title: Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka.
abstract: Multidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka.
  
  
  
  This is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist's recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period.
  
  
  
  A total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist's recommendations by doctors was 73.5% (200/272) (95% CI 67.9 - 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses' rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey.
  
  
  
  There was high acceptance and implementation of clinical pharmacist's recommendations regarding DRPs by the healthcare team. The doctors' views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff.
  
  
  
  Sri Lanka Clinical Trials Registry SLCTR/2013/029 Date: 13 September 2013; retrospectively registered.
authors.affiliation: Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura Kotte, Sri Lanka. thushani@sjp.ac.lk.|South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka. thushani@sjp.ac.lk.
authors.forename: Lelwala Guruge Thushani
authors.initials: LG
authors.lastname: Shanika
authors.affiliation: Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura Kotte, Sri Lanka.
authors.forename: Chandrani Nirmala
authors.initials: CN
authors.lastname: Wijekoon
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.|Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
authors.forename: Shaluka
authors.initials: S
authors.lastname: Jayamanne
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia.|University of Queensland, Brisbane, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Coombes
authors.affiliation: University of Queensland, Brisbane, Australia.|Royal Brisbane Hospital, Brisbane, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Coombes
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.
authors.forename: Nilani
authors.initials: N
authors.lastname: Mamunuwa
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.|Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia.
authors.forename: Andrew Hamilton
authors.initials: AH
authors.lastname: Dawson
authors.affiliation: Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
authors.forename: Hithanadura Asita
authors.initials: HA
authors.lastname: De Silva
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D010348:Patient Care Team / Q000458:organization & administration; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D013188:Sri Lanka; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
keywords: Acceptance; Attitudes; Clinical pharmacist; Doctors; Drug- related problems; Multidisciplinary team; Nurses