Background: Pharmaceutical care (PC) has a significant impact on optimizing pharmacotherapy and improving patients’ quality of life. We aimed to determine the attitudes and perceived barriers of final year pharmacy undergraduates towards provision of PC services in Nepal. Methods: A cross-sectional study was conducted among 232 students using a 13-item-standard PC attitude survey (PCAS) questionnaire and 12-itemed PC barrier questionnaires. Mann–Whitney U test and Kruskal–Wallis tests were used to measure the median difference between groups, at alpha=0.05, and Spearman’s rho test was used to measure the strength of the correlation. Results: Majority of students were self-motivated in undertaking the current pharmacy education (178, 76.7%) and had no previous incomplete grades that could delay their graduation (177, 76.3%). Over 80% of students had a positive attitude toward all items of PCAS (agreed and strongly agreed) except for two items. Whereas, 61 (26.3%) disagreed and strongly disagreed that providing PC takes too much time and effort. The major barriers perceived were inadequate PC training (176, 75.9%), inadequate drug information resources in the pharmacy (170, 73.3%), and lack of access to patient medical records in the pharmacy (165, 71.1%). A significant relationship was noticed between positive attitude towards PC and three factors; source of motivation, current employment in pharmacy job, and incomplete grades delaying graduation. Age factor was significant but negatively correlated with the scores of positive attitudes namely “I would like to perform PC as a pharmacist practitioner”, “Providing PC is professionally rewarding” and “I feel that the PC is the right direction for the provision to be headed”. Conclusion: Nepalese undergraduate pharmacy students had positive attitudes toward PC. Exercising proper pharmacy practice regulations and educational efforts to overcome the perceived barriers may lead to better delivery of PC.

Background: Drug utilization research has been defined by the WHO as 'the marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. Several studies of drug utilization conducted in many developed countries shows wide evidence of irrational drug use.Objectives: To assess the drug use pattern in Primary Health Care (PHC) facilities of Kaski district, Western Nepal. Methods :A prospective cross-sectional descriptive study was conducted in 11 PHC facilities of Kaski district using WHO core drug use indicators. Results: A total of 301 prescriptions was analyzed. The average age of patients visiting PHC was 33.11 years (female 35.79; male 30.40). The average number of drugs prescribed was 2.29. Percentage of encounters with at least one antibiotic prescribed was 57% whereas encounters with at least one injection prescribed was low 3%. The total percentage of drugs prescribed using generic names was found to be 59.02% and percentage of drugs prescribed from EDL was 85.19% respectively. The average consultation and dispensing time of 109 patients was 2.02 minutes and 42.52 seconds. Only 30% of patients had adequate knowledge of drug whereas none of the drugs were adequately labeled. Percentage of drugs actually dispensed was 89.63%. All health facilities had availability of Essential Drug List (EDL). The total percentage of availability of key drugs in study PHCs was 89.69%. Conclusion:The study shows trend toward irrational practice mainly on antibiotics use and nongeneric prescribing in most facilities studied. Patient care provided by health facilities studied was insufficient and thus effective intervention program for promotion of rational drug use practice is recommended in PHC facilities.

This study was conducted to assess the drug prescribing trend of anti-hypertensive and hypoglycemic agents in hypertensive and diabetic patients in tertiary care private Hospital. The study was prospective, cross-sectional and observational study. A total of 100 prescriptions were recorded. 56% were males as compared to 44% females. The age group of the patients varied from 30 to 90 years with majority individual above 50 years of age. 59% patients were hypertensive; 26% patients were diabetic and 15% had both the diseases. For the treatment of HTN, both mono-therapy and combination therapy were followed. In mono-therapy, amlodipine was most commonly prescribed followed by losartan. In combination therapy, a two-drug combination consisting of calcium channel blockers (amlodipine) and diuretics (furosemide /hydrochlorothiazide) were given to the majority of patients, followed by Diuretics and Angiotensin receptor blocker combination. Among diabetic hypertensive, 66.67% of patients were treated with single anti-hypertensive drug and 33.35% of patients were treated with anti-hypertensive drug combinations with oral hypoglycemics. This study showed that calcium channel blockers were the most prescribed antihypertensive agents while biguanides were the mostly prescribed among anti-diabetic agents. Combination therapy was observed in a high percentage of prescriptions in hypertensive patients. Prescribing pattern among antihypertensive showed some dubitable adherences to existing evidence-based JNC guidelines.Sunsari Technical College Journal 2015, 2(1):44-47

