Understanding, practice and barriers to pharmaceutical care among community pharmacists in Peshawar, Pakistan: a pilot cross-sectional survey

Abstract

Background: Pharmaceutical care reorients pharmacy practice from product supply towards responsible, patient-centered management of drug therapy. In many low- and middle-income countries its uptake in community pharmacies remains limited, and Pakistani data are scarce. Conducted a pilot survey to characterize the field and to inform a subsequent, adequately powered study. Objective: To assess, in a pilot cohort, community pharmacists’ understanding of pharmaceutical care, the frequency with which they provide its component activities, their attitudes towards it, and the barriers to its implementation in Peshawar, Pakistan. Methods: A pilot cross-sectional survey was undertaken in November 2025 using a pre-tested, 34-item self-completion questionnaire spanning demographics, understanding, frequency of provision, attitudes and barriers (Likert-scaled). Questionnaires were distributed to 90 practicing pharmacists across 60 community pharmacies in southern and central Peshawar; 62 usable responses were analyzed. Internal consistency of the Likert subscales was assessed by Cronbach’s α. Data were summarized descriptively in SPSS v22, with Wilson 95% confidence intervals (CIs) for key proportions. The sample size required for a definitive study was estimated using Cochran’s formula. Reported in accordance with STROBE. Results: Of 90 questionnaires, 62 were returned in usable form (68.9%; 95% CI 58.7–77.5). Respondents were predominantly male (79.0%) and aged 20–30 years (87.1%), with 80.6% having 1–5 years’ experience. Endorsement of the aim of pharmaceutical care was high (93.4%; 95% CI 84.6–97.5), but only 69.4% (95% CI 57.0–79.4) correctly endorsed its definition and 77.4% wrongly agreed it is “just a medication-counselling service”, indicating conceptual confusion. Prescription checking (95.1%) and directions for use (90.2%) were commonly provided, whereas monitoring of adverse drug reactions and adherence was reported by only 46.8% (95% CI 34.9–59.0). Attitudes were generally favorable. The most strongly perceived barriers were slow implementation of pharmacy laws (91.9%; 95% CI 82.5–96.5), health-system structure (75.8%) and inter-professional resistance, clinical-education and skills gaps (each ~71–74%). Conclusion: In this pilot cohort, community pharmacists showed partial understanding of pharmaceutical care and delivered only selected elements of it, remaining anchored in dispensing and counselling. Legislative reform, targeted clinical education, remuneration mechanisms and inter-professional collaboration are needed to advance pharmaceutical care in Pakistan.