الفهرس 
INTRODUCTION AND AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
Environmental pollution poses a worldwide concern for developed and developing nations. Pharmacies contribute to this issue by consuming various resources such as water, electricity, petroleum products, chemicals, food articles, construction materials, and gases. The utilization of these items generates a carbon footprint, leading to global warming and climate change that can have detrimental effects on the environment.
While there is no universally accepted definition of a green pharmacy, it can be described as a structure that is carefully planned and designed to make efficient use of natural resources in an environmentally friendly manner. Exploring this approach is crucial as it presents a potential solution to the problem of pharmaceutical pollution. Therefore, this research aimed to evaluate the knowledge, attitudes, and practices of pharmacists regarding eco-friendly pharmaceutical practices at Kafr Elsheikh General Hospital.
The study was conducted through multiple field visits for collecting data from the ten pharmacies in Kafr El Sheikh General Hospital of the Ministry of Health and Population, which is considered to be the largest hospital in the governorate until the study time.
Aim of the study
The study aimed at assessing Knowledge, Attitude and Practices of Pharmacists Regarding the Eco-Friendly Pharmaceutical Practices in Kafr Elsheikh General Hospital.
This objective was achieved through a cross-sectional study using Observational checklist for the pharmacies, Observational checklist for pharmacists regarding their eco-friendly strategies, and Predesigned self-administered questionnaire, which was used to ask about knowledge, attitudes, and practices towards the eco-friendly pharmaceutical practices.
Methods:
An observational checklist used to assess the eco-friendly pharmaceutical practices in the hospital pharmacies which included four sections: pollution prevention, energy conservation, and water conservation and infection control.
Another observational checklist for assessing the pharmacists’ eco-friendly practices which included different practices like: use of lab coats that can be laundered, use of scrape paper for internal notes, and handling the expired drugs in an eco-friendly way.
A questionnaire to assess knowledge, attitude and practices of the pharmacists’ eco-friendly pharmaceutical strategies which included four main items:
The first one was concerned with the socio-demographic factors of the participants such as: age, gender, educational level, and years of experience (Q1–Q4).
The second part of the questionnaire assessed knowledge of the pharmacists regarding eco-friendly pharmaceutical practices (Q5–Q18). These questions covered the main concepts, which entailed eco-friendly pharmacy definition, 4 Rs of going green, proper protocol for pharmaceutical waste disposal.
The third items assessed the attitude of the pharmacists towards eco-friendly pharmaceutical practices using a 3-point Likert scale on the agreement scored from 0 to 2 (Q19 – Q31). The questions included different concepts of eco-friendly pharmacy like: the pharmacists’ willingness to replace the traditional practices with eco-friendly ones, their attitude regarding the traditional pharmaceutical practices and, the sufficiency of their information regarding the eco-friendly pharmacy.
The last one assessed the pharmacists’ eco-friendly pharmaceutical practice (Q32 – Q37).
Appropriate statistical analysis was applied to handle the data and the following results revealed that:
• According to the observational checklist, the results of this study showed that there was no pharmacy in Kafr Elsheikh General Hospital that effectively applied any of the eco-friendly pharmaceutical practices.
• Concerning the observational checklist of the pharmacist’s eco-friendly practices, the mean total score was 3.97 ± 0.695 which corresponds to poor practice.
• The percentage of males was (19.4%), and females were (80.6%), and the age range was from 26 years to 50 years.
• The mean knowledge score was 4.99 ± 1.72 which corresponds to poor knowledge, none of the pharmacists had a good level, only one had a fair level, and the majority of them 99% had a poor level of knowledge.
• Regarding the attitude, the mean score of the respondents was 16.82 ± 2.558, (13.27%) of the participants had positive attitude, (82.65%) had neutral attitude, and only (4.08%) had good attitude.
• The pharmacists’ self-reporting mean practice regarding eco-friendly pharmaceutical practices was 6.87±2.029. This corresponds to poor practice.
• None of the socio-demographic factors had an influence on the pharmacists’ knowledge and eco-friendly pharmaceutical practices.
• All the Participants with different years of experience had fair attitude score which showed statistical significance at 0.002. Other factors also didn’t have an effect on the attitude.
• Correlations between total knowledge, attitude, and practice were weak; this can be due to the poor knowledge of the participants.
