Awareness and approach in a sample of Community Pharmacists’ towards Patient Counseling in Thi-Qar/ Iraq and providing the appropriate solutions for the development of counseling

— The main activity of community pharmacies throughout the world is directed with regard to dispensing medication and patient care rather than compounding. Patients counseling has improved health-related outcomes in many acute and chronic conditions. The aim of this study is to assess the knowledge of community pharmacist about the counseling practice of patients in a sample of pharmacists in Thi-Qar/Iraq and Providing the appropriate means for developing the counseling and continuing education programs for community pharmacist. A cross-sectional study plan employing questionnaires was arranged based on previous studies and accomplished on a good specimen sample of sixty-one community pharmacists from Thi-Qar from separated areas of Thi-Qar participated in this survey. There were about 33% males and 67% females of respondents. The generality of pharmacists were giving advising to the patients and 65% of them drained 1-5 minutes for the purposes of deal with a prescription and provide counseling. Pharmacist concentrated on side effect, indication, duration, frequency and the dose of the drug during counseling in different proportions. Most pharmacists reported that patient response to counseling was mostly positive. One of the main strategies was highlighted to overcoming the obstacles in patient counseling which was providing special area in the pharmacy for counseling. Another important strategy was preparation of continuous pharmacist education programs that can assist in ameliorate the counseling practice furthermore.


I. INTRODUCTION
The main role of community pharmacy was to be the popular goals of supplying prescriptions and component focused concern to person centered concern which includes providing of prescribed and over-the-counter (OTC), medications preparation , patients' adverse effects consideration and drug information delivery [1,2,3].
Community pharmacists today are involved in a wide range Of professional activities which may be considered as either product or patient oriented [4], anyway, community pharmacist can play an important role in patients' counseling and should be able to give all drug information in terms of appropriate drug usage, administration, dosage, side effects, storage, drug-drug and drug-food interactions [5], For the current time, it is conducted with regard to affording medicine data and facts and person care rather than medicine ordering and preparation [6,7]. Patient counseling is a cornerstone of ethical pharmacy practice and high quality pharmaceutical care, Counseling promotes patient compliance with prescription regimens and prevents dangerous drug interactions and medication errors. Counseling also promotes informed consent and protects pharmacists against legal risks [8].
Pharmacists' counseling has improved health-related outcomes in many acute and chronic conditions as well as pharmacists have been contributing to decrease morbidity rate and death rate related to medication, Health related outcomes and other surrogate endpoints have been used to explain useful from these services, such as patients' drug therapy knowledge, disease knowledge, self-care and medication adherence. Therefore, pharmacists' counseling is a clinical service that has been playing a significant role to all human society [9]. For the purpose of ameliorate the pharmacist's work in the general public and build up the patient's education and advising experiences. Many continuing education programs are present. The denomination -continuing education‖ has been expressed as knowledge training and actions in which (medical management professionals) involve after they have finished entry-stage academic learning and workout. These experiences are presented to support the continuous elaboration of the abilities, outlooks and directions required to preserve efficiency, supply aspect assistance and reacted with patient requirements [10,11,12]. In order to improve the professional roles of pharmacists, there is a need for training the community pharmacists towards patient counseling, assessing the current perception of the community pharmacists can be useful to start appropriate therapy [13,14,15] , Hence, the present study was undertaken with this field. Previous studies showed that difficulties encountered in providing pharmaceutical care were lack of material, equipment, pharmacotherapy/ therapeutics information and motivation, and also difficulties in accessing medical history, clinical and laboratory data of the patients [16]. The present study was designed to assess the knowledge of community pharmacist about the counseling practice of patients in a sample of pharmacists in Thi-Qar, Iraq and Providing the appropriate means for developing the counseling and continuing education programs for community pharmacist.

A-Data collection:
A cross-sectional study plan achieved on a good specimen of community pharmacists at community pharmacies in separated regions of Thi-Qar including Thiqar center, Algaraf and al Shatrah in February 2023. Information's was congregated by applying a pre examined questionnaire especially planned from a collection of research and studies that dealt with the subject of study with few adjustments to cogitate the performance and job quality in Thi-Qar [2,11].

B-Sampling:
Sixty-one pharmacists were shared in this study, divided into fourty-one females and twenty males, and the response rate was 75%.

C-Questionnaire
This section comprise of nine questions. The first four questions ( name, age, sex and experience in years) were composed the demographic information of community pharmacists, after that; another questions which associated with the approach with regard to patients advising were scored either on 4 point (1-4) Likert scale with selected term (always to rarely), the other question used to view the instructions that the pharmacists introduced to the patients and another used to view pharmacists perceptions in respect of determining the problems concerned in supplying pharmaceutical and therapeutic appointment, (Appendix). The publishers notify the contributors about the plan of the analysis at the initiation of the questionnaire; in other words, the participants were notify that their contribution was intentional.

III. STATISTICAL ANALYSIS
Statistical part was supplied by applying the Microsoft excel (2010), the answers of participants were founded as frequencies and percentages. Faculty of perceiving of community pharmacists in regard with patients advising was examined by a scaling manner.

