Home Print this page Email this page
Users Online: 1320
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 36-42

Knowledge, attitude, and practice of community pharmacists toward dispensing drugs available in different delivery systems at Khartoum locality

1 Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
2 Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan

Date of Submission22-May-2020
Date of Decision24-Jul-2020
Date of Acceptance11-Oct-2020
Date of Web Publication2-Feb-2021

Correspondence Address:
Bashir Alsiddig Yousef
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, Khartoum 11111
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhas.IJHAS_102_20

Rights and Permissions

BACKGROUND: Many Food and Drug Administration-approved drugs are available in different delivery systems, such as immediate-release, delayed-release, and extended-release systems. Community pharmacists are supposed to have good knowledge about the differences between those formulations and adopt a systemic dispensing of drugs with the different delivery systems. Thus, this study aimed to assess the knowledge, attitude, and practice of community pharmacists toward dispensing drugs with varying systems of delivery.
METHODS: A cross-sectional study was conducted among community pharmacists (n = 172) using a validated self-administered questionnaire. A simple random sampling method was applied to select the participants. The overall knowledge, attitude, and practice scores were calculated, and then, the associations between these scores and demographic characteristics were measured by Chi-square test and analyzed by the Statistical Package for Social Sciences (SPSS).
RESULTS: Out of 172 pharmacists, 67.4% of them were female, whereas pharmacists with bachelor represented 68%. Regarding the knowledge of the respondents, 19.8%, 44.2%, and 36% of them have high, moderate, and low levels of knowledge, respectively. Furthermore, 76.7% of the respondents showed a negative attitude, whereas 23.3% of the total respondents have a positive attitude. In addition, 52% of the pharmacists exhibited good practice performance, whereas 48% had a bad practice toward dispensing available drugs with multiple formulations. Moreover, there are positive correlations between knowledge, attitude, and practice of pharmacists in dispensing drugs available with different delivery systems.
CONCLUSION: 44.2% of the community pharmacists have a moderate level of knowledge, 76.7% had a negative attitude, and 52% had a good practice toward dispensing drugs with different delivery systems.

Keywords: Community pharmacists, controlled release, delivery system, tablet crushing

How to cite this article:
Ramadan M, Yousef BA. Knowledge, attitude, and practice of community pharmacists toward dispensing drugs available in different delivery systems at Khartoum locality. Int J Health Allied Sci 2021;10:36-42

How to cite this URL:
Ramadan M, Yousef BA. Knowledge, attitude, and practice of community pharmacists toward dispensing drugs available in different delivery systems at Khartoum locality. Int J Health Allied Sci [serial online] 2021 [cited 2023 Nov 29];10:36-42. Available from: https://www.ijhas.in/text.asp?2021/10/1/36/308578

  Introduction Top

The core professional activity of community pharmacists is dispensing medications, which represents together with patient counseling an integral part of the quality use of medicine. If these duties are conducted in an improper or interrupted manner, it may lead to poor quality outcomes for the patient and serious complications such as morbidity and mortality and increase health expenditure due to hospitalization and treatment.[1],[2] Drugs are available in different dosage formulations that play essential roles in improving the utilization of the drugs.[3] Different formulations provide many objectives, including enhancing the drug bioavailability, providing alternative routes of administration, particularly for special populations, and increasing patient convenience.[4] However, the availability of multiple products with similar names, different formulations, and lack of caregiver understanding of the properties of the various preparations creates a significant risk of adverse drug events.[5],[6] Many previous reports have shown the incidence and the consequences of prescribing errors involving various dosage forms.[5],[7],[8] As there is a lack of information regarding the benefits or risks of interchanging different formulations and release systems for identical active pharmaceutical ingredients. Thus, such interchanging between various medication forms is not recommended without scientific justification to protect patients from serious complications.

Community pharmacists should also be aware of similar risks when working with different medication dosage forms, particularly for some drugs such as nifedipine, sodium valproate, and carbamazepine.[9],[10] In Sudan, there is an irrational dispensing of some medications with different delivery systems, which could be dangerous, especially in an emergency situation. Furthermore, some community pharmacists exchange the medical dosage forms, and some of them may split tablets that carry a label stating that the medication should not be crushed or broken.

