INTRODUCTION:

The changing vision for the practice of pharmacy got an important boost in 1990, when a term ‘pharmaceutical care’ was defined by Helper and Strand¹.Although about two decades passed since the introduction of concept of pharmaceutical care but the pharmacists in India have not yet completely embraced the concept. It is generally felt the community pharmacists in India are under trained to meet the changing needs of their role towards pharmaceutical care^2,3. The abundance of many newly developed drugs and drug delivery systems in India coupled with inflow of information technology in society in general has had a significant effect on community pharmacists’ behaviour towards dispensing and managing supply of medicines.

If the future of Indian pharmacists lies in the ability of pharmacists to provide pharmaceutical care, it follows that current pharmacists must also improve the skills needed to equip them to be part of this change. Until recently, Indian community pharmacy practice was limited to sell of ready-to-dispense drugs, without presenting professional front. Most pharmacists in Indian community pharmacy practice have had limited exposure to modern dispensing practice.

Various methods by which these shortcomings can be overcome have been currently debated in India⁴. Educational workshop, a form of continuing education to pharmacists, is much talked method today to keep abreast and provide optimum training. Despite the debate on conductance of educational workshop, surprisingly there is lack of literature about the interest, attitudes and opinions of pharmacists’ outcomes of such workshop. The success of an educational workshop is fully dependent on analysis of pharmacists’ behaviour and positive outcomes of the course⁵. Therefore, analysis of interest of participants, understanding of the behaviour and assessment of change in knowledge must be an integral part of an evaluation of the success of a continuing education programme. A study by Basak ET al.⁶ showed that the importance of educational workshop for Indian community pharmacists, demonstrating that training would improve their knowledge.

This study was carried out to assess the change in knowledge, and the variables associated with the change in knowledge, of community pharmacists attending an educational workshop. The pharmacists’ opinions about the workshop in producing changes in knowledge were also investigated.

Table 1: Workshop participants’ (n=49) demographics

Characteristics		Number	Percentage
Gender
	Male	39	79.6
	Female	10	20.4
Age
	30 or less	25	51.0
	31 to 40	18	36.7
	41 and above	6	12.3
Position
	Owner	9	18.4
	Staff	40	81.6
Experience
	No previous course	42	85.7
	One previous course	7	14.3

METHODS:

A series of two workshops for community pharmacists were organized under the auspices of a sponsored project on community pharmacy, and with the assistance of pharmacy practice staff at the Department of Pharmacy, Annamalai University (second oldest University in the Tamilnadu State). The study was carried out during the year 2003. The study included all participants who had attended the second workshop and had completed both the pre and post-tests.

The workshop consisted of a single theory-discussion session that lasted 8 hours (9 am to 5 pm) including a recess for an hour. The session was divided into 6 classes. Every class was about 50 minute’s duration. The class was divided into two parts. Part one dealt with lecture. Participants were presented with general information about proper use of medicines, stability and storage of medicines, laws and regulations related to pharmacy in India, new dosage forms, and recent trends and issues. Part two dealt with discussion of the lecture. Participants were encouraged to seek clarification. In addition study materials were provided prior to start of lecture session.

Table 2: Changes in knowledge in different groups of pharmacists

Group (n)	Pre-test scores	Post-test scores	Mean changes	p
Group (n)	Mean ± SD	Mean ± SD	Mean changes	p
Male (39)	5.29±2.32	10.66±2.71	5.37	0.235
Female (10)	4.48±1.89	10.46±2.11	5.98	0.235
30 or less (25)	4.79±2.02	10.76±2.33	5.97	0.652
31 to 40 (18)	5.28±2.19	10.26±2.11	4.98
41 and above (6)	6.06±1.23	10.15±1.67	4.09
Owner (9)	4.38±1.63	09.02±1.56	4.64	0.701
Staff (40)	5.29±2.73	10.91±2.79	5.62	0.701
No previous course (42)	4.92±2.43	10.30±2.88	5.38	0.401
One previous course (7)	6.19±1.13	12.01±1.22	5.82	0.401
All subjects (49)	5.10±1.89	10.57±2.78	5.57± 1.22	< 0.01*

A multiple choice question (MCQ) test paper consisting of 20 questions was developed to cover concepts dealt with the lecture sessions. Each question had 4 possible answers of which only one was correct. The same MCQ test paper was given at the start (pre-test) and the end (post-test) of the workshop (without informing the participants that the same MCQ test paper would be used). Each participant was given 20 minutes to complete each test. Each correct answer was awarded one mark, and no marks were given for wrong answers. Therefore, the final scores in both the tests could be between 0 to 20. The change in pharmacists’ knowledge was calculated as the difference between the pre-test and post-test scores. Opinions and perceptions of the participants about the workshop were assessed on a 5-point scale. Participants were requested to rate their opinions on a scale of 1 to 5, with 5 being “strongly agree” and 1 being “strongly disagree”. The summation of scores was assessed to reflect the level of satisfaction; high scores above 3 correlating with high level of involvement and vice versa. Descriptive statistics was used for the responses of the community pharmacists. Comparison of the mean scores obtained by respondents was used to evaluate statistical significance. The statistical significance was set at a p-value of 0.05 or less.

