J Hosp Pharm. 2017;70(2):150-155.
Sharif PS, Javadi M, Asghari F. Pharmacy ethics: evaluation pharmacists' ethical attitude. J Med Ethics Hist Med. 2011;4:5.
Wilbur K. Continuing professional pharmacy development needs assessment of Qatar pharmacists. Int J Pharm Pract. 2010;18(4):236-241. https://dx.doi.org/10.1111/j.2042-7174.2010.00034.x
Kheir N, Fahey M. Pharmacy practice in Qatar: challenges and opportunities. South Med Rev. 2011;4(2):92-96. https://dx.doi.org/10.5655/smr.v4i2.1007
Population of Hashemite Kingdom of Jordan According to the 1952, 1961, 1979 ,1994,2015 and 2017 Censuses. Departemnt of Statistics. Available at: http://dosweb.dos.gov.jo/population/population-2/ (accessed Oct 6, 2018).
Deans ZU. The ethics of pharmacy practice: an empirical and philosophical study [dissertation]. University of Bristol. 2008.
Virani A. The Pharmacist’s guide to evidence-based medicine for clinical decision making. Can J Hosp Pharm. 2009; 62(5): 423-424.
Martin LC, Donohoe KL, Holdford DA. Decision-making and problem-solving approaches in pharmacy education. Am J Pharm Educ. 2016;80(3):52. https://dx.doi.org/10.5688/ajpe80352
Saw PS, Chuah LH, Lee SWH. A practical approach toward teaching ethics to community pharmacists. Int J Clin Pharm. 2018;40(5):1131-1136. https://dx.doi.org/10.1007/s11096-018-0707-8
Bader LR, McGrath S, Rouse MJ, Anderson C. A conceptual framework toward identifying and analyzing challenges to the advancement of pharmacy. Res Social Adm Pharm. 2017;13(2):321-331. https://dx.doi.org/10.1016/j.sapharm.2016.03.001
Weissman MA, Bensinger L, Koestler JL. Resident as teacher: educating the educators. Mt Sinai J Med. 2006;73(8):1165-1169.
Spielthenner G. Why comply with a code of ethics? Med Health Care Philos. 2015;18(2):195-202. https://dx.doi.org/10.1007/s11019-014-9594-5
Sim TF, Sunderland B, Hattingh HL. Exploring influences on pharmacists' and students' ethical reasoning in a changing practice landscape in Australia. Int J Clin Pharm. 2019;41(1):280-288. https://dx.doi.org/10.1007/s11096-018-0774-x
Miederhoff PA, Olin BR, LeFevre J. Ethics education for clinical pharmacy practice. Drug Intell Clin Pharm. 1980;14(7-8):537-539.
The High Health Council. The National Strategy for Health Sector in Jordan 2015- 2019. Available at: http://www.hhc.gov.jo/uploadedimages/The%20National%20Strategy%20for%20Health%20Sector%20in%20Jordan%202015-2019.pdf (accessed Oct 6, 2018).
Rogers W. Ethical issues in public health: a qualitative study of public health practice in Scotland. J Epidemiol Community Health. 2004;58(6):446-450. https://dx.doi.org/10.1136/jech.2003.013417
Salman Popattia A WS, La Caze A. Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review. Int J Pharm Pract. 2018;26(2):93-103. https://dx.doi.org/10.1111/ijpp.12425
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