Pharmacists have a particular position of trust among the community. They must not abuse this position of trust, which they hold in the relationship they have with their patients. Recently, there has been an increasing demand for community pharmacies to play a crucial role in providing safe and optimum health care services, particularly for minor cases, rather than for patients to visit emergency departments. Bisha Health Directorate is considered to be a rural area, which is part of Aseir Province. In 2007, the population was 199,613 people and there were only 25 community pharmacies [1]. By 2017, the population had increased to 388,055 people and the number of community pharmacies had increased dramatically to 125 [2]. From this data, it can be seen that the population increased by approximately 94% over this 10 years period, with an approximately 500% increase in the number of community pharmacies during the same period. Therefore, the pharmacy business is growing rapidly in the Bisha area with no or limited information on how pharmacies can provide good pharmacy practice (GPP), especially counseling, to the community.
According to the laws and regulations in Saudi Arabia, medicines in community pharmacies, i.e. private pharmacies, are divided into two classes [3]. The first class includes prescription-only medicines, which are defined as medicines that cannot be dispensed without an authorized prescription. The second class includes non-prescription or over-the-counter (OTC) medicines, which are defined as medicines that can be supplied without a prescription. OTCs are considered to be safe and effective if they are used according to the guidelines available on the package or the label [4]. In addition, World Health Organization (WHO) recommended pharmacists to spend at least three minutes with every patient for orientation and counseling. However, in many developing countries they spent much less time, i.e., much less than three minutes, with patients. For example, the average time reported in Cyprus, Brazil, Sudan, Nepal, Tanzania, Nigeria and Bangladesh was 149 seconds, 53.9 seconds, 21.8 seconds, 86.1 seconds, 77.8 seconds, 12.5 and 23 seconds respectively [5, 6].
One of the essential services of a community pharmacy is patient counseling, either for prescription-only or OTC medicines. Many organizations have provided suggested guidelines and recommendations to pharmacists about patient education and counseling for both prescription-only and OTC medicines. Pharmacists should provide the following information to their patients: name of the drug, description of the drug, indication, how to use it, the method of treatment, precautions, adverse drug reactions, and any contraindications [7, 8, 9, 10]. In addition, all the guidelines emphasize the importance of gathering enough information from the patient to ensure patient safety, patient understanding about the medication, and whether the medication will meet patient needs [7, 8, 9, 11]. Okumura et al. (2014) found in their systematic review study that patient counseling can improve drug and disease knowledge, clinical outcome, patient satisfaction, and the quality of life of patients. Moreover, by law, pharmacists are not allowed to dispense any medicine without a prescription, written by an authorized person, unless the medicine is categorized as OTC [3].
In addition, Toklu et al. (2010) focused on implementing GPP in a specific district in Istanbul, Turkey. They found that GPP was poorly applied in community pharmacies [20]. Also, Gokcekus et al. (2012) conducted a similar study in the northern Turkish region of Cyprus. They concluded that GPP in that region was insufficient and needed improvement [6]. Halial et al. (2015) studied the evidence-based practice of community pharmacists for OTC medicines in Parana State, Brazil. They concluded that there was a major problem of poor knowledge regarding evidence-based practice among community pharmacists, which negatively affected the counseling practice [21]. Tully et al. (2011) studied the predictors of no counseling, no questioning, and no information provided to patients during counseling in community pharmacies in Sweden. Thier conclusion suggested the importance of therapeutic classes and busy times as predictors of no counseling about prescription medicines in Swedish pharmacies [22].
GPP, mainly counseling, has been investigated during the past years in Saudi Arabia, especially in the legal perspective of prescribing medicines. In addition, many studies have been conducted on the misuse of antibiotics in community pharmacies. Patient counseling was included in the evaluation process in some of these studies. Many studies from 1992 until now described the level of GPP especially patient counseling and following Saudi regulations. Three deferent studies found that community pharmacies did not adhere to pharmaceutical law and regulations [12, 13, 14]. A systematic review study in 2016 concluded that the dominant service of the community pharmacy in Saudi Arabia was in selling medicines without providing any pharmaceutical care to the patients [15].
Since there is limited information about counseling in Bisha Health Directorate. The present study aimed to evaluate the practice of counseling by community pharmacists for both OTC and prescription-only medicines in the Bisha Health Directorate, Saudi Arabia.