Exploring how guidelines and other factors influence prescribing in cardiology and the role of clinical pharmacists in Sudan

Abstract

Introduction: The use of guidelines in prescribing has become part of clinical practice in many countries around the world. Guidelines are considered to provide information based on scientific evidence from high quality research and hence are expected to lead to appropriate prescribing. Prescribing based on evidence is expected to improve morbidities and mortalities. Pharmacists in different parts of the world are acquiring a clinical professional identity especially in hospital settings where they have moved to bed-side roles to become an effective member of the patient–care team. They are thus expected to play an important role in assisting appropriate prescribing and have a positive impact on patient care. The influence of guidelines on prescribing and the practice of clinical pharmacy have not been studied in Sudan.Aim: The aim of the study was to investigate the use of guidelines (if any) for prescribing by doctors in the main cardiac hospitals in Sudan, and to explore the influence of availability (or non-availability) of guidelines on the new role of clinical pharmacy in hospitals in Sudan.Method: The study used a mixed method approach to examine the study questions. Interviews were conducted with the cardiology consultants in two of the main cardiac hospitals in Sudan. This was followed by a survey among all the doctors in the hospitals. Later on a focus group discussion was carried out with clinical pharmacists in the two hospitals followed by an online survey sent to the available email addresses of clinical pharmacists in Sudan.Results: Twelve prescribers were interviewed and 47 prescribers (60%) replied to the questionnaire that followed. The majority of the doctors relied on foreign guidelines to prescribe for their patients. The doctors acknowledged the limitation of using foreign guidelines in Sudan. Few prescribers were not in favour of following any guidelines as they perceived that the practice in Sudan does not allow implementation of guidelines. The prescribers were positive about the new role of clinical pharmacists in patient care but they seem not to be in contact with these clinical pharmacists. On the other hand, four pharmacists participated in one focus group and 51(34%) completed the on-line survey. Clinical pharmacists faced a number of obstacles that hindered their progress in practice and the unavailability of guidelines was considered to be one of these obstacles. Other obstacles were related to the pharmacists themselves, to the lack of senior clinical pharmacists for leadership, to the environment they were working in and to the training they received in clinical pharmacy.Conclusion: The making of guidelines is usually a tedious and costly process. Medical practice in places with limited resources has to rely on guidelines made in foreign countries if they want to get the benefits of these guidelines to their patients. The prescribers in Sudan had to find a way to adapt foreign guidelines to their patients and to the healthcare system they are working within. With regard to the clinical pharmacists in Sudan, they are faced with a number of obstacles that they will have to overcome in order to advance in their new role. The new clinical pharmacists will have to be the leaders to pave the way for clinical pharmacy in Sudan. However, they will require support from pharmacy educational institutions, other healthcare professionals and healthcare institutions.

Date of Award	31 Oct 2015
Original language	English
Awarding Institution	University of Bath
Supervisor	Marjorie Weiss (Supervisor), Jennifer Scott (Supervisor) & Raisa Laaksonen (Supervisor)