Scope of work and factors associated with pharmacist practice in public and private hospitals in Kampala, Uganda

Abstract

Background: For a long time, Uganda had a small number of pharmacists. Hospitals operated without them because pharmacy training in Uganda only started in 1988, and the numbers that trained from outside Uganda were too small to serve the whole country. Thirty years on, no evaluation of the extent to which pharmacists perform different roles in hospital pharmacy practice has been done. Goal: To evaluate the scope of work and the factors associated with the pharmacist practice in both public and private hospitals in Kampala, Uganda. Methods: A hybrid of both quantitative and qualitative research methods were employed to study pharmacists, hospital managers, and clinicians in hospitals in Kampala. Forty one pharmacists and twelve hospital managers from hospitals in Kampala participated in the study. The quantitative portion of the study employed a 5-point Likert psychometric scale questionnaire while the qualitative arm employed key informant interviews using key informant guides. Quantitative data was entered into EpiData then analyzed by SPSS software. A composite sum of the Likert type data was generated and described using descriptive statistics namely; mode and median. Qualitative data was analyzed by N-Vivo software to identify the dominant themes for each objective from the narratives of study participants. Results: The main roles of hospital pharmacists were; ensuring medicine supply to the hospital (90.2%), quality assurance of medicines (78.1), training student trainees and intern pharmacists (65.9%), staff mentorship (58.5%) and dispensing of medicines (58.5%). The roles that had least involvement of the pharmacists were; compounding medicines (17.1%), attending clinical ward rounds with doctors and nurses (31.7 %), maintaining a report system of pharmacovigilance (39.0%), and conducting research (41.5%). Level of education, number of pharmacists in the hospital, duration spent at the institution, departmentalization and specialization, human resources capacity, poor remuneration, lack of supervision, organizational culture all combined to undermine the ability of pharmacists to work effectively and efficiently. This study revealed that there were mixed perceptions about pharmacists by other medical workers in hospitals. While some perceptions were largely negative, they were reported by few participants and such perceptions were shaped by many factors including level of education, age, seniority, training background, exposure to interprofessional practice (IPP) as well as the workload. Conclusion and Recommendations: This study revealed that roles that required hospital pharmacists to take up active roles on the clinical care teams were least performed. Personal, interpersonal and organizational factors contributed to undermine the performance of pharmacists. Pharmacy training institutions should review their curriculums to focus more on the expanded roles of pharmacists. Pharmaceutical audit be done in order to identify the critical needs and capacities available and to recruit more pharmacists in order to address these gaps. Further studies involving a wider study area should be done to build on the available knowledge.