Raising awareness of the benefits in order to make a change in retailers’ occupational activities at pharmacies and drug stores meeting the gpp standard (A before and after intervention study) – Trinh Hong Minh

Journal of military pharmaco-medicine n o 4-2018 144 RAISING AWARENESS OF THE BENEFITS IN ORDER TO MAKE A CHANGE IN RETAILERS’ OCCUPATIONAL ACTIVITIES AT PHARMACIES AND DRUG STORES MEETING THE GPP STANDARD (A before and after intervention study) Trinh Hong Minh*; Pham Dinh Luyen*; Phan Van Binh*** SUMMARY Objectives: To evaluate the results obtained from popularizing retailers’ awareness of benefits that directly affects their business activities at pharmacies and drug stores with GPP endorsement. Method: A cross-sectional and semi-empirical intervention (comparison before and after without a control group). Results: There was a dramatic rise in the appropriate perception of benefits of implementing right business activities. This rate increased from 34.7% to 59.1% for pharmacists (5-year training) and from 27.1% to 35.8% for intermediate pharmacists (2-year training). Since these changes, there have been increases in percentage of implementation of 06 business activities with the corresponding rates from 33% to 51.4% for pharmacists and from 27.1% to 39.1% for intermediate pharmacists. Conclusion: Pharmaceutical retailers’ awareness about the benefits from adequate business activities will promote retailers’ good performance under GPP standard. * Keywords: Perception; Benefits; Business activities; Pharmacy; Drug stores; Retailers. INTRODUCTION Business activities are basic ones in the professional practice of pharmacists and medical staff at pharmacies that meet GPP (Good Pharmacy Practice) standards in Vietnam. One of the very first principles of this standard is to prioritize the profit of patients and health of the community [1]. In 2014, we conducted a survey on the reality of drug retailers’ occupational activities at pharmacies and drug stores in Dongnai province. The results showed that their awareness of benefits from right business activities had a statistically significant effect on the pharmacy practice [2]. Therefore, we conducted this study with a view to: Evaluate the results of raising awareness of the benefits to make a change in the occupational activity of drug retailers at GPP-endorsed pharmacies. SUBJECTS AND METHODS 1. Subjects. Drug retailers including pharmacists and intermediate pharmacists at pharmacies and drug stores with GPP standards in Dongnai province. * Dongnai Medical College ** Hochiminh University of Medicine and Pharmacy *** Vietnam Military Medical University Corresponding author: Trinh Hong Minh (hongminh@cyd.edu.vn) Date received: 10/02/2018 Date accepted: 23/03/2018 Journal of military pharmaco-medicine n o 4-2018 145 2. Methods. - Research design: Cross-sectional and semi-empirical interventional studies [3]. The research model is represented by the following symbol: RO1 XO2. The result is determined by the formula: E = O2 - O1. * Study sample: Use the sample size formula based on the two-factor comparison calculating formula and use in the intervention study design: 60 retailers [4]. * Sampling method: Collecting a sample of 60 retailers who agreed to participate in the intervention process out of 180 people were observed and interviewed (not by university and intermediate levels; by area). * Data collecting method: Use observation checklist and questionnaire. * Content and method of intervention: - Direct propaganda: Popularize benefits to drug retailers in the implementation of professional activities. - Organize discussion group to exchange experiences in occupational activities for two subjects including pharmacists and intermediate pharmacists (from 3 to 5 people each) depending on the area of operation. * Research indicators: - Results of perceptions of the benefits of good performance of occupational activities of pharmacists and intermediate pharmacists before and after intervention. - The results of six occupational activities of the pharmacists and intermediate pharmacists before and after intervention. * Data analysis and processing: Comparison of pre-test performance - Wilcoxon test for quantitative variables without standard distribution [6]. Comparison of change results after intervention of two groups by Chi-squared test [5]. Use statistical software SPSS 20.0. * Research sites: At the pharmacies and drug stores that meet GPP standards in Dongnai province. * Time of study: November to December, 2014. RESULTS AND DISCUSSION 1. Change in retailers’ awareness of benefits when implementing right business activities. Using interview surveys on the drug retailers’ and their clients’ benefits with eight questions. Likert score with five - grading scales was used: complete disagreement, disagreement, neutral, agreement, and complete agreement. The scales of agreement and complete agreement illustrate the perception of benefits from retailers. After conducting a propaganda, an interview will be done to evaluate the drug retailers’ awareness of the advantages of occupational activities. Methods Collecting statistics (After intervention) Collecting statistics (before intervention) Comparison and analysis Journal of military pharmaco-medicine n o 4-2018 146 Table 1: Changes in retailers’ awareness about benefits before and after intervention. Pharmacists (n = 22) Intermediate pharmacists (n = 38) Benefits Level Before After Wilcoxon signed- Rank test Before After Wilcoxon signed- Rank test 1 2 0 8 1 2 5 2 15 11 3 3 1 4 6 4 8 8 10 17 Implementation of all business activities will make a success of drug retailers rather than invest in facilities 5 4 11 p < 0.05 1 3 p < 0.05 1 4 2 13 1 2 4 4 10 10 3 7 4 9 9 4 3 5 3 14 Implementation of regulations on selling medicine without prescription will help increase turnover and gain prestige 5 4 7 p < 0.05 3 4 p < 0.05 1 6 1 10 7 2 3 4 15 16 3 6 4 5 4 4 5 6 6 9 Making good exchanges of information about medicine with patients, retailers can earn experience and broaden expertise to ameliorate business activities 5 2 7 p < 0.05 2 2 p < 0.05 1 3 2 6 5 2 6 5 19 20 3 7 5 9 8 4 4 5 3 4 Instructing clients for medical examination in particular situations, retailers should put patient’s benefits higher than private profits and build their trust 5 2 5 p < 0.05 1 1 p > 0.05 1 6 1 13 7 2 7 6 11 12 3 4 3 6 5 4 3 6 3 8 Providing buyers with information about drugs to help retailers to share professional experience and enhance their business activities 5 2 6 p < 0.05 5 6 p < 0.05 Journal of military pharmaco-medicine n o 4-2018 147 1 4 2 8 5 2 8 8 12 15 3 5 5 8 8 4 4 2 8 8 Implementation of regulations on selling drugs with prescription increases the number of clients and strengthens the relationship with physicians 5 1 5 p < 0,05 2 2 p > 0,05 1 0 0 9 2 2 5 3 14 14 3 4 3 3 5 4 9 10 7 12 Ensuring a reasonable price and publicity of drug prices will give confidence to the buyer and earn good reputation for the establishment 5 4 6 p < 0.05 5 5 p < 0.05 1 4 1 7 1 2 7 2 15 14 3 5 5 9 8 4 2 6 6 11 The implementation of professional rules will enhance the credibility of the seller and help the buyers select well-qualified pharmacy 5 4 8 p < 0.05 1 3 p < 0.05 After the research, pharmacists had proper awareness of 8 benefits from obeying the occupational activities (p < 0.05). The approval rate significantly increased by 24.4% (from 34.7% to 59.1%); for intermediate pharmacists, the percentage of agreement increased by 14.2% (from 21.7% to 35.9%), 6 out of 8 contents showed significant relevant changes (p < 0.05). The two remaining contents remained unchanged, that is, the benefits from guiding the drug buyer for medical examination and selling the prescription drug. 2. Change in bussiness activities. * Results in selling medicine without prescription in common diseases: The results of the change in the non-prescription drug sales in common illnesses of the pharmacists and intermediate pharmacists. Table 2: Change in the non-prescription drug sales in common illnesses before - after intervention. Pharmacists (n = 22) Intermediate pharmacists (n = 38) Before After Before After Activities Yes No Yes No Yes No Yes No Finding out information about disease’s syndromes 18 4 22 0 30 8 38 0 Collecting information about drug users: Asking patients’ information: sex, age 19 3 22 0 21 17 38 0 Other diseases 18 4 22 0 17 21 38 0 Journal of military pharmaco-medicine n o 4-2018 148 Giving advice and inform drug buyers the following contents: Exchange the buyer to choose the suitebale medicine and proper finance 0 22 4 18 0 38 0 38 Instructions 20 2 22 0 32 6 33 5 Provide the buyer with general information of drug (side effects, drug interactions...) 