INTRODUCTION:

Hospital pharmacies and the role of pharmacists within them play a pivotal and influential part in the medication and treatment process, particularly in countries with advanced and modern healthcare systems^1–6. Pharmacists are essential members of the healthcare team, recognized and valued by physicians, nurses, and other medical personnel for their expertise and contributions^1,2,7,8. They are strategically positioned within multiple departments of the hospital, establishing a symbiotic relationship with the treatment process within these respective departments^9–12. In advanced-country hospitals, pharmacists engage in a wide range of services, encompassing various aspects of pharmaceutical care^13–16. These activities include integrating with the drug information system, providing drug consultations to physicians and nurses, participating in treatment committees to facilitate drug selection, and contributing to the procurement and distribution of medications and healthcare products^17,18.

However, the current state of hospital pharmacies in Afghanistan presents a contrast to their counterparts in advanced countries, resembling the situation of American hospital pharmacies in the 1940s¹⁹. While focusing primarily on medication compounding and product distribution within hospital departments, the involvement of Afghan hospital pharmacists in scientific communication with these departments remains relatively limited^20–22. This calls for hospital pharmacies and pharmacists to adopt a more active role in delivering comprehensive pharmaceutical and clinical services, requiring meticulous planning and time allocation.

Notably, a study conducted by the United States Agency for International Development (USAID) shed light on the distribution and prescription processes of medications and healthcare products within public hospitals in Afghanistan, revealing significant deficiencies and anomalies²³. These shortcomings have resulted in reduced financial and human resources within the organizations, raising concerns about the effectiveness and resilience of these departments.

To enhance pharmacist involvement at the patient's bedside and improve hospital pharmacy functioning, a systematic approach is essential to identify and address existing challenges and their root causes²⁴. Pharmacists' active engagement is pivotal in patient-centered care, such as in cardiology units, where they help mitigate drug-related adverse reactions and enhance medication adherence²⁵. Their role has evolved from medication delivery to patient-focused care, optimizing drug therapy outcomes and improving the quality of life for patients, especially in managing conditions like diabetes²⁶.

Prior research studies have highlighted the effectiveness of pharmacists in providing pharmaceutical services^27–31. For instance, Indonesia, with a significant diabetes population, highlights the importance of pharmacist counseling in improving therapy outcomes³². In addition, the knowledge, attitude, and practice of pharmacists in immunization delivery can play a significant role in increasing vaccine coverage, although barriers such as concerns about vaccine quality and availability need to be addressed³³. A study by Hafeez & Ahmad (2020) identified qualified pharma-service by adopting the service delivery model for community pharmacy³⁴. Utami et al. (2020) concludes that patients were generally satisfied with the professional pharmaceutical services provided by certified pharmacists³⁵. Kassa et al. (2021) showed that the outpatients' perception of pharmaceutical service quality in hospitals with APTS in Ethiopia was positive³⁶. Similarly, Ismaya et al. (2021) explaind that pharmacy service is an important part of hospital service and low-quality service can decrease the quality of health service³⁷.

For hospital pharmacy managers to be effective and proactive, their active participation in financial, medical, and pharmaceutical committees is essential^38–40. Fostering close relationships with hospital departments, doctors, and nurses allows for a comprehensive understanding of existing challenges^41,42. Other critical aspects of pharmacy management include personnel training, implementing efficient drug and healthcare product distribution systems, ensuring competent staff employment, addressing workforce shortages, and conducting functional evaluations to assess job competencies^43–48.

To facilitate active involvement of pharmacists at the patient's bedside and bring about positive changes in hospital pharmacy functioning, a systematic approach is required to identify and address existing challenges and their underlying causes^49–52.

The primary objective of this study is to investigate the role of pharmacists in delivering pharmaceutical services within selected government hospitals in Kabul. The findings of this research aim to serve as a valuable basis for implementing measures aimed at enhancing the quality and efficacy of pharmaceutical services offered within hospital pharmacies.

HYPOTHESES:

· Null Hypothesis (H0): There is no significant relationship between the role of pharmacists and the combined indices of tangible factors, reliability and credibility, responsiveness, reassurance, and empathy in the provision of pharmaceutical services in selected government hospitals in Kabul.

· Alternative Hypothesis (Ha): There is a positive and significant relationship between the role of pharmacists and the combined indices of tangible factors, reliability and credibility, responsiveness, reassurance, and empathy in the provision of pharmaceutical services in selected government hospitals in Kabul.

