Quantitative resultsSociodemographic characteristics of the participants

The study had a 97.7% response rate. Out of a total of 301 participants, 173 (57.5%) were male. The mean age of participants was 30.13 years, with an SD of 6.55 years, and most of the participants were from Amhara ethnic groups (263, or 87.4%). Regarding the marital status of the participants, 124 (41.2%), 161 (53.5%), and 16 (5.3%) were single, married, and divorced, respectively (Table 1).

Table 1 Sociodemographic characteristics of PPs (n = 301), Dessie city administration, 2019Socioeconomic characteristics of the participants

From a total of 301 respondents, 49.5% were diploma holders, 46.8% were bachelor's degree holders, and 3.7% were master’s degree holders. Among the 301 study participants, 151 (50.2%) were government employees, and 150 (49.8%) worked in private institutions. The mean age of the participants was 6.8 years, with a standard deviation of 5.5 years. The mean monthly income of the participants was 5250.8 ± 2785.5 Birr. Ninety-seven (32.2%) of the PPs spent 5–10 min of their time with a single patient. The average time spent by PPs with a client is described in Fig. 1. In this category, none indicate that PPs have clearly measured their average time spent with clients.

Fig. 1

Average time spent by PPs (n = 301) with patients in Dessie city administration, north-east Ethiopia, 2019

As illustrated in Fig. 2, 114 (37.9%) of the pharmacists were working at the hospitals, followed by 85 (28.1%) at drug retail outlets and 44 (14.6%) at wholesalers.

Fig. 2

Workplace of the PPs (n = 301), Dessie city administration, north-east Ethiopia, 2019

Regarding the current working units of the PPs in Dessie town, more than one-third (34.5%) were working at drug retail outlets, followed by those at outpatient department (OPD) pharmacies (20.9%) and stores (12.3%) (Fig. 3).

Fig. 3

Working units of PPs (n = 301) in Dessie city administration, north-east Ethiopia, 2019

Roles of pharmacy professionals

By computing the ordinal responses of pharmacists' different activities in binary groups as poor perception (strongly disagree, disagree, and not sure) and good perception (agree and strongly agree) and adding all variables to take the average value, a single independent variable with binary outcomes is obtained. 203 (67.4%) of the participants perceived their roles as chemists, and 230 (76.4%) perceived themselves as clinicians or patient care providers (Table 2).

Table 2 Perception of PPs’ (n = 301) roles in Dessie city administration, north-east Ethiopia, 2019Perceptions of pharmacy professionals towards their current roles

By dividing the ordinal responses of PPs' various activities into binary groups as poor perception (strongly disagree, disagree, and not sure) and good perception (agree and strongly agree) and adding all variables to take the average value, a single dependent variable with binary outcomes is produced, which could be useful for logistic regression analysis. One hundred seventy-eight (59.1%) of study participants strongly agreed that pharmaceutical care was in charge of providing medicine therapy. More than three-fourths (76.7%) of the participants agreed and strongly agreed that they perceived PPs’ roles as listening to patients' signs and symptoms in cases of minor illnesses. But the rest, 23.3%, disagreed about listening to patients' signs and symptoms in cases of minor illnesses. Dichotomized into binary outcomes, the dependent variable of this study was perception (1 = good perception, 0 = poor perception). Among 301 participants, 263 (87.4%) had a good perception and 38 (12.6%) had a poor perception of their current professional roles in the health care system in Dessie city administration health institutions. Each individual value is described in the following Table 3.

Table 3 PPs' (n = 301; after dichotomizing to binary outcomes) perceptions of their professional role in Dessie city administration in north-east Ethiopia, 2019Perceptions of pharmacy professionals towards service-related factors

One hundred and eighty-four (61.1%) of the participants agreed that there is a shortage of physical access for pharmaceutical care provision, and the rest, 117 (38.9%), did not agree on this. Poor access to patients' clinical and laboratory data was agreed upon by 191 (63.5%) of the participants but not by 110 (36.5%). One hundred sixty-seven (55.5%) of the respondents agreed that there was effective communication skill among PPs, while the remaining 134 (44.5%) did not agree. One hundred fifty-one (50.2%) and 150 (498.8%) participants agreed and disagreed, respectively, that there was a lack of patient acceptance of pharmaceutical care provision. Lack of training among PPs was agreed upon by 187 (62.1%) and 114 (37.3%) of the participants (Table 4).