5 17 10 12 1 37 4 34 Record notes for non-packaged medicine 3 19 12 10 0 38 3 35 Implement regulations on selling antibiotics 0 22 4 18 0 38 0 38 Keep patients’ information after selling drugs 0 22 0 22 0 38 0 38 Total 83 115 118 80 101 241 154 188 Percentage 41.9 58.1 59.6 40.4 29.5 70.5 45.0 55.0 After the research, the results of the sale of non-prescription drugs in the common disease showed a statistically significant change for pharmacist bachelors (improvement from 41.9% to 59.6%); for intermediate pharmacists trainers, the proportion showed the same upward trend from 29.5% to 45%. However, there was a tiny change or nearly stable in business activities such as exchanging with buyers to determine appropriate treatment drug and financial ability or selling antibiotics and keeping patient’s information. 2. The results of non-prescription drug sale in pathologies that must be diagnosed by the physician. For diseases that require physician’s diagnosis, retailers must refuse to sell drugs and advise drug buyers to visit the doctor. Changes in this activity before and after research treatment are shown in figure 1. Figure 1: The percentage of refusal in selling drugs of disease requiring the diagnosis of the physician before - after intervention. After the research, the results of selling medicine with physician’s diagnosis and no prescription drugs changed significantly among pharmacists, the rate of refusal to sell drug and instruction patients for medical examination increased from 31.8% to 50%. These rates increased from 15.8% to 26.4% for intermediate pharmacists, this result was not statistically significant. Journal of military pharmaco-medicine n o 4-2018 149 3. Results of selling drugs with prescription. Table 3: The results of changes in selling drugs with prescription before - after intervention. Pharmacists (n = 22) Intermediate pharmacists (n = 38) Before After Before After Activities Yes No Yes No Yes No Yes No Check prescriptions before selling (detect errors) 0 22 7 15 0 38 4 34 Give instructions on how to use and remind buyers to follow strictly the prescription 8 14 21 1 23 15 38 0 Check and compare prescription to drugs sold before giving them to the buyers 18 4 20 2 33 5 38 0 Give the right medicine as prescription Sell drugs similar to the ones in the prescription must consult the buyer Sell another drug in the name of the drug but the same ingredients 20 - 1 2 2 1 1 - - 1 1 0 29 0 1 9 9 8 31 - 1 7 7 6 Record drug information for follow-up 0 22 0 22 0 38 0 38 Total 47 67 70 42 86 122 112 92 Percentage 41.2 58.8 62.5 37.5 41.3 58.7 54.9 45.1 After the research, the results of the sale of prescription drugs had a statistically significant change for the university pharmacists (the rate of correct implementation increased from 41.2% to 62.5%); for intermediate pharmacists, these rates increased from 41.3% to 54.9%. However, the activity of recording drug information for follow-up did not change before and after research. 4. Results of selling medicines at fixed prices. Figure 2: Results of selling medicines at fixed prices before - after intervention. After research, the results of the implementation of selling drugs at fixed prices of pharmacist have changed, rising up from 40.9% to 54.5%; however, this change does Journal of military pharmaco-medicine n o 4-2018 150 not statistically make sense. For intermediate pharmacists, these rates increased from 36.8% to 57.9%, in this case, the results changed significantly. 