MATERIALS AND METHODS:

Study Design and Data Collection

This research adopts a quantitative approach, aiming to investigate the role of pharmacists in providing pharmaceutical services in selected government hospitals in Kabul, Afghanistan in the year 2022. Through the utilization of a questionnaire-based survey, the study seeks to assess the impact of pharmacists on service quality and explore various dimensions related to pharmaceutical services.

Sampling and Sample Size Determination:

The statistical population for this research comprises all patients of government hospitals in Kabul. However, due to security concerns, time limitations, and budget constraints, the study focused on patients from 10 government hospitals in Kabul.

The sample size was determined using Cochran's formula⁵³, with a desired confidence level of 95% and a margin of error of 5%. According to the formula, the resulting sample size was 338 individuals, which adequately represents the population.

Validity and Reliability of Research Questionnaires:

Both (mass and IR spectroscopy) studied were conducted as per regular standard procedures.

The Parasuraman service quality standard questionnaire⁵⁴, containing 22 questions and a researcher-designed questionnaire, containing 22 questions, were thoroughly validated through feedback obtained from the research supervisor, consultant professor, and a group of respondents. Upon approval, the questionnaires were employed in the research.

Table 1: Cronbach's Alpha Test Results

Variables	Number of questions	Cronbach's Alpha
Tangible factors	4 Questions	0.887
Reliability and Credibility	5 Questions	0.836
Responsiveness	4 Questions	0.62
Reassurance	4 Questions	0.75
Empathy	5 Questions	0.672
Role of Pharmacists	22 Questions	0.863

Reliability of the questionnaires was assessed using Cronbach's alpha for each indicator related to the research hypotheses. According to the table 1, the obtained alpha values were as follows: 0.887 for the "tangible factors" index, 0.836 for "reliability and credibility", 0.620 for "responsiveness," 0.750 for "reassurance", 0.672 for "empathy", and 0.863 for the "role of pharmacists" index. These values indicate that the questionnaires exhibited good reliability.

Data Analysis and Interpretation:

The collected data were analysed using SPSS software to ensure accurate and precise analysis. Each question and response option from the questionnaires were coded, and the codes selected by respondents were entered into the SPSS program. Inferential tests, including regression analysis, was employed to assess the relationship between the independent variables (tangible factors, reliability and credibility, responsiveness, reassurance, and empathy) and the dependent variable (pharmacists' role).

RESULT:

Due to the constraints of examining the entire statistical population encompassing the entire country, the research inevitably employed sampling. The sample population for this study comprised 338 patients who were hospitalized in selected hospitals, ensuring appropriate representation across different categories. The Socio-demographic characteristics are showed in table 2:

Table 2: Socio-Demographic Characteristics

Respondents Characteristics		Percentage
Gender	Female	7.10%
Gender	Male	42.90%
Marital Status	Single	44.97%
Marital Status	Married	55.03%
Age	18-25	37.57%
	26-35	50.00%
	36-50	12.43%
Education Level	Illiterate	65.38%
	Diploma	29.99%
	Bachelor'sdegree	5.33%
	Master's degree	0.30%
Hospitalization Period	Less than10days	47.93%
	11-20days	42.31%
	More than 20 days	9.76%

Regarding gender distribution, an effort was made to maintain uniformity between men and women respondents in the questionnaire distribution. However, cultural factors played a role, leading to 57.10% of the statistical population being male and 42.90% being female.

Civil status was recognized as a factor that might influence response patterns, prompting a question addressing this variable. Out of the 338 respondents, 55.03% reported being married, while 44.97% were single.

The age distribution among the respondents revealed that 37.41% fell within the 18-25 years age bracket, 50% were aged 26-35 years, and 12.43% were between 36-50 years of age.

In terms of educational attainment, 28.99% of the respondents held a diploma, 5.33% possessed a bachelor's degree, and 0.30% attained a master's degree.

Analyzing the work experience of the respondents, 47.93% reported having less than 10 days of experience, 42.31% had 11 to 20 days of experience, and 9.76% reported more than 20 days of experience.

Hypothesis Testing:

In this research, the examination of the relationships outlined in the hypothesis necessitates the application of appropriate statistical methods for inferential analysis. To this end, the linear regression test has been selected as the analytical tool for investigating the associations between the variables under scrutiny.