Poor knowledge and practice of community pharmacists toward treatment with medications of different dosage forms is a significant risk of dispensing errors. Therefore, the present study aimed to assess the knowledge, attitude, and practice of community and hospital pharmacists in dispensing and exchange of medications with the different delivery systems.

  Methods Top

Study setting

The setting of the current study was a descriptive cross-sectional study. The targeted population was the registered community pharmacists working in Khartoum locality, Khartoum state, Sudan. The study was carried out in the period from April to July 2017.

Inclusion and exclusion criteria

The registered pharmacists working in the community pharmacies located in Khartoum locality and agreed to participate and fill the questionnaire were included in the study, whereas pharmacists who refused to fill the questionnaire were excluded from the study.

Sample size and sampling technique

The number of community pharmacies located in Khartoum locality at the time of the study is 408 pharmacies. Using Slovin's equation,[11] the sample size (n = 202) was calculated from the known population as follows:

“where N = total target population attending the center, n = sample size, and e = margin of error (0.05) at 95% confidence level.” A simple sampling method was applied for the selection of the pharmacists. However, 30 community pharmacists refused to participate in this study, and the sample size was 172. Thus, the response rate was 85.2%.

Data collection method

A pilot study using 5 questionnaires was conducted to check the validity of the questionnaire, and these 5 questionnaires were excluded from the study. The data were collected using a self-administered questionnaire in English, which contained four parts, the first part included the demographic characteristics of each pharmacist, and the second part consisted of 10 questions to assess their knowledge. The third part contained 3 questions to evaluate the orientation of attitude, and the fourth part consisted of 11 questions to assess the practice of pharmacists about dispensing drugs available with the different delivery systems. The collected data were manually scored by comparing with the proper answer obtained from the literature and finally coded before the analysis. For each correct response, a score of 1 was given, whereas a 0 score was given for an incorrect or false response. The total knowledge score for each participant was 10; those who scored 1–4 were classified as a low level of knowledge, 4–7 as moderate level, and 8–10 were considered having a high level of knowledge. For attitude, pharmacists who scored 3 were classified as a positive attitude, whereas a negative attitude if participants scored <3. About practice, the total score was 11. Those who obtained a score of 1–6 were classified as poor practice and 7–11 were considered to have a good practice.

Data analysis

Collected data were entered and analyzed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) for Windows, version 22.0 software (Armonk, NY, USA: IBM Corp). The descriptive statistics were illustrated as tables. A Chi-square test was applied to check the significant difference between various variables. P < 0.05 was considered statistically significant.

Ethical consideration

The study was approved by the Ethical Committee of Faculty of Pharmacy, University of Khartoum (FPEC-09-2017). The verbal consent was obtained from the pharmacists who agreed to participate in the study. All questionnaires were coded with ensuring confidentiality throughout the study.

  Results Top

A total of respondents were 172 pharmacists from different community pharmacies; majority of them were female (67.4%). Most of the participants were 22–30 years (~74.4%). Furthermore, the higher percentage of respondents (68.0%) was qualified to bear a bachelor's degree (B. Pharm), whereas the rest of them (32.0%) had a master's degree [Table 1].
Table 1: Sociodemographic characteristics of the community pharmacists (n=172)

Click here to view

Regarding the pharmacists' knowledge about dispensing drugs available with different delivery systems, 79.7% of them were familiar with all existing types of release system within the same dosage form. 94.2% of the pharmacists knew that there is a significant difference between different kinds of release system within the same dosage form. For a given drug with a specific dosage form, but with two different types of release systems, 79.1% of the respondents knew that the two drugs could provide different onset of action. Furthermore, most of the pharmacists (76.2%) agree with extended-release formulation that does prolong the release of the active pharmaceutical ingredient to provide different dosing frequencies than conventional ones, and 59.3% of the respondents knew that the delayed-release formulation had a specific release site in the gastrointestinal tract. For a given drug, in terms of dosage frequency; only 62.2% of the pharmacists realized that immediate release has more dosage frequency than extended formulation. Furthermore, 55.2% of the participants recognized that the film-coated immediate-release formulations have a faster onset of action among the mentioned options [Table 2]. After calculating the overall knowledge scores, 44.2% of the pharmacists had a moderate level of knowledge, 36% of the pharmacists had a low level of knowledge, and only 19.8% had a high level of knowledge. Further analysis demonstrated that there was no significant association between knowledge and gender (P = 0.973) or degree of qualification (P = 0.898).
Table 2: Knowledge of community pharmacists about toward dispensing drugs available with different delivery systems (n=172)