IV. RESULT
For the purpose of rating the faculty of perceiving of Iraqi pharmacist in regard with patient advising, a good specimen of 61 community pharmacists from separated areas of Thi-Qar involved in this analysis. There were about (33%) males and (67%) females of respondents. partly of the participants were in the age class of twenty-five to thirty-five years old (70.5%) and about half of them practice background of less than two years (49.1%).The demographic data of all participants are shown in table (1). More than half (65%) of the participants consumed from 1-5 minutes for the purpose of dispense a prescription and nearly (16%) spent less than one minutes and (13%) take 5-10 minutes to dispense prescriptions and less than (5%) take more than 10 minutes to dispense a prescription as shown in table 2. More than half of the participants stated that they frequently provide consultation when dispensing any prescription as shown in table 3.   Figure 1: key points used by community pharmacists in patients counseling Figure 1 manifest that there were different aspects among the community pharmacists concerning the key points in advising clients. nearly 42% of them advocated persons on all key-points including therapeutic indications and contraindications, duration, indication and side effects followed by four key point involving dose and frequency, duration and indication (14.7%), The same percent mentioned the same key-points except the duration, 6.5% of them mentioned dose and frequency. The same percent mentioned the same key-points as well as side effects of the drug and 3% of them advocated patients on frequency of the drug only.
Concerning the Strategies to overcome barriers to patient counseling, approximately (31%) of participants indicated that providing private space for counseling can assist them to enhance the consultative application. In addition to, attending continuing education program is important in accordance to (29%) of pharmacists and just about (3%) observe that elevated in the number of pharmacists in single pharmacy can help. Other solutions discussed by few pharmacists recommended that all these clarifications are the keys to upgrade the advising application in addition to encouraging society realization about the significance of pharmacist's directions as manifested in table 5.

V. DISCUSSION
Pharmaceutical care is a philosophy of practice that puts patients at the center of the pharmacist's activities. This implies a way of practice in which pharmacists assume the responsibility of ensuring that everything done is in the best interest of the patient [16,17,18]. World Health Organization (WHO) has clearly defined the roles and responsibilities of community pharmacists, Apart from dispensing prescription medications, other professional roles of pharmacists include patient counseling, clinical pharmacy services, drug information, and health promotions [17]. Concerning with ongoing education which has been clarified as studying experiences and actions in which (medical management professionals) involve after they have finished entry-stage academic learning and workout. These experiences are presented to support the continuous elaboration of the abilities, outlooks and directions required to preserve efficiency, supply aspect assistance and reacted with patient requirements [19,20,21]. In spite of the fact that tasks applications for great of the pharmacists was lower than two years, however, the considerable percentage of participants exhibit a giant propensity for counseling. In addition, The duration of undergraduate pharmacy education can be intensive and extensive during the five years of the academic study, consisting more clinical content (Additional courses of pharmaceutical care, clinical pharmacy, pharmacotherapy, professional communication skills) making a good opportunity for future. In the present study, majority of the pharmacists were willing to provide pharmaceutical care services and this is In agreement with previous reports in Malta investigating the community pharmacists' attitudes about pharmaceutical care, 72% of the community pharmacists declared their willingness to provide pharmaceutical care [18], comparably, two another analysis in various areas showed that the pharmacists at all the times supply advising to their clients [22,23]. According to this study, In table (2) the majority of pharmacists (65%) require from one to five minute to dispense the prescription and provide counseling. These outcomes are conforming with another analysis done in other places and areas, as in Nepalese which showed that the generality of pharmacists spent from 1-5 minutes for supplying a prescription [12,24], While another studies which evaluated the Saudi community pharmacists' outlooks about pharmaceutical care practice in Saudi Arabia indicated that the average time for counseling session is about 7.5 minutes and in in Nepal; The drug utilization study has suggested that the average dispensing time in the public sector is 86.1 seconds [24,25]. In table (3), 54% of the pharmacists stated that they frequently supply advices when supplying any prescription, while in previous study; the participants stated that they at all the times supply advices when supplying the prescription [11]. In table (4), 39% of the pharmacists involved that most clients were listening frequently to their advising. Providing special space for advising and showing continuing education program was regarded as the two main methods to answer the obstacles of weak counseling according to the higher proportion of the participants in this study, as In table (5), 31% of the participants concluded that providing private space is the appropriate solving for advising, and nearly twenty-nine% concluded that attending continuing education program is the appropriate solving to overcome their lack of knowledge, while another common solution suggested by pharmacists is elevation the number of pharmacists, while in other past analysis favour continuing education program as the appropriate solving on the others [25,26]. Majority of the pharmacists rated dose and frequency, duration, indication and side effects' as the key points in counseling the patients. In comparison with, preceding analysis in Malaysia showed that only 11% of the participants counseled patients on all three points [2]. All pharmacists were concerned with the Continuing education program and certained that the Continuing pharmacy education program would help in improving their knowledge, previous studies interested in effect of a continuous community pharmacy practice and suggested that the program was beneficial for all students and participating pharmacists [27,28]. In developing countries, where there are still great challenges in ensuring access to safe, effective, and affordable essential medicines, national efforts are mostly directed toward ensuring availability and access to drugs, while appropriate use of drugs largely remains an issue of low priority, This is clearly reflected in the quality and level of pharmaceutical care services provided in community pharmacies [29,30].

VI. CONCLUSION
The best outstanding finding of this survey is that the generality of community pharmacists in Thi-qar/ Iraq had an hopeful perception towards clients advising and continuing pharmacy education methods. More private areas for counseling in community pharmacies are needed in Thi-Qar's pharmacies. As well as to that, great percentage of them showed a giant propensity to the necessity of continuing education programs which are not or infrequent in Iraq to upgrade their career and reduce the obstacles .