Determinants of exit-knowledge of ambulatory patients on their dispensed medications: The case in the outpatient pharmacy of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Semere Welday Kahssay; Peacock Mulugeta

doi:10.1371/journal.pone.0268971

Peer Review History

Original SubmissionNovember 26, 2021
11 Apr 2022 Decision Letter - Rafael Santos Santana, Editor PONE-D-21-37588Exit-Knowledge About Dispensed Medications and Associated Factors Among Patients Attending the Outpatient Pharmacy of Mizan-Tepi University Teaching Hospital, Southern EthiopiaPLOS ONE Dear Dr. Welday, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 26 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Patients and Methods: In Study Population, what were the inclusion criteria? What is the basis teorical for the decision to exclude patients with more than three dispensed medications? Data Collection Techniques and Procedures, reference if the instrument used has been validated. How it's do calculation of knowledge level? Ethical considerations, it is suggested to include the registration number with the Research and Ethical Review Committee of Mizan-Tepi University. Result: Place each table in your manuscript file directly after the paragraph in which it is first cited (read order). Discussion: To correct 177. This is not a prospective longitudinal study, as there is no follow-up of participants over time. I suggest that the discussion be revised, with the aim of bringing the reader alternatives to increase the level of output knowledge about drugs. I note that the study corroborates with several others, this is important for the text, however, I suggest that the discussion be expanded to how we can mitigate these factors associated with the lowest level of output knowledge about medicines. Thus, the study will give the reader something new, since similar analyzes and results have already been carried out before. I also suggest that the percentages previously presented in the results are not repeated in the discussion. Reviewer #2: Exit-Knowledge About Dispensed Medications and Associated Factors Among Patients Attending the Outpatient Pharmacy of Mizan-Tepi University Teaching Hospital, Southern Ethiopia Congratulations for this work Indroducion Line 41 suggest including as barriers "the high workload of dispensers” this barrier appears under discussion Line 47 (…) halt the existence of drug therapy problems. Are you sure about that? I suggest change the word (decrease?). Line 59 (…) The findings of this study would promote good dispensing and counselling practices (…) Could the findings promote good practices in dispensing and counseling? Consider this at the conclusion of the study. Patients and Methods Study Population (…) Who fulfilled the inclusion criteria (…). What the inclusion criteria? Describe them. (…) ambulatory patients visiting the outpatient pharmacy (…) What patients? All patients? What the criteria did you use to select the patients? Any patients refused to provide oral consent? If so, were excluded from the study? Sample Size and Sampling Technique Line 87 (…) eligible participants were consecutively enrolled until the required sample size reached (…) include study eligibility criteria, because is not clear. Data Collection Techniques and Procedures Questionnaires were translated to local language? Data Quality Control, Analysis and Interpretation Line 105 (…) SPSS version 24 Include: The Statistical Package for the Social Science (SPSS) software version 24 for analysis… Line 108 (…) Potential predictor variables with p value ≤0.25 in univariate analysis were considered for subsequent binary logistic regression analysis. How did you choose the variables for this analysis (Table 4)? because in table 1 there are other variables that were not presented in table 4. For example: age group, sex, residence, etc., did they not influence the model? Results Line 133 (…) The main media of communication with the pharmacists was Benchigna. It is not clear. Patient- Pharmacist Interaction Could the findings promote good practices in dispensing and counseling? Consider this at the conclusion of the study. Discussion Line 227 (...) This is obvious Suggests change this word The use of face-to-face interview can potentially lead to recall bias by respondentes, which should be taken into consideration while interpreting the result. Table 1: Exclude the symbol (%) from male and female variables Conclusion: I would probably focus more on the implications of the findings about promote good practices in dispensing. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. 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Revision 1
19 Apr 2022 Author Response Response for reviewer -1 � In Study Population, what were the inclusion criteria? • Those ambulatory patients who were mentally stable, willing to participate, and visited the outpatient pharmacy during the study period were included in the study. (It is now included in the revised manuscript line 74). � What is the basis for the decision to exclude patients with more than three dispensed medications? • The reason for excluding patients with more than three medications is that polypharmacy can potentially lead to increased difficulty in information retention and recalling ability; thus, it could negatively affect the overall study result. � reference if the instrument used has been validated. • We used a questionnaire whose face validity was established using experts (senior staffs from our college) and it was also pilot tested on a subset of participants. In addition to these, principal components analysis (PCA) and Cronbach’s Alpha (CA) analysis were carried out and corrections were made accordingly. � How did you do the calculation of knowledge level? • The participant was considered to have sufficient exit knowledge about the dispensed medication when he/she responded a positive answer for at least two-thirds (≥10 out of 15) of the total knowledge assessing questions. Those who gave a positive response for less than two-thirds (≤9 out of 15) of