Click here to view

Regarding the attitude of pharmacists, 90.7% of the pharmacists agreed with the importance of being aware about different types of the same dosage form. However, 39.5% of them agreed that the content of the active substance in the controlled-release formulation is higher than in immediate release. In addition, 62.8% of the pharmacists agreed with the difference in the release system that could provide different patient compliance. Collectively, the overall attitude scores showed that 76.7% have a negative attitude and only 23.3% have a positive attitude [Table 3]. The Chi-square test indicated no significant association between gender and attitude (P = 0.965). However, there was a significant correlation (P = 0.034) between the attitude and degree of qualification.
Table 3: Attitude of community pharmacists toward dispensing drugs available with different delivery systems (n=172)

Click here to view

Describing pharmacists' practices, only 43.6% of them did not agree to use the term delayed-release with extended-release interchangeable. However, 73.8% of the pharmacists disagree with using the term controlled-release and immediate-release interchangeable, and 41.3% of the pharmacists agree with interchanging controlled-release and sustained-release formulation. Regarding crushing/splitting different formulations according to patient need, 47.7% of the pharmacists disagree with crushing/splitting immediate release/film coated. Furthermore, 53.5% agree with interchange immediate-release carbamazepine with a controlled-release one due to patient specification, whereas 39% of the pharmacists disagree with physician practice using nifedipine 10 mg long acting to treat the preeclampsia patient in the early stage [Table 4]. Moreover, the calculated overall practice indicated that 52% of the respondents have a good practice. Chi-square tests showed no significance associate between practice and gender (P = 0.128). However, there is a significant association between practice and qualifying (P = 0.002). Interestingly, our findings indicated significant correlations between the knowledge and attitude scores (P = 0.001), knowledge and practice scores (P = 0.003), and practice and attitude scores (P = 0.003).
Table 4: Practice of community pharmacists toward dispensing drugs available with different delivery systems (n=172)

Click here to view

  Discussion Top

Prescribing and dispensing errors are one of the most common causes of adverse drug events in practice.[12],[13] Errors in dosage formulations are one of the frequent factors related to prescribing and dispensing errors.[14],[15] Therefore, adequate knowledge of the health-care professionals, including pharmacists, is essential to minimize the errors in dosage formulation dispensing and practice. The current study assessed the levels of knowledge, attitude, and practice among community pharmacists working in Khartoum locality. One hundred and seventy-two community pharmacists were involved, and 67.4% of them were female. Most of the participants (74.4%) were in the age group of 22–30 years. This may be due to most of the fresh-graduated pharmacists who start working in community pharmacies before seeking other jobs.[16] The experience of community pharmacists is a crucial factor in reducing dispensing errors and enhancing good dispensing performance and better services.[17]

Regarding the knowledge of community pharmacists about dispensing available drugs with multiple formulations, 70.01% of them showed a moderate level of knowledge with no influence of either gender or level of education at the level of knowledge. The drug delivery system refers to formulations, technologies, and approaches for delivering safe, active compounds in the body to produce its pharmacological effects.[18] Herein, the majority of the pharmacists (94.2%) recognized that there was a significant difference between different formulations in the same dosage form and 79.1% of them realized that different formulations have different onset of action, whereas only 47.1% knew the definition of bioequivalence. The lack of knowledge of those pharmacists could be due to the unavailability of ongoing education programs for providing adequate pharmaceutical care for the patients. Thus, implementation of educational processes will be required to overcome these obstacles during pharmaceutical care.[19]

Furthermore, the attitude score showed a tendency toward negativity, representing 76.7% of the total respondents, which indicated a negative attitude toward dispensing drugs with different formulations. These findings were in deal with the study conducted in Sudan by Sumia et al. in 2014, where the majority of the respondents >90% have negative views regarding practice standards. In contrast, almost all of them believed that they could have an essential role in chronic disease management.[20] Statistically, we found that the gender did not influence the attitude and practice of pharmacists. Still, the level of education was significant to affect them, as the master holder had a better attitude than bachelor's degree holders.