Table 3 shows that the combined effect of the independent variables (tangible factors, reliability and credibility, responsiveness, reassurance, and empathy) explains approximately 41.2% of the variance in the role of pharmacists (R Square = 0.412). The Adjusted R Square (0.403) takes into account the number of predictors in the model and provides a slightly more conservative estimate of the model's explanatory power. The standard error of the estimate (0.42882) represents the average deviation of the observed values from the predicted values, indicating the accuracy of the model's predictions. The F Change (46.498) is highly significant (p < 0.001), indicating that the model as a whole is a good fit for the data.

Table 4 Indicates that the regression model is highly significant (p < 0.001), suggesting that the combined effect of the independent variables (tangible factors, reliability and credibility, responsiveness, reassurance, and empathy) has a significant impact on the role of pharmacists. The regression model accounts for a substantial amount of variance in the role of pharmacists, as evidenced by the significant F-statistic (46.498).

Table 5 represent the relationships between the dependent variable (role of pharmacists) and each independent variable (tangible factors, reliability and credibility, responsiveness, reassurance, and empathy). The standardized coefficients (Beta) indicate the relative importance of each variable in predicting the role of pharmacists. Among the indices, reliability and credibility have the highest standardized coefficient (0.427), followed by tangible factors (0.243). Responsiveness, reassurance, and empathy have smaller coefficients and are not statistically significant predictors (p > 0.05) in this model.

Table 3: Summary of Model Results

Model	R	R Square	Adjusted R Square	Std. Error of the Estimate	Change Statistics
Model	R	R Square	Adjusted R Square	Std. Error of the Estimate	R Square Change	F Change	df1	df2	Sig. F Change
1	0.642^a	0.412	0.403	0.42882	0.412	46.498	5	332	0.000

a. Predictors: (Constant), Tangible Factors, Reliability and Credibility, Responsiveness, Reassurance, Empathy

Table 4: Anova Results

Model		Sum of Squares	df	Mean Square	F	Sig.
1	Regression	42.751	5	8.550	46.498	0.000^b
	Residual	61.050	332	0.184
	Total	103.801	337

a. Dependent Variable: Role of Pharmacists

b. Predictors: (Constant), Tangible Factors, Reliability and Credibility, Responsiveness, Reassurance, Empathy

Table 5: Coefficients Results

Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.
Model		B	Std. Error	Beta	t	Sig.
1	(Constant)	1.863	0.133		14.055	0.000
	Tangible Factors	0.091	0.026	0.243	3.486	0.001
	Reliability and Credibility	0.213	0.038	0.427	5.581	0.000
	Responsiveness	-0.015	0.074	-0.030	-0.204	0.838
	Reassurance	-0.004	0.027	-0.008	-0.152	0.879
	Empathy	0.030	0.074	0.057	0.401	0.689
a. Dependent Variable: Role of Pharmacists

DISCUSSION:

The results of the study aimed to explore the relationship between the role of pharmacists in providing pharmaceutical services in selected government hospitals in Kabul and the combined indices of tangible factors, reliability and credibility, responsiveness, reassurance, and empathy. The analysis revealed important insights into the factors that significantly influence the level of patient satisfaction with the quality of services offered in healthcare facilities.

Regarding tangible factors, such as hospital decoration and interior design, employee dress code and discipline, hospital brochures and receipt sheets, and internal facilities, the findings showed a significant positive relationship with the role of pharmacists in providing pharmaceutical services. These physical aspects play a crucial role in shaping patients' perceptions and overall satisfaction with the healthcare experience. The confirmation of this hypothesis underscores the importance of improving and validating tangible factors within government hospitals in Kabul to enhance the pharmacists' role in service delivery.

The analysis of reliability and credibility factors, including adherence to promises, maintaining good records, conducting honest transactions, and overall reliability, also yielded a significant positive relationship with the role of pharmacists. The findings suggest that these aspects contribute significantly to the level of patient satisfaction with the quality of services provided. Ensuring high levels of reliability within healthcare facilities can foster trust and confidence among patients, positively influencing their overall healthcare experience.

Regarding responsiveness, problem-solving for customers, accuracy in time management, swift resolution of patients' issues, and cooperative engagement with patients, the study found a significant positive relationship with the role of pharmacists. These factors play a crucial role in shaping patient perceptions of the responsiveness and accountability of healthcare providers. The confirmation of this hypothesis emphasizes the need for healthcare facilities to prioritize responsiveness to enhance the role of pharmacists in providing pharmaceutical services effectively.