the total knowledge assessing questions were considered as having insufficient exit knowledge. � it is suggested to include the registration number with the Research and Ethical Review Committee of Mizan-Tepi University. • Thank you for your suggestion, the registration number is now included in the revised manuscript (line 116). � Place each table in your manuscript file directly after the paragraph in which it is first cited (read order). • Thank you, the tables are now placed after the paragraph they are first cited (general table guidelines are followed in the revised manuscript). � To correct 177. This is not a prospective longitudinal study, as there is no follow-up of participants over time. I also suggest that the percentages previously presented in the results are not repeated in the discussion. • Thank you for your comments, but as mentioned earlier in the methodology section it was to mean a prospective cross-sectional study design, not a prospective cohort study design; thus, as you have stated there is no follow-up of participants over time. (the appropriate terminology is used in the revised manuscript line 198) • The percentages of major findings are tried to be incorporated in the discussion section. Response for reviewer -2 Thank you for your comments and suggestions � Line 41 suggest including as barriers "the high workload of dispensers” this barrier appears under discussion • Thank you, It is now included in the revised manuscript (line 43) � Line 47 (…) halt the existence of drug therapy problems. Are you sure about that? I suggest changing the word (decrease?). • Thank you for your suggestion, the word change has been applied. (line 49) � Line 59 (…) The findings of this study would promote good dispensing and counselling practices (…)Could the findings promote good practices in dispensing and counseling? Consider this at the conclusion of the study. • Yes it does, and now it is added in the conclusion of the revised manuscript (line 275) � (…) Who fulfilled the inclusion criteria (…). What the inclusion criteria? Describe them. (…) ambulatory patients visiting the outpatient pharmacy (…)What patients? All patients? What the criteria did you use to select the patients? • Those ambulatory patients who were mentally stable, willing to participate, and visited the outpatient pharmacy during the study period were included in the study. (now it is included in the revised manuscript).(line 74) � Any patients refused to provide oral consent? If so, were excluded from the study? • No patients refused to provide oral consent. � Line 87 (…) eligible participants were consecutively enrolled until the required sample size reached (…) include study eligibility criteria, because is not clear. • Thank you, now it is clearly stated in the revised manuscript.(line74) � Questionnaires were translated into the local language? • Yes, the questionnaire which was first prepared in English, was translated to the local language, Benchigna, to maintain consistency in translating the questionnaire (to keep it nuanced). (please see the revised manuscript line 103) � Line 105 (…) SPSS version 24 Include: The Statistical Package for the Social Science (SPSS) software version 24 for analysis • Thank you, the full form is now included in the revised manuscript.(line 107) � Line 108 (…) Potential predictor variables with p-value ≤0.25 in univariate analysis were considered for subsequent binary logistic regression analysis. How did you choose the variables for this analysis (Table 4)? because in table 1 there are other variables that were not presented in table 4. For example: age group, sex, residence, etc., did they not influence the model? • In table 4 only those predictor variables with P≤0.25 in univariate analysis are stated, and thus considered for subsequent binary logistic regression analysis. The predictor variables (like age, sex, residence…) were not included in table 4 because they were found to have a p-value >0.25 in univariate analysis; thus, not considered for bivariate analysis. � Line 133 (…) The main media of communication with the pharmacists was Benchigna. It is not clear. • Benchigna, is a local language used by the communities where the study was conducted. The study revealed that, they communicate with the pharmacists mainly using this language. � Could the findings promote good practices in dispensing and counseling? Consider this at the conclusion of the study. • Yes, and now it is added to the conclusion of the revised manuscript.(line 275) � Line 227 (...) This is obvious. Suggests change this word • Thank you for your suggestion, a word change has been applied (please see the revised manuscript line 249). � The use of face-to-face interviews can potentially lead to recall bias by respondents, which should be taken into consideration while interpreting the result. • Thank you and it is now included in the limitation of the study and made clear for the readers (please see the revised manuscript line 266). � Table 1: Exclude the symbol (%) from male and female variables • Thank you. Now it is cleared Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0268971.r002
12 May 2022 Decision Letter - Rafael Santos Santana, Editor Determinants of exit-knowledge of ambulatory patients on their dispensed medications: the case in the outpatient pharmacy of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia PONE-D-21-37588R1 Dear Dr. Semere Welday, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Rafael Santos Santana Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0268971.r003
Formally Accepted
13 May 2022 Acceptance Letter - Rafael Santos Santana, Editor PONE-D-21-37588R1 Determinants of exit-knowledge of ambulatory patients on their dispensed medications: the case in the outpatient pharmacy of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia Dear Dr. Welday Kahssay: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Rafael Santos Santana Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0268971.r004

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