Considering the practice of the community pharmacists toward dispensing available drugs with multiple formulations, 52% of them showed good practice performance. The study approved that some pharmacists could substitute different formulations for a particular drug, despite the clear warning report of the Food and Drug Administration, which highlight medication error documenting pharmacist, using delayed release and extended release interchangeably.[21] Many reports showed the risks of interchanging between different drug formulations.[22],[23] Furthermore, this study also provided evidence of practice in splitting or crushing different formulations as one of the common dispensing errors among community pharmacists. One of the main drugs affected by crushing are anti-epileptic drugs such as divalproex sodium (Depakote® tablets) and carbamazepine (Tegretol® tablets).[24],[25] Crushing of nifedipine XL controlled release may result in severe patient hypotension and prevention increase of heart rate which may lead to patient death.[26] Furthermore, crushing of controlled-release Tegretol CR® Divitabs will affect the absorption characteristics and result in severe clinical consequences such as therapeutic failure or toxicity because carbamazepine has a narrow therapeutic index.[27],[28] Hereby, 53.5% of the pharmacists have good practice in case of changing the immediate-release carbamazepine with controlled-release one due to patients experienced unacceptable adverse events. Another study describes the adverse event resulting from pharmacist crushing sustained-release oxycodone and enteric-coated omeprazole in hospitalized patients to facilitate swallowing.[6]

The limitations of this study are as follows: first, the cross-sectional design of the study did not allow the generalization of the findings to all community pharmacists in Sudan. Second, the response rate of this study was relatively low. Therefore, more works are required to include a large number of community pharmacists in various areas in Sudan.