Table 4 Perception of PPs (n = 301), in line with pharmacy service-related factors, towards their professional roles in Dessie city administration, north-east Ethiopia, 2019Factors associated with the perception of pharmacy professionals towards their roles

The study found, after running binary logistic regression, that sex (p-value = 0.098), level of education (p-value = 0.17), experience of PPs (p-value = 0.062), lack of physical space for pharmaceutical care (p-value = 0.002), poor access to patient clinical and laboratory data (p-value = 0.061), lack of effective communication skills (p-value = 0.036), lack of training for PPs (p-value = 0.037), poor initiative for pharmaceutical care (p-value = 0.07), poor expectations of the pharmacy practice (p-value = 0.052), the dispensary's distance from the patient care area (p-value = 0.21), and lack of support from administrators (p-value = 0.056) were statistically significant at a p-value ≤ 0.2, and were candidates for the multivariate logistic regression (Table 5).

Table 5 Factors associated with the perception of PPs (n = 301) towards their professional roles in the Ethiopian health care system in Dessie city administration, north-east Ethiopia, 2019

The following factors were not statistically significant: age (p-value = 0.6262), work experience (p-value = 0.35), marital status (p = 0.74), current working unit (p-value = 0.45), employer institution (p-value = 0.71), work place of the participant (p-value = 0.89), average monthly income (p-value = 0.44), lack of patient acceptance to pharmaceutical care (p-value = 0.74), unclear scope of pharmaceutical care (p-value = 0.85), lack of confidence in pharmaceutical care (p-value = 0.65), poor cooperation with other health care professionals (p-value = 0.77), lack of commitment to pharmaceutical care (p-value = 0.29), low compensation (p-value = 0.75), and a shortage of PPs (p-value = 0.73).

Hosmer and Lemeshow's assumption of model fitness was assessed, and the model fitness assumption was fulfilled (p = 0.847). Multiple logistic regressions were used as the final point of comparison in the analysis; enter the method for calculating variables and consider a p value of less than 0.05 to be statistically significant. Finally, those variables entered into multiple logistic regression were described in a regression table with their crude and adjusted odds ratios and 95% confidence intervals. Then, four variables were found to be statistically significant in multiple logistic regression: lack of physical access (p-value = 0.041; AOR = 0.32; 95% CI 0.049, 0.63); poor initiatives (p-value = 0.012; AOR = 0.25; 95% CI 0.01, 0.97); poor communication skill (p-value = 0.035; AOR = 0.87; 95% CI 0.18, 0.96); and the administrator does not support pharmaceutical care (p-value = 0.019; AOR = 0.49; 95% CI 0.16, 0.83).

One of the factors influencing PPs' perceptions of their current professional roles was a lack of physical space for pharmaceutical care. Those PPs who perceived a lack of space for pharmaceutical care had 0.32 (p-value = 0.041; AOR = 0.32; 95% CI 0.049, 0.63) times lower odds of good perception towards their current professional roles compared to those who perceived good physical space for pharmaceutical care, keeping all other variables constant.

PPs' effective communication skills were significantly related to their perceptions of their professional roles. Those PPs with poor communication skills had 0.87 times (p-value = 0.035; AOR = 0.87; 95% CI 0.18, 0.96) lower odds of having a positive perception of their professional roles compared to those with good communication skills, keeping all other variables constant.

The perception of PPs toward their professional roles in the health care system was significantly associated with the pharmaceutical care initiative. Those PPs with poor initiative for pharmaceutical care were 0.25 times (p-value = 0.012; AOR = 0.25; 95% CI 0.01, 0.97) less likely to have good perceptions towards their professional roles compared to those with poor initiative for pharmaceutical care, keeping all other variables constant.