5. The results of drug packaging process. The differences before and after research in following drug packaging regulation of pharmacist and intermediate pharmacists are illustrated in table 4. Table 4: Results of following drug packaging regulation before - after intervention. Pharmacists (n = 22) Intermediate pharmacists (n = 38) Before After Before After Activities Yes No Yes No Yes No Yes No Comply with packaging regulations for drugs used outside 0 22 0 22 0 38 0 38 Follow sealed packaging process for drugs that cannot be touched directly 3 19 16 6 1 37 9 29 Total 3 41 16 28 1 75 9 67 Percentage 6.8 93.2 36.4 63.6 1.3 98.7 11.8 88.2 After the research, the results of the implementation of drug packages among the pharmacists bachelors had a statistically significant change, rocketed from 6.8% to 36.4%. For intermediate pharmacists, the rate of right implementation rose from 1.3% to 11.8%, the results also changed significantly. Despite the change, the results are rather low, which meant that drug packaging has not yet received much attention of drug retailers. 6. Results of other professional activities. The changes in other professional activities among pharmacists and intermediate pharmacists are presented in table 5. Table 5: Results of other professional activities before - after intervention. Pharmacists (n = 22) Intermediate pharmacists (n = 38) Before After Before After Activities Yes No Yes No Yes No Yes No At workplace Wearing uniform 19 3 22 0 33 5 34 4 Wearing badge 0 22 1 21 0 38 0 38 Journal of military pharmaco-medicine n o 4-2018 151 Temperature and humidity control Temperature (< 300C) 1 21 5 17 1 37 1 37 Humidity (< 75%) 19 3 22 0 38 0 38 0 Arrange medicine based on the preservation conditions on the label 0 22 0 22 0 38 0 38 Total 39 71 50 60 72 118 73 117 Percentage 35.5 64.5 45.5 54.5 37.9 62.1 38.4 61.6 After research, the results of some other professional activities among pharmacists have changed from 35.5% to 45.5%, which is statistically significant; for intermediate pharmacists, the proportion of implementation increased from 37.9% to 38.4%, this change not statistically significant. Two completely unchanged activities before and after research are wearing badge at workplace and arranging medicine based on the preservation conditions stated on the label. CONCLUSIONS AND RECOMMENDATIONS By direct propaganda and discussion group, pharmacists are supposed to enhance their awareness during the performance of business activities. Conducting a re-evaluation after the research showed that there was a significant change in perception of retailers, the rate of awareness of the benefits received among the pharmacists increased from 34.7% to 59.1% (up 24.4%), and that of the intermediate pharmacists increased from 21.7% to 35.8% (by 14.2%). Through the change in perception, there was a change in the rate of implementation of 06 occupational activities, this rate increased from 33% to 51.4% (by 18.4%) for pharmacists and from 27.1% to 39.1% (by 12%) for the intermediate pharmacists. The comparison between the two groups of retailers was statistically significant. Nevertheless, this change is still low. Hence, we think it is necessary to develop a comprehensive intervention that co- ordinates the propaganda of the benefits of right business activities with the state’s management. The drug retailers are encouraged to increase the management competence, make the most of drug users to stimulate drug retailer activities, ensure the sustainability of the intervention. REFERENCES 1. Ministry of Health. Promulgating, principles, standards good pharmacy practice. Circular No. 46/2011/TT-BYT of December 21, 2011. 2. Trinh Hong Minh, Pham Dinh Luyen, Phan Van Binh. Surveying the impacts of perception of benefits on the performance of drug retailers’ occupational activities in Dongnai province. Journal of Military Pharmaco-Medicine. 2016, 41 (6), pp.240-247. 3. Nguyen Thanh Do, Nguyen Viet Lam. Marketing research coursebook. National Economics University. Hanoi. 2008, pp.145-364. 4. Vu Thi Hoang Lan and La Ngoc Quang. Epidemiology. Medical Publishing House. Hanoi. 2011, pp.111-123. 5. Nguyen Ngoc Rang. The distribution and a chi-squared test (χ2 test) (15/02/2013) retrieved from www.bvag.com.vn. 2012. 6. Cleophas T.J, Zwinderman A.H. Non- parametric-tests. Statistical Analysis of Clinical Data on a Pocket Calculator. Springer, Dordrecht. 2012.