RESULTS:

Of the 60 selected pharmacists, 53 attended the workshop and 49 fulfilled the inclusion criteria. A majority, 39 (79.6%) were male and also majority (81.6%) were staff pharmacists. With respect to previous training, only 7 pharmacists (14.3%) had previously attended one similar course. The participants’ average age was 31.9 years (CI95% = 30.13-33.67). The participants were divided into 3 groups based on age, those under 30 years of age (51%) were the most prevalent. The demographic profile of the participants is summarized in Table 1.

Although 53 participants attended the workshop, 49 completed both the tests. On the pre-test, the lowest score was 1 and the highest score was 9. The most common score was 6 points, obtained by 13 participants (26.5%). The average pre-test score was 5.10 (CI95% = 4.46-5.64). On the post-test, the lowest score was 4 and the highest score was 15. The most common score was 10 points, obtained by 10 participants (20.4%). The average post-score was 10.57 (CI95% = 9.78-11.36).

One pharmacist (2%) showed no change between pre-test (6 points) and post-test (6 points) scores, while 3 pharmacists (6.1%) had a difference of 3 points. The most common difference between pre-test and post-test scores was 6 points, obtained by 14 (28.6%) of the participants. The average difference was 5.47 (CI95% = 4.99 – 5.97) and 22.4% (11) of the participants had a difference greater than 7 points.

Data on changes in knowledge in various sub groups participant pharmacists are summarized in Table 2. There was slightly greater effect of the training in acquiring knowledge in women (mean change 5.98 for women and 5.37 for men) and also in participants aged ≤ 30 years versus older participants. In the study it is found that women, who started with lower mean baseline scores, are more likely to benefit from training than men. However, the relationship between the variables (both dependent and independent) was not statistically significant. The relationship between pre-test and post-test scores was statistically significant.

Table 3: Final evaluation by participants

S. No	Items	Mean score*	SD
1	I have improved my knowledge	4.37	1.34
2	I feel course content is easy to follow	4.13	1.87
3	I would like to participate in similar future workshop	4.88	2.11
4	I shall put my knowledge gain into practice	3.89	1.11

* 5= strongly agree; 4= agree; 3= neither agree nor disagree; 2= disagree; 1= strongly disagree

Although base line knowledge of aged participants was higher, but grasping knowledge was comparatively lower than younger participants. Regarding the participants’ position in pharmacy, staff pharmacists, as expected, showed greater mean change (mean change 5.62 for staff and 4.64 for owner). With respect to previous training, it was observed that pharmacists who had formerly attended one workshop scored higher scores on the pre-test, compared to pharmacists who did not attend. In the subjective evaluation participants felt strongly that their knowledge base was improved (Table 3).

DISCUSSION:

More than three-fourth of the participants in this study were male pharmacists, it is not surprising that the majority are male pharmacists, irrespective of age, in India. There was no statistical difference in learning between the variables, even between who attended previous course and those who did not. This could be related to the fact that the average base line knowledge of Indian pharmacist is limited. The greatest mean scores change was among younger pharmacists and women pharmacists, indicating a very good trend. The relationship between the pre-test scores and the post-test scores was statistically significant. The results depend on both on the participants’ prior knowledge and on the quality of the workshop.

The study suffers from a few limitations. The number of pharmacists included in the study was small. The study didn’t attempt to compare with control group. The pre-post tests designs allowed to know the effect within a day half an hour after the workshop, but not to determine the remembrance effect of the participants. Finally, it is possible that pharmacists’ subjective evaluation of the programme correlated with the hospitality offered.

CONCLUSIONS:

The study demonstrated that workshop and training improves participant pharmacists’ knowledge. This increase in knowledge was not statistically related to participants’ gender, age or position in pharmacy. Although there are limitations as mentioned earlier, the study results from the first ever attempted in India can be utilized by the various stakeholders to devise future programmes on the role of continuing education.

REFERENCES:

1. Helper CD and Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990; 47:533-43.

2. Varma D, Girish, M, Shafanas KK and Renjit PB. A study on community pharmacy in Kerala. Indian J. Hosp. Pharm. 2000; 37:49-52.

3. Basak SC, Raja R, Ramesh S and Senthil Kumar S. From policy to practice of community pharmacy in India: A growing need. Indian J. Hosp. Pharm. 2001; 38: 169-172.

4. Rajendran SD, Satish T, Ulaganathan K, Swamyshankar C, Srinivasan KM, Ponnusankar S, Badrinath and Senthil Kumar A. Impact of improved pharmacy services in community pharmacies on patient perception. Indian J Hosp Phar. 2000; 37:11-13.

5. Patterson BD. Distance education in a rural state: assessing change in pharmacy practice as a result of a pharmaceutical care certificate program. Am J Pharm Edu. 1999; 63:56-63.

6. Basak SC. Responding to educational workshop: an evaluation study of pharmacists’ attitudes in pharmacy practice. Indian J Pharm Educ. 2004; 38: 19-24.

Received on 21.10.2008 Modified on 14.12.2008

Research J. Pharm. and Tech. 2(1): Jan.-Mar. 2009; Page 144-146