Administrator support of pharmaceutical care was significantly associated with the perception of PPs towards their professional roles in the health care system. Those PPs who perceived a lack of administrator support were 0.49 times (p-value = 0.019; AOR = 0.49; 95% CI 0.16, 0.83) less likely to have a positive perception of their professional roles compared to those with poor initiative for pharmaceutical care, keeping all other variables constant.

Qualitative findings

This study's qualitative findings yield two main themes: perceived PP roles and perceived determinants of their roles. The second theme, perceived determinants, was again categorized into two sub-themes: perceived facilitators and perceived barriers to the roles of PPs.

Sociodemographic descriptions of the participants

The mean age of the participants was 30 years. The key informants (n = 12) were all men. The educational status of participants was one diploma, ten bachelors, and one master. Regarding the employment status of the participants, seven were from governmental institutions and five were from private institutions. Table 6 shows that participants had a minimum of 2 years and a maximum of 12 years of experience.

Table 6 Sociodemographic descriptions of the key informants (n = 12), Dessie city, north-east Ethiopia, 2019Perceived pharmacy professional roles

According to the study participants, various perceived professional roles were mentioned. These were coded into categories, such as counselor, researcher, leader, communicator, compounder, manufacturer, production manager, quality control, and technical manager. It was perceived that PPs are the core of the health care team, from dispensing to industry as well as research and development levels, especially in medicine production and manufacturing, including their rational utilization in patient care.

PPs play a variety of roles in the community, collaborating with other health care providers as researchers, teachers, compounding, counseling, dispensing, quality control, production management, leaders, and in industry. (P1).

In decreasing order of perceived frequency, the perceived roles were counselor, manager (drug supply, production, technical, and quality control), dispenser, teacher, chemist (as compounder and manufacturer), communicator, researcher, and leader. Participants most frequently described the counselor role, followed by the dispenser role.

We, the PPs, have different roles; one is counseling patients about their medications. (P1).

Consequentially, the finding revealed that some (n = 6) of the participants perceived their roles as dispensers and one-third of them as teachers.

Currently, patients come to PPs only to get the prescribed medicines; i.e., though PPs turn out to be involved starting with diagnostic procedures, patients do not come to PPs but rather their supporters. (P6).

When I see PPs in various locations, they do not do what is expected of them; rather, they dispense what is prescribed. (P12)

Perceived facilitators of pharmacy professional roles

Positive perceptions of PPs' roles and interactions with patients and other health care providers, including good opportunities and perceived encouraging impacts in the health service as a result of them (the PPs).

The era of clinical pharmacy practice that leads to good pharmaceutical care practices, being the source of drug information centers and increasing interaction with both clients and other health care providers, integrity and being honest for the profession, being updated using different learning opportunities, the scientific background that makes pharmacists drug experts, respected, and business opportunists were perceived as facilitators of the roles of PPs. Other perceived facilitators include the presence of regulatory bodies like the Ethiopian Food and Drug Administration (EFDA), the experience and professional alliance of PPs, adequate human power, supplies, and commodities.

According to key informants, being honest for the profession and respected by clients, the presence of a regulatory body like the EFDA, the work experience of the PPs, adequate human power and supply of commodities, pharmaceutical care practice, the interaction of the PPs with clients and other health care providers, being a business owner, professional updating, and the presence of a strong curriculum were perceived facilitators of the role of the PPs.

The image of the participants towards the pharmacy profession was positive in the past, serving the community, and negative currently, considered business-oriented, but most of the participants perceived a positive image towards their profession roles, which will facilitate professional practice.

According to the perceptions of the informants, the profession of pharmacy is the focal point of the health care delivery system and patient care.

Because they are drug specialists, many of the PPs are improving pharmacy services by performing what is expected in the community; they provide public services in the area of drug-related services that were needed; thus, the profession is the "backbone" of the health care system. (P1).

