title: Pharmacists' perspectives about their role in care of patients with diabetes observing Ramadan.
abstract: Diabetes is a common chronic condition amongst Australians. Ongoing management requires adherence to medication and diet regimens. Religious practices such as fasting, such as the Ramadan fast observed by Muslims can impact medication use and diabetes control. Pharmacists as medication experts have a key role in helping people observing religious practices, to maintain optimal control over their medication regimen.
  
  
  
  This study aimed to explore the perspective of Australian community pharmacists about professional services for patients with Type 2 diabetes (T2D) who may opt for observing the Ramadan fast.
  
  
  
  Qualitative, semi-structured interviews with a purposive convenient sample of pharmacists practicing in areas of ethnic diversity in Sydney were undertaken. Interview data were thematically analyzed using a constructivist paradigm.
  
  
  
  Twenty-one semi-structured interviews (57% male participants) were conducted during June-August 2015, and the analysis of verbatim transcripts established several themes. Although most participants encountered fasting patients, and were willing to engage in diabetes services for them, our analyses indicated reactive counseling, lack of perceived need for counseling patients or delegation of patient care in a few instances as well as organizational issues as a practice barrier. Some participants highlighted the need for training and skills development in this area and cited other organizational barriers such as time, infrastructure and patient expectations/attitudes that might impede service provision. Key themes related to patients included: experiencing adverse outcomes of fasting on diabetes, varying levels of self-efficacy, help seeking behaviors and negative attitudes to pharmacist involvement.
  
  
  
  Pharmacists encounter patients with chronic conditions who observe religious fasts that may interrupt established medication regimens. Proactive counseling about medication use in these instances is offered only by some pharmacists. Professional awareness of the effect of religious practices is important and protocols to assist patients in these situations should be developed and disseminated. Standardized service provision is likely to facilitate positive patient expectations so that pharmacies and pharmacists are viewed as a normal channel for seeking help by fasting patients.
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Building A15, Sydney, NSW 2006, Australia. Electronic address: halm7156@uni.sydney.edu.au.
authors.forename: Hadi A
authors.initials: HA
authors.lastname: Almansour
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Building A15, Sydney, NSW 2006, Australia.
authors.forename: Betty
authors.initials: B
authors.lastname: Chaar
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Building A15, Sydney, NSW 2006, Australia.
authors.forename: Bandana
authors.initials: B
authors.lastname: Saini
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003376:Counseling / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005215:Fasting; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007514:Islam; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010595:Pharmacists / Q000458:organization & administration* / Q000706:statistics & numerical data; D024382:Professional Role; D020377:Self Efficacy; D055815:Young Adult
keywords: Fasting; Pharmacist; Ramadan; Type 2 diabetes