Pharmacists’ Knowledge, Attitudes, and Practices and Healthcare Stakeholders’ Perspectives on Clinical Pharmacy Services in Referral Hospitals in Mainland Tanzania: A Mixed-Methods Study

Abstract

Background Clinical pharmacy services (CPS) support safe, effective, and rational medicine use. In Tanzania, CPS is a core professional responsibility of pharmacists, but evidence on hospital implementation remains limited. This study assessed pharmacists’ knowledge, attitudes, and self-reported practices and explored stakeholder perspectives on CPS implementation in referral hospitals. Methods A cross-sectional mixed-methods study was conducted in 17 regions of mainland Tanzania during August-September 2021. The quantitative component included 251 pharmacists. The qualitative component included in-depth interviews of 14 hospital administrators and focus group discussions of 83 pharmacists, medical doctors, and nurses. Quantitative data were analysed using IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, New York, United States), while qualitative data were analysed thematically. Results Most pharmacists had adequate knowledge of CPS (96.0%), whereas 48.6% had negative attitudes and 47.8% reported poor practice. Prescription review and dispensing-related activities were reported more frequently than ward-round participation, treatment planning, and clinical documentation. Facility level was associated with practice; pharmacists in regional referral hospitals had a lower prevalence of good practice than those at the national hospital (adjusted prevalence ratio (aPR)=0.43, 95% CI: 0.33-0.55; p<0.001). Qualitative findings confirmed recognition of pharmacists’ clinical value but identified staffing shortages, workload, weak institutional integration, and limited operational guidance as major barriers. Doctors and nurses generally viewed pharmacists’ involvement in direct patient care positively. Conclusion Pharmacists demonstrated high awareness and conceptual understanding of CPS, but comprehensive implementation remained limited. Strengthening CPS will require adequate staffing, institutional support, clearly defined clinical roles, practical training and mentorship, operational guidance, and structured interprofessional collaboration.