With respect to reassurance factors, such as customers' sense of confidence and security, employees' politeness and good manners, healthy and proper support of employees from the hospital, and trusting the hospital's employees, the analysis revealed a significant positive relationship with the role of pharmacists. Patients' perception of reassurance and a supportive environment can have a profound impact on their overall satisfaction with the quality of services received. The findings emphasize the importance of creating an atmosphere of assurance within healthcare facilities to strengthen the pharmacists' role in service delivery.

Regarding empathy factors, such as individual attention of patients and staff to patients, proper understanding of patients' needs, attention to patients' interests, and providing services at suitable hours for all patients, the study identified a significant positive relationship with the role of pharmacists. Demonstrating empathy and understanding patients' individual needs can significantly influence patient satisfaction with pharmaceutical services. The confirmation of this hypothesis highlights the role of empathy in shaping the pharmacists' effectiveness in meeting patients' expectations.

The findings of the present research align with prior studies conducted by Hafeez and Ahmad (2020), Utami et al. (2020), and Kassa et al. (2021)^28-31.

CONCLUSION:

This research highlights the significant role of pharmacists in providing pharmaceutical services in selected government hospitals in Kabul. Through a quantitative approach and comprehensive questionnaires, the study explored various dimensions of service quality, including tangible factors, reliability, responsiveness, reassurance, and empathy.

The findings indicate that service quality, especially tangible aspects, exceeded the expectations of the target society, leading to favorable patient satisfaction. Understanding society's desires and addressing its shortcomings is crucial for maintaining social stability. Customer satisfaction, particularly among patients, is essential for organizational success, fostering loyalty and positive word-of-mouth advertising.

The confirmed hypothesis demonstrate that tangible factors, reliability, responsiveness, reassurance, and empathy positively and significantly influence patients' satisfaction with pharmaceutical services provided by pharmacists. These insights have implications for hospital pharmacy management, emphasizing proactive engagement with hospital departments and patients to enhance healthcare services.

Going forward, prioritizing service quality as a strategic imperative will contribute to the success and reputation of healthcare facilities. Continuous assessment and improvement of service quality will create a positive and satisfying healthcare experience for patients, ultimately fostering loyalty and competitiveness in the healthcare landscape.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

The authors gratefully acknowledge the valuable contributions and support from various individuals and institutions that made this research possible. We extend our sincere appreciation to the management and staff of the selected government hospitals in Kabul for their cooperation and assistance during the data collection process. Our heartfelt thanks go to the patients who participated in this study, providing essential insights for our research. We are indebted to the Department of Health Services Management, Faculty of Health, Tehran Medical Sciences, Islamic Azad University, and the Health Economics Policy Research Center, Tehran Medical Branch, Islamic Azad University, for their unwavering support. Furthermore, we express our gratitude to our research team members for their diligent efforts in data analysis and interpretation, contributing significantly to the findings of this study. Without the collective efforts and encouragement from these individuals and institutions, this research would not have been possible.

REFERENCES:

1. Besson C, Chareyre S, Kirouani N, Jean-Jean S, Bretagnolle C, Henry A, et al. [Contribution of a hospital pharmacy team to critical care of patients infected with SARS-CoV-2]. Ann Pharm Fr. 2021; 79(4): 473–80. https://doi.org/10.1016/j.pharma.2021.01.007

2. Garattini L, Padula A, Mannucci PM. Community and hospital pharmacists in Europe: encroaching on medicine? Intern Emerg Med. 2021; 16(1): 7–10. https://doi.org/10.1007/s11739-020-02496-9

3. Gonçalves JR, Ramalhinho I, Sleath BL, Lopes MJ, Cavaco AM. Probing pharmacists’ interventions in Long-Term Care: a systematic review. EurGeriatr Med. 2021; 12(4): 673–93. https://doi.org/10.1007/s41999-021-00469-5

4. Greener S. The novice researcher. European Journal of Hospital Pharmacy. 2020; 27(6): 321–2. http://dx.doi.org/10.1136/ejhpharm-2020-002423

5. Gennimata D, Nikou K, Kouri L, Marini F, Perdikouri K. 1ISG-036 The impact of hospital pharmacy infrastructure and human resources on medicines optimisation and integrated care. European Journal of Hospital Pharmacy. 2019; 26(Suppl 1): A17–A17. http://dx.doi.org/10.1136/ejhpharm-2019-eahpconf.36

