OBJECTIVES: The study aimed to assess and compare medication counselling and dispensing practices at community pharmacies in three major cities of Pakistan. METHODS: A total of 1113 patient dispenser interactions were observed from a randomly selected sample of 371 pharmacies by using convenient sampling technique in the three respective cities namely Islamabad (118), Peshawar (120) and Lahore (133). The data collection tool was adapted from WHO structure observation form and was modified according to the objectives of the study. MAIN OUTCOME MEASURES: The process of prescription handling at community pharmacies in terms of patient dispenser interaction, prescription validation and medication counseling was assessed. The data was coded, entered and analyzed by using SPSS Version 16. RESULTS: A total of 1113 patient dispenser interactions were observed at the community pharmacies in the three respective cities namely Islamabad (n = 354), Peshawar (n = 360) and Lahore (n = 399). Out of 1113 patient/dispenser interactions the providers present at the community pharmacies were; pharmacist (degree of B-pharm/pharm D) 1.6% (n = 18), pharmacy assistant (diploma in pharmacy) 7% (n = 78), diploma holder (certified course of drug dispensing) 5.6% (n = 62) and salesmen (no medicine related education) 85.8% (n = 955).There was no significant difference in the practice between pharmacists, pharmacy assistants, diploma holders and salesmen. Prescription validation was carried out in 18% (n = 206) of the cases, drugs verification in 32% (n = 360) of the cases while labelling of drugs was performed in only 6% (n = 76) of the cases. Completely counselling about medication was provided in 3.1% (n = 35) of the cases while no counselling at all was given in 52.7% (n = 582) of the cases. CONCLUSION: The process of medication counselling and dispensing practices at community pharmacies in Pakistan is not satisfactory. The patients are largely handled by unqualified salesmen. Thus there is a strong need to improve medication counselling and dispensing practices at community pharmacies by improving the skills of the dispensers through a mix of interventions, and law should be implemented to ensure presence of qualified person which in turn will result in the provision of better patient oriented services at community pharmacies.
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