Background Community pharmacies are easily accessible outlets providing medicines to the general public in Nepal, but it is known that irrational dispensing of antibiotics from such outlets contributes to antimicrobial resistance. Objective To assess the understanding of community pharmacy personnel around antibiotic-dispensing in Eastern Nepal and the relationship between this understanding and their personal characteristics. Methods A cross-sectional survey was conducted on 312 pharmacy personnel working in community pharmacies of three districts within Eastern Nepal using a self-administered questionnaire. Descriptive statistics were used to analyze participants’ characteristics and their understanding of antibiotic dispensing. The relationships between their understanding of antibiotic dispensing and their characteristics were determined using Chi-square tests. Results Most of the pharmacy personnel considered that dispensing antibiotics without a valid prescription is a problem (76.9%), and that it would not be legal to do so (86.9%). In the survey, 34.9% of participants agreed that they had dispensed antibiotics without prescription, and 26.9% disagreed with the assertion that inappropriate dispensing of antibiotics could promote antimicrobial resistance. Most (94.5%) reported that they would advise patients to follow their antibiotic dosage regimen, but 34.3% reported that they believed antibiotics to reduce pain and inflammation. Bivariate analysis showed that the level of understanding about antibiotic indication was significantly associated with age (p<0.001), work experience (p<0.001) and qualifications (p=0.017) of the pharmacy personnel. Work experience and qualifications also had significant but independent relationships with the level of understanding that irrational dispensing of antibiotics promotes antimicrobial resistance (p=0.018 and p=0.004) and is on the need for patient follow-up after dispensing antibiotics (p<0.001 and p=0.042). Conclusion The understanding of community pharmacy personnel about antibiotic dispensing in Eastern Nepal requires significant improvement. Degree of understanding of some aspects of antibiotic dispensing was influenced by age, work experience and qualifications.

Background: Self-medication is the use of drugs to treat self-diagnosed disorders/symptoms, or the intermittent/continued use of a prescribed drug for chronic/recurrent disease/symptoms (WHO). It is the cause for antibiotic resistance, inappropriate treatment, financial burden and many deaths. WHO listed self-medication as one of the priority research area at the local context. The objective of the study was to find the prevalence and pattern of self-medication in surrounding communities of Birat Medical College and Teaching Hospital. Methods: A community-based cross-sectional study was conducted at the surrounding communities of Birat Medical College from 1st August 2018 to 15th December 2018. Multistage sampling was used to collect information from 348 household having family members aged 16 years and above. Ethical approval was taken from Institutional Review Committee of Birat Medical College. Pre-tested semi-structured questionnaire was used. Results: The mean age of the participants was 40.5±15.9 years. Prevalence of self-medication was 44.04%. Majority took self-medication for headache 43.6% followed by common cold 39.1% etc. Majority used allopathic drugs 82.7% followed by traditional healers 9.8%. Common medication were antipyretics 18.8%, antibiotics 16.5%, proton pump inhibitor 7.5%, antihistamines 6.8% etc. The reason behind self-medication were low cost 30.1%, time saving 24.1%, illness too trivial/mild for consultation 18.8%, quick relief 18.1%, high doctor fee 15 %, lack of awareness 13.5 %,  familiar with treatment options 12.8%, long waiting line in hospital 12% etc. Out of them 8.3% noticed side effects of self-medication. Out of all 59.5% felt the need of awareness program on rational use of medicines. Age, sex, marital status, ethnicity, religion, education and occupation of participants, education and occupation of head of household, poverty status, family type, house residence type, type of house has no significant association with self-medication. Participants residing in alani/rent households were 1.93 times more likely to self-medicate than those residing in their own and participants having negative attitude were 1.90 times more likely to self-medicate than those who had positive attitude and both were statistically significant.  Conclusions: The burden of self-medication was present and allopathic drugs including antibiotics were common. Adverse drug reactions were reported but participants were unaware about the place to report. Participants had negative attitude towards self-medication which is harmful for their health. As pharmacy was the common source of self-medication, the prescription based medicine dispensary should be advocated.