  Conclusion Top

Around half of the total respondents have a moderate level of knowledge, 76.7% had a negative attitude, and 52% had a good practice toward dispensing drugs with different delivery systems. There was no association between demographic data and collected data, except statistically significant correlation between the level of education with both attitude and practice. Moreover, there was statistical significance in the association of knowledge, attitude, and practice. Thus, great efforts are required to improve the knowledge and practice of community pharmacists toward dispensing drugs with different formulations.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Saqib A, Atif M, Ikram R, Riaz F, Abubakar M, Scahill S. Factors affecting patients' knowledge about dispensed medicines: A qualitative study of healthcare professionals and patients in Pakistan. PLoS One 2018;13:e0197482.  Back to cited text no. 1
American Society of Hospital Pharmacists. ASHP guidelines: Minimum standard for pharmacies in hospitals. Am J Health Syst Pharm 2013;70:1619-30.  Back to cited text no. 2
Castañeda-Hernández G, Caillé G, du Souich P. Influence of drug formulation on drug concentration-effect relationships. Clin Pharmacokinet 1994;26:135-43.  Back to cited text no. 3
Tiwari G, Tiwari R, Sriwastawa B, Bhati L, Pandey S, Pandey P, et al. Drug delivery systems: An updated review. Int J Pharm Investig 2012;2:2-11.  Back to cited text no. 4
Lesar TS. Prescribing errors involving medication dosage forms. J Gen Intern Med 2002;17:579-87.  Back to cited text no. 5
Cornish P. “Avoid the crush”: Hazards of medication administration in patients with dysphagia or a feeding tube. CMAJ 2005;172:871-2.  Back to cited text no. 6
Grünewald RA, Mack CJ. Medical errors. Different formulations of drugs often look confusingly similar. BMJ 2001;322:1423.  Back to cited text no. 7
Lesar TS, Lomaestro BM, Pohl H. Medication-prescribing errors in a teaching hospital. A 9-year experience. Arch Intern Med 1997;157:1569-76.  Back to cited text no. 8
Gracia-Vásquez SL, González-Barranco P, Camacho-Mora IA, González-Santiago O, Vázquez-Rodríguez SA. Medications that should not be crushed. Med Univ 2017;19:50-63.  Back to cited text no. 9
Bachynsky J, Wiens C, Melnychuk K. The practice of splitting tablets: Cost and therapeutic aspects. Pharmacoeconomics 2002;20:339-46.  Back to cited text no. 10
Galero-Tejero E. A Simplified Approach to Thesis and Dissertation Writing. Mandaluyong City: National Book Store; 2011. p. 43-4.  Back to cited text no. 11
Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995;274:29-34.  Back to cited text no. 12
Aronson JK. Medication errors: Definitions and classification. Br J Clin Pharmacol 2009;67:599-604.  Back to cited text no. 13
Bohand X, Simon L, Perrier E, Mullot H, Lefeuvre L, Plotton C. Frequency, types, and potential clinical significance of medication-dispensing errors. Clinics (Sao Paulo) 2009;64:11-6.  Back to cited text no. 14
Anacleto TA, Perini E, Rosa MB, César CC. Drug-dispensing errors in the hospital pharmacy. Clinics (Sao Paulo) 2007;62:243-50.  Back to cited text no. 15
Ibrahim M, Badi S, Yousef B. Knowledge and practice of community pharmacists toward dispensing of cough medications for children Khartoum State: A cross-sectional study. Int J Health Allied Sci 2020;9:147-52.  Back to cited text no. 16
  [Full text]  
Melton BL, Lai Z. Review of community pharmacy services: What is being performed, and where are the opportunities for improvement? Integr Pharm Res Pract 2017;6:79-89.  Back to cited text no. 17
Wen H, Jung H, Li X. Drug delivery approaches in addressing clinical pharmacology-related issues: Opportunities and challenges. AAPS J 2015;17:1327-40.  Back to cited text no. 18
Silva BB, Fegadolli C. Implementation of pharmaceutical care for older adults in the brazilian public health system: A case study and realistic evaluation. BMC Health Serv Res 2020;20:37.  Back to cited text no. 19
Mohamed SS, Mahmoud AA, Ali AA. The role of Sudanese community pharmacists in patients' self-care. Int J Clin Pharm 2014;36:412-9.  Back to cited text no. 20
Holquist C, Phillips J. FDA safety page. Drug Top 2001;145:42-3.  Back to cited text no. 21
Seoane-Vazquez E, Rodriguez-Monguio R, Hansen R. Interchangeability, safety and efficacy of modified-release drug formulations in the USA: The case of opioid and other nervous system drugs. Clin Drug Investig 2016;36:281-92.  Back to cited text no. 22
Reed RC, Dutta S, Liu W. Once-daily dosing is appropriate for extended-release divalproex over a wide dose range, but not for enteric-coated, delayed-release divalproex: Evidence via computer simulations and implications for epilepsy therapy. Epilepsy Res 2009;87:260-7.  Back to cited text no. 23
Bialer M. Extended-release formulations for the treatment of epilepsy. CNS Drugs 2007;21:765-74.  Back to cited text no. 24
Wheless JW, Phelps SJ. A clinician's guide to oral extended-release drug delivery systems in epilepsy. J Pediatr Pharmacol Ther 2018;23:277-92.  Back to cited text no. 25
Schier JG, Howland MA, Hoffman RS, Nelson LS. Fatality from administration of labetalol and crushed extended-release nifedipine. Ann Pharmacother 2003;37:1420-3.  Back to cited text no. 26
Nidanapu RP, Rajan S, Mahadevan S, Gitanjali B. Tablet splitting of antiepileptic drugs in pediatric epilepsy: Potential effect on plasma drug concentrations. Paediatr Drugs 2016;18:451-63.  Back to cited text no. 27
Brandt C, May TW. Extended-release drug formulations for the treatment of epilepsy. Expert Opin Pharmacother 2018;19:843-50.  Back to cited text no. 28


  [Table 1], [Table 2], [Table 3], [Table 4]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded191    
    Comments [Add]    

Recommend this journal