Lack of access to the patient medical record (90.6%) was the major barrier for the integration of pharmaceutical care into practice. The majority of participants (93.0%) encouraged creating a website that provides pharmaceutical care. Furthermore, 45.1% would pay for such a service if present. Moreover, the majority (89.8%) agreed that creating a comprehensive database for patients’ data will help in decreasing medical errors. Among the four aspects of pharmaceutical care (technical, psychosocial, communication and administrative) that were assessed for students and pharmacist’s, general weakness in all aspects was noticed. This study highlights that absence of proper documentation of patient medical information raises the risk of medical problems and is considered the most documented barrier for the integration of pharmaceutical care. This emphasizes the future role of telemedicine and the availability of a specialized website and database repository that stores patient’s information to ensure the continuity of care even during pandemics.

Electronic Medical Files, Pandemic, Pharmaceutical Care

Improving the responsiveness of healthcare systems to the demands of its patients is a major task for all healthcare systems (Sacristán 2013; Mohammed et al. 2019). Consequently, researchers are more interested in improving the healthcare experiences in a way that matches expectations of the patients (Merks et al. 2014; Geurts et al. 2015; Alsayed et al. 2022b). Besides, because patients play a crucial role in setting priorities within the healthcare system, it is important to increase patient role in the pharmaceutical care (PC) process (Geurts et al. 2015). Hence, as patients, healthcare professionals, and health authorities have different ideas about what constitutes high-quality healthcare (Pomey et al. 2015), patients’ acceptability of care considered an important component of quality evaluation (Fox and Reeves 2015).

For decades, pharmacists have worked diligently to broaden their job beyond basic drug dispensing and PC services in Jordan have been growing over the past years. Clinical pharmacists increasingly work collaboratively with healthcare providers in hospitals and other clinical settings to achieve optimal patient outcomes and therapy management (Bulatova et al. 2007; Bradley 2009; Aburuz et al. 2013; Toklu and Hussain 2013; Basheti et al. 2016; Farha et al. 2016; Khader et al. 2021). However, such PC services in Jordan and majority of other Arabic countries are currently being provided free of charge. Thus, commissioned services should be evaluated by patients, stakeholders (who provide direct patient care), and policymakers.

Patient satisfaction is affected by many aspects, including pharmacist professionalism and communication, counseling, service speed, and pharmacy location. The convenience of the pharmacy and the pharmacist’s free advise were the main reasons for Jordanians to visit the pharmacy (Wazaify et al. 2008; Basheti et al. 2014). Similarly, in Saudi Arabia, proximity to a community pharmacy and the presence of a competent pharmacist were the top reasons for people to visit the pharmacy (Wazaify et al. 2008; Al-Arifi 2012). As a result, global research showed positive patient perceptions but also substantial hurdles for PC optimization, particularly in community pharmacies (Kassam et al. 2010; El Hajj et al. 2011; Perepelkin 2011; Aburuz et al. 2012; Al-Arifi 2012). Many studies showed that patients are satisfied with the various accessible PC services (Teh et al. 2001; Al-Arifi 2012; Fahmi Khudair and Raza 2013). In a developing country like Jordan, awareness of people’s attitude and consent to pay for PC services might assist pharmacists to serve their patients’ needs better. Additionally, in Jordan, patients appreciate the pharmacy profession and recommend the expansion of PC services (Aburuz et al. 2012; Basheti et al. 2016).

Telemedicine is defined as the utilization of medical information communicated between distant sites using electronic way of communications, to enhance a patient’s clinical health status when a patient is receiving a remote clinical service (also known as telehealth) (Kvedar et al. 2014). Numerous patients continue to favor telemedicine modes of treatment due to the convenience the cost savings, and the reduced travel time (Kruse et al. 2017; Orlando et al. 2019).

Since chronic disease treatment is especially important during a pandemic of coronavirus disease 2019 (COVID-19), telemedicine has been shown to be very useful in ensuring continuity of treatment for at-risk individuals while also allowing for social distancing and reducing the chance of infection (Kuperman et al. 2018; Eberly et al. 2020; Lakkireddy et al. 2020; Wosik et al. 2020; Kakani et al. 2021).

For this study, the goal was to gather information about how pharmacy students, pharmacists, and physicians in Jordan viewed PC services and telemedicine during the COVID-19 pandemic. The second objective was to ascertain perceived obstacles to patients seeking pharmacist consultation and assess pharmacy students’ and pharmacists` perceptions preparedness to provide PC.