6. Layqah LA, Alakeel YS, Shamou JZ. The practice of counseling in pharmacy: patients’ perspectives. Asian Journal of Research in Pharmaceutical Science. 2018; 8(3): 170-6. DOI: https://doi.org/10.5958/2231-5659.2018.00030.9

7. Mohiuddin AK. Ethics and Professionalism: Pharmacy Profession. 2019 Jan 15. http://dx.doi.org/10.28933/AJPA)

8. Shekhar SK, Jose TP, Sudhakar R. A study on work life balance of female pharmacists working in private hospitals. Research Journal of Pharmacy and Technology. 2018; 11(1): 107-10. DOI: https://doi.org/10.5958/0974-360X.2018.00020.3

9. Wei M, Wang X, Zhang D, Zhang X. Relationship between the number of hospital pharmacists and hospital pharmaceutical expenditure: A macro-level panel data model of fixed effects with individual and time. BMC Health Serv Res. 2020; 20(1): 1–8. https://doi.org/10.1186/s12913-020-4907-2

10. Tsuyuki RT, Bond C. The evolution of pharmacy practice research—Part I: Time to implement the evidence. Canadian Pharmacists Journal. 2019; 152(2): 71–2. https://doi.org/10.1177/1715163519828318

11. Holdford DA, Brown TR. Introduction to hospital and health-system pharmacy practice. ASHP; 2010.

12. Panfilova, H., Nemchenko, A., Korzh, I., Zaytzeva, Y., Bogdan, N., Tsurikova, O., and Simonian, L. Scientific measurement of the current role of pharmacist in the paradigm of pharmaceutical care development. Research Journal of Pharmacy and Technology. 2019; 12(2): 817-826. DOI: https://doi.org/10.5958/0974-360X.2019.00142.2

13. Neto MPL, Sousa PHM, Duarte VJC. Role of the pharmaceutical professional in the scope of pharmaceutical assistance. Research, Society and Development. 2020; 9(11): e76191110561–e76191110561. https://doi.org/10.33448/rsd-v9i11.10561

14. Da Costa FA, Lee V, Leite SN, Murillo MD, Menge T, Antoniou S. Pharmacists reinventing their roles to effectively respond to COVID-19: A global report from the international pharmacists for anticoagulation care taskforce (iPACT). J Pharm Policy Pract. 2020; 13(1):1–3. https://doi.org/10.1186/s40545-020-00216-4

15. Raman-Wilms L, Moles RJ. Widening Our Horizons: Pharmacy Practice from a Global Perspective. Can J Hosp Pharm. 2015; 68(5): 417. https://doi.org/10.4212%2Fcjhp.v68i5.1491

16. Campbell G, Auyeung V, McRobbie D. Clinical pharmacy services in a London hospital, have they changed? Int J Clin Pharm. 2013; 35(5): 688–91. https://doi.org/10.1007/s11096-013-9800-1

17. Terry D, Ganasan S, Aiello M, Huynh C, Wilkie V, Hughes E. Pharmacists in advanced clinical practice roles in emergency departments (PARED). Int J Clin Pharm. 2021; 43(6): 1523–32. https://doi.org/10.1007/s11096-021-01275-6

18. Omboni S, Caserini M. Effectiveness of pharmacist’s intervention in the management of cardiovascular diseases. Open Heart. 2018 ; 5(1):e000687. http://dx.doi.org/10.1136/openhrt-2017-000687

19. Shom H. Glossary of Terms Used in Medication Care. Kabul: Drug Safety Committee, Ministry of Public Health, Afghanistan; 2015.

20. Bashaar M, Hassali MA, Saleem F. Community pharmacists’ attitudes toward the quality and price of locally manufactured generic medicines in Kabul, Afghanistan. J Pharm Policy Pract. 2015; 8(1): 1–7. https://doi.org/10.1186/s40545-015-0037-3

21. Harper J, Strote G. Afghanistan pharmaceutical sector development: Problems and prospects. South Med Rev. 2011; 4(1):29–39. https://doi.org/10.5655/SMR.V4I1.75

22. Wright K. Afghanistan: An assessment of the status of health care and pharmacy mentoring efforts in an Afghan National Army Hospital. Journal of the American Pharmacists Association. 2009; 49(5): 637–41. https://doi.org/10.1331/japha.2009.08078