The ways to facilitate the roles of PPs for better future health care practice were self-respect, improving awareness and perceptions of pharmacy services in the community, having the employer organization fulfill materials for pharmacy services, having hard work and good performance of what is expected from PPs, having good interaction with other health care providers, having quality education for quality PP production, and having regular monitoring and evaluation by the regulatory body.

Because the pharmacy profession is respected in Ethiopia and around the world, it is important to respect oneself and have a positive image of oneself in order to serve the community in the future. (P1).

Quality education for PPs, regular monitoring and evaluation by regulatory bodies such as the EFDA, creating drug awareness among patients, and preparing various workshops for health care providers were all ways to improve pharmacists' perceptions for better future health care practice. (P7).

Most participants saw positive interactions between PPs and other health professionals, but few saw such interactions between PPs and patients.

We (the PPs) had positive interactions with nurses and physicians, especially in terms of communication on drug types and their dosages. (P8)

The majority of participants perceived a positive interrelationship between PPs and patients, but only a minority of participants perceived that interrelationship.

We (PPs) especially help patients by giving information on drug types, their doses, and how to take these drugs. (P8).

Being truthful about the profession and the recent launch of clinical pharmacy services aided pharmacy practice.

Serving patients anywhere with the best ethical discipline, knowledge, and skills is a good opportunity to practice the pharmacy profession. (P11)

The good will of the PPs, the current launch of the clinical pharmacy service, and the high number of PPs were opportunities to improve pharmacy practice. (P12)

The pharmacy service is essential to improving clinical care and patient outcomes, so its services can reduce negative impacts on patients. (P4)

Perceived barriers to pharmacy professional roles

The most commonly explored perceived barriers to the roles of PPs were lack of central focus, poor infrastructure, budget shortage, lack of administrative support, professional complexity, negligence of the PPs, and a high work burden due to a high patient load. Other perceived barriers were the lack of training for PPs, the PPs being business-centered, communication barriers, the absence of morning sessions, and the lack of departmentalization of different disciplines like dermatology, oncology, etc.

The lack of an effective central focus for PPs was one of the barriers to pharmacy practice.

Other health care providers and administrative staff, even employer organizations, did not understand the burdens of pharmacists. (P1)

Also, lack of administrative support and poor infrastructure were perceived barriers to the pharmacy practice.

The challenges for pharmacy practice were a shortage of materials and equipment, a lack of physical spaces, administrative issues like the low attitude of people in different positions within the pharmacy profession, and the absence of “unique departments" like dermatology and oncology. (P12).

Some of the study participants (n = 4) perceived barriers towards the profession of pharmacy because the practitioners in this field are only business-oriented, which negatively affects the implementation of pharmacy practice.

Currently, PPs are concerned with their business, while others are concerned with their professional service. When the profession is considered, the public benefits; when the business is considered, the public suffers. (P7).

Some other participants (n = 5) perceived that the interrelationship of PPs with patients differs from place to place, and these were barriers for the pharmacy profession. Some of the participants perceived a negative interrelationship between PPs and other health care providers.

We (the PPs) have poor interactions with patients in hospitals because it is a government facility with high patient flow and low PP satisfaction, but there is good interaction in private pharmacies because we work for business and want to bring them (the patients) as our regular customers. (P1).

The complexity of the profession and the lack of a clear job description were also barriers to the role of pharmacy practice.

PPs fear physicians because of the conflicting roles between them. (P1)

There is conflict with nurses since they prescribe for themselves. (P9)

One of the barriers to pharmacy practice was pharmacists' poor communication with patients and other health care providers.

Communication barriers were the practice's biggest challenge. (P9)

We (the PPs) have negative relationships with other health care providers. We isolated ourselves from other health care providers and had poor communication even after the start of clinical pharmacy services. (P5).

Negligence is one of the barriers that may hinder the practice of PPs’ roles.

There is some abandonment and contempt, as well as feelings of abandonment and contempt. (P5).