This questionnaire was completed by a total of 541 respondents, most of them were females (67.3%), medically free (90.4%), with an average age of 24.7 (±7.20) years. As most of the respondents were students (70.2%), 301 (55.6%) had no income, and the majority were not working (76.2%) (Table 1). All of the respondents had a medical background, including pharmacy students, 380 (70.2%), pharmacists working in a community pharmacy, 62 (11.5%), pharmacists not working in a community pharmacy, 49 (9.1%), and physicians, 50 (9.2%). During the participants’ lifetime, around half of them experienced at least one medical error (Table 1).

Upon evaluating the attitude of respondents towards PC, we found that most respondents (89.1%) strongly agreed or agreed that all pharmacists should perform PC and that it should be the pharmacist’s primary responsibility (81.1%). Indeed, the majority believed that PC would improve patients’ health (91.3%) and would be professionally rewarding (77.2%). Nevertheless, 372 (68.8%) thought that providing PC takes long time and effort and is not worth the additional workload that it places on the pharmacist (63.6%) (Table 2).

The potential barriers to the integration of PC into practice are shown in Fig. 1. Lack of access to the patient medical record in the pharmacy (90.6%), followed by lack of private counseling areas (86.9%), lack of communication/coordination with physicians (85.2%), pharmacists’ physical separation from patient care areas (80.0%) were cited as the major barriers for the integration of PC into practice by the respondents (Fig. 1).

Figure 1. 

Major barriers to the integration of PC into practice according to the study participants (N = 541).

There were only 83 (15.3%) respondents had an electronic patient file as patients at the pharmacy. However, the majority of respondents (93.0%) encouraged the idea of creating a website that provides PC and 244 (45.1%) of respondents would pay for such a service if present. Almost one-third (33.3%) were ready to pay 20$ or less per year for those services (Table 3).

The failure of proper documentation for patient medical information (89.3%) and patient difficulty in remembering the details of their medical history (84.7%) were two major factors that could increase medical errors. Moreover, the majority (89.8%) agreed that creating a comprehensive database for patients’ data will help in decreasing medical errors (Table 4).

As more than the half of students were at their last year of studying (63.9%), only 47 (12.4%) did not start their training yet, and more than half of students (55.2%) had completed at least 720 training hours out of the required 1440 credit hours. Community pharmacies were the most frequent training location (78.2%), as for the feedback provided by students on their training location. More than three-quarters of community pharmacies (76.6%) provided some counseling to patients and only 116 (30.5%) had electronic medical files for patients (Table 5). Students’ participation in PC consisted mainly of justifying the drug indication (89.5%), providing information on proper use and dose (88.4%), and warning the patients about side effects (82.1%). Since most of the students were approaching the end of their studies, they were asked if they feel prepared to start practicing PC, and the majority reported that they weren’t sure if they were (47.6%) (Table 5).

Among 62 pharmacists working in a community pharmacy, all gave advice to patients while providing the medication (100%). The time spent giving advice to patients was reported as: less than five minutes by 24 (38.7%) respondents, five to nine minutes by 24 (38.7%) respondents, while no one reported spending more than fifteen minutes. To further assess existing PC practices, respondents were asked whether they had electronic medical files for patients, to which only 26 (41.9%) confirmed. Nevertheless, most respondents felt prepared to implement various aspects of PC 38 (61.3%) (Table 6). About three quarters (71%) thought that this service should be paid: by number of patients (45.5%), by minutes spent with each patient (22.7%), by number of prescriptions (22.7%), and by other methods (9.1%).

Respondents were asked what they usually do if they encounter any problem in a prescription, their responses were as following: calling the doctor (71.0%), changing the drug to another better alternative (19.4%), dispensing the drugs even if they are not appropriate (6.5%), or refusing to dispense (3.2%). As for the response of physicians to comments provided by pharmacists, most participants agreed that physicians only sometimes (87.1%) accept the comments (Table 6).

Among the four aspects of PC (technical, psychosocial, communication and administrative) that were assessed for students and pharmacist’s extent of preparedness to several statements by a scale, general weakness in all aspects was noticed (Table 7). Among technical aspects the lowest skills appeared in monitoring pharmacokinetic parameters in both students and pharmacists. Among psychosocial aspects the lowest skills were appeared in using computers and data in professional practice for both students and pharmacists. Regarding communication aspects, the lowest skills appeared in providing the medical records information to health professionals. Finally, considering administrative/management aspects there were general weakness in all aspects (Table 7).

The survey included a question for the physicians which asked them about their response if a pharmacist tells him/her about a wrong or inappropriate prescription, half of them (50%) sometimes accept the pharmacist recommendation, while 19 physicians (38%) always accept and 6 (12%) do not accept the recommendations.

This is the first study to address the perspectives of healthcare providers and pharmacy students about PC and telemedicine during COVID-19 pandemic and the barriers to the integration of PC into practice in Jordan. This study highlights the need for the presence of electronic medical files for patients to be accessed easily by healthcare providers. Most of the participant (93.0%) encouraged the idea of a website that contains patients’ medical files which abridge PC process with around half (45.1%) of them were willing to pay for it. Most participants agreed that absence of proper documentation of patient medical information and patient difficulty to remember his medical history increases the risk of medical errors and creating a database that contains all related patients’ medical information decreases such risk.

Participants in this study had positive attitudes toward PC; most believed it is the primary pharmacist’s responsibility and would improve patients’ health. Subsequently, this complies with several studies conducted to explore pharmacists’ and pharmacy students’ opinions in Saudi Arabia (Mohammed Basheeruddin Asdaq et al. 2021), Qatar (El Hajj et al. 2016), Iraq (Mohammed et al. 2019), Malaysia (Loh et al. 2021), United Arab Emirates (Tawfiq et al. 2021), France (Perraudin et al. 2011), as well as in Jordan (Aburuz et al. 2012). The top perceived barriers to the integration of PC in this study were lack of access to the patient medical record in the pharmacy (90.6%), lack of private counselling areas (86.9%), and lack of communication/ coordination with physicians (85.2%). The first two was also reported by patients to be the main barriers to the integration of PC in a very recent study conducted in Jordan (submitted paper). Findings from studies in other countries have reported several barriers such as inconvenient access to patient medical information, lack of staff and time, inadequate training in PC, lack of PC models, lack of interaction with patients and healthcare providers, absence of private counselling area, poor image of the pharmacist’s role, organizational obstacles, lack of remuneration, and pharmacists’ physical separation from patient care areas (Perraudin et al. 2011; El Hajj et al. 2016; Awaisu et al. 2018; Loh et al. 2021; Tawfiq et al. 2021).

The lack of access to the patient medical record was the most documented barrier for the integration of PC and one of the factors that may increase the incidence of medical problems according to this study. This is consistent with findings in studies conducted in other countries (El Hajj et al. 2016; Loh et al. 2021; Tawfiq et al. 2021) as well as previously in Jordan (Aburuz et al. 2012). The availability of electronic medical records is not common in community pharmacies in Jordan. Although the main pharmacy chains keep electronic records for their patients (Nazer and Tuffaha 2017), the proportion of community pharmacies that have electronic medical records in Jordan is not clear. In this study, different responses were reported by the different participants categories regarding the use of the electronic files for the patients. In 2009; the Jordanian government implemented a nationwide e-health system to connect all the public hospitals and clinics under the name HAKEEM (Nazer and Tuffaha 2017). However, there is no such an official source for documentation of patients’ demographic and medical information in community pharmacies, as well as for those who do not have the governmental insurance. The availability of a database that connect community pharmacies will help in improving PC and decreasing medical errors. In addition to the clinical benefit, the economic benefit of PC is well established in the literature (Westerlund and Marklund 2009; De Oliveira et al. 2010). Increasing the awareness of public and healthcare providers about this economic benefit may also increases their willingness to have and to pay for a service that facilitate PC.

Moreover, the lack of private counselling area was the second most documented barrier for integration of PC. This barrier was also reported in studies conducted in Qatar (Awaisu et al. 2018), Kuwait (Katoue et al. 2014a; Awaisu et al. 2018), and the United Arab Emirates (Tawfiq et al. 2021). The regulations in Jordan do not necessitate the presence of special counselling area in community pharmacies. Furthermore, the design of most community pharmacies does not allow for the presence of actual private area for counselling. However, the Jordan Pharmaceutical Association (JPA) started the Good Pharmacy Practice (GPP) program which recommends offering a private counselling area for patients and the main pharmacy chains are implementing this feature (Nazer and Tuffaha 2017). The presence of counselling area with high level of privacy increases the counselling practice and encourage patients which are integral part in PC process to ask about their medical issues (Kimberlin et al. 2011).

Lack of communication / coordination, the third barrier, was one of the top perceived barriers and it has been reported in other similar studies (El Hajj et al. 2016; Loh et al. 2021). Interprofessional collaboration is crucial for implementing PC (Zielińska-Tomczak et al. 2021; Alsayed et al. 2022c). Several studies have explored the factors that may influence interprofessional collaboration and barriers to implementing it in Arab countries (El-Awaisi et al. 2018; Hasan et al. 2018; Albassam et al. 2020). These factors include patient and physician acceptance, logistic and financial issues and perceived pharmacist competence (Hasan et al. 2018), role conflict, and hierarchical differences between healthcare professionals (Albassam et al. 2020). Lack of time and financial compensation, lack of face-to-face communication, the possible fragmentation of patient care by the involvement of multiple healthcare professionals are some other factors (Albassam et al. 2020). The implementation of official channels of communication which can be achieved by telemedicine may enhance interprofessional collaboration, improves PC, and decreases medication errors.

While 61.3% of participated pharmacists and 43.9% of pharmacy students felt prepared to implement various aspects of PC, general weakness in all aspects of PC (technical, psychosocial, communication, and administrative) among them had been noticed in this study based on their self-assessment of their competencies. However, students usually overestimate themselves in self-assessment tools (Austin and Gregory 2007). The weakest competencies were in the administrative aspect of PC which is in line with other studies conducted in the United States of America (Scott et al. 2010), Kuwait (Katoue et al. 2014b), and Turkey (Okuyan et al. 2016). This is not surprising knowing that the administrative pharmacy courses in pharmacy schools’ curricula is limited. With the GPP recommendations of extending continuing training programs to enhance pharmacists’ role in delivering healthcare services (Nazer and Tuffaha 2017), these results emphasize the need to concentrate on continuing education as well as pharmacy undergraduate education that improves readiness of pharmacists and future pharmacists to implement various aspects of PC and especially the administrative aspects (Alsayed et al. 2022d).

Another important aspect of this study is the introduction and emphasizing the future role of telemedicine. Telemedicine and the availability of specialized website that contains patient’s information ensure the continuity of care when patients move from one care setting to another (inpatient to outpatient) especially in the absence of specialized care in the second location (Le et al. 2020). Moreover, the benefit of telemedicine was obvious recently during the COVID-19 pandemic where the people worldwide are facing several lockdowns and the access to medical help is difficult (Hong et al. 2020; Margusino-Framiñán et al. 2020). Although all pharmacists participated in this study documented giving advice to their patients upon prescribing, most of them (75.4%) spend less than ten minutes for each patient and none spends more than 15 minutes. This was explained due to workload, time concern, and no reimbursement for such PC. About 71% thought that they should be paid for their advice. Therefore, the idea of telemedicine and the presence of a website that provides PC can be a solution for this problem. In our study, 93% of participants encourage telemedicine websites and 60% were willing, to a varying degree, to pay for this service.

The medical services in Jordan are provided by either governmental or private organizations. Patients seeking governmental sector pay much less amount of money compared to those who are seeking private sectors. Due to financial constraints the Jordanians face, most of them prefer to attend the governmental one. This makes a lot of demand and pressure on health workers and leads to less time spent with patient and more medication related problems. All of that induces the desire in people and health care providers to adopt web-based telemedicine and PC. Similar trend was seen in previous studies in Iraq (Abd Ghani and Jaber 2015) and Canada (Gagnon et al. 2003) where the benefits of telemedicine affected not only the patients and health providers, but also the entire healthcare organization.

Consequently, the management of chronic diseases (Spethmann and Köhler 2022), adherence to medications, and patient self-management were positively affected by telemedicine services (Niznik et al. 2018). The participants are willing to pay for such services but further education on the role of telemedicine and PC is needed to increase the acceptance of this idea in all levels of the community. Cost-benefit analysis of services provided by telemedicine, and clarification for methods of payment for these services and the role medical insurance coverage will make the people and policy makers more appreciative to adopt telemedicine in the healthcare system (Shafie and Hassali 2010).

Finally, this study has some limitations such as the small sample size of pharmacists who participated in this study compared to pharmacy students. This may skew the results to more perceived opinions than actual ones seen in real practice and the self-assessment of preparedness of providing PC which overestimates results and may not evaluate actual competencies. Moreover, participants were asked to estimate the payment that may offer to a website that facilitate PC and telemedicine without thorough explanation of its content and without pre-knowledge about the economic benefit of PC and this may underestimate the willingness to pay for this service.

This is the first study to address the perspectives of healthcare providers and pharmacy students about PC and telemedicine during COVID-19 pandemic in Jordan. This study highlights that absence of proper documentation of patient medical information and patient difficulty to remember his medical history increases the risk of medical problems and is considered the most documented barrier for the integration of PC. This emphasizes the future role of telemedicine and the availability of a specialized website that contains patient’s information to ensure the continuity of care even during the pandemics. Creating an electronic database, to be easily accessed by healthcare providers, that contains all related patients’ medical information should decrease the risk of medical problems.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

All authors declare no conflict of interest related to this article.

A.R.Al.: Idea; Protocol; Literature Searching; Formal analysis; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Roles/Writing - original draft; Writing - review & editing. H.A.K.: Writing - review & editing. L.H.: Writing - review & editing. D.A.: Literature Searching; Validation; Writing - review & editing. D.A.: Data collection; Validation. T.N.AL.: writing- review & editing. A.S.: Literature Searching, review & editing.

A very special thanks goes out to the pharmacy students and healthcare professionals who contribute in sharing this study questionnaire.