23. USAID. Afghanistan Health Sector Fact Sheet. 2023. Available from: https://www.usaid.gov/sites/default/files/2023-03/USAID%20Afghanistan%20Health%20Sector%20Fact%20Sheet%20-%20March%202023.pdf

24. Pribadi P, Kristina SA, Syahlani SP. The empirical test of pharmacist-patient relationship model in hospital pharmacy practice: Indonesia context. Research Journal of Pharmacy and Technology. 2019; 12(10): 4623-7. DOI: https://doi.org/10.5958/0974-360X.2019.00795.9

25. Alissa I, Alotaibi A, Aldossari M, Alhelal H, Sreeharsha N. The Roles of Pharmacists in Cardiac Care units in Hospitals. Research Journal of Pharmacy and Technology. 2021; 14(9): 5039-46. DOI: https://doi.org/10.52711/0974-360X.2021.00879

26. Inasu ST, Kumudavalli MV, Venkateswarlu BS. Clinical pharmacist role and their importance in the systematic analysis of diabetes management studies. Research Journal of Pharmacy and Technology. 2022; 15(11): 5273-7. DOI: https://doi.org/10.52711/0974-360X.2022.00888

27. Navarrete J, Yuksel N, Schindel TJ, Hughes CA. Sexual and reproductive health services provided by community pharmacists: a scoping review. BMJ Open. 2021; 11(7): e047034. http://dx.doi.org/10.1136/bmjopen-2020-047034

28. Ayele AA, Islam MS, Cosh S, East L. Involvement and practice of community pharmacists in maternal and child health services: A systematic review. Research in Social and Administrative Pharmacy. 2021; 17(4): 643–52. https://doi.org/10.1016/j.sapharm.2020.07.035

29. Sanyal C, Husereau D. Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists. Appl Health Econ Health Policy. 2020; 18(3): 375–92. https://doi.org/10.1007/s40258-019-00535-x

30. Daisuke H, Yuya I, Shirou K. Role of pharmacists in a clinical setting: Effectiveness of pharmacists in charge of ward work. J Nippon Med School. 2019; 15: 115–27. https://doi.org/10.1272/manms.15.115

31. Riaz H, Atif Raza S, Ali S. Worldwide role of clinical pharmacists in optimizing patient health: A systematic review. ~ 321 ~ The Pharma Innovation Journal. 2019; 8(11): 321–6. Available from: https://www.thepharmajournal.com/archives/?year=2019&vol=8&issue=11&ArticleId=4162

32. Rahmawati D, Lestari K, Indriyanti N, Lisni I. Counseling by Pharmacists on Diabetes Mellitus patients in Indonesia: Narrative Review. Research Journal of Pharmacy and Technology. 2023; 16(6): 2927-34. DOI: https://doi.org/10.52711/0974-360X.2023.00483

33. ADJE DU, Olayinka RA, Omuta MC. An appraisal of Pharmacists’ involvement in Immunization delivery in Lagos State, Nigeria. Age. 2023; 20: 29. DOI: https://doi.org/10.52711/0974-360X.2023.00526

34. Hafeez A, Ahmad S. Implementation of Professional Pharmacy Services. Advances in Pharmacology and Pharmacy. 2020 Dec; 8(4):81–6. DOI: 10.13189/app.2020.080404

35. Utami P, Ghozali MT, Hadning I, Syafani FL. Patients’ level of satisfaction from pharmaceutical services provided by private pharmacies using the servqual model analysis. Int J Res Pharm Sci. 2020; 11(3): 3773–9. Retrieved from https://ijrps.com/home/article/view/869

36. Kassa DG, Xiang C, Hu S, Hayat K, Andegiorgish AK, Fang Y, et al. Patients’ perception of the outpatient pharmaceutical service quality in hospital pharmacies with auditable pharmaceutical transactions and services in Ethiopia: a cross-sectional study. BMJ Open. 2021; 11(5):e042853. http://dx.doi.org/10.1136/bmjopen-2020-042853

37. Ismaya NA, Kania L, Puji R, Pratiwi RD, Purnama F, Indah S, et al. Oupatient Satisfaction Analyze of Pharmacy Service in T Hospital, Bogor, West Java, March-April 2020. Advances in Social Science, Education and Humanities Research. 2021; 584: 725–31. https://doi.org/10.2991/assehr.k.211102.095

38. Ciccarello C, Leber MB, Leonard MC, Nesbit T, Petrovskis MG, Pherson E, et al. ASHP Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System. American Journal of Health-System Pharmacy. 2021;78(10): 907–18. DOI: 10.1093/ajhp/zxab080

39. Mohamed Ibrahim MI. Pharmaceutical Health Services Administration, Planning, Management, and Leadership: Lessons Learned for LMICs. Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. 2022; 1–14. https://doi.org/10.1007/978-3-030-50247-8_78-1

40. Basak SC, Sathyanarayana D. Evaluation of the impact of an educational workshop for community pharmacists. Research Journal of Pharmacy and Technology. 2009; 2(1): 144-6.

41. Melkamu E, Woldemariam S, Haftu A. Inter-professional collaboration of nurses and midwives with physicians and associated factors in Jimma University specialized teaching hospital, Jimma, south West Ethiopia, 2019: Cross sectional study. BMC Nurs. 2020; 19(1):1–9. https://doi.org/10.1186/s12912-020-00426-w

42. Komaromy M, Madden EF, Zurawski A, Kalishman S, Barker K, O’Sullivan P, et al. Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status. Patient Educ Couns. 2018; 101(3): 524–31. https://doi.org/10.1016/j.pec.2017.08.019

43. ASHP. ASHP News Center. 2022. Hospitals and Health Systems Experiencing Severe Shortage of Pharmacy Technicians.

44. Haas CE. Pharmacy Times. 2022. Where Have All the Workers Gone?

45. Ashour A, Phipps DL, Ashcroft DM. The role of non-technical skills in community pharmacy practice: an exploratory review of the literature. International Journal of Pharmacy Practice. 2021; 29(3): 203–9. https://dx.doi.org/10.1093/ijpp/riaa014

46. Lopez-Rico I, Vives R, Cruel M, Cerdan C, Moron-Besolí A, Ruiz MA, et al. Financial impact of the hospital pharmacy’s participation in clinical trials. European Journal of Hospital Pharmacy. 2021; 28(e1): e185–90. http://dx.doi.org/10.1136/ejhpharm-2020-002601

47. Ahtiainen HK, Kallio MM, Airaksinen M, Holmström AR. Safety, time and cost evaluation of automated and semi-automated drug distribution systems in hospitals: a systematic review. European Journal of Hospital Pharmacy. 2020; 27(5): 253–62. http://dx.doi.org/10.1136/ejhpharm-2018-001791

48. Wallis N, Gust C, Porter E, Gilchrist N, Amaral A. Implementation of field hospital pharmacy services during the COVID-19 pandemic. American Journal of Health-System Pharmacy. 2020; 77(19): 1547–51. https://dx.doi.org/10.1093/ajhp/zxaa211

49. Durand C, Douriez E, Chappuis A, Poulain F, Yazdanpanah Y, Lariven S, et al. Contributions and challenges of community pharmacists during the COVID-19 pandemic: a qualitative study. J Pharm Policy Pract. 2022; 15(1): 1–7. https://doi.org/10.1186/s40545-022-00438-8

50. Abu Zwaida T, Elaroudi K, Beauregard Y. The challenges of drug shortages in the Canadian hospital pharmacy supply chain — a systematic literature review. Journal of Public Health (Germany). 2022; 30(11): 2593–604. https://doi.org/10.1007/s10389-021-01485-2

51. Silva R de OS, de Araújo DCSA, dos Santos Menezes PW, Neves ERZ, de Lyra DP. Digital pharmacists: the new wave in pharmacy practice and education. Int J Clin Pharm [Internet]. 2022; 44(3): 775–80. https://doi.org/10.1007/s11096-021-01365-5

52. Gillani SW, Gulam SM, Thomas D, Gebreighziabher FB, Al-Salloum J, Assadi RA, et al. Role and Services of a Pharmacist in the Prevention of Medication Errors: A Systematic Review. Curr Drug Saf. 2020; 16(3): 322–8. DOI: 10.2174/1574886315666201002124713.

53. Cochran WG. Cochran_1977_Sampling_Techniques__Third_Edition.pdf. 1977; 448. ISBN: 978-0-471-16240-7

54. Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retailing. 1988; 64(1): 12-40. Retrieved from: https://psycnet.apa.org/record/1989-10632-001

Received on 04.09.2023 Modified on 21.11.2023

Research J. Pharm. and Tech 2024; 17(2):820-826.

DOI: 10.52711/0974-360X.2024.00127