5.2 Conclusion
Based on the results of the current study it can be concluded that:
The study conducted at Kafr Elsheikh General Hospital aimed to assess the knowledge, attitude, and practices of pharmacists regarding eco-friendly pharmaceutical strategies. The results revealed several key findings:
• Firstly, none of the hospital pharmacies implemented any eco-friendly pharmaceutical strategies, indicating a lack of sustainable initiatives.
• Moreover, the observational checklist showed very poor eco-friendly practice of the participants.
• Additionally, the majority of pharmacists exhibited poor knowledge and neutral attitude towards eco-friendly practices, with a corresponding poor self-reported practice score.
• Furthermore, the study showed that all the socio demographic factors didn’t influence participants’ knowledge, attitude and practice except for the experience which showed significance regarding the attitude of the pharmacists. Also, the study found weak correlations between total knowledge, attitude, and practice, suggesting a need for improvement in these areas.
• Importantly, the study highlighted the insufficient knowledge among pharmacists, which hindered the implementation of eco-friendly practice at the hospital.
5.3 Recommendations
Based on the previously mentioned conclusion and considering the emergence of eco-friendly pharmacy as a novel concept, the following evidence-based guidelines can be recommended:
5.3.1 Recommendations for pharmacists:
Pharmacists’ awareness needs to be raised, this can be achieved through:
• Awareness Raising: as eco-friendly pharmacy is a new and emerging concept, it is important to organize workshops, seminars, and conferences to enhance pharmacists’ understanding of eco-friendly pharmacy and foster a positive attitude towards adopting green practices.
• Curriculum Integration: Collaborate with pharmacy faculties in universities to incorporate the concept of eco-friendly pharmacy into the existing curriculum, thereby promoting transformation in the field. Also, knowledge about the impact of pharmaceutical practices on the environment should be integrated in the curriculums as the future of green pharmacy rests in the hands of the younger pharmacy students.
• Context-specific Understanding: Develop survey tools to assess pharmacists’ knowledge, attitudes, and practices towards eco-friendly pharmacy in various contexts, and conduct regular survey.
5.3.2 Recommendations for local authorities:
• Monitoring and Enforcement: Establish special monitoring cells to evaluate the implementation of eco-friendly pharmacy by pharmacists and take strict actions against those who do not comply with the concept.
• Financial Support: Create special non-profit organizations (NGOs) or provide government subsidies to help conventional pharmacies transition to eco-friendly pharmacies.
• Rewards Program: Establish an organization that offers a ”Green Rewards” program to support the sustainability and green initiatives of its members, such as discounts on sustainable products and services.
• Incentive-based Approach: Promote eco-friendly pharmacy by providing incentives and encouragement, allowing for a degree of choice rather than enforcing new practices.
• Creating eco-friendly infrastructure at hospitals and pharmacies is an important step towards sustainable healthcare.
• Research Support: Encourage and support research in the field of eco-friendly pharmacy and provide grants to facilitate further study and development.
• Ministry of Health should play a significant role in establishing adequate public health education about the handling and disposal of pharmaceutical waste and expired drugs from healthcare facilities in their household.
5.3.3 Recommendations for NGOs:
• Support Proper Disposal of Pharmaceuticals: Raise awareness about the proper disposal of pharmaceuticals to prevent the contamination of water bodies and ecosystems. NGOs can collaborate with local communities, healthcare facilities, and governments to establish collection programs for unused or expired medications and facilitate safe disposal methods.
• Advocate for Sustainable Sourcing: Encourage pharmaceutical companies to source raw materials from sustainable and environmentally responsible suppliers. This includes promoting the use of natural resources, such as plant-based ingredients, which can be replenished without causing harm to the environment.
• Educate Healthcare Professionals and Consumers: Conduct educational campaigns to raise awareness among healthcare professionals and consumers about the environmental impact of pharmaceuticals. Provide information on proper medication disposal, the importance of choosing eco-friendly products, and the potential environmental consequences of pharmaceutical waste.
5.3.4 Recommendations for further research:
• Multi-Center Study: Conduct a larger-scale study involving multiple hospitals across different regions in Egypt. This can help determine if the findings from the initial study are representative of the broader population of pharmacists in the country.
• Intervention Studies: Design and implement intervention studies to evaluate the effectiveness of specific strategies or interventions aimed at promoting eco-friendly pharmaceutical practices among pharmacists. This could involve educational programs, training